Volume 88, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Studies on gestational malaria and placental malaria have been scarce in malaria-endemic areas of the Western Hemisphere. To describe the histopathology of placental malaria in Colombia, a longitudinal descriptive study was conducted. In this study, 179 placentas were studied by histologic analysis (112 with gestational malaria and 67 negative for malaria). Placental malaria was confirmed in 22.35%, 50.0% had previous infections, and 47.5% had acute infections. Typical malaria-associated changes were observed in 37%. The most common changes were villitis, intervillitis, deciduitis, increased fibrin deposition, increased syncytial knots, mononuclear (monocytes/macrophages and lymphocytes), polymorphonuclear cell infiltration, and trophozoites in fetal erythrocytes. No association was found between type of placental changes observed and histopathologic classification of placental malaria. The findings are consistent with those reported for placental malaria in other regions. was the main parasite responsible for placental and gestational malaria, but its role in the pathogenesis of placental malaria was not conclusive.


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  1. Duffy P, Fried M, , 2005. Malaria in the pregnant woman. Curr Top Microbiol Immunol 295: 169200. [Google Scholar]
  2. Falade C, Tongo O, Ogunkunle O, Orimadegun A, , 2010. Effects of malaria in pregnancy on newborn anthropometry. J Infect Dev Ctries 4: 448453. [Google Scholar]
  3. Nosten F, McGready R, Simpson J, Thwai K, Balkan S, Cho T, Hkirijaroen L, Looareesuwan S, White N, , 1999. Effects of Plasmodium vivax malaria in pregnancy. Lancet 354: 546549.[Crossref] [Google Scholar]
  4. Beeson J, Rogerson S, Cooke B, Reeder J, Chai W, Lawson A, Molyneux M, Brown G, , 2000. Adhesion of Plasmodium falciparum-infected erythrocytes to hyaluronic acid in placental malaria. Nat Med 6: 8689.[Crossref] [Google Scholar]
  5. Beeson J, Rogerson S, Elliott S, Duffy M, , 2005. Targets of protective antibodies to malaria during dregnancy. JID 192: 16471660.[Crossref] [Google Scholar]
  6. Okoko BJ, Enwere G, Ota MO, , 2003. The epidemiology and consequences of maternal malaria: a review of immunological basis. Acta Trop 87: 193205.[Crossref] [Google Scholar]
  7. Rogerson S, Hviid L, Duffy P, Leke R, Taylor D, , 2007. Malaria in pregnancy: pathogenesis and immunity. Lancet 7: 105117.[Crossref] [Google Scholar]
  8. Rogerson S, Mwapasa V, Meshnick S, , 2007. Malaria in pregnancy: linking immunity and pathogenesis to prevention. Am J Trop Med Hyg 77: 1422. [Google Scholar]
  9. Castejón O, Molinaro M, de Zamora G, , 2001. The hairiness placental in the event of infected primigesta for Plasmodium vivax and tried with cloroquine. Gac Med Caracas 109: 345351. [Google Scholar]
  10. Davison B, Cogswell F, Baskin G, Falkenstein K, Henson E, Tarantal A, Krogstad D, , 1998. Plasmodium coatneyi in the rhesus monkey (Macaca mulata) as a model of malaria in pregnancy. Am J Trop Med Hyg 59: 189201. [Google Scholar]
  11. Ismail M, Ordi J, Menendez C, Ventura PA, Kahigwa E, Hirt R, Cardesa A, Alonso PL, , 2000. Placental pathology in malaria: an histological, immunohistochemical and quantitative study. Hum Pathol 31: 8593.[Crossref] [Google Scholar]
  12. Singh N, Shukla M, Sharma V, , 1999. Epidemiology of malaria in pregnancy in central India. Bull World Health Organ 77: 567572. [Google Scholar]
  13. Khunrae P, Higgins M, , 2010. Structural insights into chondroitin sulfate binding in pregnancy-associated malaria. Biochem Soc Trans 38: 13371341.[Crossref] [Google Scholar]
  14. Fried M, Hixson K, Anderson L, Ogata Y, Mutabingwa T, Duffy P, , 2007. The distinct proteome of placental malaria parasites. Mol Biochem Parasitol 155: 5765.[Crossref] [Google Scholar]
  15. Flick K, Scholander C, Chen Q, Fernandez V, Pouvelle B, Gysin J, Wahlgren M, , 2001. Role of nonimmune IgG bound to PfEMP1 in placental malaria. Science 293: 20982100.[Crossref] [Google Scholar]
  16. Rasti N, Namusoke F, Chêne A, Chen Q, Staalsoe T, Klinkert MQ, Mirembe F, Kironde F, Wahlgren M, , 2006. Nonimmune immunoglobulin binding and multiple adhesion characterize Plasmodium falciparum-infected erythrocytes of placental origin. Proc Natl Acad Sci USA 103: 1379513800.[Crossref] [Google Scholar]
  17. Carvalho B, Lopes S, Nogueira P, Orlandi P, Bargieri D, Blanco Y, Mamoni R, Leite J, Rodrigues M, Soares I, Oliveira T, Wunderlich G, Lacerda M, del Portillo H, Araújo M, Russell B, Suwanarusk R, Snounou G, Rénia L, Costa F, , 2010. On the cytoadhesion of Plasmodium vivax-infected erythrocytes. J Infect Dis 202: 638647.[Crossref] [Google Scholar]
  18. Galbraith R, Fox H, Hsi B, Galbraith G, Bray R, Faulk W, , 1980. The human materno-foetal relationship in malaria: II. Histological, ultras structural and inmunopatological studies of the placenta. Trans R Soc Trop Med Hyg 74: 6171.[Crossref] [Google Scholar]
  19. Philippe E, Walter P, , 1985. Placental lesions in malaria. Arch Fr Pediatr 42: 921923. [Google Scholar]
  20. Walter P, Garin Y, Blot P, , 1982. Placental pathologic changes in malaria. A histologic and ultrastructural study. Am J Pathol 109: 330342. [Google Scholar]
  21. Bulmer JN, Rasheed FN, Francis N, Morrison L, Greenwoods BM, , 1993. Placental malaria. I. Pathological classification. Histopathology 22: 211218.[Crossref] [Google Scholar]
  22. Bulmer JN, Rasheed FN, Morrison L, Francis N, Greenwood BM, , 1993. Placental malaria. II. A semi-quantitative investigation of the pathological features. Histopathology 22: 219225.[Crossref] [Google Scholar]
  23. Leopardi O, Naughten W, Salvia L, Colecchia M, Matteelli A, Zucchi A, Shein A, Muchi J, Carosi G, Ghione M, , 1996. Malaric placentas. A quantitative study and clinico-pathological correlations. Pathol Res Pract 192: 892898.[Crossref] [Google Scholar]
  24. McGready R, Davison B, Stepniewska K, Cho T, Shee H, Brockman A, Udomsangpetch R, Looareesuwan S, White N, Meshnick S, Nosten F, , 2004. The effects of Plasmodium falciparum and P. vivax infections on placental histopathology in an area of low malaria transmission. Am J Trop Med Hyg 70: 398407. [Google Scholar]
  25. Muehlenbachs A, Fried M, McGready R, Harrington W, Mutabingwa T, Nosten F, Duffy P, , 2010. A novel histological grading scheme for placental malaria applied in areas of high and low malaria transmission. J Infect Dis 202: 16061616.[Crossref] [Google Scholar]
  26. Rogerson S, Mkundika P, Kanjala M, , 2003. Diagnosis of Plasmodium falciparum malaria at delivery: comparison of blood film preparation methods and of blood films with histology. J Clin Microbiol 41: 13701374.[Crossref] [Google Scholar]
  27. Watkinson M, Rushton D, , 1983. Plasmodial pigmentation of placenta and outcome of pregnancy in west African mothers. BMJ 287: 251254.[Crossref] [Google Scholar]
  28. Boström S, Ibitokou S, Oesterholt M, Schmiegelow C, Persson JO, Minja D, Lusingu J, Lemnge M, Fievet N, Deloron P, Luty AJ, Troye-Blomberg M, , 2012. Biomarkers of Plasmodium falciparum infection during pregnancy in women living in northeastern Tanzania. PLoS ONE 7: e48763.[Crossref] [Google Scholar]
