title: 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.
abstract: 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.
authors.affiliation: Departamento de Genética, Evolução e Bioagentes, Universidade Estadual de Campinas - Campinas, SP, Brazil.
authors.forename: Bruna O
authors.initials: BO
authors.lastname: Carvalho
authors.forename: Joycenéa S
authors.initials: JS
authors.lastname: Matsuda
authors.forename: Sergio L B
authors.initials: SL
authors.lastname: Luz
authors.forename: Flor E
authors.initials: FE
authors.lastname: Martinez-Espinosa
authors.forename: Juliana A
authors.initials: JA
authors.lastname: Leite
authors.forename: Fernanda
authors.initials: F
authors.lastname: Franzin
authors.forename: Patrícia P
authors.initials: PP
authors.lastname: Orlandi
authors.forename: Gustavo B
authors.initials: GB
authors.lastname: Gregoracci
authors.forename: Marcus V G
authors.initials: MV
authors.lastname: Lacerda
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Nogueira
authors.forename: Fabio T M
authors.initials: FT
authors.lastname: Costa
mesh_terms: D000031:Abortion, Septic; D001938:Brazil; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications / Q000175:diagnosis*; D016780:Malaria, Vivax / Q000150:complications / Q000175:diagnosis*; D008853:Microscopy; D010920:Placenta / Q000469:parasitology*; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D010966:Plasmodium vivax / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D055815:Young Adult