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Yu Z, Li Y, Deng L, Luo B, Wu P, Geng D. A high-performance cell-phone based polarized microscope for malaria diagnosis. JOURNAL OF BIOPHOTONICS 2023; 16:e202200290. [PMID: 36541739 DOI: 10.1002/jbio.202200290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/09/2022] [Accepted: 12/08/2022] [Indexed: 05/17/2023]
Abstract
We present a cell-phone based polarized microscope for diagnosing malaria through hemozoin recognition over a wide field-of-view (FOV) accompanied with decent image performance. The system is constructed based on attachment method using a lens assembly as objective, two mobile phones and two linear polarizers. A ~0.92 μm resolution across a FOV of ~3.27 mm × 3.27 mm with high imaging quality is realized, demonstrating an increased resolving power, four times improvement in FOV and better imaging quality over mobile-optical-polarization imaging device. Importantly, we also demonstrate it has capability of recognizing hemozoin within the sample for malaria diagnosis by imaging malaria-infected blood samples with similar sensitivity comparable to Leica microscopy. It is more compact, portable, and insensitive to alignment, making it highly suitable for malaria detection in a portable, easy to setup and use way in low-resource areas.
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Affiliation(s)
- Zhenfang Yu
- Analysis and Test Center of Sichuan Province, Chengdu, China
- Scientific Equipments Company of Sichuan Province, Chengdu, China
| | - Yunfei Li
- Analysis and Test Center of Sichuan Province, Chengdu, China
- Scientific Equipments Company of Sichuan Province, Chengdu, China
| | - Lin Deng
- Analysis and Test Center of Sichuan Province, Chengdu, China
| | - Bing Luo
- Analysis and Test Center of Sichuan Province, Chengdu, China
| | - Pinghui Wu
- College of Physics & Information Engineering, Quanzhou Normal University, QuanZhou, China
| | - Dongxian Geng
- Analysis and Test Center of Sichuan Province, Chengdu, China
- Scientific Equipments Company of Sichuan Province, Chengdu, China
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2
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Cardona-Arias JA, Higuita Gutiérrez LF, Carmona-Fonseca J. Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia. Trop Med Infect Dis 2023; 8:tropicalmed8020119. [PMID: 36828535 PMCID: PMC9959527 DOI: 10.3390/tropicalmed8020119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/17/2023] Open
Abstract
This study aimed to evaluate the accuracy of the thick blood smear (TBS) versus quantitative polymerase chain reaction (qPCR) for the diagnosis of malaria associated with pregnancy (MAP) caused by P. falciparum or P. vivax in Colombia in its gestational malaria (GM), placental malaria (PM), and congenital malaria (CM) forms as well as to compare its accuracy in different subgroups of pregnant women according to the presence of fever, anemia and a history of malaria. This was a diagnostic evaluation of 829 pregnant women, 579 placentas, 381 umbilical cord samples, and 221 neonatal peripheral blood samples. Accuracy was evaluated based on the parameters of sensitivity, specificity, predictive values, likelihood ratios, and validity index, with their 95% confidence intervals. The frequency of GM was 36% (n = 297/829), PM 27% (n = 159/579), and CM 16.5% (n = 63/381) in umbilical cord samples and 2% (n = 5/221) in neonatal peripheral blood samples. For GM, the sensitivity was 55%, with higher rates in those infected with P. vivax (68%), with a history of malaria (69%), and with fever (96%). These three subgroups presented the best results in terms of the negative likelihood ratio and validity index. For PM, sensitivity was 8%; in subgroup analyses in terms of species, symptomatology (anemia and fever), and history of malaria, it was 1-18%, and the negative likelihood ratio was >0.80 in all subgroups. No false positives were recorded in any of the subgroups. The TBS did not detect any cases of CM. This study found the TBS yielded satisfactory results in terms of diagnosing GM for P. vivax, pregnant women with previous malaria and febrile. It also showed that the TBS is not useful for diagnosing PM and CM. It is necessary to conduct surveillance of MAP with molecular methods in in groups where TBS is deficient (asymptomatic GM, P. falciparum, and pregnant women without history of malaria) to optimize the timely treatment of PM and CM, avoid the deleterious effects of MAP and achieve the malaria elimination goals in Colombia.
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Affiliation(s)
| | - Luis Felipe Higuita Gutiérrez
- Escuela de Microbiología, Universidad de Antioquia, Medellín 050010, Colombia
- Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín 050010, Colombia
| | - Jaime Carmona-Fonseca
- Grupo Salud y Comunidad César Uribe Piedrahíta, Facultad de Medicina, Universidad de Antioquia, Medellín 050010, Colombia
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Potoczak PS, Strassmann BI, Vincenz C. A new method for the sampling and preservation of placental specimens in low-resource settings for the identification of P. falciparum and analysis of nucleic acids. J Histotechnol 2022; 45:116-119. [PMID: 35766215 PMCID: PMC9437128 DOI: 10.1080/01478885.2022.2088191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Collection, preservation, and shipment of histological specimens in low-resource settings is challenging. We present a novel method that achieved excellent preservation of placental specimens from rural Mali by using formalin fixation, ethanol dehydration, and long-term storage in a solar-powered freezer. Sample preservation success was 92%, permitting evaluation of current and past malaria infection, anemia, placental maturity, and inflammation. Using RNAscope® hybridization we were able to visualize cell-specific gene expression patterns in the formalin-fixed paraffin-embedded (FFPE) specimens. Additionally, our method entailed mirrored sampling from the two cut faces of a cotyledon, one for the FFPE workflows and the other for storage in RNAlater™ and RNA-seq.
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Affiliation(s)
| | - Beverly I. Strassmann
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Department of Anthropology, University of Michigan, Ann Arbor, MI, USA
| | - Claudius Vincenz
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Firdaus MER, Muh F, Park JH, Lee SK, Na SH, Park WS, Ha KS, Han JH, Han ET. In-depth biological analysis of alteration in Plasmodium knowlesi-infected red blood cells using a noninvasive optical imaging technique. Parasit Vectors 2022; 15:68. [PMID: 35236400 PMCID: PMC8889714 DOI: 10.1186/s13071-022-05182-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background Imaging techniques are commonly used to understand disease mechanisms and their biological features in the microenvironment of the cell. Many studies have added to our understanding of the biology of the malaria parasite Plasmodium knowlesi from functional in vitro and imaging analysis using serial block-face scanning electron microscopy (SEM). However, sample fixation and metal coating during SEM analysis can alter the parasite membrane. Methods In this study, we used noninvasive diffraction optical tomography (DOT), also known as holotomography, to explore the morphological, biochemical, and mechanical alterations of each stage of P. knowlesi-infected red blood cells (RBCs). Each stage of the parasite was synchronized using Nycodenz and magnetic-activated cell sorting (MACS) for P. knowlesi and P. falciparum, respectively. Holotomography was applied to measure individual three-dimensional refractive index tomograms without metal coating, fixation, or additional dye agent. Results Distinct profiles were found on the surface area and hemoglobin content of the two parasites. The surface area of P. knowlesi-infected RBCs showed significant expansion, while P. falciparum-infected RBCs did not show any changes compared to uninfected RBCs. In terms of hemoglobin consumption, P. falciparum tended to consume hemoglobin more than P. knowlesi. The observed profile of P. knowlesi-infected RBCs generally showed similar results to other studies, proving that this technique is unbiased. Conclusions The observed profile of the surface area and hemoglobin content of malaria infected-RBCs can potentially be used as a diagnostic parameter to distinguish P. knowlesi and P. falciparum infection. In addition, we showed that holotomography could be used to study each Plasmodium species in greater depth, supporting strategies for the development of diagnostic and treatment strategies for malaria. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05182-1.
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Affiliation(s)
- Moh Egy Rahman Firdaus
- Department of Medical Environmental Biology and Tropical Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, 24341, Republic of Korea
| | - Fauzi Muh
- Department of Medical Environmental Biology and Tropical Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, 24341, Republic of Korea
| | - Ji-Hoon Park
- Department of Medical Environmental Biology and Tropical Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, 24341, Republic of Korea
| | | | - Sung-Hun Na
- Department of Obstetrics and Gynecology, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, 24341, Republic of Korea
| | - Won-Sun Park
- Department of Physiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, 24341, Republic of Korea
| | - Kwon-Soo Ha
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, 24341, Republic of Korea
| | - Jin-Hee Han
- Department of Medical Environmental Biology and Tropical Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, 24341, Republic of Korea
| | - Eun-Taek Han
- Department of Medical Environmental Biology and Tropical Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, 24341, Republic of Korea.
