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- Title
How Hidden Can Malaria Be in Pregnant Women? Diagnosis by Microscopy, Placental Histology, Polymerase Chain Reaction and Detection of Histidine-Rich Protein 2 in Plasma.
- Authors
Mayor, Alfredo; Moro, Laura; Aguilar, Ruth; Bardají, Azucena; Cisteró, Pau; Serra-Casas, Elisa; Sigaúque, Betuel; Alonso, Pedro L.; Ordi, Jaume; Menéndez, Clara
- Abstract
Microscopy, placental histology, and histidine-rich protein 2–based plasma diagnosis fail to identify 60% of Plasmodium falciparum infections detected by quantitative polymerase chain reaction in Mozambican pregnant women. Undetected infections are associated with maternal anemia, highlighting their clinical relevance and the need for more accurate diagnostic methods.Background. Accurate diagnosis of malaria infection during pregnancy remains challenging because of low parasite densities and placental sequestration of Plasmodium falciparum. The performance of different methods to detect P. falciparum in pregnancy and the clinical relevance of undetected infections were evaluated.Methods. P. falciparum infections were assessed in 272 Mozambican women at delivery by microscopy, placental histology, quantitative polymerase chain reaction (qPCR) and detection of histidine-rich protein 2 (HRP2) in plasma by enzyme-linked immunosorbent assay (ELISA) and a rapid diagnostic test (RDT). Association between infection and delivery outcomes was determined.Results. Among the 122 women qPCR-positive for P. falciparum in peripheral and/or placental blood samples, 87 (71.3%) did not receive a positive diagnosis by peripheral microscopy, 75 (61.5%) by HRP2 ELISA, and 74 (60.7%) by HRP2 RDT in plasma. Fifty-seven of the 98 qPCR-positive placental infections (58.2%) were not detected by histology. Women who were qPCR-positive but negative in their peripheral blood by microscopy or HRP2 RDT in plasma (n = 62) were at increased risk of anemia, compared with negative women (n = 141; odds ratio, 2.03; 95% confidence interval, 1.07–3.83; P = .029).Conclusions. Microscopy, placental histology and HRP2-based plasma diagnostic methods fail to identify the majority of the P. falciparum infections detected by qPCR in peripheral and placental blood. Undetected infections were associated with maternal anemia, highlighting the urgent need for more accurate malaria diagnostic tools for pregnant women to avoid the negative clinical impact that hidden infections can have during pregnancy.Clinical Trials Registration. NCT00209781.
- Subjects
MALARIA in pregnancy; MALARIA diagnosis; PLACENTA; HISTOLOGY; HISTIDINE; BLOOD plasma; MICROSCOPY; ENZYME-linked immunosorbent assay
- Publication
Clinical Infectious Diseases, 2012, Vol 54, Issue 11, p1561
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cis236