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Dadoun S, Demmler-Harrison GJ, Ketwaroo P, Castro EC, Cortes MS. Congenital toxoplasmosis of the brain caused by infection in late pregnancy. Lancet 2024; 403:1081-1082. [PMID: 38492943 DOI: 10.1016/s0140-6736(24)00257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Simon Dadoun
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | | | - Pamela Ketwaroo
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Eumenia C Castro
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Magdalena Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
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Kim S, Naziripour A, Prabhala P, Horváth V, Junaid A, Breault DT, Goyal G, Ingber DE. Direct therapeutic effect of sulfadoxine-pyrimethamine on nutritional deficiency-induced enteric dysfunction in a human Intestine Chip. EBioMedicine 2024; 99:104921. [PMID: 38101300 PMCID: PMC10733102 DOI: 10.1016/j.ebiom.2023.104921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Sulfadoxine-pyrimethamine (SP) antimalarial therapy has been suggested to potentially increase the birth weight of infants in pregnant women in sub-Saharan Africa, independently of malarial infection. Here, we utilized female intestinal organoid-derived cells cultured within microfluidic Organ Chips to investigate whether SP could directly impact intestinal function and thereby improve the absorption of essential fats and nutrients crucial for fetal growth. METHODS Using a human organ-on-a-chip model, we replicated the adult female intestine with patient organoid-derived duodenal epithelial cells interfaced with human intestinal endothelial cells. Nutrient-deficient (ND) medium was perfused to simulate malnutrition, resulting in the appearance of enteric dysfunction indicators such as villus blunting, reduced mucus production, impaired nutrient absorption, and increased inflammatory cytokine secretion. SP was administered to these chips in the presence or absence of human peripheral blood mononuclear cells (PBMCs). FINDINGS Our findings revealed that SP treatment effectively reversed multiple intestinal absorptive abnormalities observed in malnourished female Intestine Chips, as validated by transcriptomic and proteomic analyses. SP also reduced the production of inflammatory cytokines and suppressed the recruitment of PBMCs in ND chips. INTERPRETATION Our results indicate that SP could potentially increase birth weights by preventing enteric dysfunction and suppressing intestinal inflammation. This underscores the potential of SP as a targeted intervention to improve maternal absorption, subsequently contributing to healthier fetal growth. While SP treatment shows promise in addressing malabsorption issues that can influence infant birth weight, we did not model pregnancy in our chips, and thus its usefulness for treatment of malnourished pregnant women requires further investigation through clinical trials. FUNDING The Bill and Melinda Gates Foundation, and the Wyss Institute for Biologically Inspired Engineering at Harvard University, and the HDDC Organoid Core of the P30 DK034854.
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Affiliation(s)
- Seongmin Kim
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Arash Naziripour
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Pranav Prabhala
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Viktor Horváth
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Abidemi Junaid
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - David T Breault
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Department of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Stem Cell Institute, Cambridge, MA 02138, USA
| | - Girija Goyal
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Donald E Ingber
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA; Vascular Biology Program, Boston Children's Hospital and Department of Pathology, Harvard Medical School, Boston, MA 02115, USA; Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA 02139, USA.
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3
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Anabire NG, Quintana MDP, Ofori MF, Hviid L. The Rapid and Spontaneous Postpartum Clearance of Plasmodium falciparum Is Related to Expulsion of the Placenta. J Infect Dis 2023; 228:196-201. [PMID: 36740589 PMCID: PMC10345473 DOI: 10.1093/infdis/jiad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/29/2022] [Accepted: 02/02/2023] [Indexed: 02/07/2023] Open
Abstract
Parasitemia among pregnant women with protective immunity to Plasmodium falciparum malaria is often dominated by VAR2CSA-positive infected erythrocytes (IEs). VAR2CSA mediates sequestration of IEs in the placenta. We hypothesized that the previously observed spontaneous postpartum clearance of parasitemia in such women is related to the expulsion of the placenta, which removes the sequestration focus of VAR2CSA-positive IEs. We assessed parasitemias and gene transcription before and shortly after delivery in 17 Ghanaian women. The precipitous decline in parasitemia postpartum was accompanied by selective reduction in transcription of the gene encoding VAR2CSA. Our findings provide a mechanistic explanation for the earlier observation.
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Affiliation(s)
- Nsoh G Anabire
- Department of Immunology, Noguchi Memorial Institute for Medical Research,
University of Ghana, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, Department of
Biochemistry, Cell, and Molecular Biology, University of Ghana,
Accra, Ghana
- Centre for Medical Parasitology, Department of Immunology and Microbiology,
Faculty of Health and Medical Sciences, University of Copenhagen,
Copenhagen, Denmark
| | - Maria del Pilar Quintana
- Centre for Medical Parasitology, Department of Immunology and Microbiology,
Faculty of Health and Medical Sciences, University of Copenhagen,
Copenhagen, Denmark
| | - Michael F Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research,
University of Ghana, Accra, Ghana
| | - Lars Hviid
- Centre for Medical Parasitology, Department of Immunology and Microbiology,
Faculty of Health and Medical Sciences, University of Copenhagen,
Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet,
Copenhagen, Denmark
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Cariaco Y, Durán-Rodriguez AT, Almeida MPO, Silva NM. CCR5 contributes to adverse outcomes during malaria in pregnancy. Cytokine 2023; 162:156110. [PMID: 36565608 DOI: 10.1016/j.cyto.2022.156110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/12/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
CCR5 is a chemokine receptor that mediates cell recruitment to sites of inflammation. It has been previously reported that the expression of CCR5 is increased in the placentas of women with malaria, a disease characterized by causing deliveries with low birth weight among other complications. CCR5 has been associated with pathology of protozoan infections during pregnancy but its role during malaria in pregnancy has not been elucidated. In the present work, we assessed the pregnancy outcome, placental structure, and levels of inflammatory markers of pregnant C57BL/6 and CCR5-/- mice infected or not with Plasmodium berghei NK65, with the purpose of determine the role of CCR5 in pregnancy associated malaria complications. We demonstrated that the expression of CCR5 mRNA increases in late pregnancy placentas of C57BL/6 when compared to uninfected controls. Infected pregnant C57BL/6 mice showed preterm birth, decreased fetal weight, placental inefficiency, and reduced placental vascular space. On the other hand, CCR5 deficiency led to increased levels of maternal parasitemia, reduced fetal weight and placental inefficiency compared to C57BL/6 mice. However, the infection did not cause additional changes in these parameters or in the incidence of preterm delivery in infected CCR5-/- mice in relation to C57BL/6 mice, showing that CCR5 may contribute to the adverse effects caused by infection during pregnancy. This improvement in pregnancy outcome, observed in infected CCR5-/- mice, was accompanied by lower placental levels of the inflammatory markers, such as TNF and NAG. Furthermore, it was observed that the placentas of CCR5-/- animals showed structural differences in relation to C57BL/6 mice, which could improve the efficiency of maternal-fetal exchanges, reflecting on fetal weight. Taken together, these results indicate that CCR5 expression contributes to the adverse outcomes caused by malaria in late pregnancy.
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Affiliation(s)
- Yusmaris Cariaco
- Laboratory of Immunopathology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Andrea Tatiana Durán-Rodriguez
- Laboratory of Immunopathology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Marcos Paulo Oliveira Almeida
- Laboratory of Immunopathology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Neide Maria Silva
- Laboratory of Immunopathology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
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Megnekou R, Nana CMM, Djontu JC, Bitye BMZ, Nana BC, Zangue BKT, Donkeu CJ, Essangui E, Salawiss RM, Seumko’o RNM, Ayong L, Leke RGF. Chemokine modulation in microscopic and submicroscopic Plasmodium falciparum malaria infection in women at delivery in Yaoundé, Cameroon. PLoS One 2023; 18:e0280615. [PMID: 36689438 PMCID: PMC9870109 DOI: 10.1371/journal.pone.0280615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023] Open
Abstract
In pregnancy-associated malaria, chemokines such as CXCL-4, CXCL-13, CXCL-16, and CCL-24 play critical roles in leucocyte trafficking to tissue sites in the infected placenta where inflammatory reactions are active. However, how plasma levels of these chemokines associate with Plasmodium falciparum placental malaria and pregnancy outcomes remains not well understood. The present study analyzed the plasma levels of CXCL-4, CXCL-13, CXCL-16, and CCL-24 chemokines in matched peripheral, placental and cord blood in relation with placental malaria (PM), and with submicroscopic parasitaemia. This was a retrospective case-control study (1:3 ratio) involving samples from 134 women (34 PM+ and 100 PM-) enrolled at delivery at the Marie Reine Health Center in Yaoundé, Cameroon between June 2013 and October 2018. Samples were collected just after delivery and used to diagnose microscopic and submicroscopic Plasmodium falciparum infections. Submicroscopic infections were detected by reverse transcription LAMP whereas chemokine levels were determined by Magnetic Luminex Screening Assay. Overall, PM was associated with increased plasma levels of CXCL-13 and CXCL-16 and low levels of CXCL-4 and CCL-24 in both peripheral and placental blood (0.0002 ≤ p ≤ 0.042). Similarly, CCL-24 levels in peripheral and placental blood samples were significantly lower in submicroscopically infected women compared to healthy controls (p = 0.04 and 0.02, respectively). Maternal hemoglobin levels increased with peripheral plasma levels of CXCL-4 (p = 0.005), CXCL-16 (p = 0.03), and CCL-24 (p = 0.002) while birth weight was lower for babies born from women with high levels of peripheral CXCL-13 (p = 0.0006) and low levels of cord CXCL-4 and CCL-24 (p = 0.02 and 0.08, respectively). Together the data suggest that low levels of CXCL-4 and CCL-24 coupled with high plasma levels of CXCL-13 and for a lesser extend CXCL-16 represent signatures of PM in the study population. These findings are relevant for understanding the immunopathogenesis of PM and developing new therapeutic or preventive strategies against severe PM outcomes.
