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Jafari-Guemouri S, Courtois L, Mama A, Rouas B, Neto Braga G, Accrombessi M, Massougbodji A, Ding XC, Tuikue Ndam N, Fievet N, Briand V. A Genotyping Study in Benin Comparing the Carriage of Plasmodium falciparum Infections Before Pregnancy and in Early Pregnancy: Story of a Persistent Infection. Clin Infect Dis 2021; 73:e355-e361. [PMID: 32569359 PMCID: PMC8282262 DOI: 10.1093/cid/ciaa841] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background Malaria infections in the first trimester of pregnancy are frequent and deleterious for both mother and child health. To investigate if these early infections are newly acquired or already present in the host, we assessed whether parasites detected before pregnancy and those detected in early pregnancy are the same infection. Methods We used data from the preconceptional “RECIPAL” study (Benin, 2014–2017). Sixty-three pregnant women of 411 included who had a malaria infection detected by quantitative polymerase chain reaction both before pregnancy and at the first antenatal care (ANC) visit were selected for this study. Two highly polymorphic markers, msp-2 and glurp, and a fragment-analysis method were used to enumerate the Plasmodium falciparum genotypes and to quantify their proportions within isolates. An infection was considered as persistent when identical msp-2 and glurp genotypes were found in the corresponding prepregnancy and early-pregnancy samples. Results The median time between the 2 malaria screenings was 3 months. The median gestational age at the first ANC visit was 6.4 weeks. Most infections before pregnancy were submicroscopic infections. Based on both msp-2 and glurp genotyping, the infection was similar before and in early pregnancy in 46% (29/63) of cases. Conclusions Almost half of P. falciparum infections detected in the first trimester originate before pregnancy. Protecting young women from malaria infection before pregnancy might reduce the prevalence of malaria in early pregnancy and its related poor maternal and birth outcomes.
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Affiliation(s)
- Sayeh Jafari-Guemouri
- Université de Paris, UMR261-MERIT, Institut de Recherche pour le Développement, Paris, France
| | - Laura Courtois
- Université de Paris, UMR261-MERIT, Institut de Recherche pour le Développement, Paris, France
| | - Atika Mama
- Clinical Research Institute of Benin (IRCB), Abomey-Calavi, Benin
| | - Baptiste Rouas
- Université de Paris, UMR261-MERIT, Institut de Recherche pour le Développement, Paris, France
| | - Gabriel Neto Braga
- Université de Paris, UMR261-MERIT, Institut de Recherche pour le Développement, Paris, France
| | - Manfred Accrombessi
- Clinical Research Institute of Benin (IRCB), Abomey-Calavi, Benin.,Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Nicaise Tuikue Ndam
- Université de Paris, UMR261-MERIT, Institut de Recherche pour le Développement, Paris, France
| | - Nadine Fievet
- Université de Paris, UMR261-MERIT, Institut de Recherche pour le Développement, Paris, France
| | - Valérie Briand
- Université de Paris, UMR261-MERIT, Institut de Recherche pour le Développement, Paris, France.,University of Bordeaux, Inserm, Institut de Recherche pour le Développement, Inserm, University of Bordeaux, UMR, Bordeaux, France
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2
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Adamou R, Dechavanne C, Sadissou I, d'Almeida T, Bouraima A, Sonon P, Amoussa R, Cottrell G, Le Port A, Theisen M, Remarque EJ, Longacre S, Moutairou K, Massougbodji A, Luty AJF, Nuel G, Migot-Nabias F, Sanni A, Garcia A, Milet J, Courtin D. Plasmodium falciparum merozoite surface antigen-specific cytophilic IgG and control of malaria infection in a Beninese birth cohort. Malar J 2019; 18:194. [PMID: 31185998 PMCID: PMC6560827 DOI: 10.1186/s12936-019-2831-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/04/2019] [Indexed: 12/02/2022] Open
Abstract
