INFECTIONS DURING SEVERE PRIMARY UNDERNUTRITION AND SUBSEQUENT REFEEDING - PARADOXICAL FINDINGS

Background: Our earlier uncontrolled observations during primary famin e and subsequent refeeding did not suggest that severe undernutrition inevitably increases vulnerability to infection. Some infections appea red suppressed by famine but reactivated by refeeding. Aims: To examin e prospectively the occurrence of infections in a large cohort of prim ary famine victims before and during refeeding. Methods: From 1973 to 1993, 4382 famine victims aged 14 or more with an estimated weight los s greater than 25% were weighed and examined for infection before and after one, two, three and four weeks of refeeding. In 137, serum C-rea ctive protein was measured in an effort to detect latent asymptomatic infections before and after two weeks of refeeding. Refeeding diets in cluded wheat, sorghum, millet, ghee and milk powder. Results: Mean wei ght loss +/- SD was 28.7 +/- 2.3%. Before refeeding overt infections w ere found in 4.9%, an incidence rising to 29.1% at two weeks of refeed ing and declining after four. Those developing infections gained more weight at two weeks, 4.63 +/- 0.81 kg, than those never infected, 3.94 +/- 0.76 (p = < 0.001 t test). C-reactive protein levels confirmed th e presence of latent infections before refeeding. Conclusions: Severe undernutrition can suppress certain infections, mostly those due to in tracellular pathogens and especially P, falciparum. Refeeding reactiva tes suppressed infection and can increase vulnerability to certain new infections especially of viral origin. Those gaining weight the most rapidly may be at greatest risk. Refeeding with foods alien to local c ulture could play a role in reactivating latent infections. Our findin gs may be limited to severe undernutrition and not apply to lesser for ms or secondary undernutrition in hospital patients. These studies wer e done during charitable provision of medical care to famine victims.