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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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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 |
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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 |
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