Severe anaemia, iron deficiency, and susceptibility to invasive bacterial infections

Kelvin M Abuga; Manfred Nairz; Calman A MacLennan; Sarah H Atkinson

doi:10.12688/wellcomeopenres.18829.1

Severe anaemia, iron deficiency, and susceptibility to invasive bacterial infections

Wellcome Open Res. 2023 Feb 2:8:48. doi: 10.12688/wellcomeopenres.18829.1. eCollection 2023.

Authors

Kelvin M Abuga^{1

2}, Manfred Nairz³, Calman A MacLennan⁴, Sarah H Atkinson^{1

5

6}

Affiliations

¹ Kenya Medical Research Institute (KEMRI) Centre for Geographical Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.
² Open University, KEMRI-Wellcome Trust Research Programme - Accredited Research Centre, Kilifi, 80108, Kenya.
³ Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, 6020, Austria.
⁴ Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK.
⁵ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK.
⁶ Department of Paediatrics, University of Oxford, Oxford, OX3 9DU, UK.

Abstract

Severe anaemia and invasive bacterial infections remain important causes of hospitalization and death among young African children. The emergence and spread of antimicrobial resistance demand better understanding of bacteraemia risk factors to inform prevention strategies. Epidemiological studies have reported an association between severe anaemia and bacteraemia. In this review, we explore evidence that severe anaemia is associated with increased risk of invasive bacterial infections in young children. We describe mechanisms of iron dysregulation in severe anaemia that might contribute to increased risk and pathogenesis of invasive bacteria, recent advances in knowledge of how iron deficiency and severe anaemia impair immune responses to bacterial infections and vaccines, and the gaps in our understanding of mechanisms underlying severe anaemia, iron deficiency, and the risk of invasive bacterial infections.

Keywords: Salmonella; bacteraemia; hepcidin; iron deficiency; macrophages; neutrophils; nutritional immunity; severe anaemia; vaccines.

Publication types

Review

Grants and funding

This work was supported by Wellcome [226014 to SHA; 224315 to KMA; 203077, https://doi.org/10.35802/203077, a core award to the KEMRI-Wellcome Trust Research Programme]; the DELTAS Africa Initiative [DEL-15-003 to KMA]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from Wellcome [107769] and the UK government. For the purpose of Open Access, the author has applied a CC-BY public copyright licence to any author accepted manuscript version arising from this submission. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.