Background Substantial evidence indicates that cytophilic IgG responses to Plasmodium falciparum merozoite antigens play a role in protection from malaria. The specific targets mediating immunity remain unclear. Evaluating antibody responses in infants naturally-exposed to malaria will allow to better understand the establishment of anti-malarial immunity and to contribute to a vaccine development by identifying the most appropriate merozoite candidate antigens. Methods The study was based on parasitological and clinical active follow-up of infants from birth to 18 months of age conducted in the Tori Bossito area of southern Benin. For 399 infants, plasma levels of cytophilic IgG antibodies with specificity for five asexual stage malaria vaccine candidate antigens were determined by ELISA in infants’ peripheral blood at 6, 9, 12 and 15 months of age. Multivariate mixed logistic model was used to investigate the association between antibody levels and anti-malarial protection in the trimester following the IgG quantification. Moreover, the concentrations of merozoite antigen-specific IgG were compared between a group of infants apparently able to control asymptomatic malaria infection (CAIG) and a group of infants with no control of malaria infection (Control group (NCIG)). Protective effect of antibodies was also assessed after 15 months of malaria exposure with a Cox regression model adjusted on environmental risk. Results Cytophilic IgG responses to AMA1, MSP1, MSP2-3D7, MSP2-FC27, MSP3 and GLURP R2 were associated with increasing malarial infection risk in univariate analysis. The multivariate mixed model showed that IgG1 and IgG3 to AMA1 were associated with an increased risk of malarial infection. However infants from CAIG (n = 53) had significantly higher AMA1-, MSP2-FC27-, MSP3-specific IgG1 and AMA1-, MSP1-, MSP2-FC27-, MSP3 and GLURP-R2-specific IgG3 than those from NCIG (n = 183). The latter IgG responses were not associated with protection against clinical malaria in the whole cohort when protective effect is assessed after 15 months of malaria exposition. Conclusion In this cohort, merozoite antigen-specific cytophilic IgG levels represent a marker of malaria exposure in infants from 6 to 18 months of age. However, infants with resolution of asymptomatic infection (CAIG) seem to have acquired naturally immunity against P. falciparum. This observation is encouraging in the context of the development of multitarget P. falciparum vaccines.
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Affiliation(s)
- Rafiou Adamou
- MERIT, IRD, Université de Paris, 75006, Paris, France. .,Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin. .,Laboratoire de Biochimie et de Biologie Moléculaire, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Abomey Calavi, Benin.
| | | | - Ibrahim Sadissou
- MERIT, IRD, Université de Paris, 75006, Paris, France.,Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin.,Laboratoire de Biologie et Physiologie Cellulaires, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Cotonou, Benin.,Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Aziz Bouraima
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - Paulin Sonon
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin.,Laboratoire de Biologie et Physiologie Cellulaires, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Cotonou, Benin.,Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Roukiyath Amoussa
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | | | - Agnès Le Port
- MERIT, IRD, Université de Paris, 75006, Paris, France
| | - Michael Theisen
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark.,Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Edmond J Remarque
- Department of Parasitology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Shirley Longacre
- Laboratoire de Vaccinologie-Parasitaire, Institut Pasteur, Paris, France
| | - Kabirou Moutairou
- Laboratoire de Biologie et Physiologie Cellulaires, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Cotonou, Benin
| | - Achille Massougbodji
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - Adrian J F Luty
- MERIT, IRD, Université de Paris, 75006, Paris, France.,Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - Gregory Nuel
- Laboratoire de Probabilités et Modèles aléatoires (LPMA), UMR CNRS 7599, UPMC, Paris, France
| | | | - Ambaliou Sanni
- Laboratoire de Biochimie et de Biologie Moléculaire, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Abomey Calavi, Benin
| | - André Garcia
- MERIT, IRD, Université de Paris, 75006, Paris, France.,Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | | | - David Courtin
