Detection and clinical manifestation of placental malaria in southern Ghana
Detection and clinical manifestation of placental malaria in southern Ghana
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DOI：
10.1186/1475-2875-5-119
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发表时间：
2006-12-13
期刊：
影响因子：
3
通讯作者：
Bienzle, Ulrich
中科院分区：
文献类型：
--
作者：
Mockenhaupt, Frank P.;Bedu-Addo, George;Bienzle, Ulrich
背景：恶性疟原虫可通过显微镜、富含组氨酸蛋白2(HRP2)捕获试验或聚合酶链式反应(PCR)检测出来，但由此诊断的孕妇感染的临床相关性尚不清楚。方法：在加纳阿戈戈市839名分娩妇女的横断面研究中，从外周血和胎盘血样中筛查恶性疟原虫，并分析其与母亲贫血、低出生体重(LBW)和早产(PD)的关系。结果：镜检、HRP2试验和PCR检测外周血中恶性疟原虫的发生率分别为19%、34%和53%。对于胎盘样本，这些数字分别为35%、41%和59%。不考虑诊断工具，恶性疟原虫感染增加了贫血的风险。镜检和聚合酶链式反应阳性的外周血结果与LBW或PD无关。相比之下，HRP2测试在识别妊娠结局不良风险增加的妇女方面表现良好，特别是在外周血片阴性的情况下。对年龄、产次和产前检查进行调整后，胎盘HRP2是与LBW(调整后的优势比(AOR)，1.5(95%CI，1.0-2.2))和PD(调整后的优势比，1.4(1.0-2.1))以及贫血(AOR，2.3(1.7-3.2))相关的唯一感染标志物。同样，疑似寄生虫病妇女外周血中HRP2与PD(AOR，1.7(1.0-2.7))和贫血(AOR，2.1(1.4-3.2))相关。结论：外周血片镜检不仅低估了胎盘疟疾。在这种高度流行的情况下，它也没有将疟疾确定为胎儿损害的原因。在看似寄生虫病的妇女中，HRP2检测发现的亚显微感染增加了贫血和帕金森氏症的风险。这些发现表明，孕期疟疾的负担可能比想象的更大，并强调了在孕期采取有效的抗疟疾干预措施的必要性。
Background: Plasmodium falciparum can be detected by microscopy, histidine-rich-protein-2 (HRP2) capture test or PCR but the respective clinical relevance of the thereby diagnosed infections in pregnant women is not well established.Methods: In a cross-sectional, year-round study among 839 delivering women in Agogo, Ghana, P. falciparum was screened for in both, peripheral and placental blood samples, and associations with maternal anaemia, low birth weight ( LBW) and preterm delivery (PD) were analysed.Results: In peripheral blood, P. falciparum was observed in 19%, 34%, and 53% by microscopy, HRP2 test, and PCR, respectively. For placental samples, these figures were 35%, 41%, and 59%. Irrespective of diagnostic tool, P. falciparum infection increased the risk of anaemia. Positive peripheral blood results of microscopy and PCR were not associated with LBW or PD. In contrast, the HRP2 test performed well in identifying women at increased risk of poor pregnancy outcome, particularly in case of a negative peripheral blood film. Adjusting for age, parity, and antenatal visits, placental HRP2 was the only marker of infection associated with LBW ( adjusted odds ratio (aOR), 1.5 (95% CI, 1.0 - 2.2)) and, at borderline statistical significance, PD ( aOR, 1.4 ( 1.0 - 2.1)) in addition to anaemia ( aOR, 2.3 ( 1.7 - 3.2)). Likewise, HRP2 in peripheral blood of seemingly aparasitaemic women was associated with PD ( aOR, 1.7 ( 1.0 - 2.7)) and anaemia ( aOR, 2.1 ( 1.4 - 3.2)).Conclusion: Peripheral blood film microscopy not only underestimates placental malaria. In this highly endemic setting, it also fails to identify malaria as a cause of foetal impairment. Sub- microscopic infections detected by a HRP2 test in seemingly aparasitaemic women increase the risks of anaemia and PD. These findings indicate that the burden of malaria in pregnancy may be even larger than thought and accentuate the need for effective anti-malarial interventions in pregnancy.