|Sandrine Lydie Oyegue-Liabagui, Irene Pegha-Moukandja, Ulrich Joly Bisvigou, Edgard Brice Ngoungou and Jean Bernard Lekana-Douki*|
|Corresponding Author: JB Lekana-Douki, UPARAM, CIRMF, BP 769, Franceville, Gabon|
|Received: December 21, 2017; Accepted: March 02, 2018; Published: June 09, 2018;|
|Citation: Oyegue-Liabagui SL, Pegha-Moukandja I, Bisvigou UJ, Ngoungou EB & Lekana-Douki JB. (2018) Prevalence of Infectious Diseases in Pregnant Women in Franceville, GABON: Findings of Non-Malarial Infectious Diseases of Antenatal Care in Pregnant Women in Franceville, Gabon Study. J Immunol Res Ther, 3(1): 145-150.|
|Copyrights: ©2018 Oyegue-Liabagui SL, Pegha-Moukandja I, Bisvigou UJ, Ngoungou EB & Lekana-Douki JB. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
The clinical screening in antenatal care to prevent and treat infectious diseases in pregnant women is essential to saving maternal and newborn lives. Our research groups have been conducted studies in malaria and non-malarial infectious diseases in children and pregnant women. Here, we review the data from our recent research study on non-malarial infectious diseases of antenatal care in pregnant women in Franceville, Gabon. We conclude on high seropositivity levels of T. gondi and rubella virus infections. However, the prevalence of T. pallidum and HTLV-1 remains low among pregnant women, whereas HIV prevalence among young women was worried.
In Sub-Saharan Africa, despite the improvement of health systems with the provision of vaccines, the use of antibiotics and the introduction of anti-retrovirals for HIV/AIDS treatments, infectious diseases are still a major cause of morbidity and mortality. Indeed, the prevalence and impact of non-malarial infectious diseases are rapidly increasing in the African population . Among the target population, pregnant women and newborns are the most vulnerable groups. Indeed, during pregnancy, the immune system becomes very prone to infectious diseases [2,3] because of the immune and morphophysiological changes that the body undergoes to accept the fetus [4,5]. Several consequences of infectious diseases affecting pregnant women have also been associated with severe complications on the mother and the fetus that sometimes lead to deaths . Indeed, the worldwide, under-five mortality was 6.3 million in 2013 [7,8] with the neonatal deaths accounted for 44% of all under-five mortality in year . In Africa, the neonatal mortality rate (31 per 1000 live births) is almost 4-5 times higher than that of the Americas (8 per 1000 live births) and Europe (6 per 1000 live births) . Among these infections, HIV, Treponema pallidum, T. gondii, the rubella virus and human T-cell lymphotropic virus type 1 require special interest in African countries.
In the world, 1.5 million pregnant women live with HIV in developing countries and 90% of them live in Africa . HIV infection in pregnant women is responsible of premature birth, low birth weight, miscarriage or newborn mortality [11-14]. Although HIV transmission in utero rarely occurs because of anti-retroviral treatment during pregnancy, nevertheless, during delivery 65% of mothers transmit the virus to their child . Note however that, progresses in the prevention of mother to child transmission of HIV-infection have substantially decreased the prevalence of pediatric HIV-infection and the burden of HIV attributable-childhood infectious diseases . Nevertheless, the prevalence of HIV among pregnant women remains high in many African countries and there is an emerging recognition of higher morbidity and mortality among HIV-exposed uninfected than among HIV-unexposed young infants [17-19].
Despite the efforts made to eliminate syphilis, this disease still continues to be a cause of morbidity and mortality world widely [20,21]. Overall, an estimated 12 million people test positive for syphilis each year, of which over 2 million are pregnant women. In these pregnant women there are approximately 305 000 fetal and neonatal deaths every year and leave 215 000 infants at increased risk of dying from severe complications caused by this disease [22,23]. Indeed, syphilis during pregnancy has been associated with numerous adverse pregnancy outcomes such as perinatal death and disability, stillbirth, prematurity, low birth weight, neonatal mortality and congenital syphilis [24-26]. Also, it facilitates mother-to-child transmission of HIV [27,28].
Toxoplasma gondii is an obligate intracellular protozoan organism that can cause toxoplasmosis. Human are commonly infected by ingestion of raw or partly cooked meat containing Toxoplasma viable tissue cysts or by consumption of contaminated food and water with oocysts of T. gondii. It can also occur through placental transmission to the fetus .
Therefore, toxoplasmosis remains a major public health problem in the world. Indeed, it is estimated that about one third of the world’s population is infected with T. gondii . In Africa, the seroprevalence of T. gondii during pregnancy is generally as high as 80% [31,32]. Toxoplasmosis in pregnant women varies geographically. Also there are reports of 3.7% in Korea , 6.4% in South Africa , 17.3% in London , 24.1% in Saudi Arabia , 28.3% in Thailand , 30.9% in Tanzania , 68.6% in Brazil  and 92.5% in Ghana .
