Monocytes and macrophages and placental malaria infections in an area of unstable malaria transmission in eastern Sudan

Ninety three placentae were investigated for malaria histological changes and immunohistochemical study for monocytes and macrophages (CD68).While 1(1.1%), 2(2.2%) and 20(21.5%) of the 93 placentae had acute, chronic and past malaria infections, 70(75.2%) had no malaria infections. Monocytes and macrophage (CD 68) were detected in 29 (31.2%) of these 93 placentae. Significantly higher rate of monocytes and macrophage were detected in placentae with malaria infections [11/23 (47.8%) vs. 18/70 (25.7%); P = 0.047] especially in placentae with past malaria infections. Placental malaria infections and monocytes and macrophages cells infiltration were not different between primiparae and multiparae. There was no significant difference in the birth weight between the women with placental malaria infections/monocytes and macrophages cells infiltration and those who had no placental malaria infections/cellular infiltrations.Significantly higher rate of monocytes and macrophage were detected in placentae with malaria infections. Neither placental malaria infections nor cellular infiltrates were associated with parity or lead to reduction of birth weight.Malaria during pregnancy is a major public health problem in tropical and subtropical regions; each year 25 million African women become pregnant in malaria endemic areas [1]. Pregnant women are more susceptible to malaria than their non-pregnant counterparts [2]. Malaria infections are associated with poor maternal and fetal outcomes [3,4]. Malaria during pregnancy is a huge burden in Sudan [3,5] and it is one of the leading causes of maternal mortality [6].During pregnancy, adhesion of Plasmodium falciparum-infected erythrocytes to syncytiotrophoblast leads to parasite sequestration in the intervillous space. The parasite adheres specifically to chondroitin sulfate-A expressed on syncytiotrophoblast [7]. The increased susceptibility of pregnant women to malaria was thought to result from pregnancy-related immunomodulation an