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5
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Ngo-Thanh H, Thuy TD, Suzue K, Kamitani W, Yokoo H, Isoda K, Shimokawa C, Hisaeda H, Imai T. Long-term acrylamide exposure exacerbates brain and lung pathology in a mouse malaria model. Food Chem Toxicol 2021; 151:112132. [PMID: 33737113 DOI: 10.1016/j.fct.2021.112132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/19/2022]
Abstract
The consumption of dietary acrylamide (ACR), a carcinogen, results in the dysfunction of various organs and the immune system. However, the impact of ACR exposure on the progression of infectious diseases is unknown. This study investigated the effect of ACR on the progression of malaria infection using a mouse model of malaria. C57BL/6 mice were continuously treated with ACR at a dose of 20 mg/kg bodyweight/day for six weeks (long-term exposure) or phosphate-buffered saline (PBS). Next, the mice were infected with the rodent malaria parasite, Plasmodium berghei NK65 (PbNK). Parasitemia and survival rate were analyzed in the different treatment groups. Magnetic resonance imaging (MRI) and histopathological analyses were performed to evaluate the effect of ACR exposure on the morphology of various organs. Long-term ACR exposure exacerbated PbNK-induced multiorgan dysfunction. MRI and histopathological analysis revealed signs of encephalomeningitis and acute respiratory distress syndrome in the PbNK-infected long-term ACR exposure mice, which decreased the survival rate of mice, but not in the PbNK-infected long-term PBS exposure group. These findings enhance our understanding of the impact of ACR on the progression of infectious diseases, such as malaria.
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Affiliation(s)
- Ha Ngo-Thanh
- Department of Infectious Diseases and Host Defense, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; National Hospital for Tropical Diseases, Hanoi, Viet Nam
| | - Trang Dam Thuy
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kazutomo Suzue
- Department of Infectious Diseases and Host Defense, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Wataru Kamitani
- Department of Infectious Diseases and Host Defense, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideaki Yokoo
- Department of Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koji Isoda
- Department of Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Chikako Shimokawa
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hajime Hisaeda
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan.
| | - Takashi Imai
- Department of Infectious Diseases and Host Defense, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
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Moraleda C, Aguilar R, Quintó L, Nhampossa T, Renom M, Nhabomba A, Ruperez M, Aponte JJ, Achtman AH, Mañú Pereira MDM, Schofield L, Alonso PL, Macete E, Menéndez C. Pathophysiology of Anemia in HIV-Infected Children Exposed to Malaria. Am J Trop Med Hyg 2021; 104:1003-1012. [PMID: 33534758 DOI: 10.4269/ajtmh.19-0783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 09/24/2020] [Indexed: 11/07/2022] Open
Abstract
Anemia is a common condition in HIV-infected children; however, its pathophysiology and the contribution of frequent causes of anemia such as iron deficiency (ID) and malaria are poorly understood. We carried out an ancillary study on the effect of HIV on anemia as part of a case-control study on risk factors of anemia among Mozambican children aged 1-59 months with documented HIV status. Of them, 390 children were admitted to the hospital with anemia (hemoglobin [Hb] < 11 g/dL), whereas 272 children without anemia (Hb ≥ 11 g/dL) were recruited in the community. We assessed differences by HIV status in the presentation of anemia etiological factors and the effect of HIV infection on the association of each factor with anemia. Among the 99 HIV-infected and 563 uninfected children included, HIV-infected anemic children had an increased risk of undernutrition (P < 0.0001), Epstein-Barr virus infection (P < 0.0001), bacteremia (P = 0.0060), a decreased risk of malaria (P < 0.0001), and a similar risk of ID (P = 0.7371) compared with anemic-uninfected children. HIV-infected children were significantly less likely to have anemia associated with Plasmodium falciparum hyperparasitemia (P = 0.0444) and had a lower prevalence of parasitemia in the bone marrow (BM) (P < 0.0001) than anemic-uninfected children. Levels of BM erythropoiesis and dyserythropoiesis were comparable between groups. These findings suggest that the pathophysiology of anemia among HIV-infected malaria-exposed children is not related to HIV-specific effects. For unclear reasons, HIV-infected children had reduced risk of malaria infection, whereas ID prevalence was comparable in HIV-infected and uninfected children, suggesting that iron supplementation recommendations should not be different in HIV-infected children.
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Affiliation(s)
- Cinta Moraleda
- 1ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,2Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Ruth Aguilar
- 1ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,2Manhiça Health Research Center (CISM), Manhiça, Mozambique.,3CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Llorenç Quintó
- 1ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Montserrat Renom
- 1ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,2Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | | | - María Ruperez
- 1ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,2Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - John J Aponte
- 1ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,2Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Ariel H Achtman
- 4Walter and Eliza Hall Institute for Medical Research, Victoria, Australia.,5Department of Medical Biology, The University of Melbourne, Victoria, Australia
| | - María Del Mar Mañú Pereira
- 6Red Blood Cell Pathology- Centre for Rare Diseases, Vall d'Hebron Research Institute, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Louis Schofield
- 4Walter and Eliza Hall Institute for Medical Research, Victoria, Australia.,5Department of Medical Biology, The University of Melbourne, Victoria, Australia.,7Australian Institute of Tropical Health and Medicine, James Cook University, Douglas, Australia
| | - Pedro L Alonso
- 1ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,2Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Eusebio Macete
- 2Manhiça Health Research Center (CISM), Manhiça, Mozambique.,8National Directorate of Health, Ministry of Health, Maputo, Mozambique
| | - Clara Menéndez
- 1ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,2Manhiça Health Research Center (CISM), Manhiça, Mozambique.,3CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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7
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Ngo-Thanh H, Sasaki T, Suzue K, Yokoo H, Isoda K, Kamitani W, Shimokawa C, Hisaeda H, Imai T. Blood-cerebrospinal fluid barrier: another site disrupted during experimental cerebral malaria caused by Plasmodium berghei ANKA. Int J Parasitol 2020; 50:1167-1175. [PMID: 32882285 DOI: 10.1016/j.ijpara.2020.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 12/01/2022]
Abstract
Cerebral malaria is one of the most severe pathologies of malaria; it induces neuro-cognitive sequelae and has a high mortality rate. Although many factors involved in the development of cerebral malaria have been discovered, its pathogenic mechanisms are still not completely understood. Most studies on cerebral malaria have focused on the blood-brain barrier, despite the importance of the blood-cerebrospinal fluid barrier, which protects the brain from peripheral inflammation. Consequently, the pathological role of the blood-cerebrospinal fluid barrier in cerebral malaria is currently unknown. To examine the status of the blood-cerebrospinal fluid barrier in cerebral malaria and malaria without this pathology (non-cerebral malaria), we developed a new method for evaluating the permeabilization of the blood-cerebrospinal fluid barrier during cerebral malaria in mice, using Evans blue dye and a software-assisted image analysis. Using C57BL/6J (B6) mice infected with Plasmodium berghei ANKA strain as an experimental cerebral malaria model and B6 mice infected with P. berghei NK65 strain or Plasmodium yoelii as non-cerebral malaria models, we revealed that the permeability of the blood-cerebrospinal fluid barrier increased during experimental cerebral malaria but not during non-cerebral malaria. We observed haemorrhaging in the cerebral ventricles and hemozoin-like structures in the choroid plexus, which is a key component of the blood-cerebrospinal fluid barrier, in cerebral malaria mice. Taken together, this evidence indicates that the blood-cerebrospinal fluid barrier is disrupted in experimental cerebral malaria, whereas it remains intact in non-cerebral malaria. We also found that P. berghei ANKA parasites and CD8+ T cells are involved in the blood-cerebrospinal fluid barrier disruption in experimental cerebral malaria. An understanding of the mechanisms underlying cerebral malaria might help in the development of effective strategies to prevent and manage cerebral malaria in humans.
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Affiliation(s)
- Ha Ngo-Thanh
- Department of Infectious Diseases and Host Defense, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsutomu Sasaki
- Laboratory of Metabolic Signal, Institute for Molecular and Cellular Regulation, Gunma University, Maebashi, Gunma, Japan
| | - Kazutomo Suzue
- Department of Infectious Diseases and Host Defense, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideaki Yokoo
- Department of Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koji Isoda
- Department of Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Wataru Kamitani
- Department of Infectious Diseases and Host Defense, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; Laboratory of Clinical Research on Infectious Diseases, Research Institute for Microbial Disease, Osaka University, Osaka, Japan
| | - Chikako Shimokawa
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hajime Hisaeda
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takashi Imai
- Department of Infectious Diseases and Host Defense, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
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8
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Paul S, Karar M, Paul P, Mallick A, Majumdar T. Dual mode nitro explosive detection under crowded condition: Conceptual development of a sensing device. J Photochem Photobiol A Chem 2019. [DOI: 10.1016/j.jphotochem.2019.04.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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9
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Differential Activation of Fetal Hofbauer Cells in Primigravidas Is Associated with Decreased Birth Weight in Symptomatic Placental Malaria. Malar Res Treat 2019; 2019:1378174. [PMID: 31186834 PMCID: PMC6521392 DOI: 10.1155/2019/1378174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/05/2019] [Accepted: 03/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background Placental malaria is a leading global cause of low birth weight neonates, especially in first-time mothers. To better understand the role of innate immunity in placental malaria, we investigated the relationships between histopathological markers of placental malaria, fetal and maternal macrophage responses, and perinatal outcomes in a cross-sectional case control study of pregnant women presenting with symptomatic malaria at the time of delivery. Results Primigravidas showed increased hemozoin deposition in placental villi (p=0.02), syncytiotrophoblasts (p=0.01), and fetal Hofbauer cells (p=0.01). The percentage of hemozoin-positive villi negatively correlated with infant birth weight (regression coefficient [b] = -0.03 kg decrease in birth weight per % increase in hemozoin-positive villi, p=0.035). Malaria-infected placentas showed a twofold increase in Hofbauer cells (p<0.001) and maternal macrophages (p<0.001). Placental malaria was associated with a threefold increase in the percentage of M2 maternal macrophages (19.2% vs 6.4%, p=0.01). Primigravidas showed a significant decrease in the Hofbauer cell M2-percentage in placental malaria (92.7% vs. 97.0%, p=0.04), which was predictive of infant birth weight (b=0.08 kg increase in birth weight per % increase in M2 Hofbauer cells, p=0.001). There was no association between maternal macrophage response and infant birth weights. Conclusions Placentas with malarial infection had increased numbers of fetal Hofbauer cells in the villous stroma and maternal macrophages in the intervillous space. In primigravidas, decreased anti-inflammatory M2-type Hofbauer cells were predictive of lower birth weight. M2-type maternal macrophages were increased in placental malaria, but there was no association with gravidity or birth weight. These results suggested a protective role of M2 Hofbauer cells in fetal growth restriction.
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10
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Fescenko I, Laraoui A, Smits J, Mosavian N, Kehayias P, Seto J, Bougas L, Jarmola A, Acosta VM. Diamond Magnetic Microscopy of Malarial Hemozoin Nanocrystals. PHYSICAL REVIEW APPLIED 2019; 11:034029. [PMID: 31245433 PMCID: PMC6594715 DOI: 10.1103/physrevapplied.11.034029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Magnetic microscopy of malarial hemozoin nanocrystals is performed by optically detected magnetic resonance imaging of near-surface diamond nitrogen-vacancy centers. Hemozoin crystals are extracted from Plasmodium falciparum-infected human blood cells and studied alongside synthetic hemozoin crystals. The stray magnetic fields produced by individual crystals are imaged at room temperature as a function of the applied field up to 350 mT. More than 100 nanocrystals are analyzed, revealing the distribution of their magnetic properties. Most crystals (96%) exhibit a linear dependence of the stray-field magnitude on the applied field, confirming hemozoin's paramagnetic nature. A volume magnetic susceptibility of 3.4 × 10-4 is inferred with use of a magnetostatic model informed by correlated scanning-electron-microscopy measurements of crystal dimensions. A small fraction of nanoparticles (4/82 for Plasmodium falciparum-produced nanoparticles and 1/41 for synthetic nanoparticles) exhibit a saturation behavior consistent with superparamagnetism. Translation of this platform to the study of living Plasmodium-infected cells may shed new light on hemozoin formation dynamics and their interaction with antimalarial drugs.
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Affiliation(s)
- Ilja Fescenko
- Center for High Technology Materials and Department of
Physics and Astronomy,University of New Mexico, 1313 Goddard St SE, Albuquerque,
87106 New Mexico, USA
| | - Abdelghani Laraoui
- Center for High Technology Materials and Department of
Physics and Astronomy,University of New Mexico, 1313 Goddard St SE, Albuquerque,
87106 New Mexico, USA
| | - Janis Smits
- Center for High Technology Materials and Department of
Physics and Astronomy,University of New Mexico, 1313 Goddard St SE, Albuquerque,
87106 New Mexico, USA
- Laser Centre of the University of Latvia, Jelgavas street
3, Riga, LV-1004, Latvia
| | - Nazanin Mosavian
- Center for High Technology Materials and Department of
Physics and Astronomy,University of New Mexico, 1313 Goddard St SE, Albuquerque,
87106 New Mexico, USA
| | - Pauli Kehayias
- Center for High Technology Materials and Department of
Physics and Astronomy,University of New Mexico, 1313 Goddard St SE, Albuquerque,
87106 New Mexico, USA
- Department of Physics, Harvard University, 17 Oxford St,
Cambridge, 02138 Massachusetts, USA
| | - Jong Seto
- Department of Bioengineering and Therapeutic Sciences,
School of Medicine, University of California-San Francisco, 1700 4th St, San
Francisco, 94158 California, USA
| | - Lykourgos Bougas
- Johannes Guttenberg University, Saarstraße 21, 55128
Mainz, Germany
| | - Andrey Jarmola
- Department of Physics, University of California, Berkeley,
366 LeConte Hall, Berkeley, 94720 California, USA
- ODMR Technologies Inc., 2041 Tapscott Ave, El Cerrito,
94530 California, USA
| | - Victor M. Acosta
- Center for High Technology Materials and Department of
Physics and Astronomy,University of New Mexico, 1313 Goddard St SE, Albuquerque,
87106 New Mexico, USA
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11
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Kawahara R, Rosa-Fernandes L, Dos Santos AF, Bandeira CL, Dombrowski JG, Souza RM, Da Fonseca MP, Festuccia WT, Labriola L, Larsen MR, Marinho CRF, Palmisano G. Integrated Proteomics Reveals Apoptosis-related Mechanisms Associated with Placental Malaria. Mol Cell Proteomics 2019; 18:182-199. [PMID: 30242111 PMCID: PMC6356084 DOI: 10.1074/mcp.ra118.000907] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/15/2018] [Indexed: 12/27/2022] Open
Abstract
Malaria in pregnancy is a public health concern in malaria-endemic areas. Accumulation of maternal immune cells in the placenta and increased levels of inflammatory cytokines caused by sequestration of Plasmodium falciparum-infected erythrocytes have been associated to poor neonatal outcomes, including low birth weight because of fetal growth restriction. Little is known about the molecular changes occurring in a P. falciparum-infected placenta that has developed placental malaria during pregnancy but had the parasites cleared by pharmacological treatment (past infection). We conducted an integrated proteome, phosphoproteome and glycoproteome analysis in past P. falciparum-infected placentas aiming to find molecular changes associated with placental malaria. A total of 2946 proteins, 1733 N-linked glycosites and 4100 phosphosites were identified and quantified in this study, disclosing overrepresented processes related to oxidative stress, protein folding and regulation of apoptosis in past-infected placentas Moreover, AKT and ERK signaling pathways activation, together with clinical data, were further correlated to an increased apoptosis in past-infected placentas. This study showed apoptosis-related mechanisms associated with placental malaria that can be further explored as therapeutic target against adverse pregnancy outcomes.
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Affiliation(s)
- Rebeca Kawahara
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo São Paulo, Brazil
| | - Livia Rosa-Fernandes
- Department of Biochemistry and Molecular biology, University of Southern Denmark, Odense, Denmark
| | | | - Carla Letícia Bandeira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo São Paulo, Brazil
| | - Jamille G Dombrowski
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo São Paulo, Brazil
| | - Rodrigo M Souza
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo São Paulo, Brazil
| | | | - William T Festuccia
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | - Leticia Labriola
- Department of Biochemistry, Chemistry Institute, University of São Paulo, Brazil
| | - Martin R Larsen
- Department of Biochemistry and Molecular biology, University of Southern Denmark, Odense, Denmark
| | - Claudio R F Marinho
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo São Paulo, Brazil;.
| | - Giuseppe Palmisano
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo São Paulo, Brazil;.
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12
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Anchang-Kimbi JK, Achidi EA, Nkegoum B, Mendimi JMN, Sverremark-Ekström E, Troye-Blomberg M. IgG isotypic antibodies to crude Plasmodium falciparum blood-stage antigen associated with placental malaria infection in parturient Cameroonian women. Afr Health Sci 2016; 16:1007-1017. [PMID: 28479893 DOI: 10.4314/ahs.v16i4.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Few studies have reported an association between placental malaria (PM) infection and levels of isotypic antibodies against non-pregnancy associated antigens. OBJECTIVE To determine and evaluate IgG isotypic antibody levels to crude P. falciparum blood stage in women with and without PM infection. METHODS Levels of IgG (IgG1-IgG4) and IgM to crude P. falciparum blood stage antigen were measured by ELISA in 271 parturient women. Placental malaria infection was determined by placental blood microscopy and placental histology. Age, parity and intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) usage were considered during analysis. RESULTS P. falciparum-specific IgG1 (96.5%) and IgG3 (96.7%) antibodies were predominant compared with IgG2 (64.6%) and IgG4 (49.1%). Active PM infection was associated with significant increased levels of IgG1, IgG4 and IgM while lower levels of these antibodies were associated with uptake of two or more IPTp-SP doses. PM infection was the only independent factor associated with IgG4 levels. Mean IgG1 + IgG3/IgG2 + IgG4 and IgG1 + IgG2 +IgG3/ IgG4 ratios were higher among the PM-uninfected group while IgG4/IgG2 ratio prevailed in the infected group. CONCLUSION PM infection and IPTp-SP dosage influenced P. falciparum-specific isotypic antibody responses to blood stage antigens. An increase in IgG4 levels in response to PM infection is of particular interest.
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Affiliation(s)
| | - Eric Akum Achidi
- Department of Biochemistry and Molecular Biology , University of Buea, Buea-63, Cameroon
| | - Blaise Nkegoum
- Department of Anatomy and Pathology, University of Yaoundé Teaching Hospital, Yaoundé-812
| | - Joseph-Marie N Mendimi
- Department of Anatomy and Pathology, University of Yaoundé I Teaching Hospital, Yaoundé-812
| | - Eva Sverremark-Ekström
- Department of Molecular Bioscience, Wenner-Gren Institute, Stockholm University, SE-10691 Stockholm
| | - Marita Troye-Blomberg
- Department of Molecular Bioscience, Wenner-Gren Institute, Stockholm University, SE- 10691 Stockholm
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13
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Liu Y, Griffin JB, Muehlenbachs A, Rogerson SJ, Bailis AJ, Sharma R, Sullivan DJ, Tshefu AK, Landis SH, Kabongo JMM, Taylor SM, Meshnick SR. Diagnosis of placental malaria in poorly fixed and processed placental tissue. Malar J 2016; 15:272. [PMID: 27165119 PMCID: PMC4863337 DOI: 10.1186/s12936-016-1314-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 04/27/2016] [Indexed: 11/17/2022] Open
Abstract
Background Placental histopathology has been considered the gold standard for diagnosis of malaria during pregnancy. However, in under-resourced areas placental tissue is often improperly fixed and processed; the resulting formalin pigment is difficult to distinguish from malaria pigment. This study examines two alternative diagnostic methods: polymerase chain reaction (PCR) and a novel immunohistochemistry (IHC)-based method using an antibody against histidine-rich protein 2 (HRP2). Methods Placental histopathology from 151 pregnant women in Kinshasa was assessed by two blinded microscopists and compared with peripheral blood PCR and IHC for HRP2. The Cohen’s kappa coefficients were calculated to assess the test agreement. The sensitivity and specificity of individual tests were calculated using PCR or IHC as the reference standard as well as latent class analysis (LCA). Results PCR and IHC correlated fairly well. The correlation between the two blinded microscopists was poor, as there was widespread formalin pigment. Using LCA, all of the tests had high specificities. The most sensitive test was IHC (67.7 %), with PCR as second-best (56.1 %). Conclusions PCR and/or IHC are suitable diagnostics when the presence of formalin pigment substantially compromises placental histopathology.
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Affiliation(s)
- Yunhao Liu
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA. .,Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, NC, USA.
| | | | | | - Stephen J Rogerson
- Department of Medicine at Peter Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Anya J Bailis
- Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rajni Sharma
- Immunopathology Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David J Sullivan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Antoinette K Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Sarah H Landis
- Glaxo-Smith-Kline, Worldwide Epidemiology, Uxbridge, Middlesex, UK
| | - Jean-Marie M Kabongo
- Department of Medical Biology, Service of Pathology, University of Kinshasa Medical School and University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Steve M Taylor
- Division of Infectious Diseases & International Health and Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
| | - Steven R Meshnick
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
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14
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Ohta E, Nagayama Y, Koyama N, Kakiuchi D, Hosokawa S. Malaria in cynomolgus monkeys used in toxicity studies in Japan. J Toxicol Pathol 2016; 29:31-8. [PMID: 26989299 PMCID: PMC4766527 DOI: 10.1293/tox.2015-0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/20/2015] [Indexed: 11/19/2022] Open
Abstract
Plasmodium spp. protozoa cause malaria and are known to infect humans and a variety of animal species including macaque monkeys. Here we report both our experience with malaria recrudescence in cynomolgus monkeys (Macaca fascicularis) in a toxicity study and the results of a survey on Plasmodium infection in cynomolgus monkeys imported to Japan for laboratory use. A cynomolgus monkey from the toxicity study presented with severe anemia and Plasmodium protozoa in erythrocytes on a thin blood smear and was subsequently diagnosed with symptomatic malaria. In this animal, congestion and accumulation of hemozoin (malaria pigment) in macrophages were noted in the enlarged and darkly discolored spleen. As a follow-up for the experience, spleen sections from 800 cynomolgus monkeys in toxicity studies conducted between 2003 and 2013 were retrospectively examined for hemozoin deposition as a marker of Plasmodium infection. The origin of the animals included Cambodia, China, Indonesia, and Vietnam. Hemozoin deposition was confirmed in 44% of all examined monkeys. Monkeys from Indonesia showed the highest incidence of hemozoin deposition (approx. 80%). A high prevalence of Plasmodium infection in laboratory monkeys was also confirmed with polymerase chain reaction (PCR) by using Plasmodium genus-specific primers. Although Japan is not a country with endemic malaria, it is important to be aware of the prevalence and potential impact of background infection with Plasmodium spp. and recrudescence of symptomatic malaria in imported laboratory monkeys on pharmaceutical toxicity studies.
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Affiliation(s)
- Etsuko Ohta
- Tsukuba Drug Safety, Global Drug Safety, Biopharmaceutical Assessments Core Function Unit, Eisai Product Creation Systems, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
| | - Yuko Nagayama
- Tsukuba Drug Safety, Global Drug Safety, Biopharmaceutical Assessments Core Function Unit, Eisai Product Creation Systems, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
| | - Naoki Koyama
- Tsukuba Drug Safety, Global Drug Safety, Biopharmaceutical Assessments Core Function Unit, Eisai Product Creation Systems, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
| | - Dai Kakiuchi
- Tsukuba Drug Safety, Global Drug Safety, Biopharmaceutical Assessments Core Function Unit, Eisai Product Creation Systems, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
| | - Satoru Hosokawa
- Tsukuba Drug Safety, Global Drug Safety, Biopharmaceutical Assessments Core Function Unit, Eisai Product Creation Systems, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
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15
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Ishmukhametov RR, Russell AN, Wheeler RJ, Nord AL, Berry RM. A Simple low-cost device enables four epi-illumination techniques on standard light microscopes. Sci Rep 2016; 6:20729. [PMID: 26853732 PMCID: PMC4745110 DOI: 10.1038/srep20729] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 01/11/2016] [Indexed: 12/02/2022] Open
Abstract
Back-scattering darkfield (BSDF), epi-fluorescence (EF), interference reflection contrast (IRC), and darkfield surface reflection (DFSR) are advanced but expensive light microscopy techniques with limited availability. Here we show a simple optical design that combines these four techniques in a simple low-cost miniature epi-illuminator, which inserts into the differential interference-contrast (DIC) slider bay of a commercial microscope, without further additions required. We demonstrate with this device: 1) BSDF-based detection of Malarial parasites inside unstained human erythrocytes; 2) EF imaging with and without dichroic components, including detection of DAPI-stained Leishmania parasite without using excitation or emission filters; 3) RIC of black lipid membranes and other thin films, and 4) DFSR of patterned opaque and transparent surfaces. We believe that our design can expand the functionality of commercial bright field microscopes, provide easy field detection of parasites and be of interest to many users of light microscopy.
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Affiliation(s)
- Robert R Ishmukhametov
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Aidan N Russell
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Richard J Wheeler
- The Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Ashley L Nord
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Richard M Berry
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
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16
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Shribak M. Polychromatic polarization microscope: bringing colors to a colorless world. Sci Rep 2015; 5:17340. [PMID: 26611150 PMCID: PMC4661494 DOI: 10.1038/srep17340] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/28/2015] [Indexed: 11/23/2022] Open
Abstract
Interference of two combined white light beams produces Newton colors if one of the beams is retarded relative to the other by from 400 nm to 2000 nm. In this case the corresponding interfering spectral components are added as two scalars at the beam combination. If the retardance is below 400 nm the two-beam interference produces grey shades only. The interference colors are widely used for analyzing birefringent samples in mineralogy. However, many of biological structures have retardance <100 nm. Therefore, cells and tissues under a regular polarization microscope are seen as grey image, which contrast disappears at certain orientations. Here we are proposing for the first time using vector interference of polarized light in which the full spectrum colors are created at retardance of several nanometers, with the hue determined by orientation of the birefringent structure. The previously colorless birefringent images of organelles, cells, and tissues become vividly colored. This approach can open up new possibilities for the study of biological specimens with weak birefringent structures, diagnosing various diseases, imaging low birefringent crystals, and creating new methods for controlling colors of the light beam.
