Placental Histopathological Changes Associated with Plasmodium vivax Infection during Pregnancy

Autor(es)

Souza, Rodrigo M. ^{[1, 2]} ; Ataide, Ricardo ^[2] ; Dombrowski, Jamille G. ^[2] ; Ippolito, Vanessa ^[2] ; Aitken, Elizabeth H. ^[3] ; Valle, Suiane N. ^[1] ; Alvarez, Jose M. ^[3] ; Epiphanio, Sabrina ^{[4, 3]} ; Marinho, Claudio R. F. ^[2]

Afiliação do(s) autor(es)

^[1] Univ Fed Acre, Cruzeiro Do Sul, Acre - Brazil

^[2] Univ Sao Paulo, Dept Parasitol, ICB USP, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Dept Imunol, ICB USP, Sao Paulo - Brazil

^[4] Univ Fed Sao Paulo, Dept Ciencias Biol, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: PLoS Neglected Tropical Diseases; v. 7, n. 2 FEB 2013.
• Citações Web of Science: 33

Resumo

Histological evidence of Plasmodium in the placenta is indicative of placental malaria, a condition associated with severe outcomes for mother and child. Histological lesions found in placentas from Plasmodium-exposed women include syncytial knotting, syncytial rupture, thickening of the placental barrier, necrosis of villous tissue and intervillositis. These histological changes have been associated with P. falciparum infections, but little is known about the contribution of P. vivax to such changes. We conducted a cross-sectional study with pregnant women at delivery and assigned them to three groups according to their Plasmodium exposure during pregnancy: no Plasmodium exposure (n = 41), P. vivax exposure (n = 59) or P. falciparum exposure (n = 19). We evaluated their placentas for signs of Plasmodium and placental lesions using ten histological parameters: syncytial knotting, syncytial rupture, placental barrier thickness, villi necrosis, intervillous space area, intervillous leucocytes, intervillous mononucleates, intervillous polymorphonucleates, parasitized erythrocytes and hemozoin. Placentas from P. vivax-exposed women showed little evidence of Plasmodium or hemozoin but still exhibited more lesions than placentas from women not exposed to Plasmodium, especially when infections occurred twice or more during pregnancy. In the Brazilian state of Acre, where diagnosis and primary treatment are readily available and placental lesions occur in the absence of detected placental parasites, relying on the presence of Plasmodium in the placenta to evaluate Plasmodium-induced placental pathology is not feasible. Multivariate logistic analysis revealed that syncytial knotting (odds ratio {[}OR], 4.21, P = 0.045), placental barrier thickness (OR, 25.59, P = 0.021) and mononuclear cells (OR, 4.02, P = 0.046) were increased in placentas from P. vivax-exposed women when compared to women not exposed to Plasmodium during pregnancy. A vivax-score was developed using these three parameters (and not evidence of Plasmodium) that differentiates between placentas from P. vivax-exposed and unexposed women. This score illustrates the importance of adequate management of P. vivax malaria during pregnancy. (AU)

• Processo FAPESP: 09/53256-7 - Identificação e caracterização da síndrome respiratória aguda murina associada à malária severa: estudo da interação parasito-hospedeiro
• Beneficiário: Sabrina Epiphanio
• Modalidade de apoio: Auxílio à Pesquisa - Jovens Pesquisadores
• Processo FAPESP: 11/19525-0 - Injúria pulmonar aguda e síndrome do desconforto respiratório agudo associados à malária em modelos in vitro e in vivo
• Beneficiário: Elizabeth Helen Aitken
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 11/20921-8 - Malária gestacional: Estudo da infecção por Plasmodium vivax em gestantes do extremo-ocidente da Amazônia brasileira
• Beneficiário: Ricardo Tenreiro Estiveira de Ataide
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado