Placental pathology in malaria: A histological, immunohistochemical, and quantitative study

Ismail, Mamudo R.; Ordi, Jaume; Menéndez, Clara; Ventura, Pere Joan; Aponte, John J.; Kahigwa, Elizeus; Hirt, R.; Cardesa, Antonio; Alonso, Pedro L.

doi:10.1016/s0046-8177(00)80203-8

Cited by 267 publications

(276 citation statements)

References 29 publications

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“…Placental samples were embedded in paraffin wax, sectioned and stained with H&E stain using standard methods. Slides were examined under a light microscope by two independent observers and placentas were ascribed to one of four histologically determined malaria groups: no infection, acute infection (parasites in the intervillous space), chronic infection (parasites and malaria pigment) and resolved past infection (pigment only) [44]. Cryopreserved CBMC from 47 placentally infected newborns (15 Miami, FL) for 7 parameter staining.…”

Section: Methodsmentioning

confidence: 99%

The effect of placental malaria infection on cord blood and maternal immunoregulatory responses at birth

et al. 2010

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Placental malaria (PM), a frequent infection of pregnancy, provides an ideal opportunity to investigate the impact on immune development of exposure of the foetal immune system to foreign Ag. We investigated the effect of PM on the regulatory phenotype and function of cord blood cells from healthy Gambian newborns and peripheral blood cells from their mothers, and analyzed for effects on the balance between regulatory and effector responses. Using the gold standard for classifying PM we further distinguished between resolved infection and acute or chronic PM active at the time of delivery. We show that exposure to malarial Ag in utero results in the expansion of malaria-specific FOXP31 Treg and more generalized FOXP3 1 CD4 1 Treg in chronic and resolved PM, alongside increased Th1 pro-inflammatory responses (IFN-c, TNF-a, IFN-c:IL-10) in resolved PM infection only. These observations demonstrate a clear effect of exposure to malarial Ag in foetal life on the immune environment at birth, with a regulatory response dominating in the newborns with ongoing chronic PM, while those with resolved infection produce both regulatory and inflammatory responses. The findings might explain some of the adverse effects on the health of babies born to women with PM.

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Section: Methodsmentioning

confidence: 99%

The effect of placental malaria infection on cord blood and maternal immunoregulatory responses at birth

et al. 2010

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“…Placental histology was classified as (1) not infected (no evidence of parasites/pigment) or (2) any PM infection (presence of parasites and/or pigment) following the criteria used by Ismail et al [26]. Any PM infection thus included acute, chronic and past PM infection.…”

Section: Statistical Methods and Definitionsmentioning

confidence: 99%

“…Paraffin-embedded placental histological sections were stained with haematoxylin and eosin, Giemsa stain and the periodic acid-Schiff technique and examined for the presence of malaria parasites and malaria pigment as previously described [23,26].…”

Section: Haematological and Parasitological Assessmentsmentioning

confidence: 99%

“…Univariate and multivariate logistic regressions were used to analyse the effect of variables on MTCT. For the multivariate model, although PM infection was not significantly associated with MTCT in univariate analysis, it was included in the multivariate model in order to evaluate whether PM had an effect on MTCT after adjustment for other variables.Data entry, validation and cleaning were performed using Microsoft FOXPRO version 5.0 for Windows (Microsoft Corp., Seattle, WA) and statistical analysis was performed using STATA version 9.0 (StataCorp., College Station, TX, USA).Placental histology was classified as (1) not infected (no evidence of parasites/pigment) or (2) any PM infection (presence of parasites and/or pigment) following the criteria used by Ismail et al [26]. Any PM infection thus included acute, chronic and past PM infection.…”

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Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