  29. Campos I, Uribe M, Cuesta C, Franco-Gallego A, Carmona-Fonseca J, Maestre A, , 2011. Diagnosis of gestational, congenital, and placental malaria in Colombia: comparison of the efficacy of microscopy, nested polymerase chain reaction, and histopathology. Am J Trop Med Hyg 84: 929935.[Crossref] [Google Scholar]
  30. Carmona-Fonseca J, Maestre A, , 2009. Incidence of gestational, congenital and placental malaria in Urabá (Antioquia, Colombia), 2005–2007. Rev Colomb Obstet Ginecol 60: 1226. [Google Scholar]
  31. Almeida L, Barbosa M, Martinez-Espinosa F, , 2010. Malaria among women aged 10 to 49 years, according to SIVEP-Malaria, Manaus, State of Amazonas, 2003–2006. Rev Soc Bras Med Trop 43: 304308.[Crossref] [Google Scholar]
  32. Chagas E, do Nascimento C, de Santana Filho F, Bôtto-Menezes C, Martinez-Espinosa F, , 2009. Impact of malaria during pregnancy in the Amazon region. Rev Panam Salud Publica 26: 203208.[Crossref] [Google Scholar]
  33. Martínez-Espinosa F, Daniel-Ribeiro C, Alecrim W, , 2004. Malaria during pregnancy in a reference centre from the Brazilian Amazon: unexpected increase in the frequency of Plasmodium falciparum infections. Mem Inst Oswaldo Cruz 99: 921.[Crossref] [Google Scholar]
  34. Gómez E, López E, Ache A, , 2009. Malaria and pregnancy. San Isidro Parish, Municipality Sifontes, state of Bolívar, Venezuela, 2005–2006 [in Spanish]. Invest Clin 50: 455464. [Google Scholar]
  35. Rodriguez-Morales A, Sanchez E, Vargas M, Piccolo C, Colina R, Arria M, Franco-Paredes C, , 2006. Pregnancy outcomes associated with Plasmodium vivax malaria in northeastern Venezuela. Am J Trop Med Hyg 75: 755757. [Google Scholar]
  36. Parekh F, Davison B, Gamboa D, Hernandez J, Branch O, , 2010. Placental histopathologic changes associated with subclinical malaria infection and its impact on the fetal environment. Am J Trop Med Hyg 83: 973980.[Crossref] [Google Scholar]
  37. Parekh F, Hernandez J, Krogstad D, Casapia W, Branch O, , 2007. Prevalence and risk of Plasmodium falciparum and P. vivax malaria among pregnant women living in the hypoendemic communities of the Peruvian Amazon. Am J Trop Med Hyg 77: 451457. [Google Scholar]
  38. Espinoza E, Hidalgo L, Chedraui P, , 2005. The effect of malarial infection on maternal-fetal outcome in Ecuador. J Matern Fetal Neonatal Med 18: 101105.[Crossref] [Google Scholar]
  39. Carles G, Bousquet F, Raynal P, Peneau C, Mignot V, Arbeille P, , 1998. Pregnancy and malaria. Study of 143 cases in French Guiana [in French]. J Gynecol Obstet Biol Reprod (Paris) 27: 798805. [Google Scholar]
  40. Carmona-Fonseca J, , 2003. Malaria in the Colombian regions of Uraba and Bajo cauca, province of Antioquia: an overwiew to interpret the antimalarial therapeutic failure. Part 1. Iatreia 16: 299318. [Google Scholar]
  41. Carmona-Fonseca J, , 2004. Malaria in the Colombian regions of Uraba and Bajo cauca, province of Antioquia: an overwiew to interpret the antimalarial therapeutic failure. Part 2. Iatreia 17: 3453. [Google Scholar]
  42. Carmona-Fonseca J, Arias M, Correa A, Lemos M, , 2011. Gestational malaria and living conditions in Turbo, Colombia. Social Medicine 6: 7382. [Google Scholar]
  43. Carmona-Fonseca J, , 2011. Food and nutritional status among children of endemic malaria zones of Antioquia (Colombia). MedUNAB 14: 94102. [Google Scholar]
  44. Galbraith R, Faulk W, Galbraith G, Holbrook T, Bray R, , 19800. The human materno-foetal relationship in malaria: I. Identification of pigment and parasites in placenta. Trans R Soc Trop Med Hyg 74: 5260.[Crossref] [Google Scholar]
  45. Ordi J, Ismail M, Ventura P, Kahigwa E, Hirt R, Cardesa A, Alonso P, Menendez C, , 1998. Massive chronic intervillositis of the placenta associated with malaria infection. Am J Surg Pathol Res Pract 22: 10061011.[Crossref] [Google Scholar]
  46. Abrams E, Brown H, Chensue S, Turner G, Tadesse E, Lema V, Molyneux M, Rochford R, Meshnick S, Rogerson S, , 2003. Host response to malaria during pregnancy: placental monocyte recruitment is associated with elevated beta chemokine expression. J Immunol 170: 27592764.[Crossref] [Google Scholar]
  47. Ordi J, Menendez C, Ismail M, Ventura P, Palacín A, Kahigwa E, Ferrer B, Cardesa A, Alonso P, , 2001. Placental malaria is associated with cell-mediated inflammatory responses with selective absence of natural killer cells. J Infect Dis 183: 11001107.[Crossref] [Google Scholar]
  48. Carmona-Fonseca J, Arango E, , 2012. Mixed malaria: prevalence in Colombia and Latin America. Iatreia 25: 334346. [Google Scholar]
  49. Silvera A, Manjarrez C, Peñuela M, Villalba D, Correa E, Díaz V, Salazar S, , 2005. Anatomic and histopathological characterization of the placenta and clinical correlation in the hypertensive disease in patients of Barranquilla (Colombia). Salud Uninorte. Barranquilla (Col) 21: 4154. [Google Scholar]
  50. Pathak S, Lees CC, Hackett G, Jessop F, Sebire NJ, , 2011. Frequency and clinical significance of placental histological lesions in an unselected population at or near term. Virchows Arch 459: 565572.[Crossref] [Google Scholar]
  51. Diouf I, Fievet N, Doucouré S, Ngom M, Andrieu M, Mathieu J, Gaye A, Thiaw O, Deloron P, , 2007. IL-12 producing monocytes and IFN-gamma and TNF-alpha producing T-lymphocytes are increased in placentas infected by Plasmodium falciparum . J Reprod Immunol 74: 152162.[Crossref] [Google Scholar]
  52. Diouf I, Fievet N, Doucouré S, Ngom M, Gaye A, Dumont A, Ndao C, Le Hesran J, Chaouat G, Deloron P, , 2004. Monocyte activation and T cell inhibition in Plasmodium falciparum-infected placenta. J Infect Dis 189: 22352242.[Crossref] [Google Scholar]
  53. Ordi J, Bardaj A, Castillo P, Ismail M, Menéndez C, , 2011. Grading schemes for placental malaria. J Infect Dis 203: 16941695.[Crossref] [Google Scholar]
  54. Blair S, Carmona-Fonseca J, Piñeros J, Ríos A, Álvarez T, Álvarez G, Tobón A, , 2006. Therapeutic efficacy test for falciparum malaria in Antioquia, Colombia. Malar J 5: 14.[Crossref] [Google Scholar]
  55. Carmona-Fonseca J, Álvarez G, Blair S, , 2006. Plasmodium vivax malaria: treatment of primary attacks with primaquine, in three different doses, and a fixed dose of chloroquine, Antioquia, Colombia, 2003–2004. Biomedica 26: 353365.[Crossref] [Google Scholar]
  56. McGready R, Brockman A, Cho T, Levesque M, Tkachuk A, Meshnick S, Nosten F, , 2002. Haemozoin as a marker of placental parasitization. Trans R Soc Trop Med Hyg 96: 644646.[Crossref] [Google Scholar]
  57. Arango E, Maestre A, Carmona-Fonseca J, , 2010. Effect of submicroscopic or polyclonal Plasmodium falciparum infection on mother and gestation product. Systematic review. Rev Bras Epidemiol 13: 373386.[Crossref] [Google Scholar]
  58. Avery J, Smith G, Owino S, Sarr D, Nagy T, Mwalimu S, Matthias J, Kelly L, Poovassery J, Middii J, Abramowsky C, Moore J, , 2012. Maternal malaria induces a procoagulant and antifibrinolytic state that is embryotoxic but responsive to anticoagulant therapy. PLoS ONE 7: e31090.[Crossref] [Google Scholar]
  59. Conroy A, Liles W, Molyneux M, Rogerson S, Kain K, , 2011. Performance characteristics of combinations of host biomarkers to identify women with occult placental malaria: a case-control study from Malawi. PLoS ONE 6: e28540.[Crossref] [Google Scholar]

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  • Received : 06 Jun 2012
  • Accepted : 07 Feb 2013
  • Published online : 05 Jun 2013

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