- MERIT, IRD, Université de Paris, 75006, Paris, France
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Allain JP, Owusu-Ofori AK, Assennato SM, Marschner S, Goodrich RP, Owusu-Ofori S. Effect of Plasmodium inactivation in whole blood on the incidence of blood transfusion-transmitted malaria in endemic regions: the African Investigation of the Mirasol System (AIMS) randomised controlled trial. Lancet 2016; 387:1753-61. [PMID: 27116282 DOI: 10.1016/s0140-6736(16)00581-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transfusion-transmitted malaria is a frequent but neglected adverse event in Ghana. We did a randomised controlled clinical trial to assess the efficacy and safety of a whole blood pathogen reduction technology at preventing transfusion transmission of Plasmodium spp parasites. METHODS For this randomised, double-blind, parallel-group clinical trial, eligible adult patients (aged ≥ 18 years) with blood group O+, who required up to two whole blood unit transfusions within 3 days of randomisation and were anticipated to remain in hospital for at least 3 consecutive days after initial transfusion, were enrolled from Komfo Anokye Teaching Hospital in Kumasi, Ghana. The main exclusion criteria were symptoms of clinical malaria, antimalaria treatment within 7 days before randomisation, fever, and haemorrhage expected to require transfusion with up to two units of whole blood during the 3 days following study entry. Eligible patients were randomly assigned 1:1 by computer-generated permuted block randomisation (block size four) list to receive transfusion with either pathogen-reduced whole blood (treated) or whole blood prepared and transfused by standard local practice (untreated). Patients, health-care providers, and data collectors were masked to treatment allocation. Patients in both groups received up to two whole blood unit transfusions that were retrospectively tested for parasitaemia. Pre-transfusion and post-transfusion blood samples (taken on days 0, 1, 3, 7, and 28) were tested for presence and amount of parasite genome, and assessed for haematological and biochemical parameters. The primary endpoint was the incidence of transfusion-transmitted malaria in non-parasitaemic recipients exposed to parasitaemic whole blood, defined as two consecutive parasitaemic post-transfusion samples with parasite allelic matching, assessed at 1-7 days after transfusion. Secondary endpoints included haematological parameters and a safety analysis of adverse events in patients. This study is registered with ClinicalTrials.gov, number NCT02118428, and with the Pan African Clinical Trials Registry, number PACTR201406000777310. FINDINGS Between March 12, 2014, and Nov 7, 2014, 227 patients were enrolled into the study, one of whom was subsequently excluded because she did not meet the inclusion criteria. Of the 226 randomised patients, 113 were allocated to receive treated whole blood and 113 to receive standard untreated whole blood. 223 patients (111 treated and 112 untreated) received study-related transfusions, whereas three patients (two treated and one untreated) did not. 214 patients (107 treated and 107 untreated) completed the protocol as planned and comprised the per-protocol population. Overall, 65 non-parasitaemic patients (28 treated and 37 untreated) were exposed to parasitaemic blood. The incidence of transfusion-transmitted malaria was significantly lower for the pathogen-reduced (treated) patients (1 [4%] of 28 patients) than the untreated group (8 [22%] of 37 patients) in this population (p=0.039). Overall, 92 (41%) of 223 patients reported 145 treatment-related emergent adverse events during the conduct of the study, with a similar incidence of adverse events between groups receiving untreated or treated whole blood. No transfusion-related deaths occurred in the trial. INTERPRETATION Treatment of whole blood with the Mirasol pathogen reduction system for whole blood reduced the incidence of transfusion-transmitted malaria. The primary endpoint of the study was achieved in the population of non-parasitaemic patients receiving parasitaemic whole blood. The safety profile and clinical outcomes were similar across the two treatment groups. FUNDING Terumo BCT Inc.