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Affiliation(s)
- Rosette Megnekou
- Department of Animal Biology and Physiology of the Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Chris Marco Mbianda Nana
- Department of Animal Biology and Physiology of the Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Claude Djontu
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Bernard Marie Zambo Bitye
- Department of Animal Biology and Physiology of the Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Benderli Christine Nana
- Department of Animal Biology and Physiology of the Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Berenice Kenfack Tekougang Zangue
- Department of Animal Biology and Physiology of the Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Estelle Essangui
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Rodrigue Mbea Salawiss
- Department of Animal Biology and Physiology of the Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Reine Ndeumou Medouen Seumko’o
- Department of Animal Biology and Physiology of the Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Lawrence Ayong
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Rose Gana Fomban Leke
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
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Zhang K, Liang D, Zhang D, Cao J, Huang J. Were Women Staying on Track with Intermittent Preventive Treatment for Malaria in Antenatal Care Settings? A Cross-Sectional Study in Senegal. Int J Environ Res Public Health 2022; 19:12866. [PMID: 36232166 PMCID: PMC9566319 DOI: 10.3390/ijerph191912866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
A significant gap exists between high rates of antenatal care attendance and low uptake of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in Senegal. This study aims to investigate whether IPTp-SP is delivered per Senegal's national guidelines and to identify factors affecting the delivery of IPTp-SP at antenatal care visits. A secondary analysis was conducted using the 2014 and 2016 Senegal's Service Provision Assessment. The study sample consists of 1076 antenatal care across 369 health facilities. Multiple logit regression models were used to estimate the probability of receiving IPTp-SP during the antenatal care visit based on prior receipt of IPTp-SP and gestational age during the current pregnancy. At an antenatal care visit, the probability of receiving IPTp-SP is 84% (95% CI = [83%, 86%]) among women with no IPTp-SP history and 85% (95% CI = [79%, 92%]) among women with one prior dose. Women who visit a facility in the top quintile of the proportion of IPTp trained staff have a nearly 4-fold higher odds of receiving IPTp compared to those who visit a facility in the bottom quintile (95% CI = [1.54, 9.80]). The dose and timing of IPTp-SP provided in antenatal care settings in Senegal did not always conform with the national guideline. More training for providers and patient engagement is warranted to improve the uptake of IPTp-SP in antenatal care visits.
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Affiliation(s)
- Karen Zhang
- Graduate School of Economics, University of Helsinki, Helsinki 00100, Finland
| | - Di Liang
- School of Public Health, Global Health Institute, Fudan University, Shanghai 200032, China
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, Long Island School of Medicine, New York University, Mineola, NY 11501, USA
| | - Jun Cao
- Key Laboratory of National Health Commission on Parasitic Disease Control and Prevention, Key Laboratory of Jiangsu Province on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi 214064, China
| | - Jiayan Huang
- School of Public Health, Global Health Institute, Fudan University, Shanghai 200032, China
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7
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Sharma A, Jenkins B, Akue A, Lambert LE, Orr-Gonzalez S, Thomas ML, Mahamar A, Diarra BS, Dicko A, Fried M, Duffy PE. Plasmodium falciparum in Aotus nancymaae: A New Model for Placental Malaria. J Infect Dis 2022; 226:521-527. [PMID: 35290467 PMCID: PMC9417121 DOI: 10.1093/infdis/jiac096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/11/2022] [Indexed: 11/08/2023] Open
Abstract
Plasmodium falciparum-infected erythrocytes that display the variant surface antigen VAR2CSA bind chondroitin sulfate A (CSA) to sequester in placental intervillous spaces, causing severe sequelae for mother and offspring. Here, we establish a placental malaria (PM) monkey model. Pregnant Aotus infected with CSA-binding P. falciparum CS2 parasites during the third trimester developed pronounced sequestration of late-stage parasites in placental intervillous spaces that express VAR2CSA and bind specifically to CSA. Similar to immune multigravid women, a monkey infected with P. falciparum CS2 parasites over successive pregnancies acquired antibodies against VAR2CSA, with potent functional activity that was boosted upon subsequent pregnancy infections. Aotus also developed functional antibodies after multiple acute PM episodes and subsequent VAR2CSA immunization. In summary, P. falciparum infections in pregnant Aotus monkeys recapitulate all the prominent features of human PM infection and immunity, and this model can be useful for basic mechanistic studies and preclinical studies to qualify candidate PM vaccines. Clinical Trials Registration: NCT02471378.
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Affiliation(s)
- Ankur Sharma
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Bethany Jenkins
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Adovi Akue
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lynn E Lambert
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sachy Orr-Gonzalez
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Marvin L Thomas
- Division of Veterinary Resources, Office of Research Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Almahamoudou Mahamar
- Malaria Research and Training Center, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Bacary S Diarra
- Malaria Research and Training Center, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Alassane Dicko
- Malaria Research and Training Center, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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8
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Ozarslan N, Gaw SL. Dysregulation of placental vascular development- a mechanism for adverse pregnancy outcomes in placental malaria. EBioMedicine 2021; 74:103726. [PMID: 34844194 PMCID: PMC8633864 DOI: 10.1016/j.ebiom.2021.103726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nida Ozarslan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Stephanie L Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States.
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Doritchamou JYA, Duffy PE. Can complement fix placental malaria? BMC Med 2021; 19:231. [PMID: 34503499 PMCID: PMC8431923 DOI: 10.1186/s12916-021-02083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Justin Y A Doritchamou
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA.
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Klein MD, Proaño A, Noazin S, Sciaudone M, Gilman RH, Bowman NM. Risk factors for vertical transmission of Chagas disease: A systematic review and meta-analysis. Int J Infect Dis 2021; 105:357-373. [PMID: 33618005 PMCID: PMC8370023 DOI: 10.1016/j.ijid.2021.02.074] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vertical transmission of Trypanosoma cruzi infection from mother to infant accounts for a growing proportion of new Chagas disease cases. However, no systematic reviews of risk factors for T. cruzi vertical transmission have been performed. METHODS We performed a systematic review of the literature in PubMed, LILACS, and Embase databases, following PRISMA guidelines. Studies were not excluded based on language, country of origin, or publication date. RESULTS Our literature review yielded 27 relevant studies examining a wide variety of risk factors, including maternal age, parasitic load, immunologic factors and vector exposure. Several studies suggested that mothers with higher parasitic loads may have a greater risk of vertical transmission. A meta-analysis of 2 studies found a significantly higher parasitic load among transmitting than non-transmitting mothers with T. cruzi infection. A second meta-analysis of 10 studies demonstrated that maternal age was not significantly associated with vertical transmission risk. CONCLUSIONS The literature suggests that high maternal parasitic load may be a risk factor for congenital Chagas disease among infants of T. cruzi seropositive mothers. Given the considerable heterogeneity and risk of bias among current literature, additional studies are warranted to assess potential risk factors for vertical transmission of T. cruzi infection.
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Affiliation(s)
- Melissa D Klein
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Alvaro Proaño
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sassan Noazin
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Sciaudone
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Natalie M Bowman
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
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Garrison A, Boivin M, Khoshnood B, Courtin D, Alao J, Mireku M, Ibikounle M, Massougbodji A, Cot M, Bodeau-Livinec F. Soil-transmitted helminth infection in pregnancy and long-term child neurocognitive and behavioral development: A prospective mother-child cohort in Benin. PLoS Negl Trop Dis 2021; 15:e0009260. [PMID: 33739991 PMCID: PMC7978343 DOI: 10.1371/journal.pntd.0009260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background An estimated 30% of women in Sub-Saharan Africa suffer from soil-transmitted helminth infection during pregnancy (SHIP), which has been shown to increase risk of pre-term birth, low birth weight, and maternal anemia. A previous study in Benin found that SHIP was associated with impaired cognitive and gross motor development scores in 635 one-year-old children. The objective of the present study was to follow children prospectively to investigate whether the association between SHIP and child neurocognitive and behavioral development persisted at age six. Principal findings Our prospective child cohort included 487 live-born singletons of pregnant women enrolled in the Malaria in Pregnancy Preventive Alternative Drugs clinical trial in Allada, Benin. SHIP was assessed at three antenatal visits (ANVs) through collection and testing of stool samples. Neurocognitive and behavioral development was assessed in six-year-old children by trained investigators using the Kaufman Assessment Battery for Children 2nd edition and the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression models generated coefficients and 95% confidence intervals and potential mediating factors were tested. Prevalence of SHIP was 13% at the 1st ANV, 9% at the 2nd ANV, and 1% at delivery. SHIP was not associated with low neurocognitive scores in children at six years. Higher SDQ internalizing scores, indicating increased emotional impairments in children, were associated with helminth infection at the 2nd ANV/delivery 1.07 (95% CI 0.15, 2.00) and at least once during pregnancy 0.79 (95% CI 0.12, 1.46) in adjusted models. Mediation analysis did not reveal significant indirect effects of several mediators on this association. Conclusions Our study shows that while SHIP is not associated with impaired long-term neurocognitive development, infections may have significant negative impacts on emotional development in six-year-old children. SHIP remains a critical public health issue, and adequate prevention and treatment protocols should be enforced in low- and middle-income countries. Soil-transmitted helminth infections impact 1.5 billion individuals, primarily in low- and middle- income countries, each year and contribute to malnutrition, anemia, and impaired neurocognitive development in children. However, these infections in pregnancy and their impact on offspring have been less studied. One previous study found associations between soil-transmitted helminth infection during pregnancy and impaired cognitive functioning in offspring one year after birth. The current study aimed to follow these children prospectively until six years in order to confirm whether these associations persisted or not. Infections during pregnancy were no longer associated with cognitive or motor functioning in children; however, infections were associated with impaired behavioral development. Animal-based models have hypothesized maternal inflammation and poor birth outcomes to be the mechanisms behind this relationship; however, our findings did not support these mechanisms. This is one of very few prospective cohort studies in Sub-Saharan Africa to investigate these associations, and more research is needed to corroborate results. Limitations include limited power and the possibility that results are due to chance from multiple statistical tests. Adequate and accessible prevention and treatment efforts in pregnancy and childhood should be provided to populations in low- and middle- income countries at high risk of infection.
