Gravidity and malaria trends interact to modify P. falciparum densities and detectability in pregnancy: a 3-year prospective multi-site observational study.
Gravidity and malaria trends interact to modify P. falciparum densities and detectability in pregnancy: a 3-year prospective multi-site observational study.
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DOI：
10.1186/s12916-022-02597-6
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发表时间：
2022-11-15
期刊：
影响因子：
9.3
通讯作者：
Mayor, Alfredo
中科院分区：
文献类型：
--
作者：
Matambisso, Gloria;Brokhattingen, Nanna;Maculuve, Sonia;Cistero, Pau;Mbeve, Henriques;Escoda, Anna;Miguel, Judice;Buetas, Elena;de Jong, Ianthe;Cuna, Boaventura;Melembe, Cardoso;Ndimande, Nelo;Porras, Gemma;Chen, Haily;Tetteh, Kevin K. A.;Drakeley, Chris;Gamain, Benoit;Chitnis, Chetan;Chauhan, Virander;Quinto, Llorenc;Galatas, Beatriz;Macete, Eusebio;Mayor, Alfredo
低密度恶性疟原虫感染在低传播环境中普遍存在，在那里免疫力预计是最小的，这表明对寄生虫密度的免疫独立影响。我们的目的是描述寄生虫密度在怀孕期间，并确定妊娠和抗体介导的免疫力如何影响这些，在莫桑比克南部的疟疾传播下降的时期。我们记录了2016年11月至2019年10月期间在Ilha Josina（高至中度传播地区），Manhiça（低传播地区）和Magude（消灭前地区）首次产前保健访视时的恶性疟原虫感染（n = 6471）。使用混合效应回归模型中的双向相互作用评估定量PCR测定的恶性疟原虫阳性率（PfPRqPCR）和密度、当前诊断检测（≥ 100个寄生虫/μL）可检测感染的相对比例（pDi）和抗疟抗体的妊娠依赖性差异。在Ilha Josina，PfPRqPCR从28%下降到13%，在Magude和Manhiça从5- 7%下降到2%。在妊娠鲷科中，第一个研究年Ilha Josina的pDi最高（p = 0.048），随着PfPRqPCR下降而下降（相对变化/年：0.41，95% CI [0.08; 0.73]，p = 0.029），抗体水平无差异。在第一年，Ilha Josina的寄生虫密度较高，伴随着母体血红蛋白水平的较大降低（− 1.60，95% CI [− 2.49; − 0.72; p < 0.001），比Magude（− 0.76，95% CI [− 1.51; − 0.01]; p = 0.047）和Manhiça（− 0.44，95% CI [− 0.99; 0.10; p = 0.112）。相比之下，在Ilha Josina的传输高峰期间，multigravidae携带最低的pDi（p = 0.049）。随着PfPRqPCR下降，寄生虫密度的几何平均值增加（4.63，95% CI [1.28; 16.82]，p = 0.020），Ilha Josina的secundigrafidae中的抗体水平下降。在高度至中度传播环境中，孕妇中可检测和临床相关感染的比例最高，并随着疟疾的减少而下降。与此相反，疟疾下降的趋势伴随着寄生虫密度的增加和secundigravidae体液免疫力的降低。因此，获得性免疫以外的其他因素可能对在疟疾传播显著下降期间产生较少的可检测到的感染具有重要意义。在线版本包含补充材料，可通过10.1186/s12916-022-02597-6获得。
Low-density Plasmodium falciparum infections prevail in low transmission settings, where immunity is expected to be minimal, suggesting an immune-independent effect on parasite densities. We aimed to describe parasite densities in pregnancy, and determine how gravidity and antibody-mediated immunity affect these, during a period of declining malaria transmission in southern Mozambique. We documented P. falciparum infections at first antenatal care visits (n = 6471) between November 2016 and October 2019 in Ilha Josina (high-to-moderate transmission area), Manhiça (low transmission area), and Magude (pre-elimination area). Two-way interactions in mixed-effects regression models were used to assess gravidity-dependent differences in quantitative PCR-determined P. falciparum positivity rates (PfPRqPCR) and densities, in the relative proportion of detectable infections (pDi) with current diagnostic tests (≥ 100 parasites/μL) and in antimalarial antibodies. PfPRqPCR declined from 28 to 13% in Ilha Josina and from 5–7 to 2% in Magude and