Clinical and Parasitological Characteristics of Puerperal Malaria

Ramharter, Michael; Grobusch, Martin P.; Kiessling, Georg; Adegnika, Ayôla Akim; Möller, Ulrike; Agnandji, Selidji Todagbé; Kramer, Martin; Schwarz, Norbert; Kun, Jürgen F. J.; Oyakhirome, Sunny; Issifou, Saadou; Borrmann, Steffen; Lell, Bertrand; Mordmüller, Benjamin; Kremsner, Peter G.

doi:10.1086/427781

Cited by 46 publications

(55 citation statements)

References 18 publications

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“…In their study, Ramharter and others suggested that both mechanisms played a role, although most malaria cases were new infections acquired after delivery. 5 In our study, malaria cases were detected passively during the first six weeks after delivery. We reported a low rate of symptomatic malaria infections.…”

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confidence: 62%

“…4 Recently, two longitudinal studies found that women remained at high risk for malaria in the early postpartum period, as during pregnancy. 1,5 To investigate this issue, which may have important consequences for the management of women who recently delivered a child, we studied the immediate postpartum spontaneous evolution of malaria infections at delivery in pregnant women in Benin.…”

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confidence: 99%

“…8 Nevertheless, recent studies showed that women could have an increased risk of malaria in a two-month period after delivery compared with non-pregnant women or women before pregnancy. 1,5 These apparently conflicting results could be explained either by a temporary clearing of parasites in the immediate postpartum period, followed by a phenomenon of parasite resurfacing in the blood, or by new infections by non-placental parasites. In their study, Ramharter and others suggested that both mechanisms played a role, although most malaria cases were new infections acquired after delivery.…”

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Spontaneous Postpartum Clearance of Plasmodium falciparum Parasitemia in Pregnant Women, Benin

Bottéro¹,

Briand²,

Agbowaï³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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In malaria-endemic areas, pregnant women are more likely to be infected with malaria than non-pregnant women.1 Recent studies have demonstrated that this propensity for malaria to develop during pregnancy is attributed, at least in part, to expression of Plasmodium falciparum peculiar variant antigen on the membrane of the infected erythrocyte, which enables its adherence to specific placental receptors. The accumulation of parasites in the placenta may contribute to low birth weight and maternal anemia, 2 particularly in primigravidae who have not acquired specific immunity to those variant parasites. 3Although the effects of malaria in pregnancy are well documented, little is known about malaria in the postpartum period. A study published in the 1980s showed that women who were parasitemic at delivery cleared their parasitemia spontaneously within 48 hours postpartum. 4 Recently, two longitudinal studies found that women remained at high risk for malaria in the early postpartum period, as during pregnancy.1, 5 To investigate this issue, which may have important consequences for the management of women who recently delivered a child, we studied the immediate postpartum spontaneous evolution of malaria infections at delivery in pregnant women in Benin.Data were collected during a clinical trial on intermittent preventive treatment in pregnancy (IPTp), which was conducted during July 2005-April 2008 in Benin. 6 The study protocol was described elsewhere 6 and was reviewed and approved by ethics committees in France and Benin.Briefly, pregnant women were randomized to receive two doses of IPTp with either sulfadoxine-pyrimethamine or mefloquine. At delivery, malaria thick blood smears were prepared from maternal peripheral blood and from the maternal side of the placenta. All women who had a positive peripheral thick blood smear at delivery were tested for parasitemia 24 hours later and then daily until no parasites were detected. Control blood smears were prepared at the hospital before discharge or during scheduled visits at home. For logistical reasons, in selected cases, blood smears were not prepared on day 1 after delivery, but on days 2-5. If these women had symptoms of malaria at delivery or during follow-up or if there was a doubt on their likeliness to attend the maternity clinic in case of clinical signs (e.g., women living in remote areas), they were given a 7-day quinine treatment.During a six-week period after delivery, all women were encouraged to attend the study maternity clinic if they had symptoms suggestive of malaria. On this occasion, a thick blood smear was prepared and women were treated if malaria was confirmed. Finally, all women had a scheduled appointment at week 6 after delivery to test for current symptoms suggestive of malaria and history of fever or malaria within the past six weeks.Thick blood smears were considered positive if an asexual stage parasite was detected after examination of 200 microscope fields. Cross-readings were made for all blood smears. In case of discrepancy, a ...

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Spontaneous Postpartum Clearance of Plasmodium falciparum Parasitemia in Pregnant Women, Benin

Bottéro¹,

Briand²,

Agbowaï³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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“…However, immunity to CSA-binding parasites and reduced risk of poor delivery outcomes have been associated in some studies (9,14,41) but not in others (4,6,11,39). Furthermore, the high incidence of malaria episodes observed a few weeks after delivery (8,15,34) suggests that other mechanisms may be also involved in the susceptibility of pregnant women to malaria.…”

Section: Sequestration Of Erythrocytes Infected By Mature Forms Ofmentioning

confidence: 99%

“…Similar genotyping approaches can be used to determine if malaria infections during the postpartum period are caused by new infections or rather by the same parasites that persist after delivery. However, to date only one study, based on a small number of isolates, has addressed this issue (34).…”

Section: Sequestration Of Erythrocytes Infected By Mature Forms Ofmentioning

confidence: 99%