Pregnancy malaria: cryptic disease, apparent solution

Duffy, Patrick E.; Fried, Michal

doi:10.1590/s0074-02762011000900008

Cited by 10 publications

(5 citation statements)

References 26 publications

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“…Effective prophylaxis reduces the risk of LBW newborns, and LBW is a strong predictor for infant mortality: extrapolating from this reduction in LBW, malaria prevention was estimated to reduce the mortality of neonates born to Gambian primigravidae by 42%, and the postneonatal mortality by 18% (Greenwood et al 1992). In an observational birth cohort study, placental malaria (PM) in Tanzanian primigravidae was directly related to increased postneonatal mortality: 9.3% mortality for offspring of infected first-time mothers, compared with 2.6% for offspring of uninfected first-time mothers (Duffy and Fried 2011). PM in multigravid women did not significantly increase mortality risk of their offspring.…”

Section: Uninfected Erythrocytesmentioning

confidence: 96%

Malaria during Pregnancy

Fried

Duffy

2017

Cold Spring Harb Perspect Med

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134

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One hundred and twenty-five million women in malaria-endemic areas become pregnant each year (see Dellicour et al. e1000221 [2010]) and require protection from infection to avoid disease and death for themselves and their offspring. Chloroquine prophylaxis was once a safe approach to prevention but has been abandoned because of drug-resistant parasites, and intermittent presumptive treatment with sulfadoxine-pyrimethamine,which is currently used to protect pregnant women throughout Africa, is rapidly losing its benefits for the same reason. No other drugs have yet been shown to be safe, tolerable, and effective as prevention for pregnant women, although monthly dihydroartemisinin-piperaquine has shown promise for reducing poor pregnancy outcomes. Insecticide-treated nets provide some benefits, such as reducing placental malaria and low birth weight. However, this leaves a heavy burden of maternal, fetal, and infant morbidity and mortality that could be avoided. Women naturally acquire resistance to over successive pregnancies as they acquire antibodies against parasitized red cells that bind chondroitin sulfate A in the placenta, suggesting that a vaccine is feasible. Pregnant women are an important reservoir of parasites in the community, and women of reproductive age must be included in any elimination effort, but several features of malaria during pregnancy will require special consideration during the implementation of elimination programs.

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Section: Uninfected Erythrocytesmentioning

confidence: 96%

Malaria during Pregnancy

Fried

Duffy

2017

Cold Spring Harb Perspect Med

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134

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“…In future, vaccines specifically designed to prevent MiP may become available; VAR2CSA, in the early stages of development, seems the most promising candidate 111–116. However, there are still several uncertainties, including the number of antigenic variants to be combined for an optimal response, the timing of the vaccine, e.g.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Malaria in Pregnancy

Takem¹,

D’Alessandro

2013

Mediterr J Hematol Infect Dis

123

102

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Pregnant women have a higher risk of malaria compared to non-pregnant women. This review provides an update on knowledge acquired since 2000 on P. falciparum and P.vivax infections in pregnancy. Maternal risk factors for malaria in pregnancy (MiP) include low maternal age, low parity, and low gestational age. The main effects of MIP include maternal anaemia, low birth weight (LBW), preterm delivery and increased infant and maternal mortality.P. falciparum infected erythrocytes sequester in the placenta by expressing surface antigens, mainly variant surface antigen (VAR2CSA), that bind to specific receptors, mainly chondroitin sulphate A. In stable transmission settings, the higher malaria risk in primigravidae can be explained by the non-recognition of these surface antigens by the immune system. Recently, placental sequestration has been described also for P.vivax infections. The mechanism of preterm delivery and intrauterine growth retardation is not completely understood, but fever (preterm delivery), anaemia, and high cytokines levels have been implicated.Clinical suspicion of MiP should be confirmed by parasitological diagnosis. The sensitivity of microscopy, with placenta histology as the gold standard, is 60% and 45% for peripheral and placental falciparum infections in African women, respectively. Compared to microscopy, RDTs have a lower sensitivity though when the quality of microscopy is low RDTs may be more reliable. Insecticide treated nets (ITN) and intermittent preventive treatment in pregnancy (IPTp) are recommended for the prevention of MiP in stable transmission settings. ITNs have been shown to reduce malaria infection and adverse pregnancy outcomes by 28–47%. Although resistance is a concern, SP has been shown to be equivalent to MQ and AQ for IPTp. For the treatment of uncomplicated malaria during the first trimester, quinine plus clindamycin for 7 days is the first line treatment and artesunate plus clindamycin for 7 days is indicated if this treatment fails; in the 2nd and 3rd trimester first line treatment is an artemisinin-based combination therapy (ACT) known to be effective in the region or artesunate and clindamycin for 7 days or quinine and clindamycin. For severe malaria, in the second and third trimester parenteral artesunate is preferred over quinine. In the first trimester, both artesunate and quinine (parenteral) may be considered as options. Nevertheless, treatment should not be delayed and should be started immediately with the most readily available drug.

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“…The system was previously described [8] and includes a rotating platform and a peristaltic pump that regulates the inflow and outflow of the washing solution. The peristaltic pump delivers washing buffer (PBS) through the inlet tubing until the buffer reaches the level of the outlet tubing.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Pregnancy Malaria Vaccine Candidates: The Binding Inhibition Assay

Saveria

Duffy²,

Fried³

2015

Malaria Vaccines

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The parasite-binding inhibition assay is designed to evaluate the acquisition of naturally acquired functional antibodies that block Plasmodium falciparum binding to endothelial or placental receptors. The assay is also used to assess functional activity by antibodies induced by immunization, for example antibodies raised against pregnancy malaria vaccine candidates like VAR2CSA. Here we describe a plate-based assay to measure the levels of adhesion-blocking antibodies. This assay format can be adapted to any lab that is minimally equipped for short-term parasite culture.

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Pregnancy malaria: cryptic disease, apparent solution

Cited by 10 publications

References 26 publications

Malaria during Pregnancy

Malaria during Pregnancy

Malaria in Pregnancy

Evaluation of Pregnancy Malaria Vaccine Candidates: The Binding Inhibition Assay

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