妊娠相关性疟疾及其研究进展

恶性疟疾是对人类健康危害最为严重的传染病之一.生活在疟疾流行区的人随着年龄的增长和感染次数的增加会逐渐获得保护性免疫即临床免疫.然而,孕妇尤其是初孕妇女在妊娠过程中感染恶性疟原虫后往往呈现急性感染症状,甚至危及孕妇和胎儿的生命.妊娠相关性疟疾(pregnancy-associated malaria,PAM)主要是由于受恶性疟原虫感染的红细胞和单核细胞在胎盘绒毛问大量聚集引起的.大量的研究表明,黏附在子宫粘膜上的虫体表达一种具有特殊生物活性和抗原性的蛋白质(var2CSA).Var2CSA可特异性地与子宫粘膜上的硫酸软骨素A(Chondroitin sulfate A,CSA)结合.此外,由于var2CSA的序列相对保守,机体在感染几次以后较容易产生交叉免疫保护反应.对PAM的研究是疟疾领域内的重要内容,目前在很多领域(病原学、分子致病机理、免疫学等)已经取得重要进展.本篇综述概括了近年来在PAM研究方面的进展,包括虫体表达的主要膜蛋白质的功能、相关的人体受体以及免疫学方面等内容.     

Malaria in pregnancy

Background: Malaria in pregnancy contributes to low birth weight and increased infant mortality.     

Malaria in pregnancy

Malaria during pregnancy is a recognised risk factor for maternal and foetal complications and it is endemic in certain areas of our country. Pregnancy also enhances the severity of malaria particularly with P falciparum infestation. The outcome of effects of malaria in pregnancy on the mother and foetus is studied here. This is a prospective observational study conducted in the department of obstetrics and gynaecology of RG Kar Medical College during the period from 1st January 2001 to 31st December 2006. Forty pregnant women with malaria in pregnancy were studied. Another 40 non- pregnant women during the same period were served as control. The maternal complications were compared with the controls and the outcome of pregnancy was studied. There was statistically significant (p < 0.05) increase in the incidence of anaemia, cerebral malaria, renal failure, hepatic failure, hypoglycaemia, hypotension and death in the pregnant women in comparison to non-pregnant women. P falciparum infection was also more during pregnancy. There was also increased incidence of abqrtion, preterm labour, intra-uterine growth restriction and intra-uterine foetal death. Treatment with antimalarial drugs particularly in cerebral malaria does not give good results as there were 12 maternal deaths in this series. Every attempt should be made to prevent malaria during pregnancy by various measures as it is associated with high maternal morbidity and mortality and adversely affects the neonatal outcome.     

Malaria

Malaria is a parasitic infection of global importance. Although relatively uncommon in developed countries, where the disease occurs mainly in travellers who have returned from endemic regions, it remains one of the most prevalent infections of humans worldwide. In endemic regions, malaria is a significant cause of morbidity and mortality and creates enormous social and economic burdens. Current efforts to control malaria focus on reducing attributable morbidity and mortality. Targeted chemoprophylaxis and use of insecticide-treated bed nets have been successful in some endemic areas. For travellers to malaria-endemic regions, personal protective measures and appropriate chemoprophylaxis can significantly reduce the risk of infection. Prompt evaluation of the febrile traveller, a high degree of suspicion of malaria, rapid and accurate diagnosis, and appropriate antimalarial therapy are essential in order to optimize clinical outcomes of infected patients. Additional approaches to malaria control, including genetic manipulation of mosquitoes and malaria vaccines, are areas of ongoing research.     

Malaria in Northern Ireland

The clinical features, parasitology and prophylactic history of 67 patients who imported malaria to Northern Ireland between 1974 and 1983 are reported. P. falciparum infections were encountered more frequently than anticipated from current United Kingdom experience. The clinical implications of these findings are discussed.     

台湾省的疟疾根除

台湾于1946年在南部设立疟疾研究所，负责疟疾与蚊虫调查，媒介测定，防治研究与培训，在1952－1956年攻击防治期，每年对疟 区一部住房和牲畜棚实施DDTI事留喷洒，喷洒前每年发生的疟疾病例超过100万，1953年降至40万例，到1956年仅报道676例，1964年世界卫生组织（WHO）评价结果显示，连续三年来未发现当地原发病例，疟区喷洒3－5年后除在少数边远地区存在媒介幼虫外，住房和牲畜棚内未再发现媒介蚊虫，所以，WHO于1965年颁发了（台湾）根除疟疾证书，此后，进入对输入病例严格监测阶段。