Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities
Abstract Background Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under differ...
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| Format: | Article |
| Language: | English |
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BMC
2017-07-01
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| Series: | BMC Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12916-017-0893-6 |
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| author | Nicaise Tuikue Ndam Emmanuel Mbuba Raquel González Pau Cisteró Simon Kariuki Esperança Sevene María Rupérez Ana Maria Fonseca Anifa Vala Sonia Maculuve Alfons Jiménez Llorenç Quintó Peter Ouma Michael Ramharter John J. Aponte Arsenio Nhacolo Achille Massougbodji Valerie Briand Peter G. Kremsner Ghyslain Mombo-Ngoma Meghna Desai Eusebio Macete Michel Cot Clara Menéndez Alfredo Mayor |
| author_facet | Nicaise Tuikue Ndam Emmanuel Mbuba Raquel González Pau Cisteró Simon Kariuki Esperança Sevene María Rupérez Ana Maria Fonseca Anifa Vala Sonia Maculuve Alfons Jiménez Llorenç Quintó Peter Ouma Michael Ramharter John J. Aponte Arsenio Nhacolo Achille Massougbodji Valerie Briand Peter G. Kremsner Ghyslain Mombo-Ngoma Meghna Desai Eusebio Macete Michel Cot Clara Menéndez Alfredo Mayor |
| author_sort | Nicaise Tuikue Ndam |
| collection | DOAJ |
| description | Abstract Background Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different intensities of malaria transmission. Methods P. falciparum at delivery was assessed by microscopy, quantitative PCR (qPCR) and placental histology in 946 HIV-uninfected and 768 HIV-infected pregnant women from Benin, Gabon, Kenya and Mozambique. Resistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by Luminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery. Results P. falciparum prevalence by qPCR in peripheral and/or placental blood of HIV-uninfected Mozambican, Gabonese and Beninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. The proportion of peripheral submicroscopic infections was higher in Benin (83%) than in Mozambique (60%) and Gabon (55%; P = 0.033). Past or chronic placental P. falciparum infection was associated with an increased risk of preterm birth in Mozambican newborns (OR = 7.05, 95% CI 1.79 to 27.82). Microscopic infections were associated with reductions in haemoglobin levels at delivery among Mozambican women (–1.17 g/dL, 95% CI –2.09 to –0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in Mozambican (–1.66 g/dL, 95% CI –2.68 to –0.64) and Gabonese (–0.91 g/dL, 95% CI –1.79 to –0.02) women. Doubling qPCR-peripheral parasite densities in Mozambican women were associated with decreases in haemoglobin levels at delivery (–0.16 g/dL, 95% CI –0.29 to –0.02) and increases in the drop of haemoglobin levels (–0.29 g/dL, 95% CI –0.44 to –0.14). Beninese women had higher anti-parasite IgGs than Mozambican women (P < 0.001). No difference was found in the proportion of submicroscopic infections nor in the adverse impact of P. falciparum infections in HIV-infected women from Kenya (P. falciparum prevalence by qPCR: 9%, 32/351) and Mozambique (4%, 15/417). Conclusions The lowest levels of resistance and tolerance in pregnant women from areas of low malaria transmission were accompanied by the largest adverse impact of P. falciparum infections. Exposure-dependent mechanisms developed by pregnant women to resist the infection and minimise pathology can reduce malaria-related adverse outcomes. Distinguishing both types of defences is important to understand how reductions in transmission can affect malaria disease. Trial registration ClinicalTrials.gov NCT00811421 . Registered 18 December 2008. |
| first_indexed | 2024-12-21T05:56:46Z |
| format | Article |
| id | doaj.art-5b3a20efc20b4e3e939d7e5f97a3696f |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-21T05:56:46Z |
| publishDate | 2017-07-01 |
| publisher | BMC |
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| series | BMC Medicine |
| spelling | doaj.art-5b3a20efc20b4e3e939d7e5f97a3696f2022-12-21T19:13:50ZengBMCBMC Medicine1741-70152017-07-0115111210.1186/s12916-017-0893-6Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensitiesNicaise Tuikue Ndam0Emmanuel Mbuba1Raquel González2Pau Cisteró3Simon Kariuki4Esperança Sevene5María Rupérez6Ana Maria Fonseca7Anifa Vala8Sonia Maculuve9Alfons Jiménez10Llorenç Quintó11Peter Ouma12Michael Ramharter13John J. Aponte14Arsenio Nhacolo15Achille Massougbodji16Valerie Briand17Peter G. Kremsner18Ghyslain Mombo-Ngoma19Meghna Desai20Eusebio Macete21Michel Cot22Clara Menéndez23Alfredo Mayor24Institut de Recherche pour le Développement (IRD)Ifakara Health Institute (IHI), Bagamoyo Research and Training Centre (BRTC)ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de BarcelonaISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de BarcelonaKenya Medical Research Institute (KEMRI)/Centre for Global Health ResearchCentro de Investigação em Saúde da Manhiça (CISM)ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de BarcelonaISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de BarcelonaCentro de Investigação em Saúde da Manhiça (CISM)Centro de Investigação em Saúde da Manhiça (CISM)ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de BarcelonaFaculté des Sciences de la Santé (FSS), Université d’Aboméy CalaviKenya Medical Research Institute (KEMRI)/Centre for Global Health ResearchInstitute of Tropical Medicine, University of TübingenISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de BarcelonaCentro de Investigação em Saúde da Manhiça (CISM)Faculté des Sciences de la Santé (FSS), Université d’Aboméy CalaviInstitut de Recherche pour le Développement (IRD)Institute of Tropical Medicine, University of TübingenInstitute of Tropical Medicine, University of TübingenMalaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and PreventionCentro de Investigação em Saúde da Manhiça (CISM)Institut de Recherche pour le Développement (IRD)ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de BarcelonaISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de BarcelonaAbstract Background Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. falciparum infections among African pregnant women under different intensities of malaria transmission. Methods P. falciparum at delivery was assessed by microscopy, quantitative PCR (qPCR) and placental histology in 946 HIV-uninfected and 768 HIV-infected pregnant women from Benin, Gabon, Kenya and Mozambique. Resistance was defined by the proportion of submicroscopic infections and the levels of anti-parasite antibodies quantified by Luminex, and tolerance by the relationship of pregnancy outcomes with parasite densities at delivery. Results P. falciparum prevalence by qPCR in peripheral and/or placental blood of HIV-uninfected Mozambican, Gabonese and Beninese women at delivery was 6% (21/340), 11% (28/257) and 41% (143/349), respectively. The proportion of peripheral submicroscopic infections was higher in Benin (83%) than in Mozambique (60%) and Gabon (55%; P = 0.033). Past or chronic placental P. falciparum infection was associated with an increased risk of preterm birth in Mozambican newborns (OR = 7.05, 95% CI 1.79 to 27.82). Microscopic infections were associated with reductions in haemoglobin levels at delivery among Mozambican women (–1.17 g/dL, 95% CI –2.09 to –0.24) as well as with larger drops in haemoglobin levels from recruitment to delivery in Mozambican (–1.66 g/dL, 95% CI –2.68 to –0.64) and Gabonese (–0.91 g/dL, 95% CI –1.79 to –0.02) women. Doubling qPCR-peripheral parasite densities in Mozambican women were associated with decreases in haemoglobin levels at delivery (–0.16 g/dL, 95% CI –0.29 to –0.02) and increases in the drop of haemoglobin levels (–0.29 g/dL, 95% CI –0.44 to –0.14). Beninese women had higher anti-parasite IgGs than Mozambican women (P < 0.001). No difference was found in the proportion of submicroscopic infections nor in the adverse impact of P. falciparum infections in HIV-infected women from Kenya (P. falciparum prevalence by qPCR: 9%, 32/351) and Mozambique (4%, 15/417). Conclusions The lowest levels of resistance and tolerance in pregnant women from areas of low malaria transmission were accompanied by the largest adverse impact of P. falciparum infections. Exposure-dependent mechanisms developed by pregnant women to resist the infection and minimise pathology can reduce malaria-related adverse outcomes. Distinguishing both types of defences is important to understand how reductions in transmission can affect malaria disease. Trial registration ClinicalTrials.gov NCT00811421 . Registered 18 December 2008.http://link.springer.com/article/10.1186/s12916-017-0893-6MalariaPregnancyImmunityResistanceTolerance |
| spellingShingle | Nicaise Tuikue Ndam Emmanuel Mbuba Raquel González Pau Cisteró Simon Kariuki Esperança Sevene María Rupérez Ana Maria Fonseca Anifa Vala Sonia Maculuve Alfons Jiménez Llorenç Quintó Peter Ouma Michael Ramharter John J. Aponte Arsenio Nhacolo Achille Massougbodji Valerie Briand Peter G. Kremsner Ghyslain Mombo-Ngoma Meghna Desai Eusebio Macete Michel Cot Clara Menéndez Alfredo Mayor Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities BMC Medicine Malaria Pregnancy Immunity Resistance Tolerance |
| title | Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities |
| title_full | Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities |
| title_fullStr | Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities |
| title_full_unstemmed | Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities |
| title_short | Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities |
| title_sort | resisting and tolerating p falciparum in pregnancy under different malaria transmission intensities |
| topic | Malaria Pregnancy Immunity Resistance Tolerance |
| url | http://link.springer.com/article/10.1186/s12916-017-0893-6 |
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