Malaria parasite infection during pregnancy and at delivery in mother, placenta, and newborn: efficacy of chloroquine and mefloquine in rural Malawi

Steketee, Richard W.; Wirima, Jack J.; Slutsker, Laurence; Roberts, Jacqueline M.; Khoromana, Charles O.; Heymann, David L.; Breman, Joel G.

doi:10.4269/ajtmh.1996.55.24

Cited by 90 publications

(53 citation statements)

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“…The authors found that HIV serostatus was strongly correlated with cord blood infection, suggesting that HIV may impact congenital malaria primarily by allowing for higher parasite densities in the placenta (Perrault et al, 2009). This finding was consistent with an earlier report by Steketee et al (1996b) who showed via a multivariate analysis that HIV infection was an important determinant of umbilical cord parasitaemia and added that HIV potentiates malaria infection in the umbilical blood of newborns especially in multigravidas. In addition, findings from another early study noted that HIV infection was associated with umbilical cord parasitaemia in univariate analysis and was probably acting as surrogate marker for maternal malaria infection (Reed et al, 1996).…”

Section: Effect Of Maternal Hiv Infection On Congenital Malariasupporting

confidence: 83%

Congenital malaria: an overview

Uneke

2011

Tanzania J Hlth Res

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Congenital malaria is a public health concern globally. This report reviews publications on congenital malaria in the last two decades with the view to establishing the current global epidemiological trends and the public health implications. A Medline Entrez-PubMed search was performed and published studies on congenital malaria in the last two decades were identified. A combination of key words "congenital malaria" were used for the search which yielded 180 publications as of December 2010. Of the 180 publications, 93 were within the period 1990 to 2010. Bibliographies of all publications selected were checked for additional relevant references and were obtained and included in the review. The critical issues identified and discussed include the (i) current global trends of congenital malaria; (ii) controversies associated with the frequency of occurrence of congenital malaria; (iii) mechanism and clinical features; (iv) role of maternal HIV infection (v) effects of congenital malaria on infants; (vi) diagnostic challenges; and (vii) treatment considerations. Operational research into various aspects of congenital malaria is essentially lacking as many unresolved issues requiring urgent scientific investigation abound. Public health policy on malaria control should integrate guidelines on congenital malaria management and control. _____________________________________________________________________________________

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Section: Effect Of Maternal Hiv Infection On Congenital Malariasupporting

confidence: 83%

Congenital malaria: an overview

Uneke

2011

Tanzania J Hlth Res

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“…The prevalence of moderate and severe anemia in Blantyre was lower than that of several other series, 5,17,18 but similar to that reported elsewhere in Malawi. 8,10,19 Staff constraints meant that we were not able to evaluate confounding factors such as socioeconomic status or type of housing, and were not able to measure blood levels of hematinics, 4,5,15 human immunodeficiency virus (HIV) serostatus, 20,21 or stool hookworm burden. It may be that malaria and/or anemia are influenced by one or more of these agents.…”

Section: Discussionmentioning

confidence: 99%

Malaria and anemia in antenatal women in Blantyre, Malawi: a twelve-month survey.

Rogerson¹,

Broek²,

Chaluluka³

et al. 2000

Am J Trop Med Hyg

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Abstract. Malaria and anemia are common in pregnant African women. We screened 4,764 Malawian women at first antenatal visits for malaria and anemia. A total of 42.7% had a malaria infection, which was more common and of higher density in primigravidae (prevalence ϭ 47.3%, geometric mean ϭ 332 parasites/l) and teenagers (49.8%, 390/1) than in multigravidae (40.4%, 214/l) or older women (40.6%, 227/l). However, 35% of gravida 3ϩ women were parasitemic. A total of 57.2% of the women was anemic (hemoglobin Ͻ 11 g/dl), with moderate anemia (7.0-8.9 g/dl) in 14.9% and severe anemia (Ͻ 7 g/dl) in 3.2%. Prevalences of malaria and anemia were highest in the rainy season. Women with moderate/severe anemia had higher parasite prevalences and densities than women with mild/no anemia. Logistic regression showed that age, season, and trimester of presentation were significantly associated with the prevalence of malaria, but gravidity was not. In this urban setting, age and season are more important than gravidity as predictors of malaria at first antenatal visit, and parasitemia is frequent in women of all gravidities.

