Complement activation, placental malaria infection, and birth weight in areas characterized by unstable malaria transmission in central Sudan

Diagnostic Pathology

Ishag Adam²  Ahmed A Mohmmed¹  Elhassan M Elhassan³  Awad-Elkareem Abass⁴  Naser E.Bilal⁴  Ammar Alim⁴ 

[1] Faculty of Medicine, Ribat University, Khartoum, Sudan;Faculty of Medicine, University of Khartoum, Khartoum, Sudan;Faculty of Medicine, University of Geziera, Medani, Sudan;Faculty of Medical laboratory Sciences, University of Khartoum, Khartoum, Sudan

关键词: Sudan;    Birth weight;    Hemoglobin;    Complement;    Pregnancy;    Malaria;   

Others  :  1214030
DOI  :  10.1186/s13000-015-0275-3

 received in 2014-10-17, accepted in 2015-04-16,  发布年份 2015

【 摘 要 】

Background

The pathogenesis of malaria during pregnancy is not completely understood. There are few published data on complement activation and malaria during pregnancy. This study aimed to investigate complement activation and malaria during pregnancy, and their association with hemoglobin and birth weight.

Methods

A cross-sectional study was conducted at Medani, Sudan. Soluble terminal complement complex (TCC) levels were measured using ELISA in maternal and cord blood samples from 126 parturient women.

Results

There were no Plasmodium falciparum-positive blood films from maternal peripheral blood, the placenta, or cord blood samples. Three (2.4%) and 22 (17.5%) of the placentas showed chronic and previous infection with histopathological examination, respectively, while 101 (80.2%) of them had no malaria infection. The mean [SD] of the maternal (22.4 [6.1] vs. 26.5 [3.5] ng/ml, P < 0.001) and cord blood (24.5 [4.5] vs. 26.8 [4.4] ng/ml, P = 0.024) TCC levels were significantly lower in cases of placental malaria infection (n = 25) than in those without placental malaria infection (n = 101). Linear regression showed that placental malaria infection was significantly associated with birth weight (−0.353 g, P = 0.013), but there were no associations between maternal and cord TCC levels and maternal hemoglobin, or between TCC levels and birth weight.

Conclusion

Maternal and cord blood TCC levels are lower in women with placental malaria infection than in those without placental malaria infection.