et al. 2008

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Malaria infection may impact on mother-to-child transmission (MTCT) of HIV-1. Prevention of malaria in pregnancy could thus potentially affect MTCT of HIV. We studied the impact of intermittent preventive treatment during pregnancy (IPTp) on HIV-1 MTCT in southern Mozambique. MethodsA total of 207 HIV-positive Mozambican pregnant women were enrolled in the study as part of a randomized placebo-controlled trial of two-dose sulfadoxine-pyrimethamine (SP) IPTp in women receiving single-dose nevirapine to prevent MTCT of HIV. HIV RNA viral load, maternal anaemia and peripheral and placental malaria were assessed at delivery. Infant HIV status was determined by DNA polymerase chain reaction (PCR) at 1 month of age. ResultsThere were 19 transmissions of HIV in 153 mother-infant pairs. IPTp with SP did not have a significant impact on MTCT (11.8% in the SP group vs. 13.2% in the placebo group; P 5 0.784) or on maternal HIV RNA viral load [16 312 (interquartile range {IQR} 4076-69 296) HIV-1 RNA copies/mL in the SP group vs. 18 274 (IQR 5471-74 104) copies/mL in the placebo group; P 5 0.715]. In multivariate analysis, maternal HIV RNA viral load [adjusted odds ratio (AOR) 19.9; 95% confidence interval (CI) 2.3-172; P 5 0.006] and anaemia (haematocrit o33%; AOR 7.5; 95% CI 1.7-32.4; P 5 0.007) were independent risk factors for MTCT. Placental malaria was associated with a decrease in MTCT (AOR 0.23; 95% CI 0.06-0.89; P 5 0.034). ConclusionsIPTp with SP was not associated with a significant impact on MTCT of HIV. Maternal anaemia was an independent risk factor for MTCT.Keywords: anaemia, intermittent preventive treatment, mother-to-child transmission, placental malaria, pregnancy Received: 18 February 2008, accepted 15 May 2008 Introduction HIV/AIDS and malaria infections are two of the most important global health problems of our time, and strongly overlap in sub-Saharan Africa [1]. The detrimental effects of this interaction may be especially relevant during pregnancy, with adverse outcomes for both the mother and the infant [2,3].Vertical transmission of HIV occurs at an approximate rate of 25-40% in untreated breast feeding populations [4,5]. Maternal RNA viral load [2,6,7] [6,7,11], it has been suggested that malaria, by increasing the replication of HIV, may increase the risk of MTCT [2,6]. However, studies assessing the impact of placental malaria (PM) on MTCT have produced conflicting results, suggesting either that PM could increase MTCT or that low-density PM parasitaemia could decrease MTCT [6,7,17,18]. Pregnant women are especially susceptible to malaria infection, which is associated with considerable maternal and infant morbidity and mortality. The World Health Organization recommends that pregnant women in stable transmission areas receive intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) and sleep under insecticide-treated nets (ITNs). However, the efficacy of the concomitant use of these two interventions has not been evaluated. IPTp consists of the provision of two doses, at le...

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“…A history of a positive blood smear result at a local health facility together with clinical signs or symptoms of malaria in the last 2 weeks before infant review was considered as evidence for a recent malaria infection. The histopathological slides of placenta tissue were classified according to the criteria of Ismail et al (2000). Presence of parasites without pigment deposition is considered an acute infection, presence of parasites and a significant amount of pigment deposition a chronic infection and presence of pigment deposition without parasites a past infection.…”

Section: Definitionsmentioning

confidence: 99%

A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

et al. 2007

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Objective: To examine zinc-protoporphyrin (ZPP) and haemoglobin levels, and to determine predictors of iron deficiency anaemia (IDA) in Zambian infants. Subjects and methods: Ninety-one women and their normal birth weight (NBW) infants were followed bi-monthly during the first 6 months of life, and iron status, food intake, malaria parasitaemia and growth were monitored. At 4 months, the infants were divided into two groups, and the data were analysed according to whether or not they were exclusively breastfed. Results: Almost two-third of infants were born with low iron stores as defined by ZPP levels, and this proportion increased with age. Over 50% had developed IDA by 6 months. Exclusive breastfeeding at 4 months could be a protective factor for IDA (odds ratio (OR): 0.2; 95% confidence interval (CI): 0.0-1.1). Exclusively breastfed infants had higher haemoglobin values at 4 and 6 months (mean difference 0.6; 95% CI: 0.1-1.2 g/dl and mean difference 0.9; 95% CI: 0.2-1.7 g/dl, respectively), compared with infants with early complementary feeding. In univariate analysis, past or chronic placental malaria appeared to be a predictor of IDA at 4 and 6 months, but the significance was lost in multivariate analysis. Conclusions: Zambian NBW infants are born with low iron stores and have a high risk to develop IDA in the first 6 months of life. Continuation of exclusive breastfeeding after 4 months is associated with a reduction of anaemia. The effect of placental malaria infection on increased risk of infant IDA could not be proven.

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Placental pathology in malaria: A histological, immunohistochemical, and quantitative study

Cited by 267 publications

References 29 publications

The effect of placental malaria infection on cord blood and maternal immunoregulatory responses at birth

The effect of placental malaria infection on cord blood and maternal immunoregulatory responses at birth

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

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Placental pathology in malaria: A histological, immunohistochemical, and quantitative study

Cited by 267 publications

References 29 publications

The effect of placental malaria infection on cord blood and maternal immunoregulatory responses at birth

The effect of placental malaria infection on cord blood and maternal immunoregulatory responses at birth

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria*

A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria

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Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*