This Article Order Full text via Infotrieve Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Walter, P. R. Articles by Blot, P. Search for Related Content PubMed PubMed Citation Articles by Walter, P. R. Articles by Blot, P.

American Journal of Pathology, Vol 109, 330-342, Copyright © 1982 by American Society for Investigative Pathology

REGULAR ARTICLES

Placental pathologic changes in malaria. A histologic and ultrastructural study

PR Walter, Y Garin and P Blot

Placenta malarial changes (PMCs) related to maternal plasmodium infection were present in 33% (247 cases) of a series of 741 placentas collected from an unselected population living in an area of high malarial endemicity (Haut-Ogooue, Gabon, Africa). Plasmodia were found on material thick blood films taken at the time of delivery in 42% of the women with and 24% of women without associated PMCs. Plasmodium falciparum was the most frequent infecting organism. PMCs were more frequent and, in general, more marked in primiparas. The primiparas were significantly (P less than 0.001) more numerous in the group with PMCs than in the control group without such changes. The mean weight of term placentas with malarial changes was significantly (46 g; P less than 0.001) less than that of placentas without such changes. The morphologic changes were a combination of the following features: 1) presence of parasites in the intervillous spaces; 2) macrophage concentration in the intervillous spaces; 3) malarial pigment deposits; 4) excess of perivillous fibrinoid deposits; 5) syncytiotrophoblastic damage; and 6) trophoblastic basal lamina thickening. Plasmodia were found in placental intervillous spaces in 42% (105/247). Local parasitemia varied in magnitude; in a few cases, 30% or more of the maternal erythrocytes were infected. Macrophage concentration in the intervillous spaces was present in 29% (72/247) and was always associated with local parasitemia. Macrophages phagocytized red blood cells and malarial pigment, and their number varied inversely with that of the local parasites. It seems, therefore, that macrophages play an important role in local parasite clearance. Malarial brown pigment was observed in all cases from the series. It had characteristic ultrastructural features and occurred in perivillous deposits of fibrinoid, in macrophages, or free in intervillous spaces. Excessive perivillous fibrinoid deposits were a constant histologic finding and were usually associated with syncytiotrophoblastic necrosis or ultrastructural damage such as partial microvilli loss, filamentous material accumulation in intracytoplasmic vacuoles, and "podocytelike" cytoplasmic projections on the basal surface. At these sites the trophoblastic basal lamina was usually thickened. Previously reported morphologic data and our own findings suggest that the peculiar placental changes in malaria, restricted to intervillous spaces and to villous surfaces, may be related to an immunopathologic process.

This article has been cited by other articles:

				S. J. Rogerson, V. Mwapasa, and S. R. Meshnick Malaria in Pregnancy: Linking Immunity and Pathogenesis to Prevention Am J Trop Med Hyg, December 1, 2007; 77(6_Suppl): 14 - 22. [Abstract] [Full Text] [PDF]

				F. K. Parekh, J. N. Hernandez, D. J. Krogstad, W. M. Casapia, and O. H. Branch 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, September 1, 2007; 77(3): 451 - 457. [Abstract] [Full Text] [PDF]

				O. J. Adebami, J. A. Owa, G. A. Oyedeji, O. A. Oyelami, and G. O. Omoniyi-Esan Associations Between Placental and Cord Blood Malaria Infection and Fetal Malnutrition in an Area of Malaria Holoendemicity Am J Trop Med Hyg, August 1, 2007; 77(2): 209 - 213. [Abstract] [Full Text] [PDF]

				L. Hviid Adhesion Specificities of Plasmodium falciparum-Infected Erythrocytes Involved in the Pathogenesis of Pregnancy-Associated Malaria Am. J. Pathol., June 1, 2007; 170(6): 1817 - 1819. [Full Text] [PDF]

				N. Bir, S. S. Yazdani, M. Avril, C. Layez, J. Gysin, and C. E. Chitnis Immunogenicity of Duffy Binding-Like Domains That Bind Chondroitin Sulfate A and Protection against Pregnancy-Associated Malaria. Infect. Immun., October 1, 2006; 74(10): 5955 - 5963. [Abstract] [Full Text] [PDF]

				A. BENET, T. Y. KHONG, A. URA, R. SAMEN, K. LORRY, M. MELLOMBO, L. TAVUL, K. BAEA, S. J. ROGERSON, and A. CORTES PLACENTAL MALARIA IN WOMEN WITH SOUTH-EAST ASIAN OVALOCYTOSIS. Am J Trop Med Hyg, October 1, 2006; 75(4): 597 - 604. [Abstract] [Full Text] [PDF]

				J. Poovassery and J. M. Moore Murine Malaria Infection Induces Fetal Loss Associated with Accumulation of Plasmodium chabaudi AS-Infected Erythrocytes in the Placenta. Infect. Immun., May 1, 2006; 74(5): 2839 - 2848. [Abstract] [Full Text] [PDF]

