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Natama HM, Moncunill G, Vidal M, Rouamba T, Aguilar R, Santano R, Rovira-Vallbona E, Jiménez A, Somé MA, Sorgho H, Valéa I, Coulibaly-Traoré M, Coppel RL, Cavanagh D, Chitnis CE, Beeson JG, Angov E, Dutta S, Gamain B, Izquierdo L, Mens PF, Schallig HDFH, Tinto H, Rosanas-Urgell A, Dobaño C. Associations between prenatal malaria exposure, maternal antibodies at birth, and malaria susceptibility during the first year of life in Burkina Faso. Infect Immun 2023; 91:e0026823. [PMID: 37754682 PMCID: PMC10580994 DOI: 10.1128/iai.00268-23] [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] [Received: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 09/28/2023] Open
Abstract
In this study, we investigated how different categories of prenatal malaria exposure (PME) influence levels of maternal antibodies in cord blood samples and the subsequent risk of malaria in early childhood in a birth cohort study (N = 661) nested within the COSMIC clinical trial (NCT01941264) in Burkina Faso. Plasmodium falciparum infections during pregnancy and infants' clinical malaria episodes detected during the first year of life were recorded. The levels of maternal IgG and IgG1-4 to 15 P. falciparum antigens were measured in cord blood by quantitative suspension array technology. Results showed a significant variation in the magnitude of maternal antibody levels in cord blood, depending on the PME category, with past placental malaria (PM) more frequently associated with significant increases of IgG and/or subclass levels across three groups of antigens defined as pre-erythrocytic, erythrocytic, and markers of PM, as compared to those from the cord of non-exposed control infants. High levels of antibodies to certain erythrocytic antigens (i.e., IgG to EBA140 and EBA175, IgG1 to EBA175 and MSP142, and IgG3 to EBA140 and MSP5) were independent predictors of protection from clinical malaria during the first year of life. By contrast, high levels of IgG, IgG1, and IgG2 to the VAR2CSA DBL1-2 and IgG4 to DBL3-4 were significantly associated with an increased risk of clinical malaria. These findings indicate that PME categories have different effects on the levels of maternal-derived antibodies to malaria antigens in children at birth, and this might drive heterogeneity to clinical malaria susceptibility in early childhood.
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Affiliation(s)
- Hamtandi Magloire Natama
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Gemma Moncunill
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Marta Vidal
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Toussaint Rouamba
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Ruth Aguilar
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Rebeca Santano
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Eduard Rovira-Vallbona
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
| | - Alfons Jiménez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - M. Athanase Somé
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Hermann Sorgho
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Innocent Valéa
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Maminata Coulibaly-Traoré
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Ross L. Coppel
- Infection and Immunity Program, Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - David Cavanagh
- Centre for Immunity, Infection & Evolution, Institute of Immunology & Infection Research, Ashworth Laboratories, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Chetan E. Chitnis
- Malaria Parasite Biology and Vaccines Unit, Department of Parasites and Insect Vectors, Institut Pasteur, Université de Paris, Paris, France
| | | | - Evelina Angov
- U.S. Military Malaria Vaccine Program, Walter Reed Army Institute of Research (WRAIR), Silver Spring, Maryland, USA
| | - Sheetij Dutta
- U.S. Military Malaria Vaccine Program, Walter Reed Army Institute of Research (WRAIR), Silver Spring, Maryland, USA
| | | | - Luis Izquierdo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Petra F. Mens
- Academic Medical Centre at the University of Amsterdam, Amsterdam, the Netherlands
| | | | - Halidou Tinto
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Carlota Dobaño
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
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Asante KP, Wylie BJ, Oppong FB, Quinn A, Gyaase S, Lee AG, Ae-Ngibise KA, Burkart K, Boamah-Kaali EA, Kaali S, Chillrud S, Kinney PL, Owusu-Agyei S, Jack D. Association between malaria and household air pollution interventions in a predominantly rural area of Ghana. Malar J 2023; 22:106. [PMID: 36959655 PMCID: PMC10037900 DOI: 10.1186/s12936-022-04431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/24/2022] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Though anecdotal evidence suggests that smoke from HAP has a repellent effect on mosquitoes, very little work has been done to assess the effect of biomass smoke on malaria infection. The study, therefore, sought to investigate the hypothesis that interventions to reduce household biomass smoke may have an unintended consequence of increasing placental malaria or increase malaria infection in the first year of life. METHODS This provides evidence from a randomized controlled trial among 1414 maternal-infant pairs in the Kintampo North and Kintampo South administrative areas of Ghana. Logistic regression was used to assess the association between study intervention assignment (LPG, Biolite or control) and placental malaria. Finally, an extended Cox model was used to assess the association between study interventions and all episodes of malaria parasitaemia in the first year of infant's life. RESULTS The prevalence of placental malaria was 24.6%. Out of this, 20.8% were acute infections, 18.7% chronic infections and 60.5% past infections. The study found no statistical significant association between the study interventions and all types of placental malaria (OR = 0.88; 95% CI 0.59-1.30). Of the 1165 infants, 44.6% experienced at least one episode of malaria parasitaemia in the first year of life. The incidence of first and/or only episode of malaria parasitaemia was however found to be similar among the study arms. CONCLUSION The findings suggest that cookstove interventions for pregnant women and infants, when combined with additional malaria prevention strategies, do not lead to an increased risk of malaria among pregnant women and infants.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana.
| | - Blair J Wylie
- Department of Obstetrics and Gynecology PH Building, Columbia University Medical Center, 16th Floor 622 West 168th Street, New York, NY, 10032, USA
| | - Felix B Oppong
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Ashlinn Quinn
- Berkeley Air Monitoring Group, 1935 Addison St., Suite A, Berkeley, CA, 94704, USA
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Ayuurebobi Ae-Ngibise
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Katrin Burkart
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Seattle, WA, 98121, USA
| | - Ellen Abrafi Boamah-Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Seyram Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Steven Chillrud
- Lamont-Doherty Earth Observatory at Columbia University, Palisades, NY, USA
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Seth Owusu-Agyei
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, 722 W 168th Street, New York, NY, 10032, USA
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Dechavanne C, Nouatin O, Adamou R, Edslev S, Hansen A, Meurisse F, Sadissou I, Gbaguidi E, Milet J, Cottrell G, Gineau L, Sabbagh A, Massougbodji A, Moutairou K, Donadi EA, Carosella ED, Moreau P, Remarque E, Theisen M, Rouas-Freiss N, Garcia A, Favier B, Courtin D. Placental Malaria is Associated with Higher LILRB2 Expression in Monocyte Subsets and Lower Anti-Malarial IgG Antibodies During Infancy. Front Immunol 2022; 13:909831. [PMID: 35911674 PMCID: PMC9326509 DOI: 10.3389/fimmu.2022.909831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Placental malaria (PM) is associated with a higher susceptibility of infants to Plasmodium falciparum (Pf) malaria. A hypothesis of immune tolerance has been suggested but no clear explanation has been provided so far. Our goal was to investigate the involvement of inhibitory receptors LILRB1 and LILRB2, known to drive immune evasion upon ligation with pathogen and/or host ligands, in PM-induced immune tolerance. Method Infants of women with or without PM were enrolled in Allada, southern Benin, and followed-up for 24 months. Antibodies with specificity for five blood stage parasite antigens were quantified by ELISA, and the frequency of immune cell subsets was quantified by flow cytometry. LILRB1 or LILRB2 expression was assessed on cells collected at 18 and 24 months of age. Findings Infants born to women with PM had a higher risk of developing symptomatic malaria than those born to women without PM (IRR=1.53, p=0.040), and such infants displayed a lower frequency of non-classical monocytes (OR=0.74, p=0.01) that overexpressed LILRB2 (OR=1.36, p=0.002). Moreover, infants born to women with PM had lower levels of cytophilic IgG and higher levels of IL-10 during active infection. Interpretation Modulation of IgG and IL-10 levels could impair monocyte functions (opsonisation/phagocytosis) in infants born to women with PM, possibly contributing to their higher susceptibility to malaria. The long-lasting effect of PM on infants’ monocytes was notable, raising questions about the capacity of ligands such as Rifins or HLA-I molecules to bind to LILRB1 and LILRB2 and to modulate immune responses, and about the reprogramming of neonatal monocytes/macrophages.
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Affiliation(s)
- Celia Dechavanne
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Odilon Nouatin
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Rafiou Adamou
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Sofie Edslev
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Anita Hansen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Florian Meurisse
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Université Paris-Saclay, Inserm, CEA, Fontenay-aux-Roses, France
| | - Ibrahim Sadissou
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Erasme Gbaguidi
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Jacqueline Milet
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Gilles Cottrell
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Laure Gineau
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Audrey Sabbagh
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Achille Massougbodji
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Kabirou Moutairou
- Laboratoire de Biologie et Physiologie Cellulaires, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Benin
| | - Eduardo A. Donadi
- Laboratory of Clinical Immunology, Ribeirão Preto Medicine School, University of São Paulo, Ribeirão Preto, Brazil
| | - Edgardo D. Carosella
- CEAA, DRF-Institut François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, Paris, France
- U976 HIPI Unit, IRSL, Université Paris, Paris, France
| | - Philippe Moreau
- CEAA, DRF-Institut François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, Paris, France
- U976 HIPI Unit, IRSL, Université Paris, Paris, France
| | - Ed Remarque
- Department of Parasitology, Biomedical Primate Research Centre, Rijswijk, Netherlands
| | - Michael Theisen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Nathalie Rouas-Freiss
- CEAA, DRF-Institut François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, Paris, France
- U976 HIPI Unit, IRSL, Université Paris, Paris, France
| | - André Garcia
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Benoit Favier
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Université Paris-Saclay, Inserm, CEA, Fontenay-aux-Roses, France
| | - David Courtin
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
- *Correspondence: David Courtin,
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Poespoprodjo JR, Hafiidhaturrahmah, Sariyanti N, Indrawanti R, McLean ARD, Simpson JA, Kenangalem E, Burdam FH, Noviyanti R, Trianty L, Fadhilah C, Soenarto Y, Price RN. Intermittent screening and treatment for malaria complementary to routine immunisation in the first year of life in Papua, Indonesia: a cluster randomised superiority trial. BMC Med 2022; 20:190. [PMID: 35672703 PMCID: PMC9175359 DOI: 10.1186/s12916-022-02394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/04/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In Papua (Indonesia), infants with P. falciparum and/or P. vivax malaria are at risk of severe anaemia and death. We hypothesized that in an area of high malaria transmission, intermittent screening and treatment of infants with malaria (ISTi) will reduce morbidity compared to passive case detection (PCDi). METHODS We conducted a cluster randomised, open label, superiority trial. A total of 21 clusters of village health posts (VHP) were randomised 1:1 to either IST for infants coinciding with 4 routine immunisation visits or PCDi. Healthy term infants born to consenting mothers enrolled into a maternal malaria cluster randomised trial were included in the study and followed for 12 months. Point of care malaria rapid diagnostic tests were used to detect peripheral parasitaemia at 2, 3, 4 and 9 months old in all infants in ISTi clusters and when symptomatic in PCDi clusters. Infants with detected peripheral parasitaemia were treated with dihydroartemisinin-piperaquine. The co-primary outcomes were the incidence rate of clinical malaria in the first year of life and the prevalence of parasitaemia at age 12 months. The incidence rate ratio and prevalence ratio between ISTi and PCDi were estimated using mixed-effects Poisson and log-binomial regression modelling (accounting for clustering at VHP level). RESULTS Between May 2014 and February 2017, 757 infants were enrolled into the study, 313 into 10 ISTi clusters, and 444 into 11 PCDi clusters. Overall, 132 episodes of parasitaemia were detected, of whom 17 (12.9%) were in symptomatic infants. Over 12 months, the incidence rate (IR) of clinical malaria was 24 [95% CI, 10-50] per 1000 children-years at risk in the ISTi arm and 19 [95% CI, 8,38] per 1000 children-years in the PCDi arm (adjusted incidence rate ratio [aIRR] 1.77 [95% CI, 0.62-5.01]; p = 0.280). The prevalence of parasitaemia at 12 months was 13% (33/254) in the IST clusters and 15% (57/379) in the PCD clusters (adjusted prevalence ratio (aPR) = 0.92 (95% CI, 0.70-1.21), p = 0.55). There was no difference in the risk of anaemia between treatment arms. CONCLUSIONS In high malaria transmission area outside of Africa, our study suggests that compared to PCDi, ISTi offers no significant benefit in reducing the risk of clinical malaria in infants born to women receiving effective protection from malaria during pregnancy. TRIAL REGISTRATION ClinicalTrials.gov NCT02001428 , registered on 20 Nov 2013.
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Affiliation(s)
- Jeanne Rini Poespoprodjo
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Kesehatan no.1, Sekip, Yogyakarta, 55284, Indonesia. .,Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Jl. SP2-SP5, RSMM Area, Timika, Papua, 99910, Indonesia. .,Mimika District Hospital and District Health Authority, Jl. Yos Sudarso, Timika, Papua, 99910, Indonesia.
| | - Hafiidhaturrahmah
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Jl. SP2-SP5, RSMM Area, Timika, Papua, 99910, Indonesia
| | - Novita Sariyanti
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Jl. SP2-SP5, RSMM Area, Timika, Papua, 99910, Indonesia
| | - Ratni Indrawanti
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Kesehatan no.1, Sekip, Yogyakarta, 55284, Indonesia
| | - Alistair R D McLean
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, VIC, 3010, Melbourne, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, VIC, 3010, Melbourne, Australia
| | - Enny Kenangalem
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Jl. SP2-SP5, RSMM Area, Timika, Papua, 99910, Indonesia
| | - Faustina Helena Burdam
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Jl. SP2-SP5, RSMM Area, Timika, Papua, 99910, Indonesia.,Mimika District Hospital and District Health Authority, Jl. Yos Sudarso, Timika, Papua, 99910, Indonesia
| | - Rintis Noviyanti
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No.69, Jakarta, 10430, Indonesia
| | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No.69, Jakarta, 10430, Indonesia
| | - Chairunisa Fadhilah
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No.69, Jakarta, 10430, Indonesia
| | - Yati Soenarto
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Kesehatan no.1, Sekip, Yogyakarta, 55284, Indonesia
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX37LJ, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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5
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Agonhossou R, Akoton R, Dossou YA, Avokpaho E, Mbama DNJ, Boussougou-Sambe TS, Francis NN, Ndo C, Ntoumi F, Wondji CS, Adegnika AA, Borrmann S, Issifou S, Djogbénou LS. Surveillance of Plasmodium malariae infection among inhabitants of rural areas in Ouidah-Kpomasse-Tori Bossito health district, Benin. Parasitol Res 2022; 121:275-286. [PMID: 34981216 DOI: 10.1007/s00436-021-07398-z] [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] [Received: 09/07/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
Among the Plasmodium species that infect humans, P. falciparum has been largely studied in malaria endemic areas. However, P. malariae infection is less documented among the human population. This study aimed to monitor the prevalence and distribution of P. malariae in Southern Benin. A cross-sectional survey was conducted in rural localities in the Ouidah-Kpomasse-Tori Bossito (OKT) health district in Southern Benin from June to October 2019. Socio-demographic data were collected using a questionnaire, while malaria infection data were obtained on the one hand by microscopy diagnosis and, on the other, by nested polymerase chain reaction (PCR). Based on microscopy, the prevalence of P. malariae mono-infection and coinfection of P. falciparum, P. malariae was respectively 2.3% and 1.2% in the OKT health district. This prevalence was higher (P < 0.01) than that reported by Damien et al. (2010) 10 years ago in the same study area with 0.7% and 0.3% of P. malariae and P. falciparum/P. malariae, respectively. Based on PCR analysis, P. malariae prevalence was 14.1%, including 5.2% of mono-infection and 8.9% of mixed infection with P. falciparum. Sub-microscopic Plasmodium infections were high (30.6%) and more pronounced in older participants (>20 years). The present study revealed that P. malariae increased in the OKT health district with a high prevalence of submicroscopic infection. Since our results provide valuable evidence of increasing P. malariae infection, the National Malaria Control Programs (NMCPs) must consider P. malariae when designing future measures for effective control and malaria treatment.
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Affiliation(s)
- Romuald Agonhossou
- Tropical Infectious Diseases Research Centre (TIDRC), University of Abomey-Calavi, 01BP 526, Cotonou, Benin
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
| | - Romaric Akoton
- Tropical Infectious Diseases Research Centre (TIDRC), University of Abomey-Calavi, 01BP 526, Cotonou, Benin.
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin.
| | - Yannelle A Dossou
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
| | - Euripide Avokpaho
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
| | - Dollon N J Mbama
- Fondation Congolaise pour la Recherche Medicale (FCRM), Brazzaville, Congo
- Université Marien Ngouabi, Brazzaville, Congo
| | - Terence S Boussougou-Sambe
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Nongley N Francis
- Department of Parasitology and Medical Entomology, Centre for Research in Infectious Diseases (CRID), Centre Region, Yaounde, 237, Cameroon
- Department of Microbiology and Parasitology, University of Buea, South West, Buea, 237, Cameroon
| | - Cyrille Ndo
- Department of Parasitology and Medical Entomology, Centre for Research in Infectious Diseases (CRID), Centre Region, Yaounde, 237, Cameroon
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Medicale (FCRM), Brazzaville, Congo
- Université Marien Ngouabi, Brazzaville, Congo
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Charles S Wondji
- Department of Parasitology and Medical Entomology, Centre for Research in Infectious Diseases (CRID), Centre Region, Yaounde, 237, Cameroon
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Ayola A Adegnika
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
- Eberhard Karls Universität Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Steffen Borrmann
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Saadou Issifou
- Fondation Pour la Recherche Scientifique (FORS), ISBA, BP : 88, Cotonou, Bénin
| | - Luc S Djogbénou
- Tropical Infectious Diseases Research Centre (TIDRC), University of Abomey-Calavi, 01BP 526, Cotonou, Benin
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Botwe AK, Oppong FB, Gyaase S, Owusu-Agyei S, Asghar M, Asante KP, Färnert A, Osier F. Determinants of the varied profiles of Plasmodium falciparum infections among infants living in Kintampo, Ghana. Malar J 2021; 20:240. [PMID: 34051822 PMCID: PMC8164218 DOI: 10.1186/s12936-021-03752-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background Understanding why some infants tolerate infections, remaining asymptomatic while others succumb to repeated symptomatic malaria is beneficial for studies of naturally acquired immunity and can guide control interventions. This study compared demographic, host and maternal factors associated with being either parasite negative or having asymptomatic infections versus developing symptomatic malaria in the first year of life. Methods A birth cohort (n = 1264) was monitored longitudinally over two years for malaria infections in Kintampo, Ghana. Symptomatic and asymptomatic infections were detected actively through monthly home visits, complemented by passive case detection. Light microscopy was used to detect parasitaemia. Based on data from a minimum of eight monthly visits within the first year of life, infants were classified into one of four groups: “parasite negative”, “only-asymptomatic”, “only-symptomatic” or “alternating” i.e., sometimes symptomatic and other times asymptomatic. The host and maternal characteristics and demographic factors in relation to these four groups were compared. Results The parasite negative group formed 36% of the cohort, whilst the only-symptomatic were 35%. The alternating group were 22% and the only-asymptomatic were 7% of the cohort. There were significant associations between residence, socio-economic status (SES), parity, IPTp doses, delivery place of infant and having or not having malaria parasites. Maternal factors such as early commencement and frequency of ante-natal care (ANC) were significantly higher in the parasite negative group compared to all others. ITN use in pregnancy increased the odds of infant having only asymptomatic infections (“protected against disease”). Placental malaria was more common in the groups of infants with symptomatic malaria. Urban residence was significantly higher in the parasite negative group, while birth in the malaria transmission season were significantly more common in the alternating and parasite negative groups. Risk factors for infants with symptomatic malaria included low SES, birth in private maternity homes, sickle cell normal variant, lower MUAC, reported intake of anti-malarials and increased morbidity before the first microscopic infection was detected. Conclusion Strengthening ANC by encouraging early and regular attendance, the use of IPTp, maternal bed nets and improving the nourishment of infants help reduce the frequency of symptomatic malaria over the first year of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03752-9.
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Affiliation(s)
- Akua Kyerewaa Botwe
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana. .,Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. .,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
| | | | - Stephaney Gyaase
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.,Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Muhammad Asghar
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Anna Färnert
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Faith Osier
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Infectious Diseases, Parasitology, Heidelberg University Hospital, Heidelberg, Germany
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7
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Kakuru A, Roh ME, Kajubi R, Ochieng T, Ategeka J, Ochokoru H, Nakalembe M, Clark TD, Ruel T, Staedke SG, Chandramohan D, Havlir DV, Kamya MR, Dorsey G, Jagannathan P. Infant sex modifies associations between placental malaria and risk of malaria in infancy. Malar J 2020; 19:449. [PMID: 33272281 PMCID: PMC7713316 DOI: 10.1186/s12936-020-03522-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/25/2020] [Indexed: 01/22/2023] Open
Abstract
Background Placental malaria (PM) has been associated with a higher risk of malaria during infancy. However, it is unclear whether this association is causal, and is modified by infant sex, and whether intermittent preventive treatment in pregnancy (IPTp) can reduce infant malaria by preventing PM. Methods Data from a birth cohort of 656 infants born to HIV-uninfected mothers randomised to IPTp with dihydroartemisinin–piperaquine (DP) or Sulfadoxine–pyrimethamine (SP) was analysed. PM was categorized as no PM, active PM (presence of parasites), mild-moderate past PM (> 0–20% high powered fields [HPFs] with pigment), or severe past PM (> 20% HPFs with pigment). The association between PM and incidence of malaria in infants stratified by infant sex was examined. Causal mediation analysis was used to test whether IPTp can impact infant malaria incidence via preventing PM. Results There were 1088 malaria episodes diagnosed among infants during 596.6 person years of follow-up. Compared to infants born to mothers with no PM, the incidence of malaria was higher among infants born to mothers with active PM (adjusted incidence rate ratio [aIRR] 1.30, 95% CI 1.00–1.71, p = 0.05) and those born to mothers with severe past PM (aIRR 1.28, 95% CI 0.89–1.83, p = 0.18), but the differences were not statistically significant. However, when stratifying by infant sex, compared to no PM, severe past PM was associated a higher malaria incidence in male (aIRR 2.17, 95% CI 1.45–3.25, p < 0.001), but not female infants (aIRR 0.74, 95% CI 0.46–1.20, p = 0.22). There were no significant associations between active PM or mild-moderate past PM and malaria incidence in male or female infants. Male infants born to mothers given IPTp with DP had significantly less malaria in infancy than males born to mothers given SP, and 89.7% of this effect was mediated through prevention of PM. Conclusion PM may have more severe consequences for male infants, and interventions which reduce PM could mitigate these sex-specific adverse outcomes. More research is needed to better understand this sex-bias between PM and infant malaria risk. Trial registration ClinicalTrials.gov, NCT02793622. Registered 8 June 2016, https://clinicaltrials.gov/ct2/show/NCT02793622
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Affiliation(s)
- Abel Kakuru
- London School of Hygiene and Tropical Medicine, London, UK. .,Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda.
| | - Michelle E Roh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Teddy Ochieng
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - John Ategeka
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Harriet Ochokoru
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Miriam Nakalembe
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Tamara D Clark
- Department of Medicine, University of California, San Francisco, USA
| | - Theodore Ruel
- Department of Pediatrics, University of California, San Francisco, USA
| | | | | | - Diane V Havlir
- Department of Medicine, University of California, San Francisco, USA
| | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
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8
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Gies S, Roberts SA, Diallo S, Lompo OM, Tinto H, Brabin BJ. Risk of malaria in young children after periconceptional iron supplementation. MATERNAL AND CHILD NUTRITION 2020; 17:e13106. [PMID: 33236840 PMCID: PMC7988873 DOI: 10.1111/mcn.13106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 01/13/2023]
Abstract
This study in Burkina Faso investigated whether offspring of young mothers who had received weekly periconceptional iron supplementation in a randomised controlled trial were at increased risk of malaria. A child safety survey was undertaken in the peak month of malaria transmission towards the end of the trial to assess child iron biomarkers, nutritional status, anaemia and malaria outcomes. Antenatal iron biomarkers, preterm birth, fetal growth restriction and placental pathology for malaria and chorioamnionitis were assessed. Data were available for 180 babies surviving to the time of the survey when their median age was 9 months. Prevalence of maternal iron deficiency in the last trimester based on low body iron stores was 16%. Prevalence of active placental malaria infection was 24.8%, past infection 59% and chorioamnionitis 55.6%. Babies of iron supplemented women had lower median gestational age. Four out of five children ≥ 6 months were iron deficient, and 98% were anaemic. At 4 months malaria prevalence was 45%. Child iron biomarkers, anaemia and malaria outcomes did not differ by trial arm. Factors associated with childhood parasitaemia were third trimester C-reactive protein level (OR 2.1; 95% CI 1.1-3.9), active placental malaria (OR 5.8; 1.0-32.5, P = 0.042) and child body iron stores (OR 1.13; 1.04-1.23, P = 0.002). Chorioamnionitis was associated with reduced risk of child parasitaemia (OR 0.4; 0.1-1.0, P = 0.038). Periconceptional iron supplementation of young women did not alter body iron stores of their children. Higher child body iron stores and placental malaria increased risk of childhood parasitaemia.
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Affiliation(s)
- Sabine Gies
- Department of Biomedical Sciences, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.,Medical Mission Institute, Wurzburg, Germany
| | - Stephen A Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Salou Diallo
- Institute for Research in Health Sciences-Clinical Research Unit of Nanoro (IRSS-URCN), Ouagadougou, Burkina Faso
| | - Olga M Lompo
- Service d'Anatomocytopathologie et de Médicine Légale, Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Halidou Tinto
- Institute for Research in Health Sciences-Clinical Research Unit of Nanoro (IRSS-URCN), Ouagadougou, Burkina Faso
| | - Bernard J Brabin
- Clinical Division, Liverpool School of Tropical Medicine, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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9
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Profiles of Plasmodium falciparum infections detected by microscopy through the first year of life in Kintampo a high transmission area of Ghana. PLoS One 2020; 15:e0240814. [PMID: 33075074 PMCID: PMC7571695 DOI: 10.1371/journal.pone.0240814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 10/02/2020] [Indexed: 11/24/2022] Open
Abstract
Although malaria mortality among children under five years of age is high, the characteristics of their infection patterns are not well described. The aim of this study was to examine the longitudinal sequence pattern of Plasmodium falciparum infections in the first year of life within a birth cohort in Kintampo, Ghana (N = 1855). Infants were monitored at home with monthly sampling and also at the clinic for any febrile illness between 2008 and 2011. Light microscopy was performed on monthly scheduled visits and febrile ill visits over twelve months of follow-ups (n = 19231). Microscopy-positive visits accompanied with or without symptoms were rare during the first five months of life but were common from six to twelve months of age. Among 1264 infants with microscopy data over a minimum of eight monthly visits and also throughout in sick visits, some were microscopy negative (36%), and others positive: only-symptomatic (35%), alternating (22%) and only-asymptomatic (7%). The median age of microscopic infection was seven months for the alternating group and eight months for both the only-symptomatic and only-asymptomatic groups. The alternating group had the highest cumulative incidence of microscopic infections, the lowest age at first infection and 87 different infection patterns. Parasite densities detected by microscopy were significantly higher for symptomatic versus asymptomatic infection. We conclude that infants in malaria endemic areas experience diverse infection profiles throughout their first year of life. Further investigations should include submicroscopic reservoir and may shed more light on the factors that determine susceptibility to malaria during infancy.
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10
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Saito M, Briand V, Min AM, McGready R. Deleterious effects of malaria in pregnancy on the developing fetus: a review on prevention and treatment with antimalarial drugs. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:761-774. [PMID: 32946830 DOI: 10.1016/s2352-4642(20)30099-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/09/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022]
Abstract
All malaria infections are harmful to both the pregnant mother and the developing fetus. One in ten maternal deaths in malaria endemic countries are estimated to result from Plasmodium falciparum infection. Malaria is associated with a 3-4 times increased risk of miscarriage and a substantially increased risk of stillbirth. Current treatment and prevention strategies reduce, but do not eliminate, malaria's damaging effects on pregnancy outcomes. Reviewing evidence generated from meta-analyses, systematic reviews, and observational data, the first paper in this Series aims to summarise the adverse effects of malaria in pregnancy on the fetus and how the current drug treatment and prevention strategies can alleviate these effects. Although evidence supports the safety and treatment efficacy of artemisinin-based combination therapies in the first trimester, these therapies have not been recommended by WHO for the treatment of malaria at this stage of pregnancy. Intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine is contraindicated in the first trimester and provides imperfect chemoprevention because of inadequate dosing, poor (few and late) antenatal clinic attendance, increasing antimalarial drug resistance, and decreasing naturally acquired maternal immunity due to the decreased incidence of malaria. Alternative strategies to prevent malaria in pregnancy are needed. The prevention of all malaria infections by providing sustained exposure to effective concentrations of antimalarial drugs is key to reducing the adverse effects of malaria in pregnancy.
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Affiliation(s)
- Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Valérie Briand
- Infectious Diseases in Lower Income Countries, Research Institute for Sustainable Development, French National Institute of Health and Medical Research, University of Bordeaux, Bordeaux, France
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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11
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Kakuru A, Jagannathan P, Kajubi R, Ochieng T, Ochokoru H, Nakalembe M, Clark TD, Ruel T, Staedke SG, Chandramohan D, Havlir DV, Kamya MR, Dorsey G. Impact of intermittent preventive treatment of malaria in pregnancy with dihydroartemisinin-piperaquine versus sulfadoxine-pyrimethamine on the incidence of malaria in infancy: a randomized controlled trial. BMC Med 2020; 18:207. [PMID: 32772921 PMCID: PMC7416391 DOI: 10.1186/s12916-020-01675-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment of malaria during pregnancy (IPTp) with dihydroartemisinin-piperaquine (DP) significantly reduces the burden of malaria during pregnancy compared to sulfadoxine-pyrimethamine (SP), the current standard of care, but its impact on the incidence of malaria during infancy is unknown. METHODS We conducted a double-blind randomized trial to compare the incidence of malaria during infancy among infants born to HIV-uninfected pregnant women who were randomized to monthly IPTp with either DP or SP. Infants were followed for all their medical care in a dedicated study clinic, and routine assessments were conducted every 4 weeks. At all visits, infants with fever and a positive thick blood smear were diagnosed and treated for malaria. The primary outcome was malaria incidence during the first 12 months of life. All analyses were done by modified intention to treat. RESULTS Of the 782 women enrolled, 687 were followed through delivery from December 9, 2016, to December 5, 2017, resulting in 678 live births: 339 born to mothers randomized to SP and 339 born to those randomized to DP. Of these, 581 infants (85.7%) were followed up to 12 months of age. Overall, the incidence of malaria was lower among infants born to mothers randomized to DP compared to SP, but the difference was not statistically significant (1.71 vs 1.98 episodes per person-year, incidence rate ratio (IRR) 0.87, 95% confidence interval (CI) 0.73-1.03, p = 0.11). Stratifying by infant sex, IPTp with DP was associated with a lower incidence of malaria among male infants (IRR 0.75, 95% CI 0.58-0.98, p = 0.03) but not female infants (IRR 0.99, 95% CI 0.79-1.24, p = 0.93). CONCLUSION Despite the superiority of DP for IPTp, there was no evidence of a difference in malaria incidence during infancy in infants born to mothers who received DP compared to those born to mothers who received SP. Only male infants appeared to benefit from IPTp-DP suggesting that IPTp-DP may provide additional benefits beyond birth. Further research is needed to further explore the benefits of DP versus SP for IPTp on the health outcomes of infants. TRIAL REGISTRATION ClinicalTrials.gov, NCT02793622 . Registered on June 8, 2016.
