Persistence of
            <i>Plasmodium falciparum</i>
            Parasites in Infected Pregnant Mozambican Women after Delivery

Serra-Casas, Elisa; Menéndez, Clara; Dobaño, Carlota; Bardají, Azucena; Quintó, Llorenç; Ordi, Jaume; Sigaùque, Betuel; Cisteró, Pau; Mandomando, Inácio; Alonso, Pedro L.; Mayor, Alfredo

doi:10.1128/iai.00814-10

Cited by 12 publications

(29 citation statements)

References 44 publications

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“…In four of them, definitions about drug resistance were available, either in the text or by referring to other articles [17,23,25,26]. Self-treatment with anti-malarials was described in two studies[19,22].…”

Section: Resultsmentioning

confidence: 99%

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The epidemiology of postpartum malaria: a systematic review

Boel

Rijken

Brabin

et al. 2012

Malar J

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Pregnant women are more susceptible to malaria than their non-pregnant counterparts. Less is known about the risk of malaria in the postpartum period. The epidemiology of postpartum malaria was systematically reviewed. Eleven articles fitted the inclusion criteria. Of the 10 studies that compared malaria data from the postpartum period with pregnancy data, nine studies suggested that the risk for malaria infection decreased after delivery. All three studies that compared postpartum data with non-pregnant non-postpartum women concluded that the risk did not return to pre-pregnancy levels immediately after delivery. The results of this review have to be carefully interpreted, as the majority of studies were not designed to study postpartum malaria, and there was large variability in study designs and reported outcomes. Current evidence suggests an effort should be made to detect and radically cure malaria during pregnancy so that women do not enter the postpartum period with residual parasites.

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Section: Resultsmentioning

confidence: 99%

“…By PCR method [25], the proportion of infected women at delivery was 38/187 (20%) compared to 27/138 (20%) at 8 weeks postpartum, p = 0.866.…”

Section: Resultsmentioning

confidence: 99%

The epidemiology of postpartum malaria: a systematic review

Boel

Rijken

Brabin

et al. 2012

Malar J

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“…A recent review including 11 studies suggests a transition phase after delivery in which the susceptibility gradually returns to pre-pregnancy levels[6]. P.falciparum genotyping suggested persistence of parasites acquired during pregnancy into the post-partum period[3], [7]. Submicroscopic infections and ineffective malaria treatment during pregnancy increase the risk of recrudescence in the post-partum period[6], [7].…”

Section: Introductionmentioning

confidence: 99%

“…P.falciparum genotyping suggested persistence of parasites acquired during pregnancy into the post-partum period[3], [7]. Submicroscopic infections and ineffective malaria treatment during pregnancy increase the risk of recrudescence in the post-partum period[6], [7]. In contrast there are no reports on P.vivax in the post-partum period.…”

Section: Introductionmentioning

confidence: 99%

Malaria in the Post-Partum Period; a Prospective Cohort Study

et al. 2013

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BackgroundSeveral studies have shown a prolonged or increased susceptibility to malaria in the post-partum period. A matched cohort study was conducted to evaluate prospectively the susceptibility to malaria of post-partum women in an area where P.falciparum and P.vivax are prevalent.MethodsIn an area of low seasonal malaria transmission on the Thai-Myanmar border pregnant women attending antenatal clinics were matched to a non-pregnant, non-post-partum control and followed up prospectively until 12 weeks after delivery.ResultsPost-partum women (n = 744) experienced significantly less P.falciparum episodes than controls (hazard ratio (HR) 0.39 (95%CI 0.21–0.72) p = 0.003) but significantly more P.vivax (HR 1.34 (1.05–1.72) p = 0.018). The reduced risk of falciparum malaria was accounted for by reduced exposure, whereas a history of P.vivax infection during pregnancy was a strong risk factor for P.vivax in post-partum women (HR 13.98 (9.13–21.41), p<0.001). After controlling for effect modification by history of P.vivax, post-partum women were not more susceptible to P.vivax than controls (HR: 0.33 (0.21–0.51), p<0.001). Genotyping of pre-and post-partum infections (n⊕ = ⊕10) showed that each post-partum P.falciparum was a newly acquired infection.ConclusionsIn this area of low seasonal malaria transmission post-partum women were less likely to develop falciparum malaria but more likely to develop vivax malaria than controls. This was explained by reduced risk of exposure and increased risk of relapse, respectively. There was no evidence for altered susceptibility to malaria in the post-partum period. The treatment of vivax malaria during and immediately after pregnancy needs to be improved.

