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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