THE EFFECTS OF PLASMODIUM FALCIPARUM AND P. VIVAX INFECTIONS ON PLACENTAL HISTOPATHOLOGY IN AN AREA OF LOW MALARIA TRANSMISSION

ROSE McGREADY Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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BILLIE B. DAVISON Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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KASIA STEPNIEWSKA Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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THEIN CHO Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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HTEE SHEE Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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ALAN BROCKMAN Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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RACHANEE UDOMSANGPETCH Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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SORNCHAI LOOAREESUWAN Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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NICHOLAS J. WHITE Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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STEVE R. MESHNICK Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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FRANÇOIS NOSTEN Shoklo Malaria Research Unit, Mae Sot, Thailand; Faculty of Tropical Medicine, and Faculty of Science, Mahidol University, Bangkok, Thailand; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Comparative Pathology, Tulane National Primate Research Center, Covington, Louisiana; Departments of Epidemiology and Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina

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Placental histopathology was studied in a cohort of 204 women living in an area of low Plasmodium falciparum and P. vivax malaria transmission. Detection of malaria antenatally was active, by weekly peripheral blood smears, and all infections were treated. Significant histopathologic placental malaria changes (increased malaria pigment, cytotrophoblastic prominence, and presence of parasites) were found only in a minority of women who had P. falciparum infections in pregnancy. These changes were significantly more frequent in women with evidence of peripheral blood infection close to delivery and only in these cases were placental inflammatory cells increased. Antenatal P. vivax infection was associated only with the presence of malaria pigment in the placenta. All placental infections diagnosed by blood smear and 32.4% (12 of 37) diagnosed by histopathology were associated with patent peripheral parasitemia. This study indicates that prompt treatment of peripheral parasitemias during pregnancy limits placental pathology. The effect on birth weight reduction may not result from irreversible placental changes but from the acute insult of infection. These findings emphasize the importance of treating malaria in pregnancy promptly with effective antimalarial drugs.

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