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“…In areas with stable and intense transmission, malaria in pregnancy has been identified to be commonly asymptomatic [53], even in the presence of infected erythrocytes sequestered in the placenta [54]. Recrudescence of placental parasites can occur up to 187 days after the initial infection [55] and can persist asymptomatically for several months post-delivery [56]. However, such asymptomatic infections have been associated with maternal anemia [57], suggesting a silent health impact of these infections (Box 1).…”

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confidence: 99%

Malaria Parasites in the Asymptomatic: Looking for the Hay in the Haystack

Galatas

Bassat

Mayor

2016

Trends in Parasitology

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120

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With malaria elimination back on the international agenda, programs face the challenge of targeting all Plasmodium infections, not only symptomatic cases. As asymptomatic individuals are unlikely to seek treatment, they are missed by passive surveillance while remaining infectious to mosquitoes, thus acting as silent reservoirs of transmission. To estimate the risk of asymptomatic infections in various phases of malaria elimination, we need a deeper understanding of the underlying mechanisms favoring carriage over disease, which may involve both pathogen and host factors. Here we review our current knowledge on the determinants leading to Plasmodium falciparum symptomless infections. Understanding the host-pathogen interactions that are most likely to affect transitions between malaria disease states could guide the development of tools to tackle asymptomatic carriers in elimination settings. Being AsymptomaticPeaceful coexistence with the infected host, rarely causing clinical symptoms, is a common but poorly understood phenomenon that occurs for many human pathogens [1]. Because such asymptomatic cases of infection occur without eventual overt symptoms, they do not come to clinical attention, thus representing a large hidden reservoir of active infection that permits their persistence and eventual spread to other human hosts. This is the case for many malaria infections in semi-immune individuals from endemic areas, which commonly cause a mild febrile illness or no apparent symptoms at all, while keeping parasite numbers at low densities [2] (Box 1).Carriage of asymptomatic malaria (see Glossary) infections, being at the same time difficult to detect and to manage, has considerable implications for the design and use of malaria elimination strategies. Symptomless infections that persist during the dry season in areas of seasonal transmission have been suggested to seed the malaria outbreaks after annual rains when mosquitoes reappear [3]. Similarly, asymptomatic parasitemia may potentially contribute to persistence of transmission in low-transmission settings [4]. However, the precise contribution of asymptomatic malaria to transmission in areas that have achieved substantial reductions in the malaria burden remains a matter of debate [5], as is the assumption that detecting and targeting these individuals for radical treatment, as opposed to using mass drug administration approaches, would be an efficient and effective tactic. Moreover, eradication in Europe, North America, and other parts of the world using no better diagnostics than microscopy [6] suggest that key determinants of success might not be finding the last parasite. From a practical point of view, the proportion of asymptomatic infections in certain situations and phases of malaria elimination may impose the need for modifications of detection methods (active versus passive case detection) [7] if, for example, symptom-based surveillance at health facilities is insufficient and mass blood surveys are necessary to inform the design of elimination i...

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Persistence of Plasmodium falciparum Parasites in Infected Pregnant Mozambican Women after Delivery

Cited by 12 publications

References 44 publications

The epidemiology of postpartum malaria: a systematic review

The epidemiology of postpartum malaria: a systematic review

Malaria in the Post-Partum Period; a Prospective Cohort Study

Malaria Parasites in the Asymptomatic: Looking for the Hay in the Haystack

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