The T. gondii infection in pregnant woman may become severe disease, leading to the death. Among pregnant women acquired infection there is a wide variety of manifestations in the fetus and newborns, including spontaneous abortion, still-birth, newborn with hydrocephalus or microcephalus, cerebral calcifications and retinochoriditis. Those lead to mental retardation, blindness, epilepsy and death. The high prevalence of Toxoplasma infection and its severe consequences on the fetus and the infant shows the importance of pregnant women toxoplasmosis [40,41]. Thereby, toxoplasma antenatal screening is recommended to prevent this infection.
In sub-Sarahan Africa, the prevalence of natural anti-rubella antibodies ranges from 50% to 95% depending on age and geographical location [42,43]. Rubella virus remains an important pathogen worldwide, causing approximately 100 000 cases of congenital rubella syndrome every year [44,45]. Rubella has almost been eradicated by immunization programs in many developed countries, but outbreaks among unvaccinated individuals still occur . The infection also continues to circulate in many countries with less effective immunization programs . In some African countries, rubella seropositivity of 71-99% has been found in previous studies among women in their reproductive age, with countries like Mozambique (95%) and south Africa (97.5-98%) having highest incidence [48,49]. Rubella is a viral disease with complications including birth defects of the developing fetus, especially if the infection is acquired in the early months of pregnancy. It leads to abnormal fetal formation when it occurs in the first 11 weeks of gestation. Despite the severe consequences of rubella infection during early pregnancy, very little is known about the rubella seroprevalence in a number of African countries, Gabon in particular.
Among many human T-cell lymphotropic viruses (HTLV) described and designated, only HTLV-1 and 2 have been associated with human disease. Although the exact number of HTLV-infected individuals is not known, it is estimated that 15 to 20 million people in the world are infected by the virus . HTLV-1 is endemic in the Caribbean, Japan, South America and regions of Africa [51,52]. HTLV-1 carriers develop associated diseases, with the adult T-cell leukemia/lymphoma and it associated myelopathy/tropical spastic paraparesis being the most severe. HTLV-1 infection causes significant morbidity and mortality. Others associations include uveitis, arthropathy and HTLV-1 associated infective dermatitis [53,54].
Despite pregnancy-relevant infections being an intensive field of research, their prevalence and possible co-infections among these women are rarely specified in some African countries. In Gabon, several data on pregnant women malaria and HIV infections are available. However, studies on prevalence of others infectious diseases among pregnant women attending antenatal care are unavailable. This report summarizes the results of our study on non-malarial infectious diseases of antenatal care in pregnant women in Franceville, Gabon .
To evaluate the prevalence of non-malarial infectious diseases diagnosed during prenatal consultations of pregnant women in Franceville, the authors of this study included a total of 973 women aged 14 to 45 years from the two reference hospitals in that city, as well as the mothers and Child Health office and a private health center . All women included after obtaining their written informed consent and performing the antenatal care at the different sites of the study. This study obtained ethical clearance from the ethic committee of Gabonese Health Ministry (MSP/MD/134/2008).
For the diagnosis of HIV, they used ELISA tests (Genscreen HIV-1/2 version 2, Biorad, France) and rapid tests (HIV/1/2 DetermineTM, USA). T. pallidum was diagnosed using serological tests (Treponema pallidum Hemagglutination Assay/Venereal Disease research Laboratory, BIOLAB South Africa). T. pallidum quantification was determined using Phosphorothionate, 2-butenoic acid-3-(diethoxyphosphinothioyl) methyl ester (RPR-II) nosticon flocculation tests. The diagnosis of rubella was made using the ELFA test (Vidas Biomerieux, France). For the T. gondii diagnosis, they used the VIDAS serological test (Biomerieux, France), IgG-avidity tests and the fluorescent enzyme-linked assay (ELFA) technique. Women who were positive for HIV and T. pallidum were referred for treatment according to the national health policies in Gabon. Their statistical analyses were conducted with Stat view 5.0 (SAS Institute, USA).
After confirmation of serological tests for the diagnosis of HIV, T. pallidum, rubella and HTLV-1; HIV prevalence remains high among 26-45 year olds (5.64%). This same observation was made with the prevalence of HTLV-1, which is high in this age group. In the case of syphilis, no difference in prevalence was observed between the different age groups. There was no significant difference between the prevalence of these infectious diseases (HIV: 4%; Syphilis: 2.5%. HTLV-1: 2.88%). In addition, these three infections were not associated with social status.
About seroprevalence of rubella virus and T. gondii by age group among pregnant women, the T. gondii seronegativity is higher (42.75%, n=416) than rubella’s (12.44%, n=121; p=7.4.10-30). The difference between T. gondii and rubella prevalence of seronegative women decreases with age (48.68%, 44.00%, 37.99% for rubella, 21.51%, 11.33%, 7.35% for T. gondii, for 14-18, 18-25 and 25-45 years, respectively). Nevertheless, the prevalence of rubella’s seronegativity remains higher among the students group (19.58%, n=28) than among workers (7.59%, n=6/79) and unemployed groups (11.58%, n=87/751, p<0.01). On more time, social status was not associated with levels of T. gondii and rubella infections. However, a significant difference is observed between the prevalence of HIV and the seronegativity of T. gondii (p=5.37. 10-91), but also between the prevalence of syphilis and the seronegativity of rubella (p=3.78. 10-15).