				S. R. Elliott, A. K. Brennan, J. G. Beeson, E. Tadesse, M. E. Molyneux, G. V. Brown, and S. J. Rogerson Placental Malaria Induces Variant-Specific Antibodies of the Cytophilic Subtypes Immunoglobulin G1 (IgG1) and IgG3 That Correlate with Adhesion Inhibitory Activity Infect. Immun., September 1, 2005; 73(9): 5903 - 5907. [Abstract] [Full Text] [PDF]

				S. R. Elliott, M. F. Duffy, T. J. Byrne, J. G. Beeson, E. J. Mann, D. W. Wilson, S. J. Rogerson, and G. V. Brown Cross-Reactive Surface Epitopes on Chondroitin Sulfate A-Adherent Plasmodium falciparum-Infected Erythrocytes Are Associated with Transcription of var2csa Infect. Immun., May 1, 2005; 73(5): 2848 - 2856. [Abstract] [Full Text] [PDF]

				A. Mayor, N. Bir, R. Sawhney, S. Singh, P. Pattnaik, S. K. Singh, A. Sharma, and C. E. Chitnis Receptor-binding residues lie in central regions of Duffy-binding-like domains involved in red cell invasion and cytoadherence by malaria parasites Blood, March 15, 2005; 105(6): 2557 - 2563. [Abstract] [Full Text] [PDF]

				E. A. TAKO, A. ZHOU, J. LOHOUE, R. LEKE, D. W. TAYLOR, and R. F. G. LEKE RISK FACTORS FOR PLACENTAL MALARIA AND ITS EFFECT ON PREGNANCY OUTCOME IN YAOUNDE, CAMEROON Am J Trop Med Hyg, March 1, 2005; 72(3): 236 - 242. [Abstract] [Full Text] [PDF]

				K. Brustoski, U. Moller, M. Kramer, A. Petelski, S. Brenner, D. R. Palmer, M. Bongartz, P. G. Kremsner, A. J. F. Luty, and U. Krzych IFN-{gamma} and IL-10 Mediate Parasite-Specific Immune Responses of Cord Blood Cells Induced by Pregnancy-Associated Plasmodium falciparum Malaria J. Immunol., February 1, 2005; 174(3): 1738 - 1745. [Abstract] [Full Text] [PDF]

				A. Muthusamy, R. N. Achur, V. P. Bhavanandan, G. G. Fouda, D. W. Taylor, and D. C. Gowda Plasmodium falciparum-Infected Erythrocytes Adhere Both in the Intervillous Space and on the Villous Surface of Human Placenta by Binding to the Low-Sulfated Chondroitin Sulfate Proteoglycan Receptor Am. J. Pathol., June 1, 2004; 164(6): 2013 - 2025. [Abstract] [Full Text] [PDF]

				R. McGREADY, B. B. DAVISON, K. STEPNIEWSKA, T. CHO, H. SHEE, A. BROCKMAN, R. UDOMSANGPETCH, S. LOOAREESUWAN, N. J. WHITE, S. R. MESHNICK, et al. THE EFFECTS OF PLASMODIUM FALCIPARUM AND P. VIVAX INFECTIONS ON PLACENTAL HISTOPATHOLOGY IN AN AREA OF LOW MALARIA TRANSMISSION Am J Trop Med Hyg, April 1, 2004; 70(4): 398 - 407. [Abstract] [Full Text] [PDF]

				S. T. Agbor-Enoh, R. N. Achur, M. Valiyaveettil, R. Leke, D. W. Taylor, and D. C. Gowda Chondroitin Sulfate Proteoglycan Expression and Binding of Plasmodium falciparum-Infected Erythrocytes in the Human Placenta during Pregnancy Infect. Immun., May 1, 2003; 71(5): 2455 - 2461. [Abstract] [Full Text] [PDF]

				S. J. Rogerson, P. Mkundika, and M. K. Kanjala Diagnosis of Plasmodium falciparum Malaria at Delivery: Comparison of Blood Film Preparation Methods and of Blood Films with Histology J. Clin. Microbiol., April 1, 2003; 41(4): 1370 - 1374. [Abstract] [Full Text] [PDF]

				E. T. Abrams, H. Brown, S. W. Chensue, G. D. H. Turner, E. Tadesse, V. M. Lema, M. E. Molyneux, R. Rochford, S. R. Meshnick, and S. J. Rogerson Host Response to Malaria During Pregnancy: Placental Monocyte Recruitment Is Associated with Elevated {beta} Chemokine Expression J. Immunol., March 1, 2003; 170(5): 2759 - 2764. [Abstract] [Full Text] [PDF]

