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Nutritional status and cutaneous leishmaniasis in rural Ecuadorian children

Abstract:

The relationship between nutritional status and cutaneous leishmaniasis (CL) was evaluated in 230 children living in a rural subtropical rainforest in Northwest Ecuador. One-third of the subjects had evidence of either current (13 per cent) or past CL infection (21 per cent). Subjects with current (4.71 ± 0.44 mg) or previous disease (4.29 ± 0.35 mg) had lower mean daily dietary iron intakes than noninfected children (5.45 ± 0.2 mg; χ2 = 0.048), but not energy, protein, or other micronutrients. The low dietary iron intake data was corroborated by the reduced mean haemoglobin values observed in children with current (11.7 ± 0.3 mg/dL) or past infection (11.3 ± 0.2 mg/dL) compared to non-infected subjects (12.7 ± 0.15 mg/dL; F-ratio = 17.0, P < 0.0001). Mean hematocrit values were also lower in the two infected groups (37.4 ± 0.9 per cent and 37.4 ± 0.6 per cent v. 39.5 ± 0.5 per cent; F-ratio = 4.23, P = 0.0175). Furthermore, they were more likely to suffer from iron-deficiency anaemia than their noninfected counterparts (χ2 = 4.64, P = 0.03). However, the children with active disease accounted for most of the excess risk for anemia (Fisher's exact test P = 0.009; OR = 10.0, exact 95 per cent CI = 1.37-111.8). Finally, growth stunting (< -2.SD height-for-age) was more common in subjects with current (54 per cent) or past infection (51 per cent) compared to those without CL history (31 per cent; χ2 = 8.03, P = 0.004). It is hypothesized that chronic undernutrition increased subject susceptibility for infection with CL. Alternatively, host nutritional status may have been affected by the parasitic infection.