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Affiliation(s)
- Abel Kakuru
- London School of Hygiene and Tropical Medicine, London, UK. .,Infectious Diseases Research Collaboration, Kampala, Uganda.
| | | | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Teddy Ochieng
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Miriam Nakalembe
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Tamara D Clark
- Department of Medicine, University of California, San Francisco, USA
| | - Theodore Ruel
- Department of Paediatrics, University of California, San Francisco, USA
| | | | | | - Diane V Havlir
- Department of Medicine, University of California, San Francisco, USA
| | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
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12
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Park S, Nixon CE, Miller O, Choi NK, Kurtis JD, Friedman JF, Michelow IC. Impact of Malaria in Pregnancy on Risk of Malaria in Young Children: Systematic Review and Meta-Analyses. J Infect Dis 2020; 222:538-550. [PMID: 32219317 PMCID: PMC7377293 DOI: 10.1093/infdis/jiaa139] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Our objective was to quantify the risk of acquiring malaria among progeny of women with malaria during pregnancy. METHODS We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for eligible prospective studies. The primary predictor was malaria during pregnancy defined as placental malaria, parasitemia, clinical malaria, or pregnancy-associated malaria. Primary outcomes were parasitemia or clinically defined malaria of young children. We performed meta-analyses to pool adjusted risk estimates using a random-effects model. RESULTS Nineteen of 2053 eligible studies met inclusion criteria for the systemic review. Eleven of these studies were quantitative and were included in the meta-analyses. The pooled adjusted odds ratio (aOR) or adjusted hazard ratio (aHR) of malaria during pregnancy for detection of parasitemia in young children were 1.94 (95% confidence interval [CI], 0.93-4.07; P = .08) and 1.46 (95% CI, 1.07-2.00; P < .001), respectively. The pooled aOR or aHR for clinically defined malaria in young children were 2.82 (95% CI, 1.82-4.38; P < .001) and 1.31 (95% CI, 0.96-1.79; P = .09), respectively. CONCLUSIONS Our results confirmed that malaria during pregnancy significantly increased the overall risk of malaria in young children via indeterminate mechanisms and emphasize the urgent need to implement safe and highly effective strategies to prevent malaria during pregnancy.
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Affiliation(s)
- Sangshin Park
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea
| | - Christina E Nixon
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Olivia Miller
- Department of Global Health, DePauw University, Greencastle, Indiana, USA
| | - Nam-Kyong Choi
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Jonathan D Kurtis
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ian C Michelow
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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13
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Jensen KJ, Biering-Sørensen S, Ursing J, Kofoed PEL, Aaby P, Benn CS. Seasonal variation in the non-specific effects of BCG vaccination on neonatal mortality: three randomised controlled trials in Guinea-Bissau. BMJ Glob Health 2020; 5:e001873. [PMID: 32201619 PMCID: PMC7059430 DOI: 10.1136/bmjgh-2019-001873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 11/23/2022] Open
Abstract
The BCG vaccine protects non-specifically against other diseases than tuberculosis. Three randomised controlled trials of early BCG in Guinea-Bissau found a 38% reduction in all-cause neonatal mortality. Little is known about the underlying mechanisms. In Guinea-Bissau, prevalent infectious diseases display distinct seasonality. Revisiting the three trials (>6500 infants) comparing early BCG versus no early BCG in low weight infants on all-cause neonatal mortality over 12 consecutive years, we explored the seasonal variation in BCG’s effect on mortality. In a subgroup of participants, adaptive and innate cytokine responses were measured 4 weeks after randomisation. Consistently over the course of the three trials and 12 years, the effect of BCG on all-cause neonatal mortality was particularly beneficial when administered in November to January, coincident with peaking malaria infections. During these months, BCG was also associated with stronger proinflammatory responses to heterologous challenge. Recent studies have suggested a protective effect of BCG against malaria. BCG may also ameliorate immune-compromising fatal effects of placental malaria in the newborn.
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Affiliation(s)
- Kristoffer Jarlov Jensen
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark.,Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | | | - Johan Ursing
- Department of Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden
| | - Poul-Erik Lund Kofoed
- Department of Pediatrics, Kolding Hospital, Kolding, Denmark.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
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14
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Agbota G, Accrombessi M, Cottrell G, Martin-Prével Y, Milet J, Ouédraogo S, Courtin D, Massougbodji A, Garcia A, Cot M, Briand V. Increased Risk of Malaria During the First Year of Life in Small-for-Gestational-Age Infants: A Longitudinal Study in Benin. J Infect Dis 2020; 219:1642-1651. [PMID: 30535153 DOI: 10.1093/infdis/jiy699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/03/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND According to the Developmental Origins of Health and Diseases paradigm, the fetal period is highly vulnerable and may have profound effects on later health. Few studies assessed the effect of small-for-gestational age (SGA), a proxy for fetal growth impairment, on risk of malaria during infancy in Africa. METHODS We used data from a cohort of 398 mother-child pairs, followed from early pregnancy to age 1 year in Benin. Malaria was actively and passively screened using thick blood smear. We assessed the effect of SGA on risk of malaria infection and clinical malaria from birth to 12 months, after stratifying on the infant's age using a logistic mixed regression model. RESULTS After adjustment for potential confounding factors and infant's exposure to mosquitoes, SGA was associated with a 2-times higher risk of malaria infection (adjusted odds ratio [aOR] = 2.16; 95% confidence interval [CI], 1.04-4.51; P = .039) and clinical malaria (aOR = 2.33; 95% CI, 1.09-4.98; P = .030) after age 6 months. CONCLUSION Results suggest higher risk of malaria during the second semester of life in SGA infants, and argue for better follow-up of these infants after birth, as currently for preterm babies.
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Affiliation(s)
- Gino Agbota
- Mère et Enfant Face aux Infections Tropicales, Institut Français de Recherche pour le Développement, Université Paris 5, Sorbonne Paris Cité, France.,Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Cotonou, Benin
| | - Manfred Accrombessi
- Mère et Enfant Face aux Infections Tropicales, Institut Français de Recherche pour le Développement, Université Paris 5, Sorbonne Paris Cité, France.,Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Cotonou, Benin
| | - Gilles Cottrell
- Mère et Enfant Face aux Infections Tropicales, Institut Français de Recherche pour le Développement, Université Paris 5, Sorbonne Paris Cité, France
| | - Yves Martin-Prével
- UMR204, Institut Français de Recherche pour le Développement, Université de Montpellier, SupAgro Montpellier, France
| | - Jacqueline Milet
- Mère et Enfant Face aux Infections Tropicales, Institut Français de Recherche pour le Développement, Université Paris 5, Sorbonne Paris Cité, France
| | - Smaïla Ouédraogo
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Burkina Faso
| | - David Courtin
- Mère et Enfant Face aux Infections Tropicales, Institut Français de Recherche pour le Développement, Université Paris 5, Sorbonne Paris Cité, France
| | - Achille Massougbodji
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Cotonou, Benin
| | - André Garcia
- Mère et Enfant Face aux Infections Tropicales, Institut Français de Recherche pour le Développement, Université Paris 5, Sorbonne Paris Cité, France
| | - Michel Cot
- Mère et Enfant Face aux Infections Tropicales, Institut Français de Recherche pour le Développement, Université Paris 5, Sorbonne Paris Cité, France
| | - Valérie Briand
- Mère et Enfant Face aux Infections Tropicales, Institut Français de Recherche pour le Développement, Université Paris 5, Sorbonne Paris Cité, France
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15
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Morffy Smith CD, Russ BN, Andrew AK, Cooper CA, Moore JM. A novel murine model for assessing fetal and birth outcomes following transgestational maternal malaria infection. Sci Rep 2019; 9:19566. [PMID: 31862902 PMCID: PMC6925284 DOI: 10.1038/s41598-019-55588-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/24/2019] [Indexed: 12/12/2022] Open
Abstract
Plasmodium falciparum infection during pregnancy is a major cause of severe maternal illness and neonatal mortality. Mouse models are important for the study of gestational malaria pathogenesis. When infected with Plasmodium chabaudi chabaudi AS in early gestation, several inbred mouse strains abort at midgestation. We report here that outbred Swiss Webster mice infected with P. chabaudi chabaudi AS in early gestation carry their pregnancies to term despite high parasite burden and malarial hemozoin accumulation in the placenta at midgestation, with the latter associated with induction of heme oxygenase 1 expression. Infection yields reduced fetal weight and viability at term and a reduction in pup number at weaning, but does not influence postnatal growth prior to weaning. This novel model allows for the exploration of malaria infection throughout pregnancy, modeling chronic infections observed in pregnant women prior to the birth of underweight infants and enabling the production of progeny exposed to malaria in utero, which is critical for understanding the postnatal repercussions of gestational malaria. The use of outbred mice allows for the exploration of gestational malaria in a genetically diverse model system, better recapitulating the diversity of infection responses observed in human populations.
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Affiliation(s)
- Catherine D Morffy Smith
- Department of Infectious Diseases and Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Brittany N Russ
- Department of Infectious Diseases and Immunology, University of Florida, Gainesville, FL, United States
| | - Alicer K Andrew
- Department of Infectious Diseases and Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Caitlin A Cooper
- Department of Infectious Diseases and Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Julie M Moore
- Department of Infectious Diseases and Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States. .,Department of Infectious Diseases and Immunology, University of Florida, Gainesville, FL, United States.
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16
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Bouaziz O, Courtin D, Cottrell G, Milet J, Nuel G, Garcia A. Is Placental Malaria a Long-term Risk Factor for Mild Malaria Attack in Infancy? Revisiting a Paradigm. Clin Infect Dis 2019; 66:930-935. [PMID: 29069339 DOI: 10.1093/cid/cix899] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/18/2017] [Indexed: 11/12/2022] Open
Abstract
Background Children born to mothers with placental malaria (PM) have been described as more susceptible to the occurrence of a first malaria infection. However, whether or not these children remain more at risk during infancy has never been explored. We aimed to determine if children born to mothers with PM are more susceptible to malaria and remain at higher risk between birth and 18 months. Methods Five hundred fifty children were followed up weekly with control of temperature and, if >37.5°C, both a rapid diagnostic test for malaria and a thick blood smear were performed. Taking into account environmental risk of infection, the relationship between occurrences of malaria attacks from birth to 18 months was modeled using Cox models for recurrent events. Results PM is not associated with an overall susceptibility to malaria but only with the delay of occurrence of the first malaria attack. Children born from mothers with PM tend to have an increased risk for the first malaria attack (hazard ratio [HR] = 1.33; P = .048) but not for subsequent ones (HR = 0.9; P = .46). Children who experienced 1 malaria attack were strongly at risk to develop subsequent infections independent of placental infection and environmental exposure. Conclusions These results are consistent with the existence of an individual susceptibility to malaria unrelated to PM. From a public health point of view, protecting children born to infected placenta remains a priority, but seems insufficient to account for other frail children for whom a biomarker of frailty needs to be found.
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Affiliation(s)
- Olivier Bouaziz
- Laboratoire MAP5, Université Paris Descartes et CNRS, Sorbonne Paris Cité, France
| | - David Courtin
- Institut de Recherche pour le Développement, UMR216 MERIT, Mère et enfant face aux infections tropicales, France.,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Gilles Cottrell
- Institut de Recherche pour le Développement, UMR216 MERIT, Mère et enfant face aux infections tropicales, France.,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, France.,IRD, UMR 216, Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Bénin
| | - Jacqueline Milet
- Institut de Recherche pour le Développement, UMR216 MERIT, Mère et enfant face aux infections tropicales, France.,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Gregory Nuel
- Laboratoire de Probabilités et Modèles Aléatoires/Université Pierre et Marie Curie, Paris, France
| | - André Garcia
- Institut de Recherche pour le Développement, UMR216 MERIT, Mère et enfant face aux infections tropicales, France.,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, France.,IRD, UMR 216, Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Bénin
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17
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Feeney ME. The immune response to malaria in utero. Immunol Rev 2019; 293:216-229. [PMID: 31553066 DOI: 10.1111/imr.12806] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
Malaria causes tremendous early childhood morbidity and mortality, providing an urgent impetus for the development of a vaccine that is effective in neonates. However, the infant immune response to malaria may be influenced by events that occur well before birth. Placental malaria infection complicates one quarter of all pregnancies in Africa and frequently results in exposure of the fetus to malaria antigens in utero, while the immune system is still developing. Some data suggest that in utero exposure to malaria may induce immunologic tolerance that interferes with the development of protective immunity during childhood. More recently, however, a growing body of evidence suggests that fetal malaria exposure can prime highly functional malaria-specific T- and B-cells, which may contribute to postnatal protection from malaria. In utero exposure to malaria also impacts the activation and maturation of fetal antigen presenting cells and innate lymphocytes, which could have implications for global immunity in the infant. Here, we review recent advances in our understanding of how various components of the fetal immune system are altered by in utero exposure to malaria, discuss factors that may tilt the critical balance between tolerance and adaptive immunity, and consider the implications of these findings for malaria prevention strategies.
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Affiliation(s)
- Margaret E Feeney
- Departments of Pediatrics and Medicine, University of California, San Francisco, San Francisco, CA, USA
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18
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Agbota G, Polman K, Wieringa FT, Campos-Ponce M, Accrombessi M, Yovo E, Roucher C, Ezinmègnon S, Marcos JY, Vachot L, Tissières P, Massougbodji A, Fievet N, Cot M, Briand V. Maternal malaria but not schistosomiasis is associated with a higher risk of febrile infection in infant during the first 3 months of life: A mother-child cohort in Benin. PLoS One 2019; 14:e0222864. [PMID: 31536589 PMCID: PMC6752763 DOI: 10.1371/journal.pone.0222864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/09/2019] [Indexed: 01/21/2023] Open
Abstract
Background Malaria and schistosomiasis represent two of the most prevalent and disabling parasitic infections in developing countries. Few studies have evaluated the effect of maternal schistosomiasis and malaria in the peri-conceptional period on infant’s risk of infection. Methods In Benin, women were followed from the preconception period until delivery. Subsequently, their children were followed from birth to 3 months of age. Pre-pregnancy malaria, malaria in pregnancy (MiP)—determined monthly using a thick blood smear—and urinary schistosomiasis—determined once before pregnancy and once at delivery using urine filtration—were the main maternal exposures. Infant’s febrile infection (fever with respiratory, gastrointestinal and/or cutaneous clinical signs anytime during follow-up) was the main outcome. In a secondary analysis, we checked the relation of malaria and schistosomiasis with infant’s hemoglobin (Hb) concentration. Both effects were separately assessed using logistic/mixed linear regression models. Results The prevalence of MiP was 35.7% with 10.8% occurring during the 1st trimester, and the prevalence of schistosomiasis was 21.8%. From birth to 3 months, 25.3% of infants had at least one episode of febrile infection. In multivariate analysis, MiP, particularly malaria in the 1st trimester, was significantly associated with a higher risk of infant’s febrile infection (aOR = 4.99 [1.1; 22.6], p = 0.03). In secondary results, pre-pregnancy malaria and schistosomiasis were significantly associated with a lower infant’s Hb concentration during the first 3 months. Conclusion We evidenced the deleterious effect of maternal parasitic infections on infant’s health. Our results argue in favor of the implementation of preventive strategies as early as in the peri-conception.
