Ahmad Ghiffari

Department of Parasitology, Faculty of Medicine, Sriwijaya University, Palembang, Indonesia

DAAD Summer School Program 2012 IGHEP 24 June-3 July Göttingen Germany

MALARIA IN PREGNANCY

SCOPE OF PROBLEM

Single or mixed infections with any of the 4 Plasmodium sp

30,6 million malaria pregnancy globally

Maternal: anemia and mortality

Fetus: low birthweight, retardation

Desai et all, 2007. Lancet Infect Dis 7: 93–104

Desai et all, 2007. Lancet Infect Dis 7: 93–104

James G. Beeson, 2001. TRENDS in Parasitology Vol.17 No.7 July, 331-337

F Nosten, et all, 2004. TRENDS in Parasitology Vol.20 No.9 September pp.425-432

Infected erythrocytes are able to adhere Infected erythrocytes are able to adhere to the placentato the placenta

Smith and Deitsch, 2004. J Exp Med

P.F. Mens et al, 2010. European Journal of Obstetrics & Gynecology and Reproductive Biology 152, 126–132

Diagnosis

High level of awareness Peripheral blood smear

Antigen detection techniques : (PfHPR-2) Fluorescent staining PCR based assay Antibody test Placental blood smear

P. falcifarum

Parasitemia(>250.000/µL)

30-40% eritrosit

terinfeksi

Sitoaderens(+) Plasenta

(+)

Relaps (-)

P. vivax

Parasitemia(<50.000/µL)

2% eritrositterinfeksi

(retikulosit)

Sitoaderens (-) Plasenta (-)

Relaps (+)

Acute Anemia

Chronic anemia

AbortionStillbirth

Premature

Low BirthPerinatal

death

James G. Beeson, 2001. TRENDS in Parasitology Vol.17 No.7 July, 331-337

F Nosten, et all, 2004. TRENDS in Parasitology Vol.20 No.9 September pp.425-432

James G. Beeson, 2001. TRENDS in Parasitology Vol.17 No.7 July, 331-337

Histological changes due to malaria infection:

1. Excess of perivillous fibrinoid deposits2. Excessive syncytial knotting3. Trophoblastic basement membrane thickening4. Syncytiotrophoblastic damage5. Cytotrophoblastic proliferation in ultra-structural studies6. Massive chronic intervillositis

B. J. Brabina, et all, 2004. Placenta, 25, 359–378

B. J. Brabina, et all, 2004. Placenta, 25, 359–378

Variant surface antigens (VSA).

PAM is caused by Plasmodium falciparum-infected erythrocytes that bind to chondroitin sulphate A(CSA) in the placenta by PAM-associated clonally variant surface antigens (VSA).

Pregnancy-associated variant surface antigens (VSAPAM) mediate binding of the infected erythrocyte to chondroitin sulphate proteoglycans in the placental intervillous space. Several lines of evidence indicate is VAR2CSA, a relatively conserved member of the P. falciparum erythrocyte membrane protein 1 (PfEMP1) family.

Fuji et al. 2003

P.F. Mens et al, 2010. European Journal of Obstetrics & Gynecology and Reproductive Biology 152, 126–132

VAR2CSA

The VAR2CSA gene is selectively transcribed by placental and chondroitin sulphate A-selected parasites

Naturally acquired VAR2CSA specific IgG correlate with parity High levels of VAR2CSA-specific IgG are associated with decreased

risk of delivering a-low-birthweight baby. VAR2CSA-specific IgG reactive with the surface of infected

erythrocytes expressing VSAPAM can be induced by subunit vaccination.

FURTHER RESEARCH

DAAD Summer School Program 2012 IGHEP 24 June-3 July Göttingen Germany