Cargando…

Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities

BACKGROUND: Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different inte...

Descripción completa

Detalles Bibliográficos
Autores principales: Ndam, Nicaise Tuikue, Mbuba, Emmanuel, González, Raquel, Cisteró, Pau, Kariuki, Simon, Sevene, Esperança, Rupérez, María, Fonseca, Ana Maria, Vala, Anifa, Maculuve, Sonia, Jiménez, Alfons, Quintó, Llorenç, Ouma, Peter, Ramharter, Michael, Aponte, John J., Nhacolo, Arsenio, Massougbodji, Achille, Briand, Valerie, Kremsner, Peter G., Mombo-Ngoma, Ghyslain, Desai, Meghna, Macete, Eusebio, Cot, Michel, Menéndez, Clara, Mayor, Alfredo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513247/
https://www.ncbi.nlm.nih.gov/pubmed/28712360
http://dx.doi.org/10.1186/s12916-017-0893-6
_version_ 1783250621928833024
author Ndam, Nicaise Tuikue
Mbuba, Emmanuel
González, Raquel
Cisteró, Pau
Kariuki, Simon
Sevene, Esperança
Rupérez, María
Fonseca, Ana Maria
Vala, Anifa
Maculuve, Sonia
Jiménez, Alfons
Quintó, Llorenç
Ouma, Peter
Ramharter, Michael
Aponte, John J.
Nhacolo, Arsenio
Massougbodji, Achille
Briand, Valerie
Kremsner, Peter G.
Mombo-Ngoma, Ghyslain
Desai, Meghna
Macete, Eusebio
Cot, Michel
Menéndez, Clara
Mayor, Alfredo
author_facet Ndam, Nicaise Tuikue
Mbuba, Emmanuel
González, Raquel
Cisteró, Pau
Kariuki, Simon
Sevene, Esperança
Rupérez, María
Fonseca, Ana Maria
Vala, Anifa
Maculuve, Sonia
Jiménez, Alfons
Quintó, Llorenç
Ouma, Peter
Ramharter, Michael
Aponte, John J.
Nhacolo, Arsenio
Massougbodji, Achille
Briand, Valerie
Kremsner, Peter G.
Mombo-Ngoma, Ghyslain
Desai, Meghna
Macete, Eusebio
Cot, Michel
Menéndez, Clara
Mayor, Alfredo
author_sort Ndam, Nicaise Tuikue
collection PubMed
description BACKGROUND: Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different intensities of malaria transmission. METHODS: P. falciparum at delivery was assessed by microscopy, quantitative PCR (qPCR) and placental histology in 946 HIV-uninfected and 768 HIV-infected pregnant women from Benin, Gabon, Kenya and Mozambique. Resistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by Luminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery. RESULTS: P. falciparum prevalence by qPCR in peripheral and/or placental blood of HIV-uninfected Mozambican, Gabonese and Beninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. The proportion of peripheral submicroscopic infections was higher in Benin (83%) than in Mozambique (60%) and Gabon (55%; P = 0.033). Past or chronic placental P. falciparum infection was associated with an increased risk of preterm birth in Mozambican newborns (OR = 7.05, 95% CI 1.79 to 27.82). Microscopic infections were associated with reductions in haemoglobin levels at delivery among Mozambican women (–1.17 g/dL, 95% CI –2.09 to –0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in Mozambican (–1.66 g/dL, 95% CI –2.68 to –0.64) and Gabonese (–0.91 g/dL, 95% CI –1.79 to –0.02) women. Doubling qPCR-peripheral parasite densities in Mozambican women were associated with decreases in haemoglobin levels at delivery (–0.16 g/dL, 95% CI –0.29 to –0.02) and increases in the drop of haemoglobin levels (–0.29 g/dL, 95% CI –0.44 to –0.14). Beninese women had higher anti-parasite IgGs than Mozambican women (P < 0.001). No difference was found in the proportion of submicroscopic infections nor in the adverse impact of P. falciparum infections in HIV-infected women from Kenya (P. falciparum prevalence by qPCR: 9%, 32/351) and Mozambique (4%, 15/417). CONCLUSIONS: The lowest levels of resistance and tolerance in pregnant women from areas of low malaria transmission were accompanied by the largest adverse impact of P. falciparum infections. Exposure-dependent mechanisms developed by pregnant women to resist the infection and minimise pathology can reduce malaria-related adverse outcomes. Distinguishing both types of defences is important to understand how reductions in transmission can affect malaria disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT00811421. Registered 18 December 2008. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12916-017-0893-6) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5513247
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-55132472017-07-19 Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities Ndam, Nicaise Tuikue Mbuba, Emmanuel González, Raquel Cisteró, Pau Kariuki, Simon Sevene, Esperança Rupérez, María Fonseca, Ana Maria Vala, Anifa Maculuve, Sonia Jiménez, Alfons Quintó, Llorenç Ouma, Peter Ramharter, Michael Aponte, John J. Nhacolo, Arsenio Massougbodji, Achille Briand, Valerie Kremsner, Peter G. Mombo-Ngoma, Ghyslain Desai, Meghna Macete, Eusebio Cot, Michel Menéndez, Clara Mayor, Alfredo BMC Med Research Article BACKGROUND: Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different intensities of malaria transmission. METHODS: P. falciparum at delivery was assessed by microscopy, quantitative PCR (qPCR) and placental histology in 946 HIV-uninfected and 768 HIV-infected pregnant women from Benin, Gabon, Kenya and Mozambique. Resistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by Luminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery. RESULTS: P. falciparum prevalence by qPCR in peripheral and/or placental blood of HIV-uninfected Mozambican, Gabonese and Beninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. The proportion of peripheral submicroscopic infections was higher in Benin (83%) than in Mozambique (60%) and Gabon (55%; P = 0.033). Past or chronic placental P. falciparum infection was associated with an increased risk of preterm birth in Mozambican newborns (OR = 7.05, 95% CI 1.79 to 27.82). Microscopic infections were associated with reductions in haemoglobin levels at delivery among Mozambican women (–1.17 g/dL, 95% CI –2.09 to –0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in Mozambican (–1.66 g/dL, 95% CI –2.68 to –0.64) and Gabonese (–0.91 g/dL, 95% CI –1.79 to –0.02) women. Doubling qPCR-peripheral parasite densities in Mozambican women were associated with decreases in haemoglobin levels at delivery (–0.16 g/dL, 95% CI –0.29 to –0.02) and increases in the drop of haemoglobin levels (–0.29 g/dL, 95% CI –0.44 to –0.14). Beninese women had higher anti-parasite IgGs than Mozambican women (P < 0.001). No difference was found in the proportion of submicroscopic infections nor in the adverse impact of P. falciparum infections in HIV-infected women from Kenya (P. falciparum prevalence by qPCR: 9%, 32/351) and Mozambique (4%, 15/417). CONCLUSIONS: The lowest levels of resistance and tolerance in pregnant women from areas of low malaria transmission were accompanied by the largest adverse impact of P. falciparum infections. Exposure-dependent mechanisms developed by pregnant women to resist the infection and minimise pathology can reduce malaria-related adverse outcomes. Distinguishing both types of defences is important to understand how reductions in transmission can affect malaria disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT00811421. Registered 18 December 2008. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12916-017-0893-6) contains supplementary material, which is available to authorized users. BioMed Central 2017-07-17 /pmc/articles/PMC5513247/ /pubmed/28712360 http://dx.doi.org/10.1186/s12916-017-0893-6 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ndam, Nicaise Tuikue
Mbuba, Emmanuel
González, Raquel
Cisteró, Pau
Kariuki, Simon
Sevene, Esperança
Rupérez, María
Fonseca, Ana Maria
Vala, Anifa
Maculuve, Sonia
Jiménez, Alfons
Quintó, Llorenç
Ouma, Peter
Ramharter, Michael
Aponte, John J.
Nhacolo, Arsenio
Massougbodji, Achille
Briand, Valerie
Kremsner, Peter G.
Mombo-Ngoma, Ghyslain
Desai, Meghna
Macete, Eusebio
Cot, Michel
Menéndez, Clara
Mayor, Alfredo
Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities
title Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities
title_full Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities
title_fullStr Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities
title_full_unstemmed Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities
title_short Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities
title_sort resisting and tolerating p. falciparum in pregnancy under different malaria transmission intensities
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513247/
https://www.ncbi.nlm.nih.gov/pubmed/28712360
http://dx.doi.org/10.1186/s12916-017-0893-6
work_keys_str_mv AT ndamnicaisetuikue resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT mbubaemmanuel resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT gonzalezraquel resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT cisteropau resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT kariukisimon resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT seveneesperanca resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT ruperezmaria resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT fonsecaanamaria resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT valaanifa resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT maculuvesonia resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT jimenezalfons resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT quintollorenc resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT oumapeter resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT ramhartermichael resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT apontejohnj resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT nhacoloarsenio resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT massougbodjiachille resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT briandvalerie resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT kremsnerpeterg resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT mombongomaghyslain resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT desaimeghna resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT maceteeusebio resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT cotmichel resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT menendezclara resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities
AT mayoralfredo resistingandtoleratingpfalciparuminpregnancyunderdifferentmalariatransmissionintensities