				R. Chattopadhyay, A. Sharma, V. K. Srivastava, S. S. Pati, S. K. Sharma, B. S. Das, and C. E. Chitnis Plasmodium falciparum Infection Elicits Both Variant-Specific and Cross-Reactive Antibodies against Variant Surface Antigens Infect. Immun., February 1, 2003; 71(2): 597 - 604. [Abstract] [Full Text] [PDF]

				S. J. Rogerson, H. C. Brown, E. Pollina, E. T. Abrams, E. Tadesse, V. M. Lema, and M. E. Molyneux Placental Tumor Necrosis Factor Alpha but Not Gamma Interferon Is Associated with Placental Malaria and Low Birth Weight in Malawian Women Infect. Immun., January 1, 2003; 71(1): 267 - 270. [Abstract] [Full Text] [PDF]

				S. J. ROGERSON, E. POLLINA, A. GETACHEW, E. TADESSE, V. M. LEMA, and M. E. MOLYNEUX PLACENTAL MONOCYTE INFILTRATES IN RESPONSE TO PLASMODIUM FALCIPARUM MALARIA INFECTION AND THEIR ASSOCIATION WITH ADVERSE PREGNANCY OUTCOMES Am J Trop Med Hyg, January 1, 2003; 68(1): 115 - 119. [Abstract] [Full Text] [PDF]

				J. G. Beeson, N. Amin, M. Kanjala, and S. J. Rogerson Selective Accumulation of Mature Asexual Stages of Plasmodium falciparum-Infected Erythrocytes in the Placenta Infect. Immun., October 1, 2002; 70(10): 5412 - 5415. [Abstract] [Full Text] [PDF]

				C. H. Ricke, T. Staalsoe, K. Koram, B. D. Akanmori, E. M. Riley, T. G. Theander, and L. Hviid Plasma Antibodies from Malaria-Exposed Pregnant Women Recognize Variant Surface Antigens on Plasmodium falciparum-Infected Erythrocytes in a Parity-Dependent Manner and Block Parasite Adhesion to Chondroitin Sulfate A J. Immunol., September 15, 2000; 165(6): 3309 - 3316. [Abstract] [Full Text] [PDF]

				J. C. Reeder, A. N. Hodder, J. G. Beeson, and G. V. Brown Identification of Glycosaminoglycan Binding Domains in Plasmodium falciparum Erythrocyte Membrane Protein 1 of a Chondroitin Sulfate A-Adherent Parasite Infect. Immun., July 1, 2000; 68(7): 3923 - 3926. [Abstract] [Full Text] [PDF]

				S. J. Rogerson, J. G. Beeson, C. G. Mhango, F. K. Dzinjalamala, and M. E. Molyneux Plasmodium falciparum Rosette Formation Is Uncommon in Isolates from Pregnant Women Infect. Immun., January 1, 2000; 68(1): 391 - 393. [Abstract] [Full Text] [PDF]

				B. Maubert, N. Fievet, G. Tami, M. Cot, C. Boudin, and P. Deloron Development of Antibodies against Chondroitin Sulfate A-Adherent Plasmodium falciparum in Pregnant Women Infect. Immun., October 1, 1999; 67(10): 5367 - 5371. [Abstract] [Full Text] [PDF]

				R. F. G. Leke, R. R. Djokam, R. Mbu, R. J. Leke, J. Fogako, R. Megnekou, S. Metenou, G. Sama, Y. Zhou, T. Cadigan, et al. Detection of the Plasmodium falciparum Antigen Histidine-Rich Protein 2 in Blood of Pregnant Women: Implications for Diagnosing Placental Malaria J. Clin. Microbiol., September 1, 1999; 37(9): 2992 - 2996. [Abstract] [Full Text]

				H. Sartelet, O. Garraud, M. Lorenzato, C. Rogier, I. Milko–Sartelet, M. Huerre, and D. Gaillard Quantitative Computer Image Analysis of Chondroitin Sulfate A Expression in Placentas Infected with Plasmodium Falciparum J. Histochem. Cytochem., June 1, 1999; 47(6): 751 - 756. [Abstract] [Full Text]

				L. Miller, M. Good, and G Milon Malaria pathogenesis Science, June 24, 1994; 264(5167): 1878 - 1883. [Abstract] [PDF]

				R. N. Achur, M. Valiyaveettil, A. Alkhalil, C. F. Ockenhouse, and D. C. Gowda Characterization of Proteoglycans of Human Placenta and Identification of Unique Chondroitin Sulfate Proteoglycans of the Intervillous Spaces That Mediate the Adherence of Plasmodium falciparum-infected Erythrocytes to the Placenta J. Biol. Chem., December 15, 2000; 275(51): 40344 - 40356. [Abstract] [Full Text] [PDF]