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Affiliation(s)
- Amanda Garrison
- Département Méthodes Quantitatives en Santé Publique (METIS), Ecole des Hautes Etudes en Santé Publique, Rennes, France
- Université de Paris, Center of Research in Epidemiology and Statistics/CRESS, INSERM, INRA, Paris, France
- Sorbonne Universités, Université de Paris, Paris, France
- * E-mail:
| | - Michael Boivin
- Departments of Psychiatry and Neurology/Ophthalmology, Michigan State University, East Lansing, Michigan, United States of America
| | - Babak Khoshnood
- Département Méthodes Quantitatives en Santé Publique (METIS), Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | | | - Jules Alao
- Service de Pédiatrie, CHU de la Mère et de l’Enfant-Lagune de Cotonou, Cotonou, Benin
| | - Michael Mireku
- School of Psychology, University of Lincoln, Lincoln, England
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, England
| | - Moudachirou Ibikounle
- Centre de Recherche pour la lutte contre les Maladies Infectieuses Tropicales, Université d’Abomey-Calavi, Cotonou, Benin
| | | | - Michel Cot
- Université de Paris, MERIT, IRD, Paris, France
| | - Florence Bodeau-Livinec
- Département Méthodes Quantitatives en Santé Publique (METIS), Ecole des Hautes Etudes en Santé Publique, Rennes, France
- Université de Paris, Center of Research in Epidemiology and Statistics/CRESS, INSERM, INRA, Paris, France
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Durlach R, Freuler C, Messina M, Freilij H, González Ayala S, Venturini MC, Kaufer F, García F, Ceriotto M, Pardini L, Nadal M, Ortiz de Zárate M, Schneider V, Mayer-Wolf M, Jacob N, Abuin JC, Altcheh J, Fiameni F, Salomon C, Ledesma B, Guarnera E. [Argentine consensus of congenital toxoplasmosis]. Medicina (B Aires) 2021; 81:257-268. [PMID: 33906145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. Diagnosis of maternal infection and the newborn is achieved by a combination of serological tests, clinical features and ultrasound images. An early diagnosis of maternal infection allows treatment that offers a reduction both in transmission rate and risk of congenital damage. The aim of this expert consensus was to review the scientific literature which would enable an update of the clinical practice guideline of prevention, diagnosis and treatment of congenital toxoplasmosis in our country.
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Affiliation(s)
| | - Cristina Freuler
- Centro de Toxoplasmosis, Servicio de Infectología, Inmunología y Epidemiología, Hospital Alemán, Buenos Aires, Argentina
| | - Matías Messina
- Asociación Argentina de Zoonosis, Argentina
- Centro de Toxoplasmosis, Servicio de Infectología, Inmunología y Epidemiología, Hospital Alemán, Buenos Aires, Argentina
| | - Héctor Freilij
- Servicio de Parasitología e Instituto Multidisciplinario de Investigación en Patologías Pediátricas, CONICET, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | - María Cecilia Venturini
- Laboratorio de Inmunoparasitología, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, Argentina
| | - Federico Kaufer
- Centro de Toxoplasmosis, Servicio de Infectología, Inmunología y Epidemiología, Hospital Alemán, Buenos Aires, Argentina
| | - Fabiana García
- Centro de Estudios Infectológicos Dr. Daniel Stamboulian, Buenos Aires, Argentina
| | - Mariana Ceriotto
- Hospital Zonal General de Agudos Blas L. Dubarry, Mercedes, Provincia de Buenos Aires, Argentina
| | - Lais Pardini
- Laboratorio de Inmunoparasitología, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, Argentina
| | - Mónica Nadal
- Hospital Materno Infantil Ramón Sardá, Buenos Aires, Argentina
| | | | - Vanessa Schneider
- Centro de Toxoplasmosis, Servicio de Infectología, Inmunología y Epidemiología, Hospital Alemán, Buenos Aires, Argentina
| | - Micaela Mayer-Wolf
- Centro de Toxoplasmosis, Servicio de Infectología, Inmunología y Epidemiología, Hospital Alemán, Buenos Aires, Argentina
| | - Néstor Jacob
- Asociación Argentina de Zoonosis, Argentina
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
| | | | - Jaime Altcheh
- Servicio de Parasitología e Instituto Multidisciplinario de Investigación en Patologías Pediátricas, CONICET, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Facundo Fiameni
- Centro de Toxoplasmosis, Servicio de Infectología, Inmunología y Epidemiología, Hospital Alemán, Buenos Aires, Argentina
| | - Cristina Salomon
- Facultad de Ciencias Médicas, Universidad Nacional de Cuyo y Facultad de Ciencias Médicas, Universidad del Aconcagua, Argentina
| | - Bibiana Ledesma
- Laboratorio de Referencia Nacional de Toxoplasmosis, Departamento de Parasitología, Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Dr. Carlos G. Malbrán, Argentina
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13
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Muhammad FM, Majdzadeh R, Nedjat S, Sajadi HS, Parsaeian M. Socioeconomic inequality in intermittent preventive treatment using Sulphadoxine pyrimethamine among pregnant women in Nigeria. BMC Public Health 2020; 20:1860. [PMID: 33276756 PMCID: PMC7716500 DOI: 10.1186/s12889-020-09967-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment using Sulphadoxine pyrimethamine (IPTp-SP) for malaria prevention is recommended for all pregnant women in malaria endemic areas. However, there is limited evidence on the level of socioeconomic inequality in IPTp-SP use among pregnant women in Nigeria. Thus, this study aimed to determine the level of socioeconomic inequality in IPTp-SP use among pregnant women in Nigeria and to decompose it into its contributing factors. METHODS A secondary data analysis of Nigerian demographic and health survey of 2018 was conducted. A sample of 21,621 pregnant women aged between 15 and 49 years and had live birth in the previous 2 years before the survey were included in this analysis. The study participants were recruited based on a stratified two-stage cluster sampling method. Socioeconomic inequality was decomposed into its contributing factors by concentration index. RESULT Totally 63.6% of pregnant women took at least one dose of IPTp-SP prophylaxis. Among IPTp-SP users, 35.1% took one dose, 38.6% took two doses and 26.2% took three doses and more. Based on both concentration index of 0.180 (p-value = < 0.001, 95% CI: 0.176 to 0.183) and Erreyger's normalization concentration index 0.280 (p-value = < 0.001, 95% CI: 0.251 to 0.309), the IPTp-SP utilization was pro-rich. The largest contributors to the inequality in IPTp-SP uptake were wealth index (47.81%) and educational status (28.66%). CONCLUSION Our findings showed that IPTp-SP use was pro-rich in Nigeria. Wealth index and educational status were the factors that significantly contributed to the inequality. The disparities could be reduced through free IPTp service expansion by targeting pregnant women from low socioeconomic status.
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Affiliation(s)
- Fatima Mahmud Muhammad
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Department of Epidemiology & Biostatistics, Knowledge Utilization Research Center and Community-Based Participatory-Research-Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Haniye Sadat Sajadi
- Knowledge Utilization Research center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Parsaeian
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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14
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Piffer S, Lauriola AL, Pradal U, Collini L, Dell'Anna L, Pavanello L. Toxoplasma gondii infection during pregnancy: a ten-year observation in the province of Trento, Italy. Infez Med 2020; 28:603-610. [PMID: 33257637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The study analysed the trend of toxoplasmosis infection in pregnancy by using antenatal serological screening and the incidence of the congenital condition in newborns in the province of Trento, Italy. Data from pregnant women who gave birth at local maternity units between 2009 and 2018 were obtained. The serological test results were collected from birth attendance certificates (BACs), the main - and mandatory - source of information used to monitor pregnancies, births and neonatal health in Italy. The BAC used in the province of Trento acquires the results of serological tests for a vast range of infections in pregnancy. The data collected from the BACs were integrated with those provided by the Hospital Information System (HIS), which was also used to collect data on the trimester in which the seroconversion occurred. A total of 45,492 pregnant women were analysed, of whom 24% were foreigners. The average coverage of serological screening in pregnancy was 99.7%. Mean overall prevalence of Toxoplasma gondii infection was 21.7% (95% CI: 21.3-22.1): in Italians the prevalence was 17.9% (95% CI: 17.5-18.30) and in foreign nationals 32.7% (95% CI: 32.26-33.13). The mean annual seroconversion rate was 0.35% (95% CI: 3.0-4.2) of susceptible women and 0.27% (95% CI: 2.2-3.4) of all pregnant women who were screened. The seroconversion rate was higher amongst foreign women (0.32%, 95% CI: 3.0-3.6) than Italian women (0.24%, 95% CI: 2.1-2.8). In all, 91.0% of seroconverted women were treated during pregnancy in accordance with the anti-toxoplasma protocol. Five cases of congenital infection were identified (2 amongst Italians and 3 amongst foreign women), amounting to an overall transmission rate of 4.0% (2.3% in Italians and 8.8% in foreigners). Transmission risk ranged from 0.0% in the first trimester to 19% in the third. The incidence of congenital toxoplasmosis, over the entire study period, was 0.012% live births (0.011% in Italians and 0.016% in foreigners). Data collection on infections in pregnancy through BAC allows area-based assessment. Although the quality of the data recorded in the BAC can be considered satisfactory, it was also necessary to access other information sources. The screening coverage was very high. The prevalence of toxoplasmosis infection was found to be higher in foreign mothers than in Italians, as well as seroconversion. The extent of serological screening and the high treatment rate helped to keep the risk of infection transmission to the foetus low and to achieve a very low rate of congenital infection.
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Affiliation(s)
- Silvano Piffer
- Clinical and Evaluational Epidemiology Service, Trento, Italy
| | - Anna Lina Lauriola
- Paediatrics Unit, Ospedale S. Maria del Carmine, Rovereto, Trento, Italy
| | - Ugo Pradal
- Paediatrics Unit, Ospedale S. Maria del Carmine, Rovereto, Trento, Italy
| | - Lucia Collini
- Microbiology and Virology Unit, Ospedale S. Chiara, Trento, Italy
| | - Laura Dell'Anna
- Obstetrics and Gynaecology Unit, Ospedale S. Chiara Trento, Trento, Italy
| | - Lucia Pavanello
- Family Paediatrician, Provincial Health Authority, Trento, Italy
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Ssentongo P, Ba DM, Ssentongo AE, Ericson JE, Wang M, Liao D, Chinchilli VM. Associations of malaria, HIV, and coinfection, with anemia in pregnancy in sub-Saharan Africa: a population-based cross-sectional study. BMC Pregnancy Childbirth 2020; 20:379. [PMID: 32600355 PMCID: PMC7324981 DOI: 10.1186/s12884-020-03064-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malaria and HIV are common infections in Africa and cause substantial morbidity and mortality in pregnant women. We aimed to assess the association of malaria with anemia in pregnant women and to explore the joint effects of malaria and HIV infection on anemia in pregnant women. METHODS We used nationally representative, cross-sectional demographic and health surveys (DHS) that were conducted between 2012 and 2017 across 7 countries of sub-Saharan Africa (Burundi, the Democratic Republic of the Congo, Gambia, Ghana, Mali, Senegal and Togo). The outcome variables were anemia (defined as a hemoglobin concentration < 110 g/L), and hemoglobin concentration on a continuous scale, in pregnant women at the time of the interview. We used generalized linear mixed-effects models to account for the nested structure of the data. We adjusted models for individual covariates, with random effects of the primary sampling unit nested within a country. RESULTS A total of 947 pregnant women, ages, 15-49 y, were analyzed. Prevalence of malaria only, HIV only, and malaria- HIV coinfection in pregnant women was 31% (95% CI: 28.5 to 34.5%, n = 293), 1.3% (95% CI: 0.77 to 2.4%, n = 13) and 0.52% (95% CI: 0.02 to 1.3%, n = 5) respectively. Overall prevalence of anemia was 48.3% (95% CI: 45.1 to 51.5%). The anemia prevalence in pregnant women with malaria infection only was 56.0% (95% CI: 50.1 to 61.7%); HIV infection only, 62.5% (95% CI: 25.9 to 89.8%); malaria- HIV coinfection, 60.0 (95% CI: 17.0-92.7%) and without either infection, 44.6% (95% CI: 40.7 to 48.6%). In the fully adjusted models, malaria infection was associated with 27% higher prevalence of anemia (95% CI of prevalence ratio: 1.12 to 1.45; p = 0.004), and 3.4 g/L lower hemoglobin concentration (95% CI: - 5.01 to - 1.79; p = 0.03) compared to uninfected pregnant women. The prevalence of HIV infection and malaria-HIV coinfection was too low to allow meaningful analysis of their association with anemia or hemoglobin concentration. CONCLUSION Malaria was associated with an increased prevalence of anemia during pregnancy.
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Affiliation(s)
- Paddy Ssentongo
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, Penn State University, University Park, PA USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
- Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, PA USA
| | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
| | - Jessica E. Ericson
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
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Abstract
Monocytes are innate immune cells essential for host protection against malaria. Upon activation, monocytes function to help reduce parasite burden through phagocytosis, cytokine production, and antigen presentation. However, monocytes have also been implicated in the pathogenesis of severe disease through production of damaging inflammatory cytokines, resulting in systemic inflammation and vascular dysfunction. Understanding the molecular pathways influencing the balance between protection and pathology is critical. In this review, we discuss recent data regarding the role of monocytes in human malaria, including studies of innate sensing of the parasite, immunometabolism, and innate immune training. Knowledge gained from these studies may guide rational development of novel antimalarial therapies and inform vaccine development.
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Affiliation(s)
- Katherine R. Dobbs
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
- Division of Pediatric Infectious Diseases, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
| | - Juliet N. Crabtree
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Arlene E. Dent
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
- Division of Pediatric Infectious Diseases, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
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17
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Unger H, Thriemer K, Ley B, Tinto H, Traoré M, Valea I, Tagbor H, Antwi G, Gbekor P, Nambozi M, Kabuya JBB, Mulenga M, Mwapasa V, Chapotera G, Madanitsa M, Rulisa S, de Crop M, Claeys Y, Ravinetto R, D’Alessandro U. The assessment of gestational age: a comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa. BMC Pregnancy Childbirth 2019; 19:12. [PMID: 30621604 PMCID: PMC6323786 DOI: 10.1186/s12884-018-2128-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries. METHODS Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson's rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies. RESULTS A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6-38.8), by LMP, 38.4 weeks (95%CI: 38.0-38.9), by SFH, 38.3 weeks (95%CI: 38.2-38.5), and by BS 38.0 weeks (95%CI: 37.9-38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95%CI 0.50-0.75) and 0.72 (95%CI, 0.66-0.76) for LMP, 0.80 (95%CI 0.74-0.85) and 0.74 (95%CI 0.72-0.76) for SFH and 0.42 (95%CI 0.35-0.49) and 0.77 (95%CI 0.74-0.79) for BS. CONCLUSIONS In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.
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Affiliation(s)
- Holger Unger
- Department of Obstetrics and Gynaecology, Simpson Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, UK
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Australia
| | - Kamala Thriemer
- Institute of Tropical Medicine, Antwerp, Belgium
- Menzies School of Health Research, Darwin, Australia
| | - Benedikt Ley
- Institute of Tropical Medicine, Antwerp, Belgium
- Menzies School of Health Research, Darwin, Australia
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Maminata Traoré
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Innocent Valea
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Harry Tagbor
- School of Medicine, University of Health and Allied Sciences, Hohoe, Ghana
| | - Gifty Antwi
- School of Medicine, University of Health and Allied Sciences, Hohoe, Ghana
| | | | | | | | | | - Victor Mwapasa
- Department of Public Health, College of Medicine, Blantyre, Malawi
| | | | | | - Stephen Rulisa
- University of Rwanda, School of Medicine and Pharmacy, Kigali, Rwanda
| | | | - Yves Claeys
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D’Alessandro
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, UK
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18
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Affiliation(s)
- James G. Beeson
- Burnet Institute, Melbourne, Victoria, Australia
- Monash University, Central Clinical School and Department of Microbiology, Monash University, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health and Department of Medicine, The University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health and Department of Medicine, The University of Melbourne, Melbourne, Australia
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Nkhoma M, Ashorn P, Ashorn U, Dewey KG, Gondwe A, Mbotwa J, Rogerson S, Taylor SM, Maleta K. Providing lipid-based nutrient supplement during pregnancy does not reduce the risk of maternal P falciparum parasitaemia and reproductive tract infections: a randomised controlled trial. BMC Pregnancy Childbirth 2017; 17:35. [PMID: 28095801 PMCID: PMC5240436 DOI: 10.1186/s12884-016-1215-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 12/29/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Maternal infections are associated with maternal and foetal adverse outcomes. Nutrient supplementation during pregnancy may reduce the occurrence of infections by improving maternal immunity. We aimed to investigate the impact of small-quantity lipid-based nutrient supplement (SQ-LNS) on the occurrence of Plasmodium falciparum parasitaemia during pregnancy and trichomoniasis, vaginal candidiasis and urinary tract infection (UTI) after delivery. METHODS Pregnant Malawian women enrolled in the iLiNS-DYAD trial receiving daily supplementation with SQ-LNS, multiple micronutrients (MMN) or iron & folic acid (IFA) from <20 gestation weeks (gw) were assessed for P. falciparum parasitaemia at 32 gw using rapid diagnostic testing (RDT), at 36 gw using polymerase chain reaction (PCR) and at delivery using both RDT and PCR; and at one week after delivery for trichomoniasis and vaginal candidiasis using wet mount microscopy and for UTI using urine dipstick analysis. The prevalence of each infection by intervention group was estimated at the prescribed time points and the global null hypothesis was tested using logistic regression. Adjusted analyses were performed using preselected covariates. RESULTS The prevalence of P. falciparum parasitaemia was 10.7% at 32 gw, 9% at 36 gw, and 8.3% by RDT and 20.2% by PCR at delivery. After delivery the prevalence of trichomoniasis was 10.5%, vaginal candidiasis was 0.5%, and UTI was 3.1%. There were no differences between intervention groups in the prevalence of any of the infections. CONCLUSION In this population, SQ-LNS did not influence the occurrence of maternal P. falciparum parasitaemia, trichomoniasis, vaginal candidiasis or UTI. TRIAL REGISTRATION Identifier: NCT01239693 (10 November 2010).
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Affiliation(s)
- Minyanga Nkhoma
- University of Tampere School of Medicine, University of Tampere, Arvo building, FI-33014 Tampere, Finland
| | - Per Ashorn
- University of Tampere School of Medicine, University of Tampere, Arvo building, FI-33014 Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, FI-33521 Tampere, Finland
| | - Ulla Ashorn
- University of Tampere School of Medicine, University of Tampere, Arvo building, FI-33014 Tampere, Finland
| | - Kathryn G. Dewey
- Department of Nutrition, University of California, One Shields Ave., Davis, CA 95616-8669 USA
| | - Austrida Gondwe
- University of Tampere School of Medicine, University of Tampere, Arvo building, FI-33014 Tampere, Finland
| | - John Mbotwa
- School of Public Health and Family Medicine, College of Medicine, Mahatma Gandhi Road, Blantyre, Malawi
| | - Stephen Rogerson
- Department of Medicine at the Peter Doherty Institute, 792 Elizabeth Street, Melbourne, VIC 3000 Australia
| | - Steve M. Taylor
- Division of Infectious Diseases and International Health, Duke University Medical Center, Box 102359 DUMC, Durham, NC 27705 USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599-7435 USA
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, Mahatma Gandhi Road, Blantyre, Malawi
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20
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Toko EN, Sumba OP, Daud II, Ogolla S, Majiwa M, Krisher JT, Ouma C, Dent AE, Rochford R, Mehta S. Maternal Vitamin D Status and Adverse Birth Outcomes in Children from Rural Western Kenya. Nutrients 2016; 8:nu8120794. [PMID: 27941597 PMCID: PMC5188449 DOI: 10.3390/nu8120794] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 01/04/2023] Open
Abstract
Maternal plasma 25-hydroxyvitamin D (25(OH)D) status and its association with pregnancy outcomes in malaria holoendemic regions of sub-Saharan Africa is poorly defined. We examined this association and any potential interaction with malaria and helminth infections in an ongoing pregnancy cohort study in Kenya. The association of maternal plasma 25(OH)D status with pregnancy outcomes and infant anthropometric measurements at birth was determined in a subset of women (n = 63). Binomial and linear regression analyses were used to examine associations between maternal plasma 25(OH)D and adverse pregnancy outcomes. Fifty-one percent of the women had insufficient (<75 nmol/L) and 21% had deficient (<50 nmol/L) plasma 25(OH)D concentration at enrollment. At birth, 74.4% of the infants had insufficient and 30% had deficient plasma 25(OH)D concentrations, measured in cord blood. Multivariate analysis controlling for maternal age and body mass index (BMI) at enrollment and gestational age at delivery found that deficient plasma 25(OH)D levels were associated with a four-fold higher risk of stunting in neonates (p = 0.04). These findings add to the existing literature about vitamin D and its association with linear growth in resource-limited settings, though randomized clinical trials are needed to establish causation.