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Affiliation(s)
| | - Alex K Owusu-Ofori
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Moya-Alvarez V, Abellana R, Cot M. Pregnancy-associated malaria and malaria in infants: an old problem with present consequences. Malar J 2014; 13:271. [PMID: 25015559 PMCID: PMC4113781 DOI: 10.1186/1475-2875-13-271] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 06/26/2014] [Indexed: 01/10/2023] Open
Abstract
Albeit pregnancy-associated malaria (PAM) poses a potential risk for over 125 million women each year, an accurate review assessing the impact on malaria in infants has yet to be conducted. In addition to an effect on low birth weight (LBW) and prematurity, PAM determines foetal exposure to Plasmodium falciparum in utero and is correlated to congenital malaria and early development of clinical episodes during infancy. This interaction plausibly results from an ongoing immune tolerance process to antigens in utero, however, a complete explanation of this immune process remains a question for further research, as does the precise role of protective maternal antibodies. Preventive interventions against PAM modify foetal exposure to P. falciparum in utero, and have thus an effect on perinatal malaria outcomes. Effective intermittent preventive treatment in pregnancy (IPTp) diminishes placental malaria (PM) and its subsequent malaria-associated morbidity. However, emerging resistance to sulphadoxine-pyrimethamine (SP) is currently hindering the efficacy of IPTp regimes and the efficacy of alternative strategies, such as intermittent screening and treatment (IST), has not been accurately evaluated in different transmission settings. Due to the increased risk of clinical malaria for offspring of malaria infected mothers, PAM preventive interventions should ideally start during the preconceptual period. Innovative research examining the effect of PAM on the neurocognitive development of the infant, as well as examining the potential influence of HLA-G polymorphisms on malaria symptoms, is urged to contribute to a better understanding of PAM and infant health.
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MESH Headings
- Adult
- Africa South of the Sahara/epidemiology
- Antimalarials/administration & dosage
- Antimalarials/therapeutic use
- Comorbidity
- Complement Activation
- Developmental Disabilities/etiology
- Developmental Disabilities/immunology
- Drug Combinations
- Drug Resistance
- Female
- Fetal Diseases/parasitology
- Fetal Diseases/prevention & control
- Fetal Growth Retardation/etiology
- Genetic Predisposition to Disease
- HIV Infections/epidemiology
- HLA-G Antigens/genetics
- HLA-G Antigens/immunology
- Humans
- Immune Tolerance
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/parasitology
- Infectious Disease Transmission, Vertical/prevention & control
- Malaria/congenital
- Malaria/drug therapy
- Malaria/embryology
- Malaria/epidemiology
- Malaria/immunology
- Malaria/prevention & control
- Malaria/transmission
- Malaria, Cerebral/complications
- Malaria, Cerebral/embryology
- Malaria, Cerebral/immunology
- Parasitemia/congenital
- Parasitemia/epidemiology
- Parasitemia/transmission
- Plasmodium falciparum/drug effects
- Plasmodium falciparum/genetics
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/immunology
- Pregnancy Complications, Infectious/parasitology
- Pyrimethamine/pharmacology
- Pyrimethamine/therapeutic use
- Risk Factors
- Stillbirth/epidemiology
- Sulfadoxine/pharmacology
- Sulfadoxine/therapeutic use
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Affiliation(s)
- Violeta Moya-Alvarez
- Institut de Recherche pour le Développement, UMR 216 Mère et enfant face aux infections tropicales, Faculté de Pharmacie Paris Descartes, 4 Avenue de l’Observatoire, 75270 Paris, France
- Université Pierre et Marie Curie (Paris 6), Centre Biomédical des Cordeliers, 15, rue de l’Ecole de Médecine, 75006 Paris, France
- Réseau doctoral de l’Ecole des Hautes Etudes en Santé Publique, Avenue du Professeur Léon-Bernard, CS 74312-35043 Rennes, France
| | - Rosa Abellana
- Departament de Salut Pública, Facultat de Medicina, Casanova 143, 08036 Barcelona, Spain
| | - Michel Cot
- Institut de Recherche pour le Développement, UMR 216 Mère et enfant face aux infections tropicales, Faculté de Pharmacie Paris Descartes, 4 Avenue de l’Observatoire, 75270 Paris, France
- Université Pierre et Marie Curie (Paris 6), Centre Biomédical des Cordeliers, 15, rue de l’Ecole de Médecine, 75006 Paris, France
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