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Affiliation(s)
- Gino Agbota
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Cotonou, Bénin
- * E-mail:
| | - Katja Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Section Infectious Diseases, Department of Health Sciences, VU Amsterdam, Amsterdam, The Netherlands
| | - Frank T. Wieringa
- Nutripass, UMR204, Institut de Recherche pour le Développement, IRD/UM/SupAgro, Montpellier, France
| | - Maiza Campos-Ponce
- Section Infectious Diseases, Department of Health Sciences, VU Amsterdam, Amsterdam, The Netherlands
| | | | - Emmanuel Yovo
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Clémentine Roucher
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sem Ezinmègnon
- Medical Diagnostic Discovery Department (MD3), bioMérieux, Marcy l’Etoile, France
- UMR 9198, Institut de biologie Intégrative de la Cellule, Université Paris Saclay, Paris, France
| | | | - Laurence Vachot
- Medical Diagnostic Discovery Department (MD3), bioMérieux, Marcy l’Etoile, France
| | - Pierre Tissières
- UMR 9198, Institut de biologie Intégrative de la Cellule, Université Paris Saclay, Paris, France
| | - Achille Massougbodji
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Cotonou, Bénin
| | - Nadine Fievet
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Michel Cot
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
| | - Valérie Briand
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France
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19
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Ouédraogo S, Accrombessi M, Diallo I, Codo R, Ouattara A, Ouédraogo L, Massougbodji A, Cot M. Placental impression smears is a good indicator of placental malaria in sub-Saharan Africa. Pan Afr Med J 2019; 34:30. [PMID: 31762898 PMCID: PMC6859046 DOI: 10.11604/pamj.2019.34.30.20013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/18/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction Placental malaria (PM) is an important predictor of infant morbidity and mortality in sub-Saharan Africa. Although placental histology is the gold standard test to diagnose PM, the placenta impression smears remains widely used in epidemiological studies. This study is set to evaluate the performance of placental impression smears to detect PM in pregnant women in southern Benin. Methods A cross-sectional analysis was performed on data collected in the framework a multicenter randomized clinical trial (Malaria in Pregnancy Preventive and Alternative Drugs). Samples from 491 pregnant women were examined in the district of Allada, Southern Benin. Plasmodium falciparum infections have been assessed in placental blood and placental biopsy. Results Placental malaria detected by placenta impression smears and histology were prevalent in 11.4% and 10.8%, respectively. Sensitivity and specificity of placental impression smears were 90.6% and 98.4%. Among 55 pregnant women tested positive by placenta impression smears, 48 were positive by the histology, while 7 were negative (positive predictive value: 87.3%). Four hundred and twenty four (424) of the 429 tested negative by the placenta impression smears, were also negative according to histology whereas the rest (5 of 429) of the women were positive (negative predictive value: 98.8%). Conclusion Placenta impression smear is an accurate and easy method for the diagnosis of placental malaria.
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Affiliation(s)
- Smaïla Ouédraogo
- Unité de Formation et de Recherche en Science de la Santé, Université Joseph Ki-Zerbo, Ouagdougou, Burkina Faso.,Centre Hospitalier Universitaire Yalgadogo, Ouédraogo, Burkina Faso
| | | | - Ismaël Diallo
- Unité de Formation et de Recherche en Science de la Santé, Université Joseph Ki-Zerbo, Ouagdougou, Burkina Faso.,Centre Hospitalier Universitaire Yalgadogo, Ouédraogo, Burkina Faso
| | - Roussine Codo
- Faculté de Médecine de Cotonou, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Adama Ouattara
- Unité de Formation et de Recherche en Science de la Santé, Université Joseph Ki-Zerbo, Ouagdougou, Burkina Faso.,Centre Hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso
| | - Laurent Ouédraogo
- Unité de Formation et de Recherche en Science de la Santé, Université Joseph Ki-Zerbo, Ouagdougou, Burkina Faso.,Université de Ouahigouya, Ouahigouya, Burkina Faso
| | | | - Michel Cot
- MERIT- Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement, Paris, France, Université Paris Descartes, Sorbonne Paris Cité, France
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20
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Natama HM, Rovira-Vallbona E, Sorgho H, Somé MA, Traoré-Coulibaly M, Scott S, Zango SH, Sawadogo O, Zongo SC, Valéa I, Mens PF, Schallig HDFH, Kestens L, Tinto H, Rosanas-Urgell A. Additional Screening and Treatment of Malaria During Pregnancy Provides Further Protection Against Malaria and Nonmalarial Fevers During the First Year of Life. J Infect Dis 2019; 217:1967-1976. [PMID: 29659897 DOI: 10.1093/infdis/jiy140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/14/2018] [Indexed: 11/14/2022] Open
Abstract
Background Although consensus exists that malaria in pregnancy (MiP) increases the risk of malaria in infancy, and eventually nonmalarial fevers (NMFs), there is a lack of conclusive evidence of benefits of MiP preventive strategies in infants. Methods In Burkina Faso, a birth cohort study was nested to a clinical trial assessing the effectiveness of a community-based scheduled screening and treatment of malaria in combination with intermittent preventive treatment with sulfadoxine-pyrimethamine (CSST/IPTp-SP) to prevent placental malaria. Clinical episodes and asymptomatic infections were monitored over 1 year of follow-up to compare the effect of CSST/IPTp-SP and standard IPTp-SP on malaria and NMFs. Results Infants born during low-transmission season from mothers receiving CSST/IPTp-SP had a 26% decreased risk of experiencing a first clinical episode (hazard ratio, 0.74 [95% confidence interval, .55-0.99]; P = .047). CSST/IPTp-SP interacted with birth season and gravidity to reduce the incidence of NMFs. No significant effects of CSST/IPTp-SP on the incidence of clinical episodes, parasite density, and Plasmodium falciparum infections were observed. Conclusions Our findings indicate that CSST/IPTp-SP strategy may provide additional protection against both malaria and NMFs in infants during the first year of life, and suggest that malaria control interventions during pregnancy could have long-term benefits in infants.
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Affiliation(s)
- Hamtandi Magloire Natama
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso.,Department of Biomedical Sciences, University of Antwerp, Belgium
| | | | - Hermann Sorgho
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - M Athanase Somé
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Maminata Traoré-Coulibaly
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Susana Scott
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Serge Henri Zango
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso.,Centre Muraz, Bobo Dioulasso, Burkina Faso
| | - Ousséni Sawadogo
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Sibiri Claude Zongo
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Innocent Valéa
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Petra F Mens
- Department of Medical Microbiology, Parasitology Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Department of Medical Microbiology, Parasitology Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - Luc Kestens
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Belgium
| | - Halidou Tinto
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso.,Centre Muraz, Bobo Dioulasso, Burkina Faso
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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21
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Kakuru A, Staedke SG, Dorsey G, Rogerson S, Chandramohan D. Impact of Plasmodium falciparum malaria and intermittent preventive treatment of malaria in pregnancy on the risk of malaria in infants: a systematic review. Malar J 2019; 18:304. [PMID: 31481075 PMCID: PMC6724246 DOI: 10.1186/s12936-019-2943-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/28/2019] [Indexed: 09/16/2023] Open
Abstract
Background Studies of the association between malaria in pregnancy (MiP) and malaria during infancy have provided mixed results. A systematic review was conducted to evaluate available evidence on the impact of Plasmodium falciparum malaria infection during pregnancy, and intermittent preventive treatment of malaria during pregnancy (IPTp), on the risk of clinical malaria or parasitaemia during infancy. Methods MEDLINE, EMBASE, Global Health, and Malaria in Pregnancy Library databases were searched from inception to 22 May 2018 for articles published in English that reported on associations between MiP and malaria risk in infancy. Search terms included malaria, Plasmodium falciparum, pregnancy, placenta, maternal, prenatal, foetal, newborn, infant, child or offspring or preschool. Randomized controlled trials and prospective cohort studies, which followed infants for at least 6 months, were included if any of the following outcomes were reported: incidence of clinical malaria, prevalence of parasitaemia, and time to first episode of parasitaemia or clinical malaria. Substantial heterogeneity between studies precluded meta-analysis. Thus, a narrative synthesis of included studies was conducted. Results The search yielded 14 published studies, 10 prospective cohort studies and four randomized trials; all were conducted in sub-Saharan Africa. Infants born to mothers with parasitaemia during pregnancy were at higher risk of malaria in three of four studies that assessed this association. Placental malaria detected by microscopy or histology was associated with a higher risk of malaria during infancy in nine of 12 studies, but only one study adjusted for malaria transmission intensity. No statistically significant associations between the use of IPTp or different IPTp regimens and the risk of malaria during infancy were identified. Conclusion Evidence of an association between MiP and IPTp and risk of malaria in infancy is limited and of variable quality. Most studies did not adequately adjust for malaria transmission intensity shared by mothers and their infants. Further research is needed to confirm or exclude an association between MiP and malaria in infancy. Randomized trials evaluating highly effective interventions aimed at preventing MiP, such as IPTp with dihydroartemisinin–piperaquine, may help to establish a causal association between MiP and malaria in infancy.
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Affiliation(s)
- Abel Kakuru
- Infectious Diseases Research Collaboration, P.O Box 7475, Kampala, Uganda. .,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Grant Dorsey
- University of California San Francisco, San Francisco, CA, USA
| | - Stephen Rogerson
- Department of Medicine at the Doherty Institute, University of Melbourne, 792 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Daniel Chandramohan
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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22
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Avokpaho E, d'Almeida TC, Sadissou I, Tokplonou L, Adamou R, Sonon P, Milet J, Cottrell G, Mondière A, Massougbodji A, Moutairou K, Donadi EA, Teixeira Mendes Junior C, Favier B, Carosella E, Moreau P, Rouas-Freiss N, Garcia A, Courtin D. HLA-G expression during hookworm infection in pregnant women. Acta Trop 2019; 196:52-59. [PMID: 31078470 DOI: 10.1016/j.actatropica.2019.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION HLA-G plays a key role on immune tolerance. Pathogens can induce soluble HLA-G (sHLA-G) production to down-regulate the host immune response, creating a tolerogenic environment favorable for their dissemination. To our knowledge, no study has yet been conducted to assess the relationship between sHLA-G and geohelminth infections. METHODS The study was conducted in Allada, Southeastern Benin, from 2011-2014. The study population encompassed 400 pregnant women, included before the end of the 28th week of gestation and followed-up until delivery. At two antenatal care visits and at delivery, stool and blood samples were collected. Helminths were diagnosed by means of the Kato-Katz concentration technique. We used quantile regression to analyze the association between helminth infections and sHLA-G levels during pregnancy. RESULTS sHLA-G levels gradually increased during pregnancy and reached maximal levels at delivery. Prevalence of helminth infections was low, with a majority of hookworm infections. We found significantly more hookworm-infected women above the 80th quantile (Q80) of the distribution of the mean sHLA-G level (p < 0.03, multivariate quantile regression). Considering only women above the Q80 percentile, the mean sHLA-G level was significantly higher in hookworm-infected compared to uninfected women (p = 0.04). CONCLUSION High levels of sHLA-G were associated with hookworm infection in pregnant women. This result is consistent with the potential involvement of sHLA-G in immune tolerance induced by helminths during pregnancy.
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Affiliation(s)
- Euripide Avokpaho
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - Tania C d'Almeida
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - Ibrahim Sadissou
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France; Université d'Abomey-Calavi, Cotonou, Benin; Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Léonidas Tokplonou
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France; Université d'Abomey-Calavi, Cotonou, Benin
| | - Rafiou Adamou
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France; Université d'Abomey-Calavi, Cotonou, Benin
| | - Paulin Sonon
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France; Université d'Abomey-Calavi, Cotonou, Benin; Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Jacqueline Milet
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - Gilles Cottrell
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - Amandine Mondière
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | | | | | - Eduardo A Donadi
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Celso Teixeira Mendes Junior
- Department of Chemistry, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Brazil
| | - Benoit Favier
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherche en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France; Université Paris Diderot, Sorbonne Paris Cite, IUH, Hôpital Saint-Louis, UMRE5, IUH, Paris, France
| | - Edgardo Carosella
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherche en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France; Université Paris Diderot, Sorbonne Paris Cite, IUH, Hôpital Saint-Louis, UMRE5, IUH, Paris, France
| | - Philippe Moreau
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherche en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France; Université Paris Diderot, Sorbonne Paris Cite, IUH, Hôpital Saint-Louis, UMRE5, IUH, Paris, France
| | - Nathalie Rouas-Freiss
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherche en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France; Université Paris Diderot, Sorbonne Paris Cite, IUH, Hôpital Saint-Louis, UMRE5, IUH, Paris, France
| | - André Garcia
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - David Courtin
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France.
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23
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Accrombessi M, Fievet N, Yovo E, Cottrell G, Agbota G, Massougbodji A, Cot M, Briand V. Prevalence and Associated Risk Factors of Malaria in the First Trimester of Pregnancy: A Preconceptional Cohort Study in Benin. J Infect Dis 2019; 217:1309-1317. [PMID: 29325055 DOI: 10.1093/infdis/jiy009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background There is a lack of data on the burden of malaria in the first trimester of pregnancy in Africa, mainly because pregnant women generally attend the maternity clinic late. Bed nets are rarely provided to women before the second trimester of pregnancy and intermittent preventive treatment with sulfadoxine-pyrimethamine is not recommended before the second trimester, leaving women insufficiently or not protected in early pregnancy. Methods To assess the burden of first trimester malaria, 387 women were followed up monthly from preconception to delivery. They were screened for malaria monthly from early pregnancy until delivery. A logistic multilevel model was used to assess maternal factors associated with malaria during the first trimester. Results The proportion of women with at least 1 microscopic malaria infection during the first trimester of pregnancy was 20.8%. Women infected with malaria preconception were more likely to be infected during the first trimester (adjusted odds ratio: 2.68; 95% confidence interval, 1.24-5.78). Early gestational age was also positively correlated with malaria infection. Conclusions Using a preconceptional study design, we showed that malaria was highly prevalent in early pregnancy. This calls for the assessment of new strategies that could protect women as soon as the first trimester.
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Affiliation(s)
- Manfred Accrombessi
- Mère et Enfant Face aux Infections Tropicales, French National Research Institute for Sustainable Development, Paris Descartes University, France.,Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Cotonou, Benin
| | - Nadine Fievet
- Mère et Enfant Face aux Infections Tropicales, French National Research Institute for Sustainable Development, Paris Descartes University, France
| | - Emmanuel Yovo
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Cotonou, Benin
| | - Gilles Cottrell
- Mère et Enfant Face aux Infections Tropicales, French National Research Institute for Sustainable Development, Paris Descartes University, France
| | - Gino Agbota
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Cotonou, Benin
| | - Achille Massougbodji
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance, Cotonou, Benin
| | - Michel Cot
- Mère et Enfant Face aux Infections Tropicales, French National Research Institute for Sustainable Development, Paris Descartes University, France
| | - Valérie Briand
- Mère et Enfant Face aux Infections Tropicales, French National Research Institute for Sustainable Development, Paris Descartes University, France
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d'Almeida TC, Sadissou I, Sagbohan M, Milet J, Avokpaho E, Gineau L, Sabbagh A, Moutairou K, Donadi EA, Favier B, Pennetier C, Baldet T, Moiroux N, Carosella E, Moreau P, Rouas-Freiss N, Cottrell G, Courtin D, Garcia A. High level of soluble human leukocyte antigen (HLA)-G at beginning of pregnancy as predictor of risk of malaria during infancy. Sci Rep 2019; 9:9160. [PMID: 31235762 PMCID: PMC6591392 DOI: 10.1038/s41598-019-45688-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/11/2019] [Indexed: 12/14/2022] Open
Abstract
Placental malaria has been associated with an immune tolerance phenomenon and a higher susceptibility to malaria infection during infancy. HLA-G is involved in fetal maternal immune tolerance by inhibiting maternal immunity. During infections HLA-G can be involved in immune escape of pathogens by creating a tolerogenic environment. Recent studies have shown an association between the risk of malaria and HLA-G at both genetic and protein levels. Moreover, women with placental malaria have a higher probability of giving birth to children exhibiting high sHLA-G, independently of their own level during pregnancy. Our aim was to explore the association between the level of maternal soluble HLA-G and the risk of malaria infection in their newborns. Here, 400 pregnant women and their children were actively followed-up during 24 months. The results show a significant association between the level of sHLA-G at the first antenatal visit and the time to first malaria infection during infancy adjusted to the risk of exposure to vector bites (aHR = 1.02, 95%CI [1.01–1.03], p = 0.014). The level of sHLA-G is a significant predictor of the occurrence of malaria infection during infancy consistent with the hypothesis that mother sHLA-G could be a biomarker of malaria susceptibility in children.