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“…In sub-Saharan Africa, mefloquine has been shown to be more efficacious than chloroquine in decreasing persistent and breakthrough infections, as well as diminishing the risk of peripheral, placental, and umbilical cord parasitemia at the time of delivery. 6 Others, however, suggest that both mefloquine and quinine have high failure rates in pregnant women with primary and recrudescent P. falciparum infections and promote the use of Artemisinin-based treatments. 20 If possible, avoidance of malariaendemic areas by pregnant women and children is recommended.…”

Section: Clinical Perinatal/neonatal Case Presentationsmentioning

confidence: 99%

Persistence of Plasmodium falciparum in the Placenta After Apparently Effective Quinidine/Clindamycin Therapy

et al. 2001

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A 19-year-old pregnant woman, who recently immigrated to the United States from West Africa presented to the hospital with complaints of nausea, vomiting, recent diarrhea, and lower abdominal pain. She was a 34.4-week primapara and reported that her symptoms began several days before admission and were increasing in severity. The patient reported no significant past medical history. She had not taken malaria prophylaxis, as directed by her physicians in Liberia.Her physical examination on admission demonstrated a jaundiced, febrile (101.68F), gravid female in moderate distress. Vital signs disclosed tachypnea (36 bpm), tachycardia (130 bpm), and a blood pressure of 128/70 mm Hg. Her right lower abdominal quadrant was not tender to palpation and rebound tenderness was not present. The cervix was not effaced. Fetal monitoring demonstrated uterine contractions, without significant decelerations.Laboratory findings showed elevated bilirubin and liver enzymes, a significant pancytopenia, with a leukopenia (1940 WBCs/cumm) and left-shifted hematopoiesis (34% bands), thrombocytopenia (17,000 platelets/cumm), and a diminished hemoglobin and hematocrit (8.4 g/dl and 24.1%, respectively). A peripheral smear confirmed the pancytopenia, showed schistocytes, and disclosed Plasmodium-infected erythrocytes. The parasite was promptly determined to be Plasmodium falciparum and the parasitemia was determined to be 3%. The patient was treated with a combination of quinidine and clindamycin (quinidine gluconate 500 mg intravenous (IV) loading dose, followed by a continuous infusion at 1.0 to 1.2 mg/min; clindamycin 900 mg IV every 8 hours), because she had immigrated from a region where chloroquine-resistant P. falciparum strains have been reported. The antiplasmodial therapy resulted in a rapid decrease in peripheral parasitemia and subsequent elimination of plasmodia from the circulation. The patient was concurrently stabilized by packed red blood cell and platelet transfusions. She underwent cesarean section delivery secondary to nonreassuring fetal heart tones, with late decelerations and failure of the delivery to progress. At the time of delivery, the patient had received 22.5 hours of quinidine/clindamycin, with almost complete clearance of plasmodia from the peripheral circulation; extremely rare parasites were detected only after an exhaustive search. The infant was delivered without complications and did not develop malaria.Histopathologic examination of the placenta demonstrated extensive sequestration of P. falciparum-infected erythrocytes in the maternal sinuses, with a local parasitemia of 70% to 80% ( Figure 1). Other histopathologic findings, which have been associated with malaric placentas were also present, including fibrin deposition and abundant malarial pigment within placental histiocytes. Rare plasmodia were detected in the fetal circulation of the placenta. The child was treated and did not develop malaria.Several maternal and neonatal peripheral blood smears, obtained during the postpartum period, were ne...

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Malaria parasite infection during pregnancy and at delivery in mother, placenta, and newborn: efficacy of chloroquine and mefloquine in rural Malawi

Cited by 90 publications

References 0 publications

Congenital malaria: an overview

Congenital malaria: an overview

Malaria and anemia in antenatal women in Blantyre, Malawi: a twelve-month survey.

Persistence of Plasmodium falciparum in the Placenta After Apparently Effective Quinidine/Clindamycin Therapy

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