School of Microbiology, University of Antioquia, Medellín, Colombia.
"Grupo de investigación César Uribe Piedrahíta", Faculty of Medicine, University of Antioquia, Medellín, Colombia.
PLoS One. 2022 May 24;17(5):e0268949. doi: 10.1371/journal.pone.0268949. eCollection 2022.
Knowledge about placental malaria (PM) is insufficient in the world, and incipient in Colombia where studies are few and recent. In this country, PM has been reported by Plasmodium vivax, Plasmodium falciparum, and mixed infection. The objective was to determine the frequency of PM and its associated clinical-epidemiological factors in mothers and neonates in northwestern Colombia, 2009-2020. A Retrospective pooled analysis with 602 placentas captured in five investigations. The diagnosis of PM was made with thick blood smear (TBS) and qPCR. The groups with and without PM were compared using the Chi-square test, Mann-Whitney test, and crude and adjusted prevalence ratios in a log-binomial model. The prevalence of PM was 27.7% with 92% (155/167) of submicroscopic cases; 41.3% by P. vivax, 44,3% by P. falciparum, and 14.4% by mixed infections. In the multivariate adjustment, PM was associated with the diagnosis of congenital malaria, low neonatal weight, gestational malaria, maternal anemia, previous malaria during pregnancy, and age between 25-43 years. This research is the investigation with the largest number of subjects for studying PM in Colombia, in the ecoepidemiological zone that produces more cases of malaria per year, finding a high prevalence of submicroscopic PM that caused serious maternal (anemia) and neonatal (congenital malaria and low neonatal weight) effects. The results show limitations in the timely diagnosis and treatment, given that the epidemiological surveillance program in Colombia is based on thick blood smear, which generates a substantial underestimation of the magnitude of PM, with serious effects and clinical risks. It is urgent to demand that the health authorities adopt measures such as prenatal control visits as soon as the pregnancy begins, monthly implementation of TBS, and active search for infected pregnant women in their homes and workplaces.
关于胎盘疟疾（PM）的知识在全球范围内都很匮乏，在哥伦比亚更是如此，这里的研究很少且都是近期的。在该国，已经有由间日疟原虫、恶性疟原虫和混合感染引起的 PM 报告。本研究的目的是确定 2009 年至 2020 年在哥伦比亚西北部，母亲和新生儿 PM 的频率及其相关临床流行病学因素。这是一项回顾性合并分析，共纳入了来自五个研究的 602 例胎盘。PM 的诊断采用厚血涂片（TBS）和 qPCR。采用卡方检验、Mann-Whitney 检验以及对数二项模型中的粗比和调整后比值比，对有和无 PM 的组进行比较。PM 的患病率为 27.7%，其中亚临床病例占 92%（155/167）；由间日疟原虫引起的占 41.3%，由恶性疟原虫引起的占 44.3%，由混合感染引起的占 14.4%。在多变量调整后，PM 与先天性疟疾、新生儿体重低、妊娠期疟疾、产妇贫血、孕期疟疾、年龄在 25-43 岁之间有关。这是哥伦比亚针对 PM 进行的最大规模的研究，在每年产生更多疟疾病例的生态流行病学区域，发现了高比例的亚临床 PM，这对产妇（贫血）和新生儿（先天性疟疾和新生儿体重低）造成了严重影响。结果表明，由于哥伦比亚的流行病学监测计划基于厚血涂片，这会大大低估 PM 的严重程度，存在严重的漏诊和临床风险，因此在及时诊断和治疗方面存在局限性。迫切需要卫生当局采取措施，如从怀孕开始就进行产前检查、每月进行 TBS 检查以及主动在家中和工作场所寻找感染孕妇。