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Affiliation(s)
- Tania C d'Almeida
- Université Pierre et Marie Curie, Paris VI, France.,MERIT, IRD, Université Paris Descartes, Paris, 75006, France
| | - Ibrahim Sadissou
- IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin.,Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,Université d'Abomey-Calavi, Cotonou, Benin
| | - Mermoz Sagbohan
- IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin.,Université d'Abomey-Calavi, Cotonou, Benin
| | | | - Euripide Avokpaho
- IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin
| | - Laure Gineau
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France
| | - Audrey Sabbagh
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France
| | | | - Eduardo A Donadi
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Benoit Favier
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives, Direction de la Recherche Fondamentale, Institut de Biologie François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, IUH, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Cédric Pennetier
- UMR MIVEGEC (IRD-CNRS-UM), Montpellier, France.,Centre de Recherche Entomologiques de Cotonou (CREC), Cotonou, Benin
| | - Thierry Baldet
- UMR MIVEGEC (IRD-CNRS-UM), Montpellier, France.,Centre de Recherche Entomologiques de Cotonou (CREC), Cotonou, Benin
| | - Nicolas Moiroux
- UMR MIVEGEC (IRD-CNRS-UM), Montpellier, France.,Centre de Recherche Entomologiques de Cotonou (CREC), Cotonou, Benin
| | - Edgardo Carosella
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives, Direction de la Recherche Fondamentale, Institut de Biologie François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, IUH, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Philippe Moreau
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives, Direction de la Recherche Fondamentale, Institut de Biologie François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, IUH, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Nathalie Rouas-Freiss
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives, Direction de la Recherche Fondamentale, Institut de Biologie François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, IUH, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Gilles Cottrell
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France.,IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin
| | - David Courtin
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France
| | - André Garcia
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France. .,IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin.
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25
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Morffy Smith CD, Gong M, Andrew AK, Russ BN, Ge Y, Zadeh M, Cooper CA, Mohamadzadeh M, Moore JM. Composition of the gut microbiota transcends genetic determinants of malaria infection severity and influences pregnancy outcome. EBioMedicine 2019; 44:639-655. [PMID: 31160271 PMCID: PMC6606560 DOI: 10.1016/j.ebiom.2019.05.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Malaria infection in pregnancy is a major cause of maternal and foetal morbidity and mortality worldwide. Mouse models for gestational malaria allow for the exploration of the mechanisms linking maternal malaria infection and poor pregnancy outcomes in a tractable model system. The composition of the gut microbiota has been shown to influence susceptibility to malaria infection in inbred virgin mice. In this study, we explore the ability of the gut microbiota to modulate malaria infection severity in pregnant outbred Swiss Webster mice. METHODS In Swiss Webster mice, the composition of the gut microbiota was altered by disrupting the native gut microbes through broad-spectrum antibiotic treatment, followed by the administration of a faecal microbiota transplant derived from mice possessing gut microbes reported previously to confer susceptibility or resistance to malaria. Female mice were infected with P. chabaudi chabaudi AS in early gestation, and the progression of infection and pregnancy were tracked throughout gestation. To assess the impact of maternal infection on foetal outcomes, dams were sacrificed at term to assess foetal size and viability. Alternatively, pups were delivered by caesarean section and fostered to assess neonatal survival and pre-weaning growth in the absence of maternal morbidity. A group of dams was also euthanized at mid-gestation to assess infection and pregnancy outcomes. FINDINGS Susceptibility to infection varied significantly as a function of source of transplanted gut microbes. Parasite burden was negatively correlated with the abundance of five specific OTUs, including Akkermansia muciniphila and OTUs classified as Allobaculum, Lactobacillus, and S24-7 species. Reduced parasite burden was associated with reduced maternal morbidity and improved pregnancy outcomes. Pups produced by dams with high parasite burdens displayed a significant reduction in survival in the first days of life relative to those from malaria-resistant dams when placed with foster dams. At midgestation, plasma cytokine levels were similar across all groups, but expression of IFNγ in the conceptus was elevated in infected dams, and IL-10 only in susceptible dams. In the latter, transcriptional and microscopic evidence of monocytic infiltration was observed with high density infection; likewise, accumulation of malaria haemozoin was enhanced in this group. These responses, combined with reduced vascularization of the placenta in this group, may contribute to poor pregnancy outcomes. Thus, high maternal parasite burden and associated maternal responses, potentially dictated by the gut microbial community, negatively impacts term foetal health and survival in the early postnatal period. INTERPRETATION The composition of the gut microbiota in Plasmodium chabaudi chabaudi AS-infected pregnant Swiss Webster mice transcends the outbred genetics of the Swiss Webster mouse stock as a determinant of malaria infection severity, subsequently influencing pregnancy outcomes in malaria-exposed progeny. FUND: Research reported in this manuscript was supported by the University of Florida College of Veterinary Medicine (JMM, MM, and MG), the National Institute of Allergy and Infectious Diseases, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award numbers T32AI060546 (to CDMS), R01HD46860 and R21AI111242 (to JMM), and R01 DK109560 (to MM). MG was supported by Department of Infectious Diseases and Immunology and University of Florida graduate assistantships. AA was supported by the 2017-2019 Peach State LSAMP Bridge to the Doctorate Program at the University of Georgia (National Science Foundation, Award # 1702361). The content is solely the responsibility of the authors and does not necessarily represent official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Allergy and Infectious Diseases, the National Institute of Diabetes and Digestive and Kidney Diseases, or the National Institutes of Health.
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Affiliation(s)
- Catherine D Morffy Smith
- Department of Infectious Diseases and the Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Minghao Gong
- Department of Infectious Diseases and Immunology, University of Florida, Gainesville, FL, United States
| | - Alicer K Andrew
- Department of Infectious Diseases and the Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Brittany N Russ
- Department of Infectious Diseases and Immunology, University of Florida, Gainesville, FL, United States
| | - Yong Ge
- Department of Infectious Diseases and Immunology, University of Florida, Gainesville, FL, United States
| | - Mojgan Zadeh
- Department of Infectious Diseases and Immunology, University of Florida, Gainesville, FL, United States
| | - Caitlin A Cooper
- Department of Infectious Diseases and the Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States
| | - Mansour Mohamadzadeh
- Department of Infectious Diseases and Immunology, University of Florida, Gainesville, FL, United States
| | - Julie M Moore
- Department of Infectious Diseases and the Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, United States.
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26
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Natama HM, Moncunill G, Rovira-Vallbona E, Sanz H, Sorgho H, Aguilar R, Coulibaly-Traoré M, Somé MA, Scott S, Valéa I, Mens PF, Schallig HDFH, Kestens L, Tinto H, Dobaño C, Rosanas-Urgell A. Modulation of innate immune responses at birth by prenatal malaria exposure and association with malaria risk during the first year of life. BMC Med 2018; 16:198. [PMID: 30384846 PMCID: PMC6214168 DOI: 10.1186/s12916-018-1187-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/05/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Factors driving inter-individual differences in immune responses upon different types of prenatal malaria exposure (PME) and subsequent risk of malaria in infancy remain poorly understood. In this study, we examined the impact of four types of PME (i.e., maternal peripheral infection and placental acute, chronic, and past infections) on both spontaneous and toll-like receptors (TLRs)-mediated cytokine production in cord blood and how these innate immune responses modulate the risk of malaria during the first year of life. METHODS We conducted a birth cohort study of 313 mother-child pairs nested within the COSMIC clinical trial (NCT01941264), which was assessing malaria preventive interventions during pregnancy in Burkina Faso. Malaria infections during pregnancy and infants' clinical malaria episodes detected during the first year of life were recorded. Supernatant concentrations of 30 cytokines, chemokines, and growth factors induced by stimulation of cord blood with agonists of TLRs 3, 7/8, and 9 were measured by quantitative suspension array technology. Crude concentrations and ratios of TLR-mediated cytokine responses relative to background control were analyzed. RESULTS Spontaneous production of innate immune biomarkers was significantly reduced in cord blood of infants exposed to malaria, with variation among PME groups, as compared to those from the non-exposed control group. However, following TLR7/8 stimulation, which showed higher induction of cytokines/chemokines/growth factors than TLRs 3 and 9, cord blood cells of infants with evidence of past placental malaria were hyper-responsive in comparison to those of infants not-exposed. In addition, certain biomarkers, which levels were significantly modified depending on the PME category, were independent predictors of either malaria risk (GM-CSF TLR7/8 crude) or protection (IL-12 TLR7/8 ratio and IP-10 TLR3 crude, IL-1RA TLR7/8 ratio) during the first year of life. CONCLUSIONS These findings indicate that past placental malaria has a profound effect on fetal immune system and that the differential alterations of innate immune responses by PME categories might drive heterogeneity between individuals to clinical malaria susceptibility during the first year of life.
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Affiliation(s)
- Hamtandi Magloire Natama
- Department of Biomedical Sciences, Institute of Tropical Medicine, B 2000, Antwerp, Belgium.,Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso.,Department of Biomedical Sciences, University of Antwerp, B 2610, Antwerp, Belgium
| | - Gemma Moncunill
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - Universitat de Barcelona, Carrer Rossello 132, E-08036, Barcelona, Catalonia, Spain
| | - Eduard Rovira-Vallbona
- Department of Biomedical Sciences, Institute of Tropical Medicine, B 2000, Antwerp, Belgium
| | - Héctor Sanz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - Universitat de Barcelona, Carrer Rossello 132, E-08036, Barcelona, Catalonia, Spain
| | - Hermann Sorgho
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso
| | - Ruth Aguilar
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - Universitat de Barcelona, Carrer Rossello 132, E-08036, Barcelona, Catalonia, Spain
| | - Maminata Coulibaly-Traoré
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso
| | - M Athanase Somé
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso
| | - Susana Scott
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
| | - Innocent Valéa
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso
| | - Petra F Mens
- Department of Medical Microbiology - Parasitology Unit, Academic Medical Centre, Amsterdam, 1105, AZ, The Netherlands
| | - Henk D F H Schallig
- Department of Medical Microbiology - Parasitology Unit, Academic Medical Centre, Amsterdam, 1105, AZ, The Netherlands
| | - Luc Kestens
- Department of Biomedical Sciences, Institute of Tropical Medicine, B 2000, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, B 2610, Antwerp, Belgium
| | - Halidou Tinto
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso.,Centre Muraz, BP390, Bobo Dioulasso, Burkina Faso
| | - Carlota Dobaño
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - Universitat de Barcelona, Carrer Rossello 132, E-08036, Barcelona, Catalonia, Spain
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, B 2000, Antwerp, Belgium.
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27
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Harrington WE, Kakuru A, Jagannathan P. Malaria in pregnancy shapes the development of foetal and infant immunity. Parasite Immunol 2018; 41:e12573. [PMID: 30019470 DOI: 10.1111/pim.12573] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/21/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
Abstract
Malaria, particularly Plasmodium falciparum, continues to disproportionately affect pregnant women. In addition to the profoundly deleterious impact of maternal malaria on the health of the mother and foetus, malaria infection in pregnancy has been shown to affect the development of the foetal and infant immune system and may alter the risk of malaria and nonmalarial outcomes during infancy. This review summarizes our current understanding of how malaria infection in pregnancy shapes the protective components of the maternal immune system transferred to the foetus and how foetal exposure to parasite antigens impacts the development of foetal and infant immunity. It also reviews existing evidence linking malaria infection in pregnancy to malaria and nonmalarial outcomes in infancy and how preventing malaria in pregnancy may alter these outcomes. A better understanding of the consequences of malaria infection in pregnancy on the development of foetal and infant immunity will inform control strategies, including intermittent preventive treatment in pregnancy and vaccine development.
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Affiliation(s)
- Whitney E Harrington
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
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28
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Brembilla A, Faucher JF, Garcia A, Koura KG, Deloron P, Parmentier AL, Pierrat C, Cottrell G, Mauny F. Determinants of primary healthcare seeking behaviours for children during the first 18 months of life in Benin. Int Health 2018; 10:237-245. [PMID: 29659852 DOI: 10.1093/inthealth/ihy020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background Primary healthcare is a key element of management of childhood illness in Africa. The objectives were to identify primary care seeking determinants among infants and young children up to 18 mo in a birth cohort from Benin. Methods From 2007 to 2009 in Benin, a birth cohort was followed until the age of 18 mo in three health centres. Multilevel Poisson regression models were fitted to identify the factors related to the monthly number of consultations. Maternal and newborn characteristics and infant general health parameters were considered. Results A total of 566 children were followed. On average, 0.46 consultations per month per child were recorded. The number of consultations was significantly lower after the first 6 mo of life (p<0.001). A distance >1000 m was associated with fewer consultations (p=0.01). Primiparity was significantly associated with higher care seeking (relative risk 1.17 [95% CI 1.05 to 1.30], p<0.01). No child characteristics at birth were significantly associated with the number of consultations (all p>0.16). Conclusions Development of health structures and improvement of access remain important goals for strengthening of the primary care health system. Studying factors of care seeking behaviour, like parity, can help to identify women more prone to seek care for their child during the first year of life.
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Affiliation(s)
- A Brembilla
- Laboratoire Chrono-Environnement UMR CNRS 6249, Université Bourgogne Franche-Comté, 16 Route de Gray, Besançon, France.,Centre de Méthodologie Clinique, Centre Hospitalier Universitaire de Besançon, 2 Place Saint-Jacques, Besançon Cedex, France
| | - J-F Faucher
- MERIT IRD, Université Paris 5, Sorbonne Paris Cité, Faculté de pharmacie, 4 Avenue de l'Observatoire, Paris, France.,Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Limoges, Hôpital Dupuytren, 2 Avenue Martin Luther King, Limoges Cedex, France
| | - A Garcia
- MERIT IRD, Université Paris 5, Sorbonne Paris Cité, Faculté de pharmacie, 4 Avenue de l'Observatoire, Paris, France
| | - K G Koura
- MERIT IRD, Université Paris 5, Sorbonne Paris Cité, Faculté de pharmacie, 4 Avenue de l'Observatoire, Paris, France.,Union Internationale Contre la Tuberculose et les Maladies Respiratoires, 68 Boulevard Saint Michel, Paris, France
| | - P Deloron
- MERIT IRD, Université Paris 5, Sorbonne Paris Cité, Faculté de pharmacie, 4 Avenue de l'Observatoire, Paris, France
| | - A-L Parmentier
- Laboratoire Chrono-Environnement UMR CNRS 6249, Université Bourgogne Franche-Comté, 16 Route de Gray, Besançon, France.,Centre de Méthodologie Clinique, Centre Hospitalier Universitaire de Besançon, 2 Place Saint-Jacques, Besançon Cedex, France
| | - C Pierrat
- MERIT IRD, Université Paris 5, Sorbonne Paris Cité, Faculté de pharmacie, 4 Avenue de l'Observatoire, Paris, France
| | - G Cottrell
- MERIT IRD, Université Paris 5, Sorbonne Paris Cité, Faculté de pharmacie, 4 Avenue de l'Observatoire, Paris, France
| | - F Mauny
- Laboratoire Chrono-Environnement UMR CNRS 6249, Université Bourgogne Franche-Comté, 16 Route de Gray, Besançon, France.,Centre de Méthodologie Clinique, Centre Hospitalier Universitaire de Besançon, 2 Place Saint-Jacques, Besançon Cedex, France
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29
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Natama HM, Rovira-Vallbona E, Somé MA, Zango SH, Sorgho H, Guetens P, Coulibaly-Traoré M, Valea I, Mens PF, Schallig HDFH, Kestens L, Tinto H, Rosanas-Urgell A. Malaria incidence and prevalence during the first year of life in Nanoro, Burkina Faso: a birth-cohort study. Malar J 2018; 17:163. [PMID: 29650007 PMCID: PMC5898041 DOI: 10.1186/s12936-018-2315-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/09/2018] [Indexed: 12/22/2022] Open
Abstract
Background Infants are thought to be protected against malaria during the first months of life mainly due to passage of maternal antibodies. However, in high transmission settings, malaria in early infancy is not uncommon and susceptibility to the infections varies between individuals. This study aimed to determine malaria morbidity and infection during early childhood in rural Burkina Faso. Methods Malariometric indices were determined over 1-year follow-up in a birth cohort of 734 infants living in Nanoro health district. Clinical malaria episodes were determined by passive case detection at peripheral health centres while asymptomatic malaria infections were identified during 4 cross-sectional surveys at 3, 6, 9 and 12 months of age. Plasmodium falciparum infections were detected by rapid diagnostic test and/or light microscopy (LM) and quantitative PCR (qPCR). Results In total, 717 clinical episodes were diagnosed by qPCR over 8335.18 person-months at risk. The overall malaria incidence was 1.03 per child-year and increased from 0.27 per child-year at 0–3 months of age to 1.92 per child-year at 9–12 months of age. Some 59% of children experienced at least one clinical episode with a median survival time estimated at 9.9 months, while 20% of infants experienced the first episode before 6 months of age. The majority of the clinical episodes were attributable to microscopic parasitaemia (84.2%), and there was a positive correlation between parasite density and age (Spearman’s rho = 0.30; P < 0.0001). Prevalence of asymptomatic infections was similar at 3, 6 and 9 months of age (17.7–20.1%) and nearly 1.6 times higher at 12 months (31.3%). Importantly, gametocyte prevalence among the LM-positive study population was 6.7%, but increased to 10% among asymptomatic infections. In addition, 46% of asymptomatic infections were only detected by qPCR suggesting that infants below 1 year are a potential reservoir for sustaining malaria transmission. Both symptomatic and asymptomatic infections showed marked seasonal distribution with the highest transmission period (July to December) accounting for about 89 and 77% of those infections, respectively. Conclusions These findings indicate high and marked age and seasonal-dependency of malaria infections and disease during the first year of life in Nanoro, calling for intensified efforts to control malaria in rural Burkina Faso.
