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Schistosoma japonicum has been related to anemia, but the mechanisms mediating this relationship remain unresolved. The primary objective of this study was to assess the role of occult blood loss in mediating S. japonicum-associated anemia after adjusting for age, sex, socioeconomic status (SES), and other helminth infections. The secondary objective was to identify intensity categories of risk for occult blood loss for Trichuris and hookworm after adjustment for the presence of other helminth infections. The role of occult blood loss in mediating S. japonicum-associated anemia was studied cross-sectionally in 729 individuals 8–30 years old in Leyte, The Philippines. Three stool specimens were examined in duplicate for helminth eggs. Hemoglobin, fecal occult blood loss, and anemia were measured and related to the presence and intensity of helminths. Multivariate models were made to adjust for confounding by other helminths and SES. In multivariate models, hemoglobin significantly decreased with increasing infection intensity of S. japonicum, hookworm, and T. trichuria (P < 0.0031, P < 0.0001, and P < 0.0001, respectively). Individuals with higher intensities S. japonicum and T. trichuria were significantly more likely to be fecal occult positive (odds ratio [OR] = 3.54; P = 0.008 and OR = 2.68; P = 0.013, respectively), although this was not true for individuals with hookworm. Additionally, individuals with higher intensities of S. japonicum, hookworm, and T. trichuria were all more likely to be anemic (OR = 3.7, P = 0.0002; OR = 5.3, P = 0.0003; and OR = 1.6, P = 0.021, respectively). It is likely that occult blood loss plays a role only at heavier intensity S. japonicum infections and some other mechanism, such as anemia of inflammation, may be contributing to anemia.
Received May 10, 2004. Accepted for publication July 7, 2004.
Acknowledgments: We thank our field staff (Blanca Jarilla, Mario Jiz, Archie Pablo, Raquel Pacheco, Patrick Sebial, Mary Paz Urbina, and Jemaima Yu) for their diligence and energy. We also thank the study participants from Macanip, Buri, and Pitogo in Leyte, The Philippines.
Financial support: This work was funded by National Institutes of Health grants RO1AI48123 and K23AI52125.
Authors’ addresses: Hemal K. Kanzaria, Gretchen C. Langdon, Stephen T. McGarvey, Jonathan D. Kurtis, and Jennifer F. Friedman, International Health Institute, Brown University, Box G-B495, Providence, RI 02912, E-mails: Hemal.Kanzaria{at}alumni.brown.edu, Gretchen_Langdon{at}Brown.edu, Stephen_McGarvey{at}Brown.edu, Jonathan_Kurtis{at}Brown.edu, and Jennifer_Friedman{at}Brown.edu. Luz P. Acosta, Daria L. Manalo, and Remigio M. Olveda, Research Institute of Tropical Medicine, FICC, Alabang, Muntinlupa City 1770, Metro Manila, The Philippines, E-mails: Lacosta{at}ritm.gov.ph and dmanalo{at}ritm.gov.ph
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