Virtual Slide

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9600054761463915 webcite

【 授权许可】

   
2015 Alim et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Dellicour S, Tatem AJ, Guerra CA, Snow RW, Ter Kuile FO. Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med. 2010; 7:e1000221.
• [2]Desai M, ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B et al.. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007; 7:93-104.
• [3]Menendez C, Ordi J, Ismail MR, Ventura PJ, Aponte JJ, Kahigwa E et al.. The impact of placental malaria on gestational age and birth weight. J Infect Dis. 2000; 181:1740-5.
• [4]Rogerson SJ, Pollina E, Getachew A, Tadesse E, Lema VM, Molyneux ME. Placental monocyte infiltrates in response to Plasmodium falciparum malaria infection and their association with adverse pregnancy outcomes. Am J Trop Med Hyg. 2003; 68:115-9.
• [5]Ahmed R, Singh N, ter Kuile FO, Bharti PK, Singh PP, Desai M et al.. Placental infections with histologically confirmed Plasmodium falciparum are associated with adverse birth outcomes in India: a cross-sectional study. Malar J. 2014; 13:232. BioMed Central Full Text
• [6]Ali AA, Elhassan EM, Magzoub MM, Elbashir MI, Adam I. Hypoglycaemia and severe Plasmodium falciparum malaria among pregnant Sudanese women in an area characterized by unstable malaria transmission. Parasit Vectors. 2011; 4:88. BioMed Central Full Text
• [7]Adam I, Khamis AH, Elbashir MI. Prevalence and risk factors for anaemia in pregnant women of eastern Sudan. Trans R Soc Trop Med Hyg. 2005; 99:739-43.
• [8]Mohammed AH, Salih MM, Elhassan EM, Mohmmed AA, Elzaki SE, El-Sayed BB et al.. Submicroscopic Plasmodium falciparum malaria and low birth weight in an area of unstable malaria transmission in Central Sudan. Malar J. 2013; 12:172. BioMed Central Full Text
• [9]Umbers AJ, Aitken EH, Rogerson SJ. Malaria in pregnancy: small babies, big problem. Trends Parasitol. 2011; 27:168-75.
• [10]Guo RF, Ward PA. Role of C5a in inflammatory responses. Annu Rev Immunol. 2005; 23:821-52.
• [11]Silver KL, Higgins SJ, McDonald CR, Kain KC. Complement driven innate immune response to malaria: fuelling severe malarial diseases. Cell Microbiol. 2010; 12:1036-45.
• [12]Langer HF, Chung KJ, Orlova VV, Choi EY, Kaul S, Kruhlak MJ et al.. Complement-mediated inhibition of neovascularization reveals a point of convergence between innate immunity and angiogenesis. Blood. 2010; 116:4395-403.
• [13]Conroy A, Serghides L, Finney C, Owino SO, Kumar S, Gowda DC et al.. C5a enhances dysregulated inflammatory and angiogenic responses to malaria in vitro: potential implications for placental malaria. PLoS One. 2009; 4:e4953.
• [14]Muehlenbachs A, Fried M, Lachowitzer J, Mutabingwa TK, Duffy PE. Genome-wide expression analysis of placental malaria reveals features of lymphoid neogenesis during chronic infection. J Immunol. 2007; 179:557-65.
• [15]Walport MJ. Complement. First of two parts. N Engl J Med. 2001; 344:1058e66.
• [16]Khattab A, Kremsner PG, Meri S. Complement activation in primiparous women from a malaria endemic area is associated with reduced birth weight. Placenta. 2013; 34:162-7.
• [17]Malik EM, Atta HY, Weis M, Lang A, Puta C, Lettenmaier C. Sudan Roll Back Malaria Consultative Mission: Essential Actions to Support the Attainment of the Abuja Targets. Sudan RBM Country Consultative Mission Final Report. Roll Back Malaria Partnership, Geneva; 2004.
• [18]Salih MM, Mohammed AH, Mohmmed AA, Adam GK, Elbashir MI, Adam I. Monocytes and macrophages and placental malaria infections in an area of unstable malaria transmission in eastern Sudan. Diagn Pathol. 2011; 6:83. BioMed Central Full Text
• [19]Adam I, Babiker S, Mohmmed AA, Salih MM, Prins MH, Zaki ZM. ABO blood group system and placental malaria in an area of unstable malaria transmission in eastern Sudan. Malar J. 2007; 6:110. BioMed Central Full Text
• [20]Bulmer JN, Rasheed FN, Francis N, Morrison L, Greenwood BM. Placental malaria I. Pathological classification. Histopathology. 1993; 22:211-8.
• [21]Bulmer JN, Rasheed FN, Morrison L, Francis N, Greenwood BM. Placental malaria II. A semi-quantitative investigation of the pathological features. Histopathology. 1993; 22:219-25.
• [22]Batran SE, Salih MM, Elhassan EM, Mohmmed AA, Adam I. CD20, CD3, placental malaria infections and low birth weight in an area of unstable malaria transmission in Central Sudan. Diagn Pathol. 2013; 8:189. BioMed Central Full Text
• [23]Bayoumi NK, Bakhet KH, Mohmmed AA, Eltom AM, Elbashir MI, Mavoungou E et al.. Cytokine profiles in peripheral, placental and cord blood in an area of unstable malaria transmission in eastern Sudan. J Trop Pediatr. 2009; 55:233-7.
• [24]Bedu-Addo G, Gai PP, Meese S, Eggelte TA, Thangaraj K, Mockenhaupt FP. Reduced prevalence of placental malaria in primiparae with blood group O. Malar J. 2014; 13:289. BioMed Central Full Text
• [25]Rowe JA, Handel IG, Thera MA, Deans AM, Lyke KE, Koné A et al.. Blood group O protects against severe Plasmodium falciparum malaria through the mechanism of reduced rosetting. Proc Natl Acad Sci U S A. 2007; 104:17471-6.