During this study, no cases
of triple infections were reported; however, some cases of co-infections were
observed among some of these women. Indeed, there were two cases of HIV – T. pallidum co-infection and two other
VIH – HTLV-1 cases. Only one case of T. palladum
– HTLV-1 co-infection was observed. Similarly, twelve cases of HIV infection and fifteen cases of HTLV-1
infection were found among T. gondii
seronegative women. However, six women infected with HIV were also tested
seronegative against rubella. Women tested seronegative both to T. gondii and rubella were either
infected with HTLV-1 or HIV, about of two cases per group.
The level of circulation of infectious diseases remains high in Franceville. That calls to the reinforcement of antenatal care to improve mother and child health.
1. Health WO (2014) World Organisation Health. Transition.
2. Fievet N, Moussa M, Tami G, Maubert B, Cot M, Deloron P, et al. (2001) Plasmodium falciparum induces a Th1/Th2 disequilibrium, favoring the Th1-type pathway, in the human placenta. J Infect Dis 183: 1530-1534.
3. Luft BJ, Remington JS (1982) Effect of pregnancy on resistance to Listeria monocytogenes and Toxoplasma gondii infections in mice. Infect Immun 38: 1164-1171.
4. Szekeres-Bartho J (2002) Immunological relationship between the mother and the fetus. Int Rev Immunol 21: 471-495.
5. Gaunt G, Ramin K (2001) Immunological tolerance of the human fetus. Am J Perinatol 18: 299-312.
6. Wendel GD, Maberry MC, Christmas JT, Goldberg MS, Norgard MV (1989) Examination of amniotic fluid in diagnosing congenital syphilis with fetal death. Obstet Gynecol 74: 9676-9670.
7. UNICEF, WHO, World Bank, UN-DESA Population Division (2014) Levels and trends in child mortality 2014. UNICEF, New York.
8. Wang H, Coates MM (2014) Global, regional and national levels of neonatal, infant and under-5 mortality during 1990-2013: A systematic analysis for the global burden of disease study 2013. Lancet 384: 957-979.
9. WHO (2014) Global health observatory. Under-five mortality.
10. WHO (2009) HIV.
11. Schafer A, Jovaisas E, Stauber M, Lowenthal D, Koch MA (1986) Proof of diaplacental transmission of HTLV III/LAV before the 20th week of pregnancy. Geburtshife Frauenheilkd 46: 88-89.
12. Stauber M, Schafer A, Lowenthal D, Weingart B (1986) The Aids problem in pregnant women - A challenge to the obstetrician. Geburtshilfe Frauenheilkd 46: 201-205.
13. Mok JQ, Giaquinto C, De Bossi A, Grosch Worner I, et al. (1987) Infants born to mothers seropositive for human immunodeficiency virus. Preliminary findings from a multicentre European study. Lancet 1: 1151-1153.
14. Senturia YD, Ades AE, Peckham CS (1987) Seronegativity and pediatric AIDS. Lancet 1: 1151-1153.
15. Peckham CS, Senturia YD, Ades AE (1987) Obstetric and perinatal consequences of human immunodeficiency virus (HIV) infection: A review. Br J Obstet Gynecol 94: 403-407.
16. Luzuriaga K, Lynne E, Mofenson MD (2016) Challenges in the elimination of pediatric HIV-1 infection. N Engl J Med 374: 761-770.
17. Slogrove AL, Goetghebuer T, Cotton MF, Singer J, Bettinger JA (2016) Pattern of infectious morbidity in HIV-exposed infants and children. Front Immunol.
18. Filteau S (2009) The HIV-exposed, uninfected African child. Trop Med Int Health 14: 276-87.
19. Evans C, Christine E Jones, Prendergast AJ (2016) HIV-exposed, uninfected infants: New global challenges in the era of pediatric elimination. Lancet Infect Dis 16: 92-107.
20. Frickmann H, Schwarz NG, Girmann M, Hagen RM, Poppert S (2013) Serological survey of HIV and syphilis in pregnant women in Madagascar. Trop Med Int Health 18: 35-39.
21. Watson-Jones D, Oliff M, Terris-Prestholt F, Changalucha J, Gumodoka B, et al. (2005) Antenatal syphilis screening in sub-Saharan Africa: Lessons learned from Tanzania. Trop Med Int Health 10: 934-943.
22. WHO (2007) The global elimination of congenital syphilis: Rationale and strategy for action. WHO, Geneva.
23. Newman L, Rowley J, Hoorn SV, Wijesooriya NS, Unemo M, et al. (2015) Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One 10: e0143304.
24. Qin J, Yang T, Xiao S, Tan H, Feng T, Fu H (2014) Reported estimates of adverse pregnancy outcomes among women with and without syphilis: A systematic review and meta-analysis. PLoS One 9: e102203.
25. Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, et al. (2013) Untreated maternal syphilis and adverse outