Adverse pregnancy outcomes are associated with Plasmodium vivax malaria in a prospective cohort of women from the Brazilian Amazon

BackgroundMalaria in Brazil represents one of the highest percentages of Latin America cases, where approximately 84% of infections are attributed to Plasmodium (P.) vivax. Despite the high incidence, many aspects of gestational malaria resulting from P. vivax infections remain poorly studied. As such, we aimed to evaluate the consequences of P. vivax infections during gestation on the health of mothers and their neonates in an endemic area of the Amazon.Methods and findingsWe have conducted an observational cohort study in Brazilian Amazon between January 2013 and April 2015. 600 pregnant women were enrolled and followed until delivery. After applying exclusion criteria, 329 mother-child pairs were included in the analysis. Clinical data regarding maternal infection, newborn’s anthropometric measures, placental histopathological characteristics, and angiogenic and inflammatory factors were evaluated. The presence of plasma IgG against the P. vivax (Pv) MSP1₁₉ protein was used as marker of exposure and possible associations with pregnancy outcomes were analyzed. Multivariate logistic regression analysis revealed that P. vivax infections during the first trimester of pregnancy are associated with adverse gestational outcomes such as premature birth (adjusted odds ratio [aOR] 8.12, 95% confidence interval [95%CI] 2.69–24.54, p < 0.0001) and reduced head circumference (aOR 3.58, 95%CI 1.29–9.97, p = 0.01). Histopathology analysis showed marked differences between placentas from P. vivax-infected and non-infected pregnant women, especially regarding placental monocytes infiltrate. Placental levels of vasomodulatory factors such as angiopoietin-2 (ANG-2) and complement proteins such as C5a were also altered at delivery. Plasma levels of anti-PvMSP1₁₉ IgG in infected pregnant women were shown to be a reliable exposure marker; yet, with no association with improved pregnancy outcomes.ConclusionsThis study indicates that P. vivax malaria during the first trimester of pregnancy represents a higher likelihood of subsequent poor pregnancy outcomes associated with marked placental histologic modification and angiogenic/inflammatory imbalance. Additionally, our findings support the idea that antibodies against PvMSP1₁₉ are not protective against poor pregnancy outcomes induced by P. vivax infections.     

Emotional distress and its socio-political correlates in Salvadoran refugees: Analysis of a clinical sample

The emotional distress responses of refugees cannot be adequately understood using the traditional notions of stress and adaptation. In these populations it is necessary to consider the relations between emotional distress and socio-political context, particularly the processes of terror and intimidation and the conditions of migratory illegality and social marginality.This study analyses the patterns of emotional distress in a clinical sample of 71 Salvadoran refugees in an urban center of the United States. Case histories are presented and patterns of trauma, distress and associated life problems analyzed. It is argued that distress patterns reflect the particular socio-political conditions of women and men and represent the embodiment of the conflicts that refugees face. The concept of illness is used to link distress patterns and socio-political context and to avoid the reductionism of psychiatric categories.     

The convenience of the use of allosteric "probes" for the study of lipid--protein interactions in biological membranes: thermodynamic considerations.

One of the most commonly used methods to study enzyme (protein)-structure interactions at a more specific level is the use of the Arrhenius plots to detect the influence of the “environment” on the enzyme. We want to point out here that the use of a suitable “allosteric enzyme” would be a more sensitive method to detect influences of the environment than the study of Arrhenius plots. According to simple thermodynamic considerations, a change of more than 2.8 kcal/mol in the interaction between enzyme and membrane would be needed to give a noticeable change in the position of the break (T_i) of the corresponding Arrhenius plot. On the other hand, feeble changes in the membrane-enzyme interaction, of the order of 0·7–0·8 kcal/mol, would be enough to give a significant change in the values of n (Hill coefficient).     

Detection of avian malaria (Plasmodium spp.) in native land birds of American Samoa

This study documents the presence ofPlasmodium spp. in landbirds ofcentral Polynesia. Blood samples collectedfrom eight native and introduced species fromthe island of Tutuila, American Samoa wereevaluated for the presence of Plasmodiumspp. by nested rDNA PCR, serology and/ormicroscopy. A total of 111/188 birds (59%)screened by nested PCR were positive. Detection of Plasmodium spp. was verifiedby nucleotide sequence comparisons of partial18S ribosomal RNA and TRAP(thrombospondin-related anonymous protein)genes using phylogenetic analyses. All samplesscreened by immunoblot to detect antibodiesthat cross-react with Hawaiian isolates of Plasmodium relictum (153) were negative. Lack of cross-reactivity is probably due toantigenic differences between the Hawaiian andSamoan Plasmodium isolates. Similarly,all samples examined by microscopy (214) werenegative. The fact that malaria is present,but not detectable by blood smear evaluation isconsistent with low peripheral parasitemiacharacteristic of chronic infections. Highprevalence of apparently chronic infections,the relative stability of the native land birdcommunities, and the presence of mosquitovectors which are considered endemic andcapable of transmitting avian Plasmodia,suggest that these parasites are indigenous toSamoa and have a long coevolutionary historywith their hosts.