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Affiliation(s)
- Eunice N Toko
- School of Biological and Physical Sciences, Maseno University, Kisumu, Kenya.
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Odada P Sumba
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Ibrahim I Daud
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
| | - Sidney Ogolla
- School of Biological and Physical Sciences, Maseno University, Kisumu, Kenya.
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Maxwel Majiwa
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Jesse T Krisher
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853, USA.
| | - Collins Ouma
- School of Biological and Physical Sciences, Maseno University, Kisumu, Kenya.
- African Institute for Development Policy, Nairobi, Kenya.
| | - Arlene E Dent
- Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Rosemary Rochford
- SUNY Upstate Medical University, Syracuse, NY 13210, USA.
- Department of Immunology and Microbiology, University of Colorado, Denver, Aurora, CO 80045, USA.
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY 14853, USA.
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Awobode HO, Olubi IC. Prevalence of Toxoplasma gondii and HIV infection among pregnant women in Ibadan North Local Government, Oyo State. Afr J Med Med Sci 2014; 43 Suppl:39-45. [PMID: 26949779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Toxoplasmosis, a disease caused by Toxoplasma gondii poses a risk of congenital infection during pregnancy in infected women. The disease poses a threat of ocular and neurological sequelae in congenitally ilfected infants and HIV patients; however, there is little valuable information on its prevalence in Ibadan. METHODS A cross sectional study of pregnant women attending antenatal care in three primary healthcare centres in Ibadan was carried out. 179 women were screened for T gondii infection using PCR, 83 of these were also screened for HIV. Forty nine (27.4%) were positive for T gondii, and 2(2.4%) were HIV positive (P = 0.002, OR = 0.28, CL = 95%). 27 (15.1%) of the infected women were in third trimester, with 20 (11.2%) and 2 (1.1%) in second and first trimester respectively. 18 (10.1%) positive cases were identified among the primigravidas and 31 (17.2%) among the multigravidas. Risk factors associated with Toxoplasma infection were assessed, and the source of drinking water and the types of animals around habitation were found to be significantly associated with the presence of Toxoplasma infection (P = 0.002, OR = 2.109 and P = 0.004, OR = 1.693 respectively). CONCLUSION The high prevalence among women in third trimester may indicate high risk of congenital infection, and the significant association found between the source of drinking water and infection suggests environmental contamination as a major possible mode of infection. The need to educate pregnant women about the transmission mechanisms of T. gondii, and the effects of the infection on neonates and babies is pertinent in order to effectively control Toxoplasma infection.
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Abstract
We investigated 32 families of persons with acute toxoplasmosis in which > or = 1 other family member was tested for Toxoplasma gondii infection; 18 (56%) families had > or = 1 additional family member with acute infection. Family members of persons with acute toxoplasmosis should be screened for infection, especially pregnant women and immunocompromised persons.
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Ludlow LE, Hasang W, Umbers AJ, Forbes EK, Ome M, Unger HW, Mueller I, Siba PM, Jaworowski A, Rogerson SJ. Peripheral blood mononuclear cells derived from grand multigravidae display a distinct cytokine profile in response to P. falciparum infected erythrocytes. PLoS One 2014; 9:e86160. [PMID: 24465935 PMCID: PMC3899203 DOI: 10.1371/journal.pone.0086160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 12/06/2013] [Indexed: 12/02/2022] Open
Abstract
Immunopathology of placental malaria is most significant in women in their first pregnancy especially in endemic areas, due to a lack of protective immunity to Plasmodium falciparum, which is acquired in successive pregnancies. In some studies (but not all), grand multigravidae (defined as 5 or more pregnancies, G5–7) are more susceptible to poor birth outcomes associated with malaria compared to earlier gravidities. By comparing peripheral cellular responses in primigravidae (G1), women in their second to fourth pregnancy (G2–4) and grand multigravidae we sought to identify key components of the dysregulated immune response. PBMC were exposed to CS2-infected erythrocytes (IE) opsonised with autologous plasma or unopsonised IE, and cytokine and chemokine secretion was measured. Higher levels of opsonising antibody were present in plasma derived from multigravid compared to primigravid women. Significant differences in the levels of cytokines and chemokines secreted in response to IE were observed. Less IL-10, IL-1β, IL-6 and TNF but more CXCL8, CCL8, IFNγ and CXCL10 were detected in G5–7 compared to G2–4 women. Our study provides fresh insight into the modulation of peripheral blood cell function and effects on the balance between host protection and immunopathology during placental malaria infection.
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Affiliation(s)
- Louise E Ludlow
- Department of Medicine (RMH), University of Melbourne, Post Office Royal Melbourne Hospital, Melbourne, Victoria, Australia ; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Wina Hasang
- Department of Medicine (RMH), University of Melbourne, Post Office Royal Melbourne Hospital, Melbourne, Victoria, Australia ; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Alexandra J Umbers
- Department of Medicine (RMH), University of Melbourne, Post Office Royal Melbourne Hospital, Melbourne, Victoria, Australia ; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia ; Papua New Guinea Institute of Medical Research, Vector Borne Disease Unit, Madang, PNG
| | - Emily K Forbes
- Department of Medicine (RMH), University of Melbourne, Post Office Royal Melbourne Hospital, Melbourne, Victoria, Australia ; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Maria Ome
- Papua New Guinea Institute of Medical Research, Vector Borne Disease Unit, Madang, PNG
| | - Holger W Unger
- Department of Medicine (RMH), University of Melbourne, Post Office Royal Melbourne Hospital, Melbourne, Victoria, Australia ; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia ; Papua New Guinea Institute of Medical Research, Vector Borne Disease Unit, Madang, PNG
| | - Ivo Mueller
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia ; Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Vector Borne Disease Unit, Madang, PNG
| | - Anthony Jaworowski
- Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia ; Department of Infectious Diseases, Monash University, Victoria, Australia ; Department of Immunology, Monash University, Victoria, Australia
| | - Stephen J Rogerson
- Department of Medicine (RMH), University of Melbourne, Post Office Royal Melbourne Hospital, Melbourne, Victoria, Australia ; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
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Abstract
Malaria chemoprophylaxis concerns prescribing healthy individuals medication for an infection they have an unknown chance of getting. Sensible use of malaria chemoprophylaxis is a balance between the risk of infection and death, and the risk of side effects. The risk of infection can be broken down into the risk of being bitten by a malaria-infected mosquito and the risk of the malaria parasites being resistant to the drug used for prophylaxis. Our knowledge of these parameters is patchy. The risk of infection is not uniform at a given location and the standard of living will greatly influence risk. It is suggested that chemoprophylaxis should not be recommended in areas with less than ten reported cases of P. falciparum malaria per 1000 inhabitants per year. The resistance pattern is known to a certain extent but, for instance, diverging opinion of how much resistance to chloroquine there is in West Africa illustrates the lack of data. There is much debate on rare adverse events, which usually escape Phase III studies prior to registration and are only picked up by passive, postmarketing surveillance. The lessons over the past 20 years with the introduction of amodiaquine, pyrimethamine/dapsone (Maloprim, GlaxoSmithKline) and pyrimethamine/sulfadoxine (Fansidar, Roche), which were all withdrawn for prophylaxis after a few years, show how sensitive drugs for chemoprophylaxis are to side effects. Three levels of chemoprophylaxis are used: chloroquine in areas with sensitive P. falciparum, chloroquine plus proguanil in areas with low level chloroquine resistance, and atovaquone/proguanil (Malarone, GlaxoSmithKline), doxycycline or mefloquine (Lariam, Roche) in areas with extensive resistance against chloroquine and proguanil. Primaquine and the primaquone analog tafenoquine may be future alternatives but otherwise there are few new drugs for chemoprophylaxis on the horizon.
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Affiliation(s)
- Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital Skejby, DK-8200 Aarhus N, Denmark.
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Affiliation(s)
- Bernard J Brabin
- Child and Reproductive Health Group, The Liverpool School of Tropical Medicine, Liverpool, England.
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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Congenital malaria, although considered to be relatively rare, is not uncommon now, and prevalence rates vary between geographical regions. Fifteen cases of congenital malaria admitted from various parts of Thailand are reviewed. Most came from Thai border areas.
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Affiliation(s)
- Krisana Pengsaa
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Weerasinghe CR, de Silva NR, Michael E. Maternal filarial-infection status and its consequences on pregnancy and the newborn, in Ragama, Sri Lanka. Annals of Tropical Medicine & Parasitology 2013; 99:813-6. [PMID: 16297296 DOI: 10.1179/136485905x65198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- C R Weerasinghe
- Department of Infectious Diseases Epidemiology, Faculty of Medicine, Imperial College of Science, Technology and Medicine, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
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McDonald EA, Kurtis JD, Acosta L, Gundogan F, Sharma S, Pond-Tor S, Wu HW, Friedman JF. Schistosome egg antigens elicit a proinflammatory response by trophoblast cells of the human placenta. Infect Immun 2013; 81:704-12. [PMID: 23250950 PMCID: PMC3584891 DOI: 10.1128/iai.01149-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/11/2012] [Indexed: 01/23/2023] Open
Abstract
Schistosomiasis affects nearly 40 million women of reproductive age. Many of these women are infected while pregnant and lactating. Several studies have demonstrated transplacental trafficking of schistosome antigens; however, little is known regarding how these antigens affect the developing fetus and placenta. To evaluate the impact of schistosomiasis on trophoblasts of the human placenta, we isolated primary trophoblast cells from healthy placentas delivered at term. These trophoblasts were placed in culture and treated with Schistosoma japonicum soluble egg antigens (SEA) or plasma from S. japonicum-infected pregnant women. Outcomes measured included cytokine production and activation of signal transduction pathways. Treatment of primary human trophoblast cells with SEA resulted in upregulation of the proinflammatory cytokines interleukin 6 (IL-6) and IL-8 and the chemokine macrophage inflammatory protein 1α (MIP-1α). Cytokine production in response to SEA was dose dependent and reminiscent of production in response to other proinflammatory stimuli, such as Toll-like receptor 2 (TLR2) and TLR4 agonists. In addition, the signaling pathways extracellular signal-regulated kinase 1/2 (ERK1/2), Jun N-terminal protein kinase (JNK), p38, and NF-κB were all activated by SEA in primary trophoblasts. These effects appeared to be mediated through both carbohydrate and protein epitopes of SEA. Finally, primary trophoblasts cocultured with plasma from S. japonicum-infected pregnant women produced increased levels of IL-8 compared to trophoblasts cocultured with plasma from uninfected pregnant women. We report here a direct impact of SEA on primary human trophoblast cells, which are critical for many aspects of a healthy pregnancy. Our data indicate that schistosome antigens can activate proinflammatory responses in trophoblasts, which might compromise maternal-fetal health in pregnancies complicated by schistosomiasis.
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Affiliation(s)
- Emily A McDonald
- Center for International Health Research, Rhode Island Hospital, Brown University Medical School, Providence, Rhode Island, USA.
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30
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Toxoplasmosis: BVA says risk from cats should not be overplayed. Vet Rec 2012; 171:262. [PMID: 22983520 DOI: 10.1136/vr.e6145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Simsek S, Risvanli A, Zonturlu AG, Demiral O, Saat N. Absence of link between abortion and seropositivity of cystic hydatid disease in ewes and female goats in Turkey. Vet Ital 2012; 48:323-327. [PMID: 23038079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study was conducted to test whether there is a statistically significant association between seropositivity to cystic echinococcosis and abortion in ewes and female goats from the Turkish provinces of Elazig (east Anatolia), Sanliurfa (south-east Anatolia) and Kayseri (Inner Anatolia) using the enzyme-linked immunosorbent assay (ELISA). A total of 20 of 133 sera (15.1%) from ewes and 5 of 101 sera (4.9%) from goats with a history of abortion gave seropositive results that were not significantly different (p>0.05) from these, 9.9% (10/101) were reported for ewes and 1.6% (2/122) for female goats without a history of abortion. Serological prevalence rates among those animals with a history of abortion were not significantly different from the control group. No positive association was established between seropositivity for cystic echinococcosis and abortion in ewes and female goats.
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Affiliation(s)
- Sami Simsek
- Department of Parasitology, Faculty of Veterinary Medicine, University of Firat, 23119 Elazig, Turkey
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Le Port A, Watier L, Cottrell G, Ouédraogo S, Dechavanne C, Pierrat C, Rachas A, Bouscaillou J, Bouraima A, Massougbodji A, Fayomi B, Thiébaut A, Chandre F, Migot-Nabias F, Martin-Prevel Y, Garcia A, Cot M. Infections in infants during the first 12 months of life: role of placental malaria and environmental factors. PLoS One 2011; 6:e27516. [PMID: 22096588 PMCID: PMC3214070 DOI: 10.1371/journal.pone.0027516] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 10/18/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between placental malaria (PM) and first peripheral parasitaemias in early infancy was assessed in Tori Bossito, a rural area of Benin with a careful attention on transmission factors at an individual level. METHODOLOGY Statistical analysis was performed on 550 infants followed weekly from birth to 12 months. Malaria transmission was assessed by anopheles human landing catches every 6 weeks in 36 sampling houses and season defined by rainfall. Each child was located by GPS and assigned to the closest anopheles sampling house. Data were analysed by survival Cox models, stratified on the possession of insecticide-treated mosquito nets (ITNs) at enrolment. PRINCIPAL FINDINGS Among infants sleeping in a house with an ITN, PM was found to be highly associated to first malaria infections, after adjusting on season, number of anopheles, antenatal care (ANC) visits and maternal severe anaemia. Infants born from a malaria infected placenta had a 2.13 fold increased risk to present a first malaria infection than those born from a non infected placenta ([1.24-3.67], p<0.01) when sleeping in a house with an ITN. The risk to present a first malaria infection was increased by 3.2 to 6.5, according to the level of anopheles exposure (moderate or high levels, compared to the absence of anopheles). CONCLUSIONS First malaria infections in early childhood can be attributed simultaneously to both PM and high levels of exposure to infected anopheles. Protective measures as Intermittent Preventive Treatment during pregnancy (IPTp) and ITNs, targeted on both mothers and infants should be reinforced, as well as the research on new drugs and insecticides. In parallel, investigations on placental malaria have to be strengthened to better understand the mechanisms involved, and thus to protect adequately the infants high risk group.
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Affiliation(s)
- Agnès Le Port
- UMR216 Mère et enfant face aux infections tropicales, Institut de Recherche pour le Développement, Paris, France.
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Silver KL, Conroy AL, Leke RGF, Leke RJI, Gwanmesia P, Molyneux ME, Wallace DT, Rogerson SJ, Kain KC. Circulating soluble endoglin levels in pregnant women in Cameroon and Malawi--associations with placental malaria and fetal growth restriction. PLoS One 2011; 6:e24985. [PMID: 21966395 PMCID: PMC3178568 DOI: 10.1371/journal.pone.0024985] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/19/2011] [Indexed: 11/21/2022] Open
Abstract
Placental infections with Plasmodium falciparum are associated with fetal growth restriction resulting in low birth weight (LBW). The mechanisms that mediate these effects have yet to be completely described; however, they are likely to involve inflammatory processes and dysregulation of angiogenesis. Soluble endoglin (sEng), a soluble receptor of transforming growth factor (TGF)-β previously associated with preeclampsia in pregnant women and with severe malaria in children, regulates the immune system and influences angiogenesis. We hypothesized that sEng may play a role in development of LBW associated with placental malaria (PM). Plasma levels of sEng were measured in women (i) followed prospectively throughout pregnancy in Cameroon (n = 52), and (ii) in a case-control study at delivery in Malawi (n = 479). The relationships between sEng levels and gravidity, peripheral and placental parasitemia, gestational age, and adverse outcomes of PM including maternal anemia and LBW were determined. In the longitudinal cohort from Cameroon, 28 of 52 women (54%) experienced at least one malaria infection during pregnancy. In Malawi we enrolled two aparasitemic gravidity-matched controls for every case with PM. sEng levels varied over the course of gestation and were significantly higher in early and late gestation as compared to delivery (P<0.006 and P<0.0001, respectively). Circulating sEng levels were higher in primigravidae than multigravidae from both Cameroon and Malawi, irrespective of malarial infection status (p<0.046 and p<0.001, respectively). Peripheral parasitemia in Cameroonian women and PM in Malawian women were each associated with elevated sEng levels following correction for gestational age and gravidity (p = 0.006 and p = 0.033, respectively). Increased sEng was also associated with the delivery of LBW infants in primigravid Malawian women (p = 0.017); the association was with fetal growth restriction (p = 0.003) but not pre-term delivery (p = 0.286). Increased circulating maternal sEng levels are associated with P. falciparum infection in pregnancy and with fetal growth restriction in primigravidae with PM.
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Affiliation(s)
- Karlee L. Silver
- Sandra A. Rotman Laboratories, McLaughlin-Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrea L. Conroy
- Sandra A. Rotman Laboratories, McLaughlin-Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Rose G. F. Leke
- Faculty of Medicine and Biomedical Research, University of Yaoundé, Yaoundé, Cameroon
| | - Robert J. I. Leke
- Faculty of Medicine and Biomedical Research, University of Yaoundé, Yaoundé, Cameroon
| | - Philomina Gwanmesia
- Faculty of Medicine and Biomedical Research, University of Yaoundé, Yaoundé, Cameroon
| | - Malcolm E. Molyneux
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- College of Medicine, University of Malawi, Blantyre, Malawi
- School of Tropical Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Diane Taylor Wallace
- Department of Biology, Georgetown University, Washington, D.C., United States of America
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Stephen J. Rogerson
- Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kevin C. Kain
- Sandra A. Rotman Laboratories, McLaughlin-Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Angheben A, Anselmi M, Gobbi F, Marocco S, Monteiro G, Buonfrate D, Tais S, Talamo M, Zavarise G, Strohmeyer M, Bartalesi F, Mantella A, Di Tommaso M, Aiello K, Veneruso G, Graziani G, Ferrari M, Spreafico I, Bonifacio E, Gaiera G, Lanzafame M, Mascarello M, Cancrini G, Albajar-Vinas P, Bisoffi Z, Bartoloni A. Chagas disease in Italy: breaking an epidemiological silence. Euro Surveill 2011; 16:19969. [PMID: 21944554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people(travellers, migrants, blood or organ recipients,newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjectsscreened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees).No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women,three were infected (resulting in abortion in one case).In 2005 a case of acute Chagas disease was recorded in an Italian traveller. Based on our observations, we believe that a wider assessment of the epidemiological situation is urgently required in our country and public health measures preventing transmission and improving access to diagnosis and treatment should be implemented.
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Affiliation(s)
- A Angheben
- Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy.
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Smith Paintain L, Antwi GD, Jones C, Amoako E, Adjei RO, Afrah NA, Greenwood B, Chandramohan D, Tagbor H, Webster J. Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: provider knowledge and acceptability. PLoS One 2011; 6:e24035. [PMID: 21887367 PMCID: PMC3161113 DOI: 10.1371/journal.pone.0024035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 07/29/2011] [Indexed: 11/24/2022] Open
Abstract
Malaria in pregnancy (MiP) is associated with increased risks of maternal and foetal complications. The WHO recommends a package of interventions including intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP), insecticide-treated nets and effective case management. However, with increasing SP resistance, the effectiveness of SP-IPT has been questioned. Intermittent screening and treatment (IST) has recently been shown in Ghana to be as efficacious as SP-IPT. This study investigates two important requirements for effective delivery of IST and SP-IPT: antenatal care (ANC) provider knowledge, and acceptance of the different strategies. Structured interviews with 134 ANC providers at 67 public health facilities in Ashanti Region, Ghana collected information on knowledge of the risks and preventative and curative interventions against MiP. Composite indicators of knowledge of SP-IPT, and case management of MiP were developed. Log binomial regression of predictors of provider knowledge was explored. Qualitative data were collected through in-depth interviews with fourteen ANC providers with some knowledge of IST to gain an indication of the factors influencing acceptance of the IST approach. 88.1% of providers knew all elements of the SP-IPT policy, compared to 20.1% and 41.8% who knew the treatment policy for malaria in the first or second/third trimesters, respectively. Workshop attendance was a univariate predictor of each knowledge indicator. Qualitative findings suggest preference for prevention over cure, and increased workload may be barriers to IST implementation. However, a change in strategy in the face of SP resistance is likely to be supported; health of pregnant women is a strong motivation for ANC provider practice. If IST was to be introduced as part of routine ANC activities, attention would need to be given to improving the knowledge and practices of ANC staff in relation to appropriate treatment of MiP. Health worker support for any MiP intervention delivered through ANC clinics is critical.
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Affiliation(s)
- Lucy Smith Paintain
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Gifty D. Antwi
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Caroline Jones
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Esther Amoako
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rose O. Adjei
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nana A. Afrah
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Brian Greenwood
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Harry Tagbor
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Zapardiel I, Peiretti M, Godoy-Tundidor S. Concurrent puerperal hysterectomy with Ascaris lumbricoides infestation: coincidence or consequence? Am J Obstet Gynecol 2010; 202:e4-5. [PMID: 20350637 DOI: 10.1016/j.ajog.2010.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 01/15/2010] [Indexed: 11/30/2022]
Abstract
The most common etiology of postpartum hemorrhage is uterine atony, although hematologic disorders may be present. A 36-year-old nulliparous woman underwent puerperal hysterectomy caused by uncontrolled postpartum hemorrhage. One day after discharge, she vomited in the emergency room a 24-cm long Ascaris lumbricoides. Infestation during gestation may cause hematologic disorders that could complicate pregnancy outcome.
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Affiliation(s)
- Ignacio Zapardiel
- Department of Obstetrics and Gynecology, Santa Cristina University Hospital, Madrid, Spain.
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Abstract
Infection may cause stillbirth by several mechanisms, including direct infection, placental damage, and severe maternal illness. Various organisms have been associated with stillbirth, including many bacteria, viruses, and protozoa. In developed countries, between 10% and 25% of stillbirths may be caused by an infection, whereas in developing countries, which have much higher stillbirth rates, the contribution of infection is much greater. In developed countries, ascending bacterial infection, both before and after membrane rupture, with organisms such as Escherichia coli, group B streptococci, and Ureaplasma urealyticum is usually the most common infectious cause of stillbirth. However, in areas where syphilis is prevalent, up to half of all stillbirths may be caused by this infection alone. Malaria may be an important cause of stillbirth in women infected for the first time in pregnancy. The two most important viral causes of stillbirth are parvovirus and Coxsackie virus, although a number of other viral infections appear to be causal. Toxoplasma gondii, Listeria monocytogenes, and the organisms that cause leptospirosis, Q fever, and Lyme disease have all been implicated as etiologic for stillbirth. In certain developing countries, the stillbirth rate is high and the infection-related component so great that achieving a substantial reduction in stillbirth should be possible by reducing maternal infections. However, because infection-related stillbirth is uncommon in developed countries, and because those that do occur are caused by a wide variety of organisms, reducing this etiologic component of stillbirth much further will be difficult.
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Affiliation(s)
- Elizabeth M McClure
- Department of Epidemiology, UNC Global School of Public Health, Chapel Hill, North Carolina, USA.
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de Rissio AM, Scollo K, Cardoni RL. [Maternal-fetal transmission of Trypanosoma cruzi in Argentina]. Medicina (B Aires) 2009; 69:529-535. [PMID: 19897438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
In the neonates born to T. cruzi infected mothers, the diagnosis of the congenital transmission relays on the detection of the parasites and/or the specific antibodies non-transferred by their mothers, in the absence of blood transfusion and vectorial transmission. In the early stage, approximately until the 7th month of life, when maternal immunoglobulins could be present, the diagnosis depends on the detection of the parasite. Then, in the late stage, from the 8th month, the detection of specific antibodies by at least 2 of 3 serological tests confirms the infection in the neonates. The diagnostic follow up of the children born to a group of sero-reactive pregnant women was carried out in the INP. The 11% of the mothers (29 out of 267) transmitted the infection to their children. The neonates of 20 of these mothers were diagnosed in the early stage, 14 and 6 in one or two controls, respectively. In the 9 remaining mothers the children were diagnosed in the late stage of the infection, mainly serologicaly. Our analisis of previously published reports stressed that the maternal-fetal transmission rate depends on the time of diagnostic follow up of the child. In this reports, mean values of mother to child transmission reported was 2% and 9% when the diagnosis of the neonates born to sero-reactive mothers was carried out only in the early stage or in the early and also the late stage, respectively.
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Affiliation(s)
- Ana María de Rissio
- Instituto Nacional de Parasitología Fatala Chaben (INP)-ANLIS Malbrán, Buenos Aires
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Yasuda J. [Trichomoniasis]. Nihon Rinsho 2009; 67:162-166. [PMID: 19177767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Trichomonas vaginalis is the most common curable sexually transmitted disease worldwide. In spite of serious health sequelae including facilitation of HIV transmission, PID, and adverse outcomes of pregnancy, it remains an underestimated condition, as a half of female infections and the majority of male infections are asymptomatic. T. vaginalis infection was not restricted in high-risk groups, so screening or empiric treatment of low-risk groups should be considered. To develop diagnostic tests which is valuable like PCR and cheap like wet mount microscopy, and the targeted screening of asymptomatic patients will allow a large understanding of T. vaginalis epidemiology and raises concern about the impact of HIV transmission and female reproductive health. T. vaginalis can no longer be ignored.
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Affiliation(s)
- Jinsuke Yasuda
- Department of Obstetrics and Gynecology, Matsushita Memorial Hospital
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Murphy RG, Williams RH, Hughes JM, Hide G, Ford NJ, Oldbury DJ. The urban house mouse (Mus domesticus) as a reservoir of infection for the human parasite Toxoplasma gondii: an unrecognised public health issue? Int J Environ Health Res 2008; 18:177-185. [PMID: 18569146 DOI: 10.1080/09603120701540856] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Toxoplasma gondii is a protozoan parasite capable of infecting almost all warm-blooded animals. The cat is the definitive host and becomes infected by consuming contaminated meat or infected prey. Humans can act as intermediate hosts and in healthy individuals the infection is mild and self-limiting. In pregnant women it can cause spontaneous abortions and foetal abnormalities and is capable of inducing serious illness in immuno-compromised patients. In infested dwellings, mice could act as intermediate hosts and play a role in the persistence/propagation of the disease. A total of 200 mice were trapped alive in 27 infested properties in Manchester, UK, and screened for Toxoplasma infection; 59% tested positive. Evidence of vertical transmission from infected dams to foetus was found, possibly maintaining the infection in urban areas. These findings have important implications when considering approaches to rodent control.
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Affiliation(s)
- R Gai Murphy
- Built and Human Research Institute, University of Salford, Manchester,UK.
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Affiliation(s)
- Jacky Nizard
- Service de gynécologie obstétrique, Centre hospitalier intercommunal Poissy-St-Germain-en-Laye, Poissy
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Francis SE, Malkov VA, Oleinikov AV, Rossnagle E, Wendler JP, Mutabingwa TK, Fried M, Duffy PE. Six genes are preferentially transcribed by the circulating and sequestered forms of Plasmodium falciparum parasites that infect pregnant women. Infect Immun 2007; 75:4838-50. [PMID: 17698567 PMCID: PMC2044550 DOI: 10.1128/iai.00635-07] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In areas of stable malaria transmission, susceptibility to Plasmodium falciparum malaria increases during first pregnancy. Women become resistant to pregnancy malaria over successive pregnancies as they acquire antibodies against the parasite forms that sequester in the placenta, suggesting that a vaccine is feasible. Placental parasites are antigenically distinct and bind receptors, like chondroitin sulfate A (CSA), that are not commonly bound by other parasites. We used whole-genome-expression analysis to find transcripts that distinguish parasites of pregnant women from other parasites and employed a novel approach to define and adjust for cell cycle timing of parasites. Transcription of six genes was substantially higher in both placental parasites and peripheral parasites from pregnant women, and each gene encodes a protein with a putative export sequence and/or transmembrane domain. This cohort of genes includes var2csa, a member of the variant PfEMP1 gene family previously implicated in pregnancy malaria, as well as five conserved genes of unknown functions. Women in East Africa acquire antibodies over successive pregnancies against a protein encoded by one of these genes, PFD1140w, and this protein shows seroreactivity similar to that of VAR2CSA domains. These findings suggest that a suite of genes may be important for the genesis of the placental binding phenotype of P. falciparum and may provide novel targets for therapeutic intervention.
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Affiliation(s)
- Susan E Francis
- Seattle Biomedical Research Institute, 307 Westlake Ave. N, Seattle, WA 98109-5219, USA
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Senga E, Loscertales MP, Makwakwa KEB, Liomba GN, Dzamalala C, Kazembe PN, Brabin BJ. ABO blood group phenotypes influence parity specific immunity to Plasmodium falciparum malaria in Malawian women. Malar J 2007; 6:102. [PMID: 17683546 PMCID: PMC1995205 DOI: 10.1186/1475-2875-6-102] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 08/03/2007] [Indexed: 11/15/2022] Open
Abstract
Background Blood group O has been significantly associated with increased placental malaria infection in primiparae and reduced risk of infection in multiparae in the Gambia, an area with markedly seasonal malaria transmission. This study analyses the association between ABO blood group phenotypes in relation to placental malaria pathology and birth outcomes in southern Malawi, an area with perennial malaria transmission. Methods A cross-sectional study of 647 mother/child pairs delivering in Montfort Hospital, Chikwawa District between February-June 2004 and January-July 2005 was undertaken. Maternal peripheral and cord blood samples were obtained at delivery. Placental tissue was obtained and malaria histology classified as active, past or no malaria infection. Birth anthropometry was recorded. ABO blood group was measured by agglutination. Results In primiparae, blood group O was significantly associated with increased risk of active placental infection (OR 2.18, 95% CI 1.15–4.6, p = 0.02) and an increased foetal-placental weight ratio compared to non-O phenotypes (5.68 versus 5.45, p = 0.03) In multiparae blood group O was significantly associated with less frequent active placental infection (OR 0.59, 95% CI 0.36–0.98, p = 0.04), and a higher newborn ponderal index compared to non-O phenotypes (2.65 versus 2.55, p = 0.007). In multivariate regression parity was independently associated with increased risk of placental malaria (active andpast infection) in primiparae with blood group O (p = 0.034) and reduced risk in multiparae with the same phenotype (p = 0.015). Conclusion Parity related susceptibility to placental malaria is associated with the mothers ABO phenotype. This interaction influences foetal and placental growth and could be an important modifying factor for pregnancy outcomes. The biological explanation could relate to sialic acid dependent placental membrane differences which vary with ABO blood group.
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Affiliation(s)
- Edward Senga
- Department of Biochemistry, University of Malawi College of Medicine, Blantyre, Malawi
| | | | - KEB Makwakwa
- Department of Biochemistry, University of Malawi College of Medicine, Blantyre, Malawi
| | - George N Liomba
- Department of Biochemistry, University of Malawi College of Medicine, Blantyre, Malawi
| | - Charles Dzamalala
- Department of Biochemistry, University of Malawi College of Medicine, Blantyre, Malawi
| | - Peter N Kazembe
- Baylor College of Medicine Children's Foundation, Lilongwe, Malawi
| | - Bernard J Brabin
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, UK
- Emma Kinderziekenhuis, Academic Medical Centre, University of Amsterdam, The Netherlands
- Department of Community Child Health, Royal Liverpool Children's Hospital, Alder Hey NHS Trust, Liverpool, UK
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Oleinikov AV, Rossnagle E, Francis S, Mutabingwa TK, Fried M, Duffy PE. Effects of Sex, Parity, and Sequence Variation on Seroreactivity to Candidate Pregnancy Malaria Vaccine Antigens. J Infect Dis 2007; 196:155-64. [PMID: 17538896 DOI: 10.1086/518513] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 01/26/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Plasmodium falciparum-infected erythrocytes adhere to chondroitin sulfate A (CSA) to sequester in the human placenta, and pregnancy malaria (PM) is associated with the development of disease in and the death of both mother and child. A PM vaccine appears to be feasible, because women become protected as they develop antibodies against placental infected erythrocytes (IEs). Two IE surface molecules, VAR1CSA and VAR2CSA, bind CSA in vitro and are potential vaccine candidates. METHODS We expressed all domains of VAR1CSA and VAR2CSA as mammalian cell surface proteins, using a novel approach that allows rapid purification, immobilization, and quantification of target antigen. For serum samples from East Africa, we measured reactivity to all domains, and we examined the effects of host sex and parity, as well as the effects of parasite antigenic variation. RESULTS Serum samples obtained from multigravid women had a higher reactivity to all VAR2CSA domains than did those obtained from primigravid women or from men. Conversely, serum samples obtained from men had consistently higher reactivity to VAR1CSA domains than did those obtained from gravid women. Seroreactivity was strongly influenced by antigenic variation of VAR2CSA Duffy binding-like domains. CONCLUSIONS Women acquire antibodies to VAR2CSA over successive pregnancies, but they lose reactivity to VAR1CSA. Serum reactivity to VAR2CSA is variant specific, and future studies should examine the degree to which functional antibodies, such as binding-inhibition antibodies, are variant specific.
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Jaworowski A, Kamwendo DD, Ellery P, Sonza S, Mwapasa V, Tadesse E, Molyneux ME, Rogerson SJ, Meshnick SR, Crowe SM. CD16+ monocyte subset preferentially harbors HIV-1 and is expanded in pregnant Malawian women with Plasmodium falciparum malaria and HIV-1 infection. J Infect Dis 2007; 196:38-42. [PMID: 17538881 DOI: 10.1086/518443] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 01/19/2007] [Indexed: 11/03/2022] Open
Abstract
In a cross-sectional study, monocyte subsets in placental, cord, and maternal peripheral blood from pregnant Malawian women with human immunodeficiency virus (HIV)-1 infection and/or malaria were analyzed. HIV-uninfected Malawian women had higher baseline proportions of CD16(+) monocytes than those reported for healthy adults in developed countries. Malaria was associated with an increase in the proportion of CD16(+) monocytes that was significant in women coinfected with HIV-1. CD16(+) monocytes expressed higher CCR5 levels than did CD14(hi)/CD16(-) monocytes and were significantly more likely to harbor HIV-1. These data suggest a role for CD16(+) monocytes in the pathogenesis of maternal malaria and HIV-1 infections.
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Affiliation(s)
- Anthony Jaworowski
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
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Mortensen PB, Nørgaard-Pedersen B, Waltoft BL, Sørensen TL, Hougaard D, Torrey EF, Yolken RH. Toxoplasma gondii as a risk factor for early-onset schizophrenia: analysis of filter paper blood samples obtained at birth. Biol Psychiatry 2007; 61:688-93. [PMID: 16920078 DOI: 10.1016/j.biopsych.2006.05.024] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2006] [Revised: 05/05/2006] [Accepted: 05/12/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Infections during fetal life or neonatal period, including infections with Toxoplasma gondii, may be associated with a risk for schizophrenia and other mental disorders. The objectives of this study were to study the association between serological markers for maternal and neonatal infection and the risk for schizophrenia, related psychoses, and affective disorders in a national cohort of newborns. METHODS This study was a cohort-based, case-control study combining data from national population registers and patient registers and a national neonatal screening biobank in Denmark. Patients included persons born in Denmark in 1981 or later followed up through 1999 with respect to inpatient or outpatient treatment for schizophrenia or related disorders (ICD-10 F2) or affective disorders (ICD-10 F3). RESULTS Toxoplasma gondii immunoglobulin G (IgG) levels corresponding to the upper quartile among control subjects were significantly associated with schizophrenia risk (odds ratio [OR] = 1.79, p = .045) after adjustment for urbanicity of place of birth, year of birth, gender, and psychiatric diagnoses among first-degree relatives. There was no significant association between any marker of infection and other schizophrenia-like disorders or affective disorders. CONCLUSIONS Our study supports an association between Toxoplasma gondii and early-onset schizophrenia. Further studies are needed to establish if the association is causal and if it generalizes to cases with onset after age 18.
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Affiliation(s)
- Preben Bo Mortensen
- National Centre for Register-Based Research, University of Aarhus, Aarhus, Denmark.
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Berrebi A, Bardou M, Bessieres MH, Nowakowska D, Castagno R, Rolland M, Wallon M, Franck J, Bongain A, Monnier-Barbarino P, Assouline C, Cassaing S. Outcome for children infected with congenital toxoplasmosis in the first trimester and with normal ultrasound findings: a study of 36 cases. Eur J Obstet Gynecol Reprod Biol 2006; 135:53-7. [PMID: 17189666 DOI: 10.1016/j.ejogrb.2006.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Revised: 10/01/2006] [Accepted: 11/12/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We wished to investigate the prognosis of children infected with Toxoplasma gondii during the first trimester of pregnancy and whose ultrasound findings were entirely normal, in order to find out whether congenital toxoplasmosis did or did not justify termination of pregnancy if there was no fetal abnormality on ultrasound. STUDY DESIGN A prospective and retrospective study was carried out by 12 French centers who enrolled 36 children infected with T. gondii during the first trimester of pregnancy and whose ultrasound examinations showed no anomaly. The outcome of these children after the age of 12 months (mean 50 months, range 12-144 months) was analyzed. RESULTS Of the 36 infected children, 28 (78%) presented subclinical toxoplasmosis. Only specific IgG antibodies persisted after 1 year. The principal manifestation in 7 children (19%) was chorioretinitis without major vision loss. Their intellectual development was entirely normal. One child (3%) developed severe congenital toxoplasmosis. CONCLUSION Since 97% of children infected with toxoplasmosis during the first trimester of pregnancy are asymptomatic or only slightly affected, we believe that in such circumstances termination of pregnancy is not indicated. However, appropriate treatment is essential and prenatal ultrasound examinations should be free of any anomaly.
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Affiliation(s)
- Alain Berrebi
- Fédération de Gynécologie-Obstétrique, CHU Paule de Viguier, TSA 70034, 31059 Toulouse Cedex 9, France.
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Abstract
AIM To compare the clinical findings in children with symptomatic toxoplasmic ocular lesions attributable to infection acquired before or after birth. METHODS Cases were prospectively ascertained for 24 months through national surveillance units and reference laboratories in the British Isles. Age and presenting symptoms, site of lesion and visual impairment in children who were classified as acquiring infection either before or after birth on the basis of clinical and serological findings were compared. RESULTS 31 children had toxoplasmic retinochoroiditis, 15 had congenital infection and all but three of these presented before the age of 4 years. The remaining 16 children acquired toxoplasmosis postnatally, and 14 of 16 presented after the age of 10 years. A further four children had retinochoroiditis due to other causes. The presence of bilateral, multiple or posterior pole lesions did not distinguish between the two groups, but most children (16/19; 84%) presenting with acute ocular symptoms had postnatally acquired infection. Unilateral visual impairment (Snellen < or =6/18) was equally prevalent in the two groups (4/9 before birth v 7/16 after birth; p>0.5). Only two children had bilateral visual impairment, both of whom had congenital infection. No child was blind. CONCLUSIONS About 50% of children with ocular lesions due to toxoplasmosis had postnatal infection. Retinochoroidal lesions due to infection before and after birth were indistinguishable. The prognosis for bilateral visual function was good, regardless of when infection was acquired.
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Affiliation(s)
- M R Stanford
- Department of Ophthalmology, St Thomas' Hospital, London, UK
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