Manhiça. In primigravidae, pDi was highest in Ilha Josina at the first study year (p = 0.048), which declined with falling PfPRqPCR (relative change/year: 0.41, 95% CI [0.08; 0.73], p = 0.029), with no differences in antibody levels. Higher parasite densities in primigravidae from Ilha Josina during the first year were accompanied by a larger reduction of maternal hemoglobin levels (− 1.60, 95% CI [− 2.49; − 0.72; p < 0.001), than in Magude (− 0.76, 95% CI [− 1.51; − 0.01]; p = 0.047) and Manhiça (− 0.44, 95% CI [− 0.99; 0.10; p = 0.112). In contrast, multigravidae during the transmission peak in Ilha Josina carried the lowest pDi (p = 0.049). As PfPRqPCR declined, geometric mean of parasite densities increased (4.63, 95% CI [1.28; 16.82], p = 0.020), and antibody levels declined among secundigravidae from Ilha Josina. The proportion of detectable and clinically relevant infections is the highest in primigravid women from high-to-moderate transmission settings and decreases with declining malaria. In contrast, the falling malaria trends are accompanied by increased parasite densities and reduced humoral immunity among secundigravidae. Factors other than acquired immunity thus emerge as potentially important for producing less detectable infections among primigravidae during marked declines in malaria transmission. The online version contains supplementary material available at 10.1186/s12916-022-02597-6.
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影响因子：
64.8
作者：
Mancio-Silva L;Slavic K;Grilo Ruivo MT;Grosso AR;Modrzynska KK;Vera IM;Sales-Dias J;Gomes AR;MacPherson CR;Crozet P;Adamo M;Baena-Gonzalez E;Tewari R;Llinás M;Billker O;Mota MM
通讯作者：
Mota MM
影响因子：
4.1
作者：
Reece SE;Ramiro RS;Nussey DH
通讯作者：
Nussey DH
影响因子：
3.7
作者：
Feng G;Simpson JA;Chaluluka E;Molyneux ME;Rogerson SJ
通讯作者：
Rogerson SJ
影响因子：
7.7
作者：
Jacob CG;Thuy-Nhien N;Mayxay M;Maude RJ;Quang HH;Hongvanthong B;Vanisaveth V;Ngo Duc T;Rekol H;van der Pluijm R;von Seidlein L;Fairhurst R;Nosten F;Hossain MA;Park N;Goodwin S;Ringwald P;Chindavongsa K;Newton P;Ashley E;Phalivong S;Maude R;Leang R;Huch C;Dong LT;Nguyen KT;Nhat TM;Hien TT;Nguyen H;Zdrojewski N;Canavati S;Sayeed AA;Uddin D;Buckee C;Fanello CI;Onyamboko M;Peto T;Tripura R;Amaratunga C;Myint Thu A;Delmas G;Landier J;Parker DM;Chau NH;Lek D;Suon S;Callery J;Jittamala P;Hanboonkunupakarn B;Pukrittayakamee S;Phyo AP;Smithuis F;Lin K;Thant M;Hlaing TM;Satpathi P;Satpathi S;Behera PK;Tripura A;Baidya S;Valecha N;Anvikar AR;Ul Islam A;Faiz A;Kunasol C;Drury E;Kekre M;Ali M;Love K;Rajatileka S;Jeffreys AE;Rowlands K;Hubbart CS;Dhorda M;Vongpromek R;Kotanan N;Wongnak P;Almagro Garcia J;Pearson RD;Ariani CV;Chookajorn T;Malangone C;Nguyen T;Stalker J;Jeffery B;Keatley J;Johnson KJ;Muddyman D;Chan XHS;Sillitoe J;Amato R;Simpson V;Gonçalves S;Rockett K;Day NP;Dondorp AM;Kwiatkowski DP;Miotto O
通讯作者：
Miotto O
影响因子：
4.4
作者：
Ampomah, Paulina;Stevenson, Liz;Hviid, Lars
通讯作者：
Hviid, Lars