Pyrexia in pregnancy: an atypical presentation (original) (raw)
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A Mini Overview of Malaria in Pregnancy
Journal of the Egyptian Society of Parasitology
Human malaria is caused by five species of Plasmodia: P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi. Most infections are due to either P. falciparum or P. vivax, but mixed infections with more than one malarial species also occur. The majority of malariarelated deaths are due to P. falciparum. Generally, the pregnant women are a high risk group, as malaria can be a life threatening infection for both mother and fetus. Risk of stillbirth, spontaneous abortion, and other adverse pregnancy outcomes is increased in the setting of malaria, and pregnant travelers should be advised to defer travel until after delivery whenever feasible.
The association between severe malaria and Plasmodium vivax species is contentious. On the Thai-Myanmar border, all pregnant women are followed systematically with active weekly malaria screening. Over a 27-year period of providing antenatal care, 48,983 have been prospectively followed until pregnancy outcome (miscarriage or delivery) and 4,298 women have had P. vivax detected at least once. Reported here is the first known P. vivax-associated death amongst these women. The initial patient presentation was of uncomplicated P. vivax (0.5% parasitaemia) in a term, multigravida woman who responded rapidly to oral artesunate and mefloquine treatment, clearing her blood stage parasites within 48 hours. The patient appeared well, was ambulatory and due to be discharged but became unwell with acute respiratory distress syndrome (ARDS) requiring ventilation three days (67 hours) into treatment. Despite induction and delivery of a stillborn foetus, ventilatory requirements increased and the patient died on day 7. The patient had a low body mass index. Sensitive detection with nested PCR confirmed only the presence of P. vivax species and concomitant infections such as tuberculosis and human immunodeficiency virus (HIV) were also ruled out. The contemporaneous treatment of acute uncomplicated P. vivax and the onset of ARDS on day 3 in this patient implies a possible but unconfirmed association with death in this patient. Assuming this death was caused by P. vivax, the risk of ARDS-related maternal mortality in this setting did not differ significantly between Plasmodium falciparum and P. vivax (0.24 per 1,000 (1/4,158) versus 0.23 per 1,000 (1/4,298), contrary to the increased risk of maternal mortality from P. falciparum compared to P. vivax, 2.89 per 1,000 (12/4,158) versus 0.23 per 1,000 (1/4,298), P = 0.003.
Effects of Plasmodium vivax malaria in pregnancy
Background Plasmodium vivax is more common than P falciparum as a cause of malaria in many parts of the tropics outside Africa. P falciparum infection has harmful effects in pregnancy, but the effects of P vivax have not been characterised. We investigated the effects of P vivax infection during pregnancy.
BJOG: An International Journal of Obstetrics & Gynaecology, 2005
Malaria in pregnancy is one of the major causes of maternal morbidity worldwide, and leads to poor birth outcomes. There is a complex interaction between pregnancy and parasite -all favour the parasite and disadvantage the pregnant woman. Women who are semi-immune lose much of that immunity. They may present with placental malaria but with no parasites in their peripheral blood. A non-immune pregnant women and her fetus are at serious risk from falciparum malaria. The diagnosis and management of malaria in pregnancy, including the safety of antimalarial drugs and interactions of malaria with HIV in pregnancy are reviewed.
Congenital malaria: The least known consequence of malaria in pregnancy
Seminars in Fetal and Neonatal Medicine, 2007
Congenital malaria is the least known manifestation of malaria and a very neglected area of research. Most of the existing information is limited to case reports in children born to non-immune women. With the use of molecular techniques, congenital infection is being increasingly detected among infants born to semi-immune women in endemic countries. However, many gaps in knowledge remain. The mechanisms and timing of infection are unclear. Furthermore, there is a lack of information on the impact of congenital malaria infection on the subsequent risk of malaria and general morbidity in the infant. There is also a lack of consensus on the clinical guidelines for its management. More research is needed in order to establish adequate preventive and management recommendations to avoid this consequence of malaria in pregnancy.
Malaria in pregnancy: pathogenesis and immunity
The Lancet Infectious Diseases, 2007
Understanding of the biological basis for susceptibility to malaria in pregnancy was recently advanced by the discovery that erythrocytes infected with Plasmodium falciparum accumulate in the placenta through adhesion to molecules such as chondroitin sulphate A. Antibody recognition of placental infected erythrocytes is dependent on sex and gravidity, and could protect from malaria complications. Moreover, a conserved parasite gene-var2csa-has been associated with placental malaria, suggesting that its product might be an appropriate vaccine candidate. By contrast, our understanding of placental immunopathology and how this contributes to anaemia and low birthweight remains restricted, although infl ammatory cytokines produced by T cells, macrophages, and other cells are clearly important. Studies that unravel the role of host response to malaria in pathology and protection in the placenta, and that dissect the relation between timing of infection and outcome, could allow improved targeting of preventive treatments and development of a vaccine for use in pregnant women.
MALARIA IN PREGNANCY: A REVIEW
International Journal of Public Health and Clinical Sciences, 2018
Background: Malaria remains highly endemic in many countries in sub-Saharan Africa. Pregnant women, more than other adults have been shown to have higher risks of contracting the disease. Malaria in pregnancy is associated with numerous adverse pregnancy outcomes and it remains a major public health challenge in this region. Materials and Methods: A detailed literature search was conducted in Google scholar; PubMed and the Cochrane library to identify 74 articles relevant to understanding of malaria in pregnancy. Forty seven of these were original research papers (eighteen from Nigeria; seven from Burkina Faso; five from Ghana; three from Angola; two each from Cameroon, Thailand, India, and Malawi; and one each from Benin Republic, Gabon, Zambia, Kenya, Uganda, and the United Kingdom), while the remaining twenty seven comprised of systematic reviews, and reports of the WHO, CDC and the Nigerian Federal Ministry of Health. Result: Malaria in pregnancy is associated with adverse pregnancy outcomes such as: low birth weight; abortions; pre-term delivery and maternal anaemia. Even though pregnant women are more vulnerable to malaria infection compared to other adults by virtue of their pregnancy state alone, some pregnant women are more vulnerable than others by virtue of their socio-demographic and obstetric characteristics. Placental infection seems to be the central point for the pathogenesis of these adverse outcomes associated with malaria infection during pregnancy. Conclusion: Malaria in pregnancy remains a serious public health problem in malaria endemic regions. Wide spread adoption of insecticide treated nets and intermittent preventive treatment with suphadoxine-pyrimethamine have a strong potential of drastically reducing the presently observed undesirable effects of malaria in pregnancy.