Chronic inflammatory diseases, such as tuberculosis, rheumatoid arthritis, Crohn's disease, psoriasis, exfoliative dermatitis, bacterial endocarditis and chronic bacterial infections, cause deficiency by reducing the appetite and by increasing the demand for folate. Systemic infections may also cause malabsorption of folate. Severe deficiency is virtually confined to the patients with the most active disease and the poorest diet. Fever per se has also been suggested to interfere with folate metabolism by inhibiting temperature-dependent folate enzymes. In patients with sub-clinical folate deficiency from causes other than infections, intercurrent infections often precipitate severe megaloblastic anaemia.
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