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PRO-INFLAMMATORY CYTOKINES AND C-REACTIVE PROTEIN ARE ASSOCIATED WITH UNDERNUTRITION IN THE CONTEXT OF SCHISTOSOMA JAPONICUM INFECTION

Schistosomiasis is associated with undernutrition, but the mechanisms involved remain unknown. We analyzed baseline and follow-up data from a longitudinal treatment–reinfection study in N = 477 Schistosoma japonicum–infected subjects 7–20 years of age from Leyte, the Philippines. After baseline treatment with praziquantel, follow-up visits were scheduled every 3 months for 18 months; stool, venous blood, and anthropometric measurements were collected at each visit. Cytokine production by peripheral blood mononuclear cells (PBMCs) stimulated with specific S. japonicum antigens was measured once 4 weeks after treatment. After adjustment for confounders, S. japonicum intensity was associated with decreased serum albumin and Z-scores (all P < 0.05) and with increased serum C-reactive protein (CRP) and interleukin (IL)-6. CRP was associated with decreased albumin and Z-scores (all P < 0.01). Production of IL-1b and tumor necrosis factor (TNF)- in response to worm antigen was associated with decreased albumin (both P < 0.005) and height-for-age Z-score (TNF- only, P = 0.05). S. japonicum–associated undernutrition may, in part, result directly from inflammation.

Received April 21, 2006. Accepted for publication May 18, 2006.

Acknowledgments: The authors thank our field staff for their diligence and energy and the study participants from Macanip, Buri, and Pitogo in Leyte, The Philippines.

Financial support: This work was funded by National Institutes of Health Grants NIH R01AI48123 and K23AI52125.

Disclosure: We certify that none of the authors has a commercial or other association that might pose a conflict of interest.

Part of these results were presented at the Annual Meeting of the American Society of Tropical Medicine and Hygiene in Washington, DC, December 11–15, 2005.

^* Address correspondence to Hannah M. Coutinho, Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, 55 Claverick Street, Box 3, Providence, RI 02903. E-mail Hannah_Coutinho{at}Brown.edu

Authors’ addresses: Hannah Coutinho and Gretchen C. Langdon, Center for International Health Research (CIHR), Rhode Island Hospital, Brown University Medical School, 593 Eddy Street, Providence, RI 02903. Tjalling Leenstra and Jennifer F. Friedman, CIHR and Department of Pediatrics, Rhode Island Hospital, Brown University Medical School, 593 Eddy Street, Providence, RI 02903. Luz P. Acosta, Blanca Jarilla, Mario A. Jiz, and Remigio M. Olveda, Research Institute of Tropical Medicine, FICC, Alabang, Muntinlupa City 1770, Metro Manila, The Philippines. Li Su, Center for Statistical Services, Brown University, Providence, RI. Stephen T. McGarvey, Epidemiology Section, Department of Community Health and International Health Institute, Brown University Medical School, Providence, RI. Jonathan D. Kurtis, CIHR and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Medical School, 593 Eddy Street, Providence, RI 02903.

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