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Affiliation(s)
- Michael Shribak
- Marine Biological Laboratory, 7 MBL St, Woods Hole, MA 02543, USA
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17
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Pirnstill CW, Coté GL. Malaria Diagnosis Using a Mobile Phone Polarized Microscope. Sci Rep 2015; 5:13368. [PMID: 26303238 PMCID: PMC4548194 DOI: 10.1038/srep13368] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/14/2015] [Indexed: 12/15/2022] Open
Abstract
Malaria remains a major global health burden, and new methods for low-cost, high-sensitivity, diagnosis are essential, particularly in remote areas with low-resource around the world. In this paper, a cost effective, optical cell-phone based transmission polarized light microscope system is presented for imaging the malaria pigment known as hemozoin. It can be difficult to determine the presence of the pigment from background and other artifacts, even for skilled microscopy technicians. The pigment is much easier to observe using polarized light microscopy. However, implementation of polarized light microscopy lacks widespread adoption because the existing commercial devices have complicated designs, require sophisticated maintenance, tend to be bulky, can be expensive, and would require re-training for existing microscopy technicians. To this end, a high fidelity and high optical resolution cell-phone based polarized light microscopy system is presented which is comparable to larger bench-top polarized microscopy systems but at much lower cost and complexity. The detection of malaria in fixed and stained blood smears is presented using both, a conventional polarized microscope and our cell-phone based system. The cell-phone based polarimetric microscopy design shows the potential to have both the resolution and specificity to detect malaria in a low-cost, easy-to-use, modular platform.
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Affiliation(s)
- Casey W Pirnstill
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Gerard L Coté
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843.,Center for Remote Health Technologies and Systems, Texas Engineering Experiment Station, College Station, TX 77843
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18
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Rebelo M, Tempera C, Bispo C, Andrade C, Gardner R, Shapiro HM, Hänscheid T. Light depolarization measurements in malaria: A new job for an old friend. Cytometry A 2015; 87:437-45. [PMID: 25808846 DOI: 10.1002/cyto.a.22659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/28/2015] [Accepted: 02/27/2015] [Indexed: 12/15/2022]
Abstract
The use of flow cytometry in malaria research has increased over the last decade. Most approaches use nucleic acid stains to detect parasite DNA and RNA and require complex multi-color, multi-parameter analysis to reliably detect infected red blood cells (iRBCs). We recently described a novel and simpler approach to parasite detection based on flow cytometric measurement of scattered light depolarization caused by hemozoin (Hz), a pigment formed by parasite digestion of hemoglobin in iRBCs. Depolarization measurement by flow cytometry was described in 1987; however, patent issues restricted its use to a single manufacturer's hematology analyzers until 2009. Although we recently demonstrated that depolarization measurement of Hz, easily implemented on a bench top flow cytometer (Cyflow), provided useful information for malaria work, doubts regarding its application and utility remain in both the flow cytometry and malaria communities, at least in part because instrument manufacturers do not offer the option of measuring depolarized scatter. Under such circumstances, providing other researchers with guidance as to how to do this seemed to offer the most expeditious way to resolve the issue. We accordingly examined how several commercially available flow cytometers (CyFlow SL, MoFLo, Attune and Accuri C6) could be modified to detect depolarization due to the presence of free Hz on solution, or of Hz in leukocytes or erythrocytes from rodent or human blood. All were readily adapted, with substantially equivalent results obtained with lasers emitting over a wide wavelength range. Other instruments now available may also be modifiable for Hz measurement. Cytometric detection of Hz using depolarization is useful to study different aspects of malaria. Adding additional parameters, such as DNA content and base composition and RNA content, can demonstrably provide improved accuracy and sensitivity of parasite detection and characterization, allowing malaria researchers and eventually clinicians to benefit from cytometric technology.
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Affiliation(s)
- Maria Rebelo
- Molecular Microbiology and Infection Unit, Instituto De Medicina Molecular, Faculdade De Medicina, Lisbon, Portugal
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19
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Ahmed R, Singh N, ter Kuile FO, Bharti PK, Singh PP, Desai M, Udhayakumar V, Terlouw DJ. Placental infections with histologically confirmed Plasmodium falciparum are associated with adverse birth outcomes in India: a cross-sectional study. Malar J 2014; 13:232. [PMID: 24927762 PMCID: PMC4065549 DOI: 10.1186/1475-2875-13-232] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/08/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Few studies have assessed placental malaria infections from low transmission areas by histopathology to define their impact and underlying mechanisms. METHODS Peripheral smears and rapid diagnostic tests (RDTs), placental smears and histological samples, birth weight and gestational age were collected from 2,282 deliveries in three hospitals during a one-year (2006-2007) continuous cross-sectional survey in Madhya Pradesh. Placental histopathology included all 50 cases positive by microscopy or RDT plus 456 randomly selected samples of women negative for malaria by microscopy or RDT. Histological examination included parasites, inflammatory cells, pigment in fibrin, and morphological changes. RESULTS There were 52 histology-positive cases; 38 (73.1%) active (acute and chronic) and 14 past infections. Intervillous parasitaemia was low (60% had < 1% parasitaemia) and monocytosis mostly mild (63%). Compared with uninfected placentas, acute Plasmodium falciparum infections were associated with stillbirth (RR 3.8, 95% CI 1.2-12.1), lower maternal haemoglobin (mean difference: 1.5 g/dL, 95% CI 0.5-2.5), lower birth weight (mean difference 451 g, 95% CI 169-609) and shorter gestation (mean difference 0.8 weeks, 95% CI 0.2-1.4). Chronic or past infections were not associated with these outcomes. Among the 11 peripheral Plasmodium vivax cases, placental parasites were absent, but they were associated with increased placental polymorphonuclear cells. CONCLUSIONS Malaria associated stillbirth and low birth weight in women with low protective immunity may result, at least in part, from a shortened gestation triggered by acute infection, stressing the importance of early malaria detection.
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Affiliation(s)
| | | | | | | | | | | | | | - Dianne J Terlouw
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
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20
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RAMADHANI DWI, NURHAYATI SITI, RAHARDJO TUR. Haemozoin Detection in Mouse Liver Histology Using Simple Polarized Light Microscope. HAYATI JOURNAL OF BIOSCIENCES 2014. [DOI: 10.4308/hjb.21.1.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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21
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Abstract
Malaria is a leading cause of mortality worldwide and accurate diagnostic testing for malaria can potentially save an estimated 100,000 lives annually. New technologies have the potential to circumvent limitations of the traditional diagnostic method, light microscopy, which is labor intensive and requires considerable technician expertise. Immunochromatographic tests, which are easy to use in field conditions and relatively inexpensive, offer a potential solution to the problem of malaria overtreatment in resource-poor endemic countries. Assays based on the PCR are highly sensitive, can be used for unambiguous species identification and, thus, may increasingly complement or even replace light microscopy in developed countries. Experimental diagnostics using flow cytometry and mass spectrometry are currently under investigation for high-throughput screening.
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Affiliation(s)
- Michael Hawkes
- Pediatric Infectious Diseases, University of Toronto, MaRS Centre, Toronto Medical Discovery Tower, Toronto, Ontario, Canada.
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22
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Aguilar R, Moraleda C, Achtman AH, Mayor A, Quintó L, Cisteró P, Nhabomba A, Macete E, Schofield L, Alonso PL, Menéndez C. Severity of anaemia is associated with bone marrow haemozoin in children exposed to Plasmodium falciparum. Br J Haematol 2014; 164:877-87. [PMID: 24386973 DOI: 10.1111/bjh.12716] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/28/2013] [Indexed: 11/29/2022]
Abstract
There are no large-scale ex vivo studies addressing the contribution of Plasmodium falciparum in the bone marrow to anaemia. The presence of malaria parasites and haemozoin were studied in bone marrows from 290 anaemic children attending a rural hospital in Mozambique. Peripheral blood infections were determined by microscopy and polymerase chain reactions. Bone marrow parasitaemia, haemozoin and dyserythropoiesis were microscopically assessed. Forty-two percent (123/290) of children had parasites in the bone marrow and 49% (111/226) had haemozoin, overlapping with parasitaemia in 83% (92/111) of cases. Sexual and mature asexual parasites were highly prevalent (62% gametocytes, 71% trophozoites, 23% schizonts) suggesting their sequestration in this tissue. Sixteen percent (19/120) of children without peripheral infection had haemozoin in the bone marrow. Haemozoin in the bone marrow was independently associated with decreased Hb concentration (P = 0·005) and was more common in dyserythropoietic bone marrows (P = 0·010). The results of this ex vivo study suggest that haemozoin in the bone marrow has a role in the pathogenesis of malarial-anaemia through ineffective erythropoiesis. This finding may have clinical implications for the development of drugs targeted to prevent and treat malarial-anaemia.
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Affiliation(s)
- Ruth Aguilar
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - University of Barcelona), Barcelona, Spain; CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Manhiça Health Research Centre (CISM), Maputo, Mozambique
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23
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Molecular evidence for the localization of Plasmodium falciparum immature gametocytes in bone marrow. Blood 2013; 123:959-66. [PMID: 24335496 DOI: 10.1182/blood-2013-08-520767] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Plasmodium falciparum immature gametocytes are not observed in peripheral blood. However, gametocyte stages in organs such as bone marrow have never been assessed by molecular techniques, which are more sensitive than optical microscopy. We quantified P falciparum sexual stages in bone marrow (n = 174) and peripheral blood (n = 70) of Mozambican anemic children by quantitative polymerase chain reaction targeting transcripts specific for early (PF14_0748; PHISTa), intermediate (PF13_0247; Pfs48/45), and mature (PF10_0303; Pfs25) gametocytes. Among children positive for the P falciparum housekeeping gene (PF08_0085; ubiquitin-conjugating enzyme gene) in bone marrow (n = 136) and peripheral blood (n = 25), prevalence of immature gametocytes was higher in bone marrow than peripheral blood (early: 95% vs 20%, P < .001; intermediate: 80% vs 16%; P < .001), as were transcript levels (P < .001 for both stages). In contrast, mature gametocytes were more prevalent (100% vs 51%, P < .001) and abundant (P < .001) in peripheral blood than in the bone marrow. Severe anemia (3.57, 95% confidence interval 1.49-8.53) and dyserythropoiesis (6.21, 95% confidence interval 2.24-17.25) were independently associated with a higher prevalence of mature gametocytes in bone marrow. Our results highlight the high prevalence and abundance of early sexual stages in bone marrow, as well as the relationship between hematological disturbances and gametocyte development in this tissue.
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24
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RAHARDJO TUR, NURHAYATI SITI, RAMADHANI DWI. Liver Histophatological Studies of Mice (Mus musculus sp.) Infected With Gamma Rays Irradiated Plasmodium berghei Strains Anka. HAYATI JOURNAL OF BIOSCIENCES 2013. [DOI: 10.4308/hjb.20.3.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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25
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Hromatka BS, Ngeleza S, Adibi JJ, Niles RK, Tshefu AK, Fisher SJ. Histopathologies, immunolocalization, and a glycan binding screen provide insights into Plasmodium falciparum interactions with the human placenta. Biol Reprod 2013; 88:154. [PMID: 23575149 PMCID: PMC4070867 DOI: 10.1095/biolreprod.112.106195] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/06/2013] [Accepted: 03/29/2013] [Indexed: 11/01/2022] Open
Abstract
During pregnancy, Plasmodium falciparum-infected erythrocytes cytoadhere to the placenta. Infection is likely initiated at two sites where placental trophoblasts contact maternal blood: 1) via syncytiotrophoblast (STB), a multicellular transporting and biosynthetic layer that forms the surface of chorionic villi and lines the intervillous space, and 2) through invasive cytotrophoblasts, which line uterine vessels that divert blood to the placenta. Here, we investigated mechanisms of infected erythrocyte sequestration in relationship to the microanatomy of the maternal-fetal interface. Histological analyses revealed STB denudation in placental malaria, which brought the stromal cores of villi in direct contact with maternal blood. STB denudation was associated with hemozoin deposition (P = 0.01) and leukocyte infiltration (P = 0.001) and appeared to be a feature of chronic placental malaria. Immunolocalization of infected red blood cell receptors (CD36, ICAM1/CD54, and chondroitin sulfate A) in placentas from uncomplicated pregnancies showed that STB did not stain, while the underlying villous stroma was immunopositive. Invasive cytotrophoblasts expressed ICAM1. In malaria, STB denudation exposed CD36 and chondroitin sulfate A in the villous cores to maternal blood, and STB expressed ICAM1. Finally, we investigated infected erythrocyte adherence to novel receptors by screening an array of 377 glycans. Infected erythrocytes bound Lewis antigens that immunolocalized to STB. Our results suggest that P. falciparum interactions with STB-associated Lewis antigens could initiate placental malaria. Subsequent pathologies, which expose CD36, ICAM1, and chondroitin sulfate A, might propagate the infection.
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Affiliation(s)
- Bethann S. Hromatka
- Departments of Obstetrics and Gynecology, Anatomy, the Center for Reproductive Sciences, and The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, California
| | - Sadiki Ngeleza
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Jennifer J. Adibi
- Departments of Obstetrics and Gynecology, Anatomy, the Center for Reproductive Sciences, and The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, California
| | - Richard K. Niles
- Departments of Obstetrics and Gynecology, Anatomy, the Center for Reproductive Sciences, and The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, California
| | | | - Susan J. Fisher
- Departments of Obstetrics and Gynecology, Anatomy, the Center for Reproductive Sciences, and The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, California
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26
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Fried M, Muehlenbachs A, Duffy PE. Diagnosing malaria in pregnancy: an update. Expert Rev Anti Infect Ther 2013. [PMID: 23199403 DOI: 10.1586/eri.12.98] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pregnancy malaria (PM) due to Plasmodium falciparum is a major cause of morbidity and mortality for women and their offspring, but is difficult to recognize and diagnose. During PM, parasites typically sequester in the placenta, whereas peripheral blood smears often appear negative. In addition, many infected women remain asymptomatic, especially in areas of high transmission where systemic immunity is high, although sequelae including maternal anemia and intrauterine growth retardation develop insidiously and increase mortality. New rapid diagnostic tests (RDTs) have shown promise for malaria diagnosis in nonpregnant individuals, including a product recently approved by the US FDA for use in the USA. However, the sensitivity and specificity of RDTs for diagnosis of PM may be suboptimal. Here, we review the methods that are used to detect or diagnose PM, including blood smear microscopy, RDTs, PCR-based methods, and finally placental histology, which is often cited as the gold standard for use in research studies and clinical trials.
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Affiliation(s)
- Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20892, USA.
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Milroy C. Sudden Death from Malaria and Salmonellosis. Acad Forensic Pathol 2012. [DOI: 10.23907/2012.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chris Milroy
- Forensic Pathologist with the Eastern Ontario Regional Forensic Pathology Unit, the University of Ottawa in Ottawa, Canada
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In Vivo Hemozoin Kinetics after Clearance of Plasmodium berghei Infection in Mice. Malar Res Treat 2012; 2012:373086. [PMID: 22567535 PMCID: PMC3337493 DOI: 10.1155/2012/373086] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 02/14/2012] [Indexed: 11/29/2022] Open
Abstract
Hemozoin (Hz) is released into the blood stream after rupture of infected red blood cells (iRBCs) at the end of each parasite replication cycle. This free Hz is ingested by circulating and resident phagocytes. The presence of Hz in tissues after clearance of infection has been previously reported. Still, little is known about the kinetics of Hz in vivo, during and after Plasmodium infection. It is particularly important to understand Hz kinetics after malaria infections as it has been reported that Hz is associated with impairment of immune functions, including possible consequences for coinfections. Indeed, if Hz remains biologically active for prolonged periods of time inside immunocompetent cells, the potential consequences of such accumulation and presence to the immune system should be clarified. Here, using several independent methods to assess the presence of Hz, we report the long-term in vivo kinetics of Hz in diverse organs in a murine model of malaria infection.
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Karl S, Gutiérrez L, House MJ, Davis TME, St Pierre TG. Nuclear magnetic resonance: a tool for malaria diagnosis? Am J Trop Med Hyg 2011; 85:815-7. [PMID: 22049032 DOI: 10.4269/ajtmh.2011.11-0299] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Malaria control can be improved by rapid, sensitive, low-cost detection of infection. Several such strategies are being pursued. Rapid diagnostic tests can detect infections at parasite densities above 200 μL(-1). Polymerase chain reaction methods can detect low parasite densities, but are slow and prone to contamination under field conditions. Methods that detect hemozoin presence in blood have been proposed as alternatives for rapid detection of infection. In this study, we used a benchtop nuclear magnetic resonance (NMR) device to detect hemozoin. This device could be deployed in malaria-endemic settings. We measured synthetic hemozoin in phosphate-buffered saline and malaria parasites in human blood. The NMR detected hemozoin in suspensions of 4 ng μL(-1) and parasites at densities of 8,000-10,000 μL(-1) (0.2% parasitemia). Thus, our preliminary NMR approach, although providing very rapid measurements, is unlikely to achieve the required sensitivity and specificity for malaria diagnosis, unless a preliminary concentration step is performed.
