Gestational malaria associated to Plasmodium vivax and Plasmodium falciparum placental mixed-infection followed by foetal loss: a case report from an unstable transmission area in Brazil

• Published in: Malaria journal Vol. 10; no. 1; p. 178
• Main Authors: Carvalho, Bruna O, Matsuda, Joycenéa S, Luz, Sergio L B, Martinez-Espinosa, Flor E, Leite, Juliana A, Franzin, Fernanda, Orlandi, Patrícia P, Gregoracci, Gustavo B, Lacerda, Marcus V G, Nogueira, Paulo A, Costa, Fabio T M
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27-06-2011; BioMed Central; BMC
• Subjects: Abortion, Septic; Anemia; Birth weight; Brazil; Care and treatment; Case Report; Case reports; Case studies; Comorbidity; Complications and side effects; Consent; Deoxyribonucleic acid; Diagnosis; Disease transmission; DNA; Family medical history; Female; Fetuses; Foetus; Genetic testing; Health aspects; Heart rate; Hospitals; Human diseases; Humans; Infections; Malaria; Malaria, Falciparum - complications; Malaria, Falciparum - diagnosis; Malaria, Vivax - complications; Malaria, Vivax - diagnosis; Microscopic analysis; Microscopy; Nucleotide sequence; Parasites; Pathology; Patient outcomes; PCR; Peripheral blood; Placenta; Placenta - parasitology; Plasmodium falciparum; Plasmodium falciparum - isolation & purification; Plasmodium vivax; Plasmodium vivax - isolation & purification; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnant women; Risk factors; Stillbirth; Tropism; Tropisms; Ultrasonic imaging; Vector-borne diseases; Women; Womens health; Young Adult; Brazil
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/1475-2875-10-178

Gestational malaria is a multi-factorial syndrome leading to poor outcomes for both the mother and foetus. Although an unusual increasing in the number of hospitalizations caused by Plasmodium vivax has been reported in Brazil, mortality is rarely observed. This is a report of a gestational malaria case that occurred in the city of Manaus (Amazonas State, Brazil) and resulted in foetal loss. The patient presented placental mixed-infection by Plasmodium vivax and Plasmodium falciparum after diagnosis by nested-PCR, however microscopic analysis failed to detect P. falciparum in the peripheral blood. Furthermore, as the patient did not receive proper treatment for P. falciparum and hospitalization occurred soon after drug treatment, it seems that P. falciparum pathology was modulated by the concurrent presence of P. vivax. Collectively, this case confirms the tropism towards the placenta by both of these species of parasites, reinforces the notion that co-existence of distinct malaria parasites interferes on diseases' outcomes, and opens discussions regarding diagnostic methods, malaria treatment during pregnancy and prenatal care for women living in unstable transmission areas of malaria, such as the Brazilian Amazon.