Enteroparasitism and C-Reactive Protein in Children from High-Andean Communities of Acocro, Ayacucho, Peru: A Cross-Sectional Study

Background/Objectives: Inflammation contributes to the persistence of childhood anemia in the Peruvian Andes, but low-cost acute-phase markers have rarely been evaluated together with intestinal parasitism in high-altitude rural communities. We assessed the association of enteroparasitism and anemia with qualitative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in children from Acocro, Ayacucho. Methods: Cross-sectional analytical study conducted between January and June 2025 in three rural communities located at 3388–3472 m above sea level, with quota selection by anemia and parasitic status. We evaluated 110 children aged 1–12 years with stool examination (spontaneous tube sedimentation), altitude-adjusted hemoglobin, CRP latex agglutination, and capillary ESR. Prevalence ratios (PRs) were estimated with modified Poisson regression adjusted for age and sex; when no unexposed child had the outcome, risk differences (RDs) and two-sided Fisher’s exact tests were used. Results: Of 72 children with stool examination, 42 were parasitized (58.3%); Entamoeba coli, Giardia lamblia, and Hymenolepis nana were the most frequent species. No non-parasitized child had a positive CRP (0/30), compared with 11 of 42 parasitized children (26.2%; RD 26.2 percentage points, 95% CI 10.5–41.1; p = 0.002); ESR > 10 mm/h showed the same pattern. Carriage of a pathogenic parasite was associated with CRP positivity (adjusted PR 3.8; 95% CI 1.2–12.3), whereas the association with anemia was not significantly (adjusted PR 1.7; 95% CI 0.7–4.3). Conclusions: A latex-detectable acute-phase response was confined to parasitized children among the 72 children with stool examination results and was not associated with anemia. Stool examination should be integrated into the approach to childhood anemia in the rural Andes, while interpretation of anemia at high altitude should consider the adjustment method used.