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Affiliation(s)
- Stephan Karl
- School of Physics, The University of Western Australia, Crawley, Australia.
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Cho S, Kim S, Kim Y, Park Y. Optical imaging techniques for the study of malaria. Trends Biotechnol 2011; 30:71-9. [PMID: 21930322 DOI: 10.1016/j.tibtech.2011.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 08/25/2011] [Accepted: 08/26/2011] [Indexed: 02/07/2023]
Abstract
Malarial infection needs to be imaged to reveal the mechanisms behind malaria pathophysiology and to provide insights to aid in the diagnosis of the disease. Recent advances in optical imaging methods are now being transferred from physics laboratories to the biological field, revolutionizing how we study malaria. To provide insight into how these imaging techniques can improve the study and treatment of malaria, we summarize recent progress on optical imaging techniques, ranging from in vitro visualization of the disease progression of malaria infected red blood cells (iRBCs) to in vivo imaging of malaria parasites in the liver.
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Affiliation(s)
- Sangyeon Cho
- Department of Chemistry, Korea Advanced Institute of Science and Technology, Daejeon, 305-701, Republic of Korea
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Wilson BK, Behrend MR, Horning MP, Hegg MC. Detection of malarial byproduct hemozoin utilizing its unique scattering properties. OPTICS EXPRESS 2011; 19:12190-12196. [PMID: 21716456 DOI: 10.1364/oe.19.012190] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The scattering characteristics of the malaria byproduct hemozoin, including its scattering distribution and depolarization, are modeled using Discrete Dipole Approximation (DDA) and compared to those of healthy red blood cells. Scattering (or dark-field) spectroscopy and imaging are used to identify hemozoin in fresh rodent blood samples. A new detection method is proposed and demonstrated using dark-field in conjunction with cross-polarization imaging and spectroscopy. SNRs greater than 50:1 are achieved for hemozoin in fresh blood without the addition of stains or reagents. The potential of such a detection system is discussed.
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Affiliation(s)
- Benjamin K Wilson
- Intellectual Ventures Laboratories, 1600 132nd Avenue, NE, Bellevue, WA 98005, USA.
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32
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Molecular Approaches for Diagnosis of Malaria and Characterization of Genetic Markers of Drug Resistance. Mol Microbiol 2011. [DOI: 10.1128/9781555816834.ch46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abreu Velez AM, Howard MS, Restrepo-Isaza M, Smoller B. Formalin deposition as artifact in biopsies from patients affected by a new variant of endemic pemphigus foliaceus in El Bagre, Colombia, South America. J Cutan Pathol 2009; 37:835-42. [PMID: 20015189 DOI: 10.1111/j.1600-0560.2009.01492.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most autoimmune diseases occur sporadically; however, endemic pemphigus foliaceus (EPF) is present in specific locales restricted to some geographic rural regions mostly in South America, Central America and in Tunisia (Africa). Its geographic restriction makes it an invaluable natural model for studying how the environment, genetic background and host response contribute to the development of autoimmunity. We described a new variant of EPF in El Bagre, Colombia, (El Bagre-EPF). When we examined the skin biopsies from 10 patients and controls from the endemic area, we detected in a systematic manner several types of pigmentation, sometimes intracellular, and sometimes in the extracellular matrix in most biopsies. AIM We aim to determine the nature of this pigment in these skin biopsies. METHODS We studied 10 patients and 10 controls matched by sex, age and work activity living in the endemic area by routine hematoxylin and eosin (H&E). RESULTS We were unable to find any bacteriological or parasitic organism. Specifically, we searched for several tropical disease agents as possible causative agents of this pigment. Iron stains and melanin pigment bleaching techniques failed to determine the etiology of this pigment. We then tried the removal of formalin pigment using picric acid. The pigment was removed after very strong treatment with different acids including picric acid. CONCLUSIONS Formalin pigment shares many properties with hemozoin. In this case, the authors recommend the use of neutral buffered formalin to prevent the formation of formalin pigment especially after long periods of fixation when taking biopsies under extreme temperature and environmental humidity.
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Abstract
Malaria pigment is an intracellular inclusion body that appears in blood and tissue specimens on microscopic examination and can help in establishing the diagnosis of malaria. In simple light microscopy, it can be difficult to discern from cellular background and artifacts. It has long been known that if polarized light microscopy is used, malaria pigment can be much easier to distinguish. However, this technique is rarely used because of the need for a relatively costly polarization microscope. We describe a simple and economical technique to convert any standard light microscope suitable for examination of malaria films into a polarization microscope.
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Affiliation(s)
- Richard J Maude
- Centre for Tropical Diseases, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, United Kingdom.
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Anchang-Kimbi JK, Achidi EA, Nkegoum B, Sverremark-Ekström E, Troye-Blomberg M. Diagnostic comparison of malaria infection in peripheral blood, placental blood and placental biopsies in Cameroonian parturient women. Malar J 2009; 8:126. [PMID: 19505312 PMCID: PMC2702348 DOI: 10.1186/1475-2875-8-126] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 06/08/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, Plasmodium falciparum malaria in pregnancy presents an enormous diagnostic challenge. The epidemiological and clinical relevance of the different types of malaria diagnosis as well as risk factors associated with malaria infection at delivery were investigated. METHOD In a cross-sectional survey, 306 women reporting for delivery in the Mutenegene maternity clinic, Fako division, South West province, Cameroon were screened for P. falciparum in peripheral blood, placental blood and placental tissue sections by microscopy. Information relating to the use of intermittent preventive treatment in pregnancy with sulphadoxine/pyrimethamine, history of fever attack, infant birth weights and maternal anaemia were recorded. RESULTS Among these women, P. falciparum infection was detected in 5.6%, 25.5% and 60.5% of the cases in peripheral blood, placental blood and placental histological sections respectively. Placental histology was more sensitive (97.4%) than placental blood film (41.5%) and peripheral blood (8.0%) microscopy. In multivariate analysis, age (< or = 20 years old) (OR = 4.61, 95% CI = 1.47 - 14.70), history of fever attack (OR = 2.98, 95% CI = 1.58 - 5.73) were significant risk factors associated with microscopically detected parasitaemia. The use of > or = 2 SP doses (OR = 0.18, 95% CI = 0.06 - 0.52) was associated with a significant reduction in the prevalence of microscopic parasitaemia at delivery. Age (>20 years) (OR = 0.34, 95% CI = 0.15 - 0.75) was the only significant risk factor associated with parasitaemia diagnosed by histology only in univariate analysis. Microscopic parasitaemia (OR = 2.74, 95% CI = 1.33-5.62) was a significant risk factor for maternal anaemia at delivery, but neither infection detected by histology only, nor past infection were associated with increased risk of anaemia. CONCLUSION Placenta histological examination was the most sensitive indicator of malaria infection at delivery. Microscopically detected parasitaemia was associated with increased risk of maternal anaemia at delivery, but not low-grade parasitaemia detected by placental histology only.
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Ordi J, Ismail MR, Carrilho C, Romagosa C, Osman N, Machungo F, Bombí JA, Balasch J, Alonso PL, Menéndez C. Clinico-pathological discrepancies in the diagnosis of causes of maternal death in sub-Saharan Africa: retrospective analysis. PLoS Med 2009; 6:e1000036. [PMID: 19243215 PMCID: PMC2646780 DOI: 10.1371/journal.pmed.1000036] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 01/10/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. METHODS AND FINDINGS A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n = 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). CONCLUSIONS Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.
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Affiliation(s)
- Jaume Ordi
- Department of Pathology Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomédiques August Pi I Sunyer, Barcelona, Spain.