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Affiliation(s)
- Hamtandi Magloire Natama
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium. .,Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, BP 218, Burkina Faso. .,Department of Biomedical Sciences, University of Antwerp, 2610, Antwerp, Belgium.
| | - Eduard Rovira-Vallbona
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
| | - M Athanase Somé
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, BP 218, Burkina Faso
| | - Serge Henri Zango
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, BP 218, Burkina Faso.,Centre Muraz, Bobo Dioulasso, BP 390, Burkina Faso
| | - Hermann Sorgho
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, BP 218, Burkina Faso
| | - Pieter Guetens
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
| | - Maminata Coulibaly-Traoré
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, BP 218, Burkina Faso
| | - Innocent Valea
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, BP 218, Burkina Faso
| | - Petra F Mens
- Department of Medical Microbiology-Parasitology Unit, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Department of Medical Microbiology-Parasitology Unit, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands
| | - Luc Kestens
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, 2610, Antwerp, Belgium
| | - Halidou Tinto
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, BP 218, Burkina Faso.,Centre Muraz, Bobo Dioulasso, BP 390, Burkina Faso
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, 2000, Antwerp, Belgium
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Sylvester B, Gasarasi DB, Aboud S, Tarimo D, Massawe S, Mpembeni R, Swedberg G. Hyperparasitaemia during clinical malaria episodes in infants aged 0-24 months and its association with in utero exposure to Plasmodium falciparum. BMC Res Notes 2018; 11:232. [PMID: 29618382 PMCID: PMC5885461 DOI: 10.1186/s13104-018-3339-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/30/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Existing information has shown that infants who are prenatally exposed to P. falciparum are susceptible to subsequent malaria infections. However, the effect of prenatal exposure to P. falciparum on parasite density during clinical malaria episodes has not been fully elucidated. This study is a component of a prospective cohort study for which initial results have been published. This component was designed to determine the effect of prenatal exposure to P. falciparum on parasite density during clinical malaria episodes in the first 24 months of life. A total of 215 infants were involved and monitored for clinical malaria episodes defined by fever (≥ 37 °C) and parasitaemia. The geometric mean parasite counts between exposed and unexposed infants were compared using independent samples t test. The effect of in utero exposure to P. falciparum on parasite density was assessed using binary logistic regression. Results The geometric mean parasite count per µl of blood during clinical malaria episodes in exposed infants was 24,889 (95% CI 18,286–31,490) while in unexposed infants it was 14,035 (95% CI 12,111–15,960), P < 0.05. Prenatal exposure to P. falciparum was associated with hyperparasitaemia during clinical malaria episodes (OR 7.04, 95% CI 2.31–21.74), while other factors were not significantly associated (P > 0.05).
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Affiliation(s)
- Boniphace Sylvester
- Department of Parasitology and Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania.
| | - Dinah B Gasarasi
- Department of Parasitology and Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Donath Tarimo
- Department of Parasitology and Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Siriel Massawe
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gote Swedberg
- Department of Medical Biochemistry and Microbiology, Biomedical Centre, Uppsala University, P.O.BOX 582, Uppsala, Sweden
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Tassi Yunga S, Fouda GG, Sama G, Ngu JB, Leke RGF, Taylor DW. Increased Susceptibility to Plasmodium falciparum in Infants is associated with Low, not High, Placental Malaria Parasitemia. Sci Rep 2018; 8:169. [PMID: 29317740 PMCID: PMC5760570 DOI: 10.1038/s41598-017-18574-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/12/2017] [Indexed: 01/19/2023] Open
Abstract
Risk of malaria in infants can be influenced by prenatal factors. In this study, the potential for placental parasitemia at delivery in predicting susceptibility of infants to Plasmodium falciparum (Pf) infections was evaluated. Seventy-two newborns of mothers who were placental malaria negative (PM-) and of mothers who were PM+ with below (PM+ Lo) and above (PM + Hi) median placental parasitemia, were actively monitored during their first year of life. Median time to first PCR-detected Pf infection was shorter in PM + Lo infants (2.8 months) than in both PM- infants (4.0 months, p = 0.002) and PM + Hi infants (4.1 months, p = 0.01). Total number of new infections was also highest in the PM + Lo group. Only 24% of infants experienced clinical malaria episodes but these episodes occurred earlier in PM + Lo infants than in PM + Hi infants (p = 0.05). The adjusted hazard ratio (95% CI) of having Pf infection was 3.9 (1.8-8.4) and 1.5 (0.7-3.4) for infants in the PM + Lo and PM + Hi groups, respectively. Collectively, low placental parasitemia was associated with increased susceptibility to malaria during infancy. Therefore, malaria in pregnancy preventive regimens, such as sulfadoxine-pyremethamine, that reduce but do not eliminate placental Pf in areas of drug resistance may increase the risk of malaria in infants.
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Affiliation(s)
- Samuel Tassi Yunga
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, BSB320, Honolulu, HI, 96813, USA
| | - Genevieve G Fouda
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Grace Sama
- The Biotechnology Center, University of Yaoundé 1, BP 3851 Messa, Yaoundé, Cameroon
| | - Julia B Ngu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, BP 1364, Yaoundé, Cameroon
| | - Rose G F Leke
- The Biotechnology Center, University of Yaoundé 1, BP 3851 Messa, Yaoundé, Cameroon
| | - Diane W Taylor
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, BSB320, Honolulu, HI, 96813, USA.
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Boudová S, Divala T, Mungwira R, Mawindo P, Tomoka T, Laufer MK. Placental but Not Peripheral Plasmodium falciparum Infection During Pregnancy Is Associated With Increased Risk of Malaria in Infancy. J Infect Dis 2017; 216:732-735. [PMID: 28934438 DOI: 10.1093/infdis/jix372] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/27/2017] [Indexed: 11/14/2022] Open
Abstract
Pregnancy-associated Plasmodium falciparum infection impacts the health of mothers and newborns, but little is known about the effects of these infections on infant susceptibility to malaria. We followed 473 mother-infant pairs during pregnancy and through 2 years of age. We observed that children born to mothers with placental malaria, but not those born to mothers with peripheral infection without evidence of placental sequestration, had increased risk of malaria during the first year of life compared with children born to mothers with no malaria during pregnancy. Malaria infections with placental sequestration have long-lasting impact on infant susceptibility to malaria infection.
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Affiliation(s)
- Sarah Boudová
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore
| | | | | | | | - Tamiwe Tomoka
- Department of Histopathology, University of Malawi College of Medicine, Blantyre
| | - Miriam K Laufer
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore
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Harrington WE, Kanaan SB, Muehlenbachs A, Morrison R, Stevenson P, Fried M, Duffy PE, Nelson JL. Maternal Microchimerism Predicts Increased Infection but Decreased Disease due to Plasmodium falciparum During Early Childhood. J Infect Dis 2017; 215:1445-1451. [PMID: 28329160 DOI: 10.1093/infdis/jix129] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background A mother's infection with placental malaria (PM) can affect her child's susceptibility to malaria, although the mechanism remains unclear. The fetus acquires a small amount of maternal cells and DNA known as maternal microchimerism (MMc), and we hypothesized that PM increases MMc and that MMc alters risk of Plasmodium falciparum malaria during infancy. Methods In a nested cohort from Muheza, Tanzania, we evaluated the presence and level of cord blood MMc in offspring of women with and without PM. A maternal-specific polymorphism was identified for each maternal-infant pair, and MMc was assayed by quantitative polymerase chain reaction. The ability of MMc to predict malaria outcomes during early childhood was evaluated in longitudinal models. Results Inflammatory PM increased the detection rate of MMc among offspring of primigravidae and secundigravidae, and both noninflammatory and inflammatory PM increased the level of MMc. Detectable MMc predicted increased risk of positive blood smear but, interestingly, decreased risk of symptomatic malaria and malaria hospitalization. Conclusions The acquisition of MMc may result in increased malaria infection but protection from malaria disease. Future studies should be directed at the cellular component of MMc, with attention to its ability to directly or indirectly coordinate anti-malarial immune responses in the offspring.
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Affiliation(s)
- Whitney E Harrington
- Department of Pediatrics, University of Washington School of Medicine/Seattle Children's Hospital, Washington
| | - Sami B Kanaan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Atis Muehlenbachs
- Department of Pathology, University of Washington, Seattle, Washington
| | - Robert Morrison
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Philip Stevenson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - J Lee Nelson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Rheumatology, University of Washington, Seattle
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34
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d’Almeida TC, Sadissou I, Milet J, Cottrell G, Mondière A, Avokpaho E, Gineau L, Sabbagh A, Massougbodji A, Moutairou K, Donadi EA, Favier B, Carosella E, Moreau P, Rouas-Freiss N, Courtin D, Garcia A. Soluble human leukocyte antigen -G during pregnancy and infancy in Benin: Mother/child resemblance and association with the risk of malaria infection and low birth weight. PLoS One 2017; 12:e0171117. [PMID: 28166246 PMCID: PMC5293225 DOI: 10.1371/journal.pone.0171117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/04/2017] [Indexed: 11/19/2022] Open
Abstract
Human leukocyte antigen (HLA) G is a tolerogenic molecule involved in the maternal-fetal immune tolerance phenomenon. Its expression during some infectious diseases leading to immune evasion has been established. A first study conducted in Benin has shown that the production of soluble HLA-G (sHLA-G) during the first months of life is strongly correlated with the maternal level at delivery and associated with low birth weight and malaria. However sHLA-G measurements during pregnancy were not available for mothers and furthermore, to date the evolution of sHLA-G in pregnancy is not documented in African populations. To extend these previous findings, between January 2010 and June 2013, 400 pregnant women of a malaria preventive trial and their newborns were followed up in Benin until the age of 2 years. Soluble HLA-G was measured 3 times during pregnancy and repeatedly during the 2 years follow-up to explore how sHLA-G evolved and the factors associated. During pregnancy, plasma levels of sHLA-G remained stable and increased significantly at delivery (p<0.001). Multigravid women seemed to have the highest levels (p = 0.039). In infants, the level was highest in cord blood and decreased before stabilizing after 18 months (p<0.001). For children, a high level of sHLA-G was associated with malaria infection during the follow-up (p = 0.02) and low birth weight (p = 0.06). The mean level of sHLA-G during infancy was strongly correlated with the mother’s level during pregnancy (<0.001), and not only at delivery. Moreover, mothers with placental malaria infection had a higher probability of giving birth to a child with a high level of sHLA-g (p = 0.006). High sHLA-G levels during pregnancy might be associated with immune tolerance related to placental malaria. Further studies are needed but this study provides a first insight concerning the potential role of sHLA-G as a biomarker of weakness for newborns and infants.
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Affiliation(s)
- Tania C. d’Almeida
- Université Pierre et Marie Curie, Paris, France
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- * E-mail:
| | - Ibrahim Sadissou
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, 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, Cotonou, Bénin
- Université d’Abomey-Calavi, Cotonou, Bénin
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Jacqueline Milet
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Gilles Cottrell
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Amandine Mondière
- UMR 216-MERIT, Institut de Recherche pour le Développement, Campus de la Faculté des Sciences de la Santé (FSS) et de l’Institut des Sciences Biomédicales Appliquées (ISBA), Cotonou, Bénin
| | | | - Laure Gineau
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Audrey Sabbagh
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - 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, Cotonou, Bénin
- Université d’Abomey-Calavi, Cotonou, Bénin
| | | | - Eduardo A. Donadi
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Benoit Favier
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherches en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Edgardo Carosella
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherches en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Philippe Moreau
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherches en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Nathalie Rouas-Freiss
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherches en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - David Courtin
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - André Garcia
- Université Pierre et Marie Curie, Paris, France
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, 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, Cotonou, Bénin
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Kakuru A, Natureeba P, Muhindo MK, Clark TD, Havlir DV, Cohan D, Dorsey G, Kamya MR, Ruel T. Malaria burden in a birth cohort of HIV-exposed uninfected Ugandan infants living in a high malaria transmission setting. Malar J 2016; 15:500. [PMID: 27756308 PMCID: PMC5070200 DOI: 10.1186/s12936-016-1568-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background HIV-exposed, uninfected (HEU) infants suffer high morbidity and mortality in the first year of life compared to HIV-unexposed, uninfected (HUU) infants, but accurate data on the contribution of malaria are limited. Methods The incidence of febrile illnesses and malaria were evaluated in a birth cohort of HEU infants. Infants were prescribed daily trimethoprim–sulfamethoxazole (TS) prophylaxis from 6 weeks of age until exclusion of HIV-infection after cessation of breastfeeding. Infants were followed for all illnesses using passive surveillance and routine blood smears were done monthly. Malaria was diagnosed as a positive blood smear plus fever. Placental malaria was determined by histopathology, placental blood smear and PCR. Risk factors for time to first episode of malaria were assessed using a Cox proportional hazards model. Malaria incidence among HEU infants aged 6–12 months was compared to that in other cohorts of HEU and HUU infants from the same region. Results Among 361 HEU infants enrolled, 248 completed 12 months of follow-up resulting in 1562 episodes of febrile illness and 253 episodes of malaria after 305 person-years of follow-up. The incidence of febrile illness was 5.12 episodes per person-year (PPY), ranging from 4.13 episodes PPY in the first 4 months of life to 5.71 episodes PPY between 5 and 12 months of age. The overall malaria incidence was 0.83 episodes per person-year (PPY), increasing from 0.03 episodes PPY in the first 2 months of life to 2.00 episodes PPY between 11 and 12 months of age. There were no episodes of complicated malaria. The prevalence of asymptomatic parasitaemia was 1.2 % (19 of 1568 routine smears positive). Infants born to mothers with parasites detected from placental blood smears were at higher risk of malaria (hazard ratio = 4.51, P < 0.001). HEU infants in this study had a 2.4- to 3.5-fold lower incidence of malaria compared to HUU infants in other cohort studies from the same area. Conclusion The burden of malaria in this birth cohort of HEU infants living in a high-transmission setting and taking daily TS prophylaxis was relatively low. Alternative etiologies of fever should be considered in HEU-infants taking daily TS prophylaxis who present with fever. Trial Registration NCT00993031, registered 8 October, 2009
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Affiliation(s)
- Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - Paul Natureeba
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Mary K Muhindo
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Tamara D Clark
- Department of Medicine, University of California, San Francisco, USA
| | - Diane V Havlir
- Department of Medicine, University of California, San Francisco, USA
| | - Deborah Cohan
- Department of Obstetrics and Gynecology, University of California, San Francisco, USA
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
| | - Moses R Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Theodore Ruel
- Department of Pediatrics, University of California, San Francisco, USA
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36
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Timing of in utero malaria exposure influences fetal CD4 T cell regulatory versus effector differentiation. Malar J 2016; 15:497. [PMID: 27717402 PMCID: PMC5055709 DOI: 10.1186/s12936-016-1545-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/04/2016] [Indexed: 11/26/2022] Open
Abstract
Background In malaria-endemic areas, the first exposure to malaria antigens often occurs in utero when the fetal immune system is poised towards the development of tolerance. Children exposed to placental malaria have an increased risk of clinical malaria in the first few years of life compared to unexposed children. Recent work has suggested the potential of pregnancy-associated malaria to induce immune tolerance in children living in malaria-endemic areas. A study was completed to evaluate the effect of malaria exposure during pregnancy on fetal immune tolerance and effector responses. Methods Using cord blood samples from a cohort of mother-infant pairs followed from early in pregnancy until delivery, flow cytometry analysis was completed to assess the relationship between pregnancy-associated malaria and fetal cord blood CD4 and dendritic cell phenotypes. Results Cord blood FoxP3+ Treg counts were higher in infants born to mothers with Plasmodium parasitaemia early in pregnancy (12–20 weeks of gestation; p = 0.048), but there was no association between Treg counts and the presence of parasites in the placenta at the time of delivery (by loop-mediated isothermal amplification (LAMP); p = 0.810). In contrast, higher frequencies of activated CD4 T cells (CD25+FoxP3−CD127+) were observed in the cord blood of neonates with active placental Plasmodium infection at the time of delivery (p = 0.035). This population exhibited evidence of effector memory differentiation, suggesting priming of effector T cells in utero. Lastly, myeloid dendritic cells were higher in the cord blood of infants with histopathologic evidence of placental malaria (p < 0.0001). Conclusion Together, these data indicate that in utero exposure to malaria drives expansion of both regulatory and effector T cells in the fetus, and that the timing of this exposure has a pivotal role in determining the polarization of the fetal immune response.
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37
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Gbédandé K, Cottrell G, Vianou B, Ibitokou S, Fernando A, Troye-Blomberg M, Salanti A, Moutairou K, Massougbodji A, Ndam NT, Deloron P, Luty AJF, Fievet N. Infections with Plasmodium falciparum during pregnancy affect VAR2CSA DBL-5 domain-specific T cell cytokine responses. Malar J 2016; 15:485. [PMID: 27653505 PMCID: PMC5031276 DOI: 10.1186/s12936-016-1525-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/06/2016] [Indexed: 01/15/2023] Open
Abstract
Background Current knowledge of human immunological responses to pregnancy-associated malaria-specific Plasmodium falciparum protein VAR2CSA concerns almost exclusively B cell-driven
antibody-mediated activity. Knowledge of VAR2CSA-specific T cell-mediated activity is minimal by comparison, with only a single published report of a study investigating VAR2CSA-derived peptide-specific T cell responses. The study described here represents an attempt to redress this balance. Methods Within the framework of a cohort study of 1037 pregnant Beninese, sub-groups were selected on the basis of the documented presence/absence of infection with P. falciparum and conducted detailed immunological assessments both at inclusion into the study and at delivery. Peripheral blood mononuclear cells were isolated, stimulated in vitro, and VAR2CSA DBL-5 domain-specific, IFN-γ-secreting T-cell frequencies and cytokine responses were quantified using flow cytometric techniques. Multivariate analyses were used to determine primarily whether the T cell-mediated DBL5-specific activity measured was associated with infection by P. falciparum adjusted for gravidity, anaemia and other cofactors. Results Infections with P. falciparum detected at inclusion were associated with enhanced non-specific TNF responses, whilst diminished non-specific and DBL-5-specific IL-10 responses were associated with infections detected at delivery. Infections during pregnancy led to enhanced non-specific and DBL-5-specific IFN-γ responses detectable at delivery but to concomitantly lower DBL-5-specific CD8+ IFN-γ responses. Prospective assessments indicated that non-specific pro-inflammatory responses detectable at inclusion in the study were associated with the occurrence of infections subsequently during pregnancy. Conclusions The findings represent a first step in elucidating the quantity and quality of cellular immunological responses to VAR2CSA, which will help in the development of the primary vaccine candidate for prevention of pregnancy-associated malaria. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1525-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Komi Gbédandé
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin.,Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Cotonou, Benin.,Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France
| | - Gilles Cottrell
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin.,Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France.,COMUE Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Bertin Vianou
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - Samad Ibitokou
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - Aurax Fernando
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - Marita Troye-Blomberg
- Department of Molecular Biosciences, the Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Ali Salanti
- Department of International Health, Institute of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Kabirou Moutairou
- Département de Biochimie et de Biologie Cellulaire, 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 (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - Nicaise Tuikue Ndam
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin.,Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France.,COMUE Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Philippe Deloron
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France.,COMUE Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Adrian J F Luty
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France.,COMUE Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Nadine Fievet
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin. .,Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France. .,COMUE Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France.
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38
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Non-malaria fevers in a high malaria endemic area of Ghana. BMC Infect Dis 2016; 16:327. [PMID: 27400781 PMCID: PMC4940727 DOI: 10.1186/s12879-016-1654-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/07/2016] [Indexed: 12/04/2022] Open
Abstract
Background The importance of fevers not due to malaria [non–malaria fevers, NMFs] in children in sub-Saharan Africa is increasingly being recognised. We have investigated the influence of exposure-related factors and placental malaria on the risk of non-malaria fevers among children in Kintampo, an area of Ghana with high malaria transmission. Methods Between 2008 and 2011, a cohort of 1855 newborns was enrolled and followed for at least 12 months. Episodes of illness were detected by passive case detection. The primary analysis covered the period from birth up to 12 months of age, with an exploratory analysis of a sub-group of children followed for up to 24 months. Results The incidence of all episodes of NMF in the first year of life (first and subsequent) was 1.60 per child-year (95 % CI 1.54, 1.66). The incidence of NMF was higher among infants with low birth weight [adjusted hazard ratio (aHR) 1.22 (95 % CI 1.04–1.42) p = 0.012], infants from households of poor socio-economic status [aHR 1.22 (95 % CI 1.02–1.46) p = 0.027] and infants living furthest from a health facility [aHR 1.20 (95 % CI 1.01–1.43) p = 0.037]. The incidence of all episodes of NMF was similar among infants born to mothers with or without placental malaria [aHR 0.97 (0.87, 1.08; p = 0.584)]. Conclusion The incidence of NMF in infancy is high in the study area. The incidence of NMF is associated with low birth weight and poor socioeconomic status but not with placental malaria. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1654-4) contains supplementary material, which is available to authorized users.
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De Beaudrap P, Turyakira E, Nabasumba C, Tumwebaze B, Piola P, Boum Ii Y, McGready R. Timing of malaria in pregnancy and impact on infant growth and morbidity: a cohort study in Uganda. Malar J 2016; 15:92. [PMID: 26879849 PMCID: PMC4754923 DOI: 10.1186/s12936-016-1135-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/29/2016] [Indexed: 11/06/2022] Open
Abstract
Background Malaria in pregnancy (MiP) is a major cause of fetal growth restriction and low birth weight in endemic areas of sub-Saharan Africa. Understanding of the impact of MiP on infant growth and infant risk of malaria or morbidity is poorly characterized. The objective of this study was to describe the impact of MIP on subsequent infant growth, malaria and morbidity. Methods Between 2006 and 2009, 82 % (832/1018) of pregnant women with live-born singletons and ultrasound determined gestational age were enrolled in a prospective cohort with active weekly screening and treatment for malaria. Infants were followed monthly for growth and morbidity and received active monthly screening and treatment for malaria during their first year of life. Multivariate analyses were performed to analyse the association between malaria exposure during pregnancy and infants’ growth, malaria infections, diarrhoea episodes and acute respiratory infections. Results Median time of infant follow-up was 12 months and infants born to a mother who had MiP were at increased risk of impaired height and weight gain (−2.71 cm, 95 % CI −4.17 to −1.25 and −0.42 kg, 95 % CI −0.76 to −0.08 at 12 months for >1 MiP compared to no MiP) and of malaria infection (relative risk 10.42, 95 % CI 2.64–41.10 for infants born to mothers with placental malaria). The risks of infant growth restriction and infant malaria infection were maximal when maternal malaria occurred in the 12 weeks prior to delivery. Recurrent MiP was also associated with acute respiratory infection (RR 1.96, 95 % CI 1.25–3.06) and diarrhoea during infancy (RR 1.93, 95 % CI 1.02–3.66). Conclusion This study shows that despite frequent active screening and prompt treatment of MiP, impaired growth and an increased risk of malaria and non-malaria infections can be observed in the infants. Effective preventive measures in pregnancy remain a research priority. This study was registered with ClinicalTrials.gov, number NCT00495508.
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Affiliation(s)
- Pierre De Beaudrap
- Epicentre, Paris, France. .,Ceped, Institut de Recherche pour le Développement, Paris, France.
| | - Eleanor Turyakira
- Epicentre, Mbarara, Uganda. .,Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
| | | | | | - Patrice Piola
- Institut Pasteur de Madagascar, Tananarive, Madagascar.
| | | | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. .,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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40
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Brembilla A, Mauny F, Garcia A, Koura KG, Deloron P, Faucher JF. Antibiotics usage in infants during the first 18 months of life in Benin: a population-based cohort study. Eur J Clin Microbiol Infect Dis 2016; 35:681-9. [PMID: 26864042 DOI: 10.1007/s10096-016-2587-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/14/2016] [Indexed: 01/21/2023]
Abstract
Data centered on antibiotics usage and their determinants in African pediatric populations are limited. In order to define the determinants of antibiotics prescriptions (ABPr), we analyzed the data of a birth cohort in Benin. From 2007 to 2009, 538 infants were followed from birth to 18 months in three different health centers. The following determinants were assessed: infants' clinical findings at consultations, mothers' and children's characteristics at birth, and health parameters recorded at scheduled follow-up of general health parameters. Multilevel logistic models were performed for analysis. Among the 4394 consultations, fever represented 53.7 % of consultations, 64.1 % of which were non-malarial fevers. Antibiotics were prescribed during 44.2 % of the consultations and the proportion of ABPr differed significantly among health centers (p < 10(-3)). Nearly 40 % of ABPr were related to children without fever. During the first semester of life, the percentage of ABPr was twice lower than after (27.4 vs. 54.7, p < 10(-3)). Respiratory and enteric symptoms were positively associated with ABPr (p < 10(-3)). Malaria was significantly associated with a lower ABPr after the first semester [odds ratio (OR) = 0.55, 95 % confidence interval (CI) = 0.44-0.67, p < 10(-3)]. No maternal and child at-birth characteristics were associated with ABPr. ABPr was positively associated with a low breastfeeding score (p < 10(-3)). Studies on the rational use of antibiotics in this population should give priority to children more than 6 months of age, without malaria, and with respiratory and/or enteric symptoms. Our data also advocate for studies specifically designed to assess and improve healthcare providers' compliance to guidelines on antibiotics usage.
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Affiliation(s)
- A Brembilla
- Laboratoire Chrono-Environnement UMR CNRS 6249, Université Bourgogne Franche-Comté, 25000, Besançon, France. .,Centre de Méthodologie Clinique, Centre Hospitalier Régional Universitaire de Besançon, 2 Place Saint-Jacques, 25000, Besançon, France.
| | - F Mauny
- Laboratoire Chrono-Environnement UMR CNRS 6249, Université Bourgogne Franche-Comté, 25000, Besançon, France.,Centre de Méthodologie Clinique, Centre Hospitalier Régional Universitaire de Besançon, 2 Place Saint-Jacques, 25000, Besançon, France
| | - A Garcia
- UMR 216 MERIT IRD, Paris, France.,PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - K G Koura
- Union Internationale Contre la Tuberculose et les Maladies Respiratoires, Paris, France
| | - P Deloron
- UMR 216 MERIT IRD, Paris, France.,PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - J-F Faucher
- UMR 216 MERIT IRD, Paris, France.,PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
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Abstract
Malaria is one of the most serious infectious diseases with most of the severe disease
caused by Plasmodium falciparum (Pf). Naturally acquired immunity
develops over time after repeated infections and the development of antimalarial
antibodies is thought to play a crucial role. Neonates and young infants are relatively
protected from symptomatic malaria through mechanisms that are poorly understood. The
prevailing paradigm is that maternal antimalarial antibodies transferred to the fetus in
the last trimester of pregnancy protect the infant from early infections. These
antimalarial antibodies wane by approximately 6 months of age leaving the infant
vulnerable to malaria, however direct evidence supporting this epidemiologically based
paradigm is lacking. As infants are the target population for future malaria vaccines,
understanding how they begin to develop immunity to malaria and the gaps in their
responses is key. This review summarizes the antimalarial antibody responses detected in
infants and how they change over time. We focus primarily on Pf antibody responses and
will briefly mention Plasmodium vivax responses in infants.
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42
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Dechavanne C, Cottrell G, Garcia A, Migot-Nabias F. Placental Malaria: Decreased Transfer of Maternal Antibodies Directed to Plasmodium falciparum and Impact on the Incidence of Febrile Infections in Infants. PLoS One 2015; 10:e0145464. [PMID: 26698578 PMCID: PMC4689360 DOI: 10.1371/journal.pone.0145464] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/03/2015] [Indexed: 12/15/2022] Open
Abstract
The efficacy of mother-to-child placental transfer of antibodies specific to malaria blood stage antigens was investigated in the context of placental malaria infection, taking into account IgG specificity and maternal hypergammaglobulinemia. The impact of the resulting maternal antibody transfer on infections in infants up to the age of 6 months was also explored. This study showed that i) placental malaria was associated with a reduced placental transfer of total and specific IgG, ii) antibody placental transfer varied according to IgG specificity and iii) cord blood malaria IgG levels were similar in infants born to mothers with or without placental malaria. The number of malaria infections was negatively associated with maternal age, whereas it was not associated with the transfer of any malaria-specific IgG from the mother to the fetus. These results suggest that i) malaria-specific IgG may serve as a marker of maternal exposure but not as a useful marker of infant protection from malaria and ii) increasing maternal age contributes to diminishing febrile infections diagnosed in infants, perhaps by means of the transmission of an effective antibody response.
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Affiliation(s)
- Celia Dechavanne
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
- * E-mail:
| | - Gilles Cottrell
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - André Garcia
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Florence Migot-Nabias
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
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43
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Nouatin O, Gbédandé K, Ibitokou S, Vianou B, Houngbegnon P, Ezinmegnon S, Borgella S, Akplogan C, Cottrell G, Varani S, Massougbodji A, Moutairou K, Troye-Blomberg M, Deloron P, Luty AJF, Fievet N. Infants' Peripheral Blood Lymphocyte Composition Reflects Both Maternal and Post-Natal Infection with Plasmodium falciparum. PLoS One 2015; 10:e0139606. [PMID: 26580401 PMCID: PMC4651557 DOI: 10.1371/journal.pone.0139606] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022] Open
Abstract
Maternal parasitoses modulate fetal immune development, manifesting as altered cellular immunological activity in cord blood that may be linked to enhanced susceptibility to infections in early life. Plasmodium falciparum typifies such infections, with distinct placental infection-related changes in cord blood exemplified by expanded populations of parasite antigen-specific regulatory T cells. Here we addressed whether such early-onset cellular immunological alterations persist through infancy. Specifically, in order to assess the potential impacts of P. falciparum infections either during pregnancy or during infancy, we quantified lymphocyte subsets in cord blood and in infants' peripheral blood during the first year of life. The principal age-related changes observed, independent of infection status, concerned decreases in the frequencies of CD4+, NKdim and NKT cells, whilst CD8+, Treg and Teff cells' frequencies increased from birth to 12 months of age. P. falciparum infections present at delivery, but not those earlier in gestation, were associated with increased frequencies of Treg and CD8+ T cells but fewer CD4+ and NKT cells during infancy, thus accentuating the observed age-related patterns. Overall, P. falciparum infections arising during infancy were associated with a reversal of the trends associated with maternal infection i.e. with more CD4+ cells, with fewer Treg and CD8+ cells. We conclude that maternal P. falciparum infection at delivery has significant and, in some cases, year-long effects on the composition of infants' peripheral blood lymphocyte populations. Those effects are superimposed on separate and independent age- as well as infant infection-related alterations that, respectively, either match or run counter to them.
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MESH Headings
- Adult
- Antigens, Protozoan/genetics
- Antigens, Protozoan/immunology
- Benin
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/pathology
- Female
- Fetal Blood/immunology
- Fetal Blood/parasitology
- Humans
- Immunophenotyping
- Infant
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Lymphocyte Count
- Malaria, Falciparum/immunology
- Malaria, Falciparum/parasitology
- Malaria, Falciparum/pathology
- Natural Killer T-Cells/immunology
- Natural Killer T-Cells/pathology
- Placenta/immunology
- Placenta/parasitology
- Placenta/pathology
- Plasmodium falciparum/immunology
- Pregnancy
- Pregnancy Complications, Parasitic/immunology
- Pregnancy Complications, Parasitic/parasitology
- Pregnancy Complications, Parasitic/pathology
- Retrospective Studies
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/pathology
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Affiliation(s)
- Odilon Nouatin
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Komi Gbédandé
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Samad Ibitokou
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Bertin Vianou
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Parfait Houngbegnon
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Sem Ezinmegnon
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Sophie Borgella
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France
| | - Carine Akplogan
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Gilles Cottrell
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Stefania Varani
- Unit of Microbiology, Department of Diagnostic, Experimental and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Achille Massougbodji
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
| | - Kabirou Moutairou
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Marita Troye-Blomberg
- Department of Molecular Biosciences, the Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Philippe Deloron
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Adrian J. F. Luty
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Nadine Fievet
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, MERIT UMR D216 Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
- * E-mail:
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44
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Ruizendaal E, van Leeuwen E, Mens PF. Peripheral and placental biomarkers in women with placental malaria: a systematic review. Biomark Med 2015; 9:217-39. [PMID: 25731209 DOI: 10.2217/bmm.14.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Placental malaria (PM) causes significant morbidity in mothers and infants. Diagnosis of PM during pregnancy is however problematic due to placental sequestration of parasites. Host biomarkers may therefore be used as a diagnostic method. In this systematic review most studies focused on inflammatory markers. A trend was observed for increased IL-10 and TNF-α in PM positives. These markers are however unspecific, thus a combination of multiple biomarkers involved in different pathophysiological pathways of PM is indicated. Of interest are inflammatory markers (TNF-R2, CXCL-13), markers of lipid metabolism (APO-B), angiogenesis (sFlt-1) and hormones (estradiol). As the majority of published studies tested biomarker levels only at delivery, more longitudinal cohort studies will be necessary to detect biomarkers during pregnancy that can predict PM.
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Affiliation(s)
- Esmée Ruizendaal
- KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
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45
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Drame PM, Poinsignon A, Dechavanne C, Cottrell G, Farce M, Ladekpo R, Massougbodji A, Cornélie S, Courtin D, Migot-Nabias F, Garcia A, Remoué F. Specific antibodies to Anopheles gSG6-P1 salivary peptide to assess early childhood exposure to malaria vector bites. Malar J 2015. [PMID: 26198354 PMCID: PMC4511589 DOI: 10.1186/s12936-015-0800-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The estimates of risk of malaria in early childhood are imprecise given the current entomologic and parasitological tools. Thus, the utility of anti-Anopheles salivary gSG6-P1 peptide antibody responses in measuring exposure to Anopheles bites during early infancy has been assessed. Methods Anti-gSG6-P1 IgG and IgM levels were evaluated in 133 infants (in Benin) at three (M3), six (M6), nine (M9) and 12 (M12) months of age. Specific IgG levels were also assessed in their respective umbilical cord blood (IUCB) and maternal blood (MPB). Results At M3, 93.98 and 41.35% of infants had anti-gSG6-P1 IgG and IgM Ab, respectively. Specific median IgG and IgM levels gradually increased between M3 and M6 (p < 0.0001 and p < 0.001), M6–M9 (p < 0.0001 and p = 0.085) and M9–M12 (p = 0.002 and p = 0.03). These levels were positively associated with the Plasmodium falciparum infection intensity (p = 0.006 and 0.003), and inversely with the use of insecticide-treated bed nets (p = 0.003 and 0.3). Levels of specific IgG in the MPB were positively correlated to those in the IUCB (R = 0.73; p < 0.0001) and those at M3 (R = 0.34; p < 0.0001). Conclusion The exposure level to Anopheles bites, and then the risk of malaria infection, can be evaluated in young infants by assessing anti-gSG6-P1 IgM and IgG responses before and after 6-months of age, respectively. This tool can be useful in epidemiological evaluation and surveillance of malaria risk during the first year of life.
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Affiliation(s)
- Papa M Drame
- UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Institut de Recherche pour le Développement (IRD), BP64501, 34394, Montpellier, France. .,IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), 01 BP 4414RP, Cotonou, Benin. .,Laboratory of Parasitic Diseases, NIAID, NIH, 4 Center Dr, Bethesda, MD, 20892-0425, USA.
| | - Anne Poinsignon
- UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Institut de Recherche pour le Développement (IRD), BP64501, 34394, Montpellier, France.
| | - Célia Dechavanne
- IRD UMR 216 Mère et enfant face aux infections tropicales, 75006, Paris, France. .,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France.
| | - Gilles Cottrell
- IRD UMR 216 Mère et enfant face aux infections tropicales, 75006, Paris, France. .,Laboratoire de Mathématiques Appliquées, Université Paris Descartes, 75006, Paris, France.
| | - Manon Farce
- UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Institut de Recherche pour le Développement (IRD), BP64501, 34394, Montpellier, France.
| | - Rodolphe Ladekpo
- Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Cotonou, Benin.
| | - Achille Massougbodji
- Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Cotonou, Benin. .,Faculté des Sciences de la Santé, Université d'Abomey-Calavi, 01 BP 188, Cotonou, Benin.
| | - Sylvie Cornélie
- UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Institut de Recherche pour le Développement (IRD), BP64501, 34394, Montpellier, France.
| | - David Courtin
- IRD UMR 216 Mère et enfant face aux infections tropicales, 75006, Paris, France. .,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France. .,Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Cotonou, Benin.
| | - Florence Migot-Nabias
- IRD UMR 216 Mère et enfant face aux infections tropicales, 75006, Paris, France. .,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France.
| | - André Garcia
- IRD UMR 216 Mère et enfant face aux infections tropicales, 75006, Paris, France. .,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France.
| | - Franck Remoué
- UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Institut de Recherche pour le Développement (IRD), BP64501, 34394, Montpellier, France. .,IRD-UMR MIVEGEC (IRD224-CNRS5290-Universités Montpellier 1 et 2), Centre de Recherche Entomologique de Cotonou (CREC), 01 BP 4414RP, Cotonou, Benin.
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Accrombessi M, Ouédraogo S, Agbota GC, Gonzalez R, Massougbodji A, Menéndez C, Cot M. Malaria in Pregnancy Is a Predictor of Infant Haemoglobin Concentrations during the First Year of Life in Benin, West Africa. PLoS One 2015; 10:e0129510. [PMID: 26052704 PMCID: PMC4460073 DOI: 10.1371/journal.pone.0129510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/08/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Anaemia is an increasingly recognized health problem in Africa, particularly in infants and pregnant women. Although malaria is known to be the main risk factor of anaemia in both groups, the consequences of maternal factors, particularly malaria in pregnancy (MiP), on infant haemoglobin (Hb) concentrations during the first months of life are still unclear. METHODS We followed-up a cohort of 1005 Beninese pregnant women from the beginning of pregnancy until delivery. A subsample composed of the first 400 offspring of these women were selected at birth and followed until the first year of life. Placental histology and blood smear at 1st clinical antenatal visit (ANC), 2nd ANC and delivery were used to assess malaria during pregnancy. Infant Hb concentrations were measured at birth, 6, 9 and 12 months of age. A mixed multi-level model was used to assess the association between MiP and infant Hb variations during the first 12 months of life. RESULTS Placental malaria (difference mean [dm] = - 2.8 g/L, 95% CI [-5.3, -0.3], P = 0.03) and maternal peripheral parasitaemia at delivery (dm = - 4.6 g/L, 95% CI [-7.9, -1.3], P = 0.007) were the main maternal factors significantly associated with infant Hb concentrations during the first year of life. Poor maternal nutritional status and malaria infection during infancy were also significantly associated with a decrease in infant Hb. CONCLUSION Antimalarial control and nutritional interventions before and during pregnancy should be reinforced to reduce specifically the incidence of infant anaemia, particularly in Sub-Saharan countries.
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Affiliation(s)
- Manfred Accrombessi
- Institut de Recherche pour le Développement (IRD), UMR216-Mère et enfant face aux infections tropicales, Paris, France
- PRES Paris Sorbonne Cité, Université Paris Descartes, Paris, France
- Faculté de Médecine de Cotonou, Université d’Abomey-Calavi, Cotonou, Benin
- * E-mail:
| | - Smaïla Ouédraogo
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Gino Cédric Agbota
- Institut de Recherche pour le Développement (IRD), UMR216-Mère et enfant face aux infections tropicales, Paris, France
- PRES Paris Sorbonne Cité, Université Paris Descartes, Paris, France
- Faculté de Médecine de Cotonou, Université d’Abomey-Calavi, Cotonou, Benin
| | - Raquel Gonzalez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | | | - Clara Menéndez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Michel Cot
- Institut de Recherche pour le Développement (IRD), UMR216-Mère et enfant face aux infections tropicales, Paris, France
- PRES Paris Sorbonne Cité, Université Paris Descartes, Paris, France
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Apinjoh TO, Anchang-Kimbi JK, Mugri RN, Njua-Yafi C, Tata RB, Chi HF, Tangoh DA, Loh BT, Achidi EA. Determinants of infant susceptibility to malaria during the first year of life in South Western cameroon. Open Forum Infect Dis 2015; 2:ofv012. [PMID: 26034763 PMCID: PMC4438893 DOI: 10.1093/ofid/ofv012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/22/2015] [Indexed: 12/02/2022] Open
Abstract
Background. Falciparum malaria is an important pediatric infectious disease that frequently affects pregnant women and alters infant morbidity. However, the impact of some prenatal and perinatal risk factors such as season and intermittent preventive treatment during pregnancy (IPTp) on neonatal susceptibility has not been fully elucidated. Methods. A cohort of 415 infants born to women who were positive and negative for malaria was monitored in a longitudinal study in Southwestern Cameroon. The clinical and malaria statuses were assessed throughout, whereas paired maternal-cord and 1-year-old antimalarial antibodies were assayed by enzyme-linked immunosorbent assay. Infant susceptibility to malaria was ascertained after accounting for IPTp and season in the statistical analysis. Results. Malaria prevalence was higher in women (P = .039) who delivered during the rainy season and their infants (P = .030) compared with their dry season counterparts. Infants born to women who were positive for malaria (6.40 ± 2.83 months) were older (P = .028) than their counterparts who were negative for malaria (5.52 ± 2.85 months) when they experienced their first malaria episode. Infants born in September-November (adjusted odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.13-0.72) and to mothers on 1 or no IPTp-sulfadoxine/pyrimethamine (SP) dose (adjusted OR = 0.51, 95% CI = 0.28-0.91) were protected, whereas those born in the rainy season (adjusted OR = 2.82, 95% CI = 1.21-6.55) were susceptible to malaria. Conclusions. Intermittent preventive treatment during pregnancy and month of birth have important implications for infant susceptibility to malaria, with 2 or more IPTp-SP dosage possibly reducing immunoglobulin M production.
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Affiliation(s)
| | | | - Regina N. Mugri
- Medical Laboratory Science
- Microbiology and Parasitology, University of Buea
| | - Clarisse Njua-Yafi
- Department of Animal Biology and Physiology, University of Yaounde I, Cameroon
| | - Rolland B. Tata
- Medical Laboratory Science
- Microbiology and Parasitology, University of Buea
| | - Hanesh F. Chi
- Medical Laboratory Science
- Microbiology and Parasitology, University of Buea
| | - Delphine A. Tangoh
- Departments of Biochemistry and Molecular Biology
- Medical Laboratory Science
| | | | - Eric A. Achidi
- Departments of Biochemistry and Molecular Biology
- Medical Laboratory Science
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48
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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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49
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Borgella S, Fievet N, Huynh BT, Ibitokou S, Hounguevou G, Affedjou J, Sagbo JC, Houngbegnon P, Guezo-Mévo B, Massougbodji A, Luty AJF, Cot M, Deloron P. Impact of pregnancy-associated malaria on infant malaria infection in southern Benin. PLoS One 2013; 8:e80624. [PMID: 24236190 PMCID: PMC3827421 DOI: 10.1371/journal.pone.0080624] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infants of mothers with placental Plasmodium falciparum infections at delivery are themselves more susceptible to malaria attacks or to infection in early life. METHODOLOGY/ PRINCIPAL FINDINGS To assess the impact of either the timing or the number of pregnancy-associated malaria (PAM) infections on the incidence of parasitemia or malaria attacks in infancy, we followed 218 mothers through pregnancy (monthly visits) up to delivery and their infants from birth to 12 months of age (fortnightly visits), collecting detailed clinical and parasitological data. After adjustment on location, mother's age, birth season, bed net use, and placental malaria, infants born to a mother with PAM during the third trimester of pregnancy had a significantly increased risk of infection (OR [95% CI]: 4.2 [1.6; 10.5], p = 0.003) or of malaria attack (4.6 [1.7; 12.5], p = 0.003). PAM during the first and second trimesters had no such impact. Similarly significant results were found for the effect of the overall number of PAM episodes on the time to first parasitemia and first malaria attack (HR [95% CI]: 2.95 [1.58; 5.50], p = 0.001 and 3.19 [1.59; 6.38], p = 0.001) respectively. CONCLUSIONS/ SIGNIFICANCE This study highlights the importance of protecting newborns by preventing repeated episodes of PAM in their mothers.
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Affiliation(s)
- Sophie Borgella
- Centre d’étude et de recherche sur le paludisme associé à la grossesse et à l’enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Nadine Fievet
- Centre d’étude et de recherche sur le paludisme associé à la grossesse et à l’enfance (CERPAGE), Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
- * E-mail:
| | - Bich-Tram Huynh
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Samad Ibitokou
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Gbetognon Hounguevou
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Jacqueline Affedjou
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Jean-Claude Sagbo
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Parfait Houngbegnon
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Blaise Guezo-Mévo
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Achille Massougbodji
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Adrian J. F. Luty
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Michel Cot
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
| | - Philippe Deloron
- Institut de Recherche pour le Développement, UMR 216, Mère et enfant face aux infections tropicales, Paris, France
- PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté de Pharmacie, Paris, France
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50
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Hammami I, Garcia A, Nuel G. Evidence for overdispersion in the distribution of malaria parasites and leukocytes in thick blood smears. Malar J 2013; 12:398. [PMID: 24195469 PMCID: PMC3831262 DOI: 10.1186/1475-2875-12-398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/22/2013] [Indexed: 11/24/2022] Open
Abstract
Background Microscopic examination of stained thick blood smears (TBS) is the gold standard for routine malaria diagnosis. Parasites and leukocytes are counted in a predetermined number of high power fields (HPFs). Data on parasite and leukocyte counts per HPF are of broad scientific value. However, in published studies, most of the information on parasite density (PD) is presented as summary statistics (e.g. PD per microlitre, prevalence, absolute/assumed white blood cell counts), but original data sets are not readily available. Besides, the number of parasites and the number of leukocytes per HPF are assumed to be Poisson-distributed. However, count data rarely fit the restrictive assumptions of the Poisson distribution. The violation of these assumptions commonly results in overdispersion. The objectives of this paper are to investigate and handle overdispersion in field-collected data. Methods The data comprise the records of three TBSs of 12-month-old children from a field study of Plasmodium falciparum malaria in Tori Bossito, Benin. All HPFs were examined systemically by visually scanning the film horizontally from edge to edge. The numbers of parasites and leukocytes per HPF were recorded and formed the first dataset on parasite and leukocyte counts per HPF. The full dataset is published in this study. Two sources of overdispersion in data are investigated: latent heterogeneity and spatial dependence. Unobserved heterogeneity in data is accounted for by considering more flexible models that allow for overdispersion. Of particular interest were the negative binomial model (NB) and mixture models. The dependent structure in data was modelled with hidden Markov models (HMMs). Results The Poisson assumptions are inconsistent with parasite and leukocyte distributions per HPF. Among simple parametric models, the NB model is the closest to the unknown distribution that generates the data. On the basis of model selection criteria AIC and BIC, HMMs provided a better fit to data than mixtures. Ordinary pseudo-residuals confirmed the validity of HMMs. Conclusion Failure to take overdispersion into account in parasite and leukocyte counts may entail important misleading inferences when these data are related to other explanatory variables (malariometric or environmental). Its detection is therefore essential. In addition, an alternative PD estimation method that accounts for heterogeneity and spatial dependence should be seriously considered in epidemiological studies with field-collected parasite and leukocyte data.
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Affiliation(s)
- Imen Hammami
- , Laboratoire de Mathématiques Appliquées (MAP5) UMR CNRS 8145Université Paris Descartes, Paris, France.
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