Title:
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Changing Trends in P. falciparum Burden, Immunity, and Disease in Pregnancy
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Author:
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Mayor Aparicio, Alfredo Gabriel; Bardají, Azucena; Macete, Eusébio; Nhampossa, Tacilta; Fonseca, Ana Maria; González, Raquel; Maculuve, Sónia Amós; Cisteró, Pau; Rupérez, María; Campo, Joe; Vala, Anifa; Sigaúque, Betuel; Jiménez, Alfons; Machevo, Sonia; Fuente, Laura de la; Nhama, Abel; Luis, Leopoldina; Aponte, John J.; Acácio, Sozinho; Nhacolo, Arsénio; Chitnis, Chetan E.; Dobaño, Carlota, 1969-; Sevene, Esperança Júlia Pires; Alonso, Pedro; Menéndez, Clara
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Abstract:
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Background Prevention of reinfection and resurgence is an integral component of the goal to eradicate malaria. However, the adverse effects of malaria resurgences are not known.
Methods We assessed the prevalence of Plasmodium falciparum
infection among 1819 Mozambican women who delivered infants
between 2003 and 2012. We used microscopic and histologic
examination and a quantitative polymerase-chain-reaction (qPCR)
assay, as well as flow-cytometric analysis of IgG antibody
responses against two parasite lines. Results Positive qPCR
tests for P. falciparum decreased from 33% in 2003 to 2% in 2010
and increased to 6% in 2012, with antimalarial IgG antibody
responses mirroring these trends. Parasite densities in
peripheral blood on qPCR assay were higher in 2010-2012
(geometric mean [+/-SD], 409+/-1569 genomes per microliter) than
in 2003-2005 (44+/-169 genomes per microliter, P=0.02), as were
parasite densities in placental blood on histologic assessment
(50+/-39% of infected erythrocytes vs. 4+/-6%, P<0.001). The
malaria-associated reduction in maternal hemoglobin levels was
larger in 2010-2012 (10.1+/-1.8 g per deciliter in infected
women vs. 10.9+/-1.7 g per deciliter in uninfected women; mean
difference, -0.82 g per deciliter; 95% confidence interval [CI],
-1.39 to -0.25) than in 2003-2005 (10.5+/-1.1 g per deciliter
vs. 10.6+/-1.5 g per deciliter; difference, -0.12 g per
deciliter; 95% CI, -0.67 to 0.43), as was the reduction in birth
weight (2863+/-440 g in women with past or chronic infections
vs. 3070+/-482 g in uninfected women in 2010-2012; mean
difference, -164.5 g; 95% CI, -289.7 to -39.4; and 2994+/-487 g
vs. 3117+/-455 g in 2003-2005; difference, -44.8 g; 95% CI,
-139.1 to 49.5). Conclusions Antimalarial antibodies were
reduced and the adverse consequences of P. falciparum infections
were increased in pregnant women after 5 years of a decline in
the prevalence of malaria. (Funded by Malaria Eradication
Scientific Alliance and others.). |
Subject(s):
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-Plasmodium falciparum -Malària -Embaràs -Epidemiologia -Immunologia -Plasmodium falciparum -Malaria -Pregnancy -Epidemiology -Immunology |
Rights:
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(c) Massachusetts Medical Society, 2015
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Document type:
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Article Article - Published version |
Published by:
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Massachusetts Medical Society
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