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Hänscheid T, Längin M, Lell B, Pötschke M, Oyakhirome S, Kremsner PG, Grobusch MP. Full blood count and haemozoin-containing leukocytes in children with malaria: diagnostic value and association with disease severity. Malar J 2008; 7:109. [PMID: 18549498 PMCID: PMC2435542 DOI: 10.1186/1475-2875-7-109] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 06/12/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diligent and correct laboratory diagnosis and up-front identification of risk factors for progression to severe disease are the basis for optimal management of malaria. METHODS Febrile children presenting to the Medical Research Unit at the Albert Schweitzer Hospital (HAS) in Lambaréné, Gabon, were assessed for malaria. Giemsa-stained thick films for qualitative and quantitative diagnosis and enumeration of malaria pigment, or haemozoin (Hz)-containing leukocytes (PCL) were performed, and full blood counts (FBC) were generated with a Cell Dyn 3000 instrument. RESULTS Compared to standard light microscopy of Giemsa-stained thick films, diagnosis by platelet count only, by malaria pigment-containing monocytes (PCM) only, or by pigment-containing granulocytes (PCN) only yielded sensitivities/specificities of 92%/93%; 96%/96%; and 85%/96%, respectively. The platelet count was significantly lower in children with malaria compared to those without (p < 0.001), and values showed little overlap between groups. Compared to microscopy, scatter flow cytometry as applied in the Cell-Dyn 3000(R) instrument detected significantly more patients with PCL (p < 0.01). Both PCM and PCN numbers were higher in severe versus non-severe malaria yet reached statistical significance only for PCN (p < 0.0001; PCM: p = 0.14). Of note was the presence of another, so far ill-defined pigment-containing group of phagocytic cells, identified by laser-flow cytometry as lymphocyte-like gated events, and predominantly found in children with malaria-associated anaemia. CONCLUSION In the age group examined in the Lambaréné area, platelets are an excellent adjuvant tool to diagnose malaria. Pigment-containing leukocytes (PCL) are more readily detected by automated scatter flow cytometry than by microscopy. Automated Hz detection by an instrument as used here is a reliable diagnostic tool and correlates with disease severity. However, clinical usefulness as a prognostic tool is limited due to an overlap of PCL numbers recorded in severe versus non-severe malaria. However, this is possibly because of the instrument detection algorithm was not geared towards this task, and data lost during processing; and thus adjusting the instrument's algorithm may allow to establish a meaningful cut-off value.
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Affiliation(s)
- Thomas Hänscheid
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Molecular Medicine, Lisbon Medical College, Lisbon, Portugal
| | - Matthias Längin
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Parasitology, Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Bertrand Lell
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Parasitology, Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Marc Pötschke
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Parasitology, Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Sunny Oyakhirome
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Parasitology, Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Peter G Kremsner
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Parasitology, Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Martin P Grobusch
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Infectious Diseases Unit, Infectious Diseases Unit, Division of Clinical Microbiology and Infectious Diseases, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, 7 York Road, Parktown, South Africa
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An autopsy study of maternal mortality in Mozambique: the contribution of infectious diseases. PLoS Med 2008; 5:e44. [PMID: 18288887 PMCID: PMC2245982 DOI: 10.1371/journal.pmed.0050044] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 01/08/2008] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Maternal mortality is a major health problem concentrated in resource-poor regions. Accurate data on its causes using rigorous methods is lacking, but is essential to guide policy-makers and health professionals to reduce this intolerable burden. The aim of this study was to accurately describe the causes of maternal death in order to contribute to its reduction, in one of the regions of the world with the highest maternal mortality ratios. METHODS AND FINDINGS We conducted a prospective study between October 2002 and December 2004 on the causes of maternal death in a tertiary-level referral hospital in Maputo, Mozambique, using complete autopsies with histological examination. HIV detection was done by virologic and serologic tests, and malaria was diagnosed by histological and parasitological examination. During 26 mo there were 179 maternal deaths, of which 139 (77.6%) had a complete autopsy and formed the basis of this analysis. Of those with test results, 65 women (52.8%) were HIV-positive. Obstetric complications accounted for 38.2% of deaths; haemorrhage was the most frequent cause (16.6%). Nonobstetric conditions accounted for 56.1% of deaths; HIV/AIDS, pyogenic bronchopneumonia, severe malaria, and pyogenic meningitis were the most common causes (12.9%, 12.2%, 10.1% and 7.2% respectively). Mycobacterial infection was found in 12 (8.6%) maternal deaths. CONCLUSIONS In this tertiary hospital in Mozambique, infectious diseases accounted for at least half of all maternal deaths, even though effective treatment is available for the four leading causes, HIV/AIDS, pyogenic bronchopneumonia, severe malaria, and pyogenic meningitis. These observations highlight the need to implement effective and available prevention tools, such as intermittent preventive treatment and insecticide-treated bed-nets for malaria, antiretroviral drugs for HIV/AIDS, or vaccines and effective antibiotics for pneumococcal and meningococcal diseases. Deaths due to obstetric causes represent a failure of health-care systems and require urgent improvement.
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Hänscheid T, Egan TJ, Grobusch MP. Haemozoin: from melatonin pigment to drug target, diagnostic tool, and immune modulator. THE LANCET. INFECTIOUS DISEASES 2007; 7:675-85. [PMID: 17897610 DOI: 10.1016/s1473-3099(07)70238-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Plasmodium spp produce a pigment (haemozoin) to detoxify the free haem that is generated by haemoglobin degradation. Haemozoin was originally thought to be an inert waste byproduct of the parasite. However, recent research has led to the recognition that haemozoin is possibly of great importance in various aspects of malaria. Haemozoin is the target of many antimalarial drugs, and the unravelling of the exact modes of action may allow the design of novel antimalarial compounds. The detection of haemozoin in erythrocytes or leucocytes facilitates the diagnosis of malaria. The number of haemozoin-containing monocytes and granulocytes has been shown to correlate well with disease severity and may hold the potential for becoming a novel, automated laboratory marker in the assessment of patients. Finally, haemozoin has a substantial effect on the immune system. Further research is needed to clarify these aspects, many of which are important in clinical practice.
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Affiliation(s)
- Thomas Hänscheid
- Institute of Molecular Medicine, Lisbon Medical College, Lisbon, Portugal
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Kassam SN, Nesbitt S, Hunt LP, Oster N, Soothill P, Sergi C. Pregnancy outcomes in women with or without placental malaria infection. Int J Gynaecol Obstet 2006; 93:225-32. [PMID: 16626713 DOI: 10.1016/j.ijgo.2006.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 02/14/2006] [Accepted: 02/28/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess delivery outcomes in women with placental malaria who presented at public hospitals in Kisumu, a holoendemic region in western Kenya. METHODS A cross-sectional study using both histology and molecular biology was conducted with 90 consecutive pregnant women who presented at 3 hospitals during a 2-week period. Data collectors completed standardized questionnaires using each patient's hospital record and physical examination results, and registered birth indices such as weight, head circumference, and weight-head ratio. Malaria infection of the placenta was assessed using a molecular biology approach (for genomic differences among parasite species) as well as histology techniques. Of the 5 histologic classes of placental infection, class 1 corresponds to active infection and class 4 to past infection; class 2 and 3 to active chronic infection; and class 5 to uninfected individuals. Plasmodium species typing was determined by polymerase chain reaction amplification of the parasite's genome. RESULTS In newborns at term, low birth weight was directly associated with classes 2 and 4 of placental infection (P = 0.053 and P = 0.003, respectively), and differences in birth weight remained significant between the 5 classes (P < 0.001) even after adjusting for parity and mother's age. Plasmodium falciparum was the only detected parasite. CONCLUSIONS In Kisumu, infection with P. falciparum is an important cause of low birth weight and morbidity when it is associated with histologic classes 2 and 4 of placental infection. Moreover, polymerase chain reaction assays should be supported by ministries of health as an ancillary method of collecting data for malaria control during pregnancy and providing a baseline for future interventions.
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Affiliation(s)
- S N Kassam
- School of Biomedical Sciences, University of Bristol, Bristol, UK
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Owens S, Chamley LW, Ordi J, Brabin BJ, Johnson PM. The association of anti-phospholipid antibodies with parity in placental malaria. Clin Exp Immunol 2006; 142:512-8. [PMID: 16297164 PMCID: PMC1809541 DOI: 10.1111/j.1365-2249.2005.02936.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Anti-phospholipid antibodies (aPL) are autoantibodies associated with both infections and the pathogenesis of certain pregnancy complications. In the latter, but not the former, aPL are dependent on a co-factor, beta(2) glycoprotein I (beta2GPI), which can also be used as an antigen for detection of such aPL in pregnancy. A cross-sectional study was carried out on serum samples from Kumasi, Ghana, to determine the occurrence and beta2GPI-dependence of aPL in placental malaria. Anti-cardiolipin, anti-phosphatidylserine and anti-beta2GPI enzyme-linked immunosorbent assays (ELISAs) were performed on sera from 103 HIV-non-infected gravid women. Placental malaria, both active and past infection, was diagnosed in 33/103 (32%) based on placental histology. In multiparae, beta2GPI-independent IgM antibodies to cardiolipin (P = 0.018) and phosphatidylserine (P = 0.009) were observed, which were most pronounced in past placental malaria infection. In primiparae, no association emerged between aPL and placental malaria. Trends for improved clinical parameters were identified in infected women with levels of anti-cardiolipin beyond the 99th multiple of the median for a healthy, non-malarious population. This study in placental malaria reports parity associations of beta2GPI-independent aPL profiles, and does not support a role for beta2GPI-dependent aPL. It is of significance in the context of the known parity differences in pregnancy malaria immunity.
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Affiliation(s)
- S Owens
- MRC Laboratories, Atlantic Road, Fajara, The Gambia
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