A morphometric and histological study of placental malaria shows significant changes to villous architecture in both Plasmodium falciparum and Plasmodium vivax infection

Malaria Journal

Research

Atis Muehlenbachs¹  Urai Chaisri²  Parnpen Viriyavejakul²  Sethawud Chaikitgosiyakul²  Emsri Pongponratn²  Gareth D Turner³  Sue J Lee⁴  Marcus J Rijken⁵  Francois Nosten⁶  Rose McGready⁶ 

[1] Department of Pathology, University of Washington, 91895, Seattle, WA, USA;Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, 10400, Bangkok, Thailand;Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, 10400, Bangkok, Thailand;Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, 10400, Bangkok, Thailand;Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, OX3 7LJ, Oxford, UK;Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, 10400, Bangkok, Thailand;Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, OX3 7LJ, Oxford, UK;Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, 10400, Bangkok, Thailand;Shoklo Malaria Research Unit, Mae Sot, Thailand;Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, 10400, Bangkok, Thailand;Shoklo Malaria Research Unit, Mae Sot, Thailand;Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, OX3 7LJ, Oxford, UK;

关键词: Malaria;    Placenta;    Pregnancy;    Pathophysiology;    Morphometry;    Image analysis;    Villi;   

DOI  :  10.1186/1475-2875-13-4

 received in 2013-10-14, accepted in 2013-12-28,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMalaria in pregnancy remains a major health problem. Placental malaria infection may cause pathophysiological changes in pregnancy and result in morphological changes to placental villi. Quantitative histomorphological image analysis of placental biopsies was performed to compare placental villous architecture between active or treated placental malaria cases and controls.MethodsA total of 67 placentas were studied from three clinical groups: control patients who did not have malaria (n = 27), active (n = 14) and treated (n=26) malaria cases, including both Plasmodium falciparum and Plasmodium vivax infections. Image analysis of histological placental sections was performed using ImageJ software to measure the number and size (area) of terminal villi, perimeter measurement per villus and total perimeter per unit area, and number of capillaries per villus (vascularity). Histological features of placental malaria were scored and these results were correlated with malaria status and clinical outcomes.ResultsVillous size correlated with vascularity (p <0.0001) but was inversely correlated with observed villi per unit area, (p = 0.0001). Significantly greater villous area and vascularity was observed in UK controls. Indices of histological malaria infection were significantly greater in active versus treated malaria cases. Active placental malaria cases showed significantly smaller villous area (p <0.0084), vascularity (p <0.0139) and perimeter (p <0.0006) than treated malaria cases or controls, but significantly more villi per unit area (p <0.0001). Villous size in treated malaria cases was significantly larger than active placental malaria cases (p <0.001) and similar to controls. There was a significant relationship between villous number and anaemia at the time of infection (p <0.0034), but not placental weight, birth weight or gestational age at delivery. No differences were found between histology or villous morphology comparing infections with P. falciparum or P. vivax.ConclusionsThese results imply that villous size, perimeter and vascularity are acutely decreased during active placental malaria, decreasing the surface area available for gas exchange per villus. However the increased number of villi per unit area offsets this change and persists after treatment. Histopathological and villous architectural changes may be reversed by early detection and appropriate anti-malarial treatment.

【 授权许可】

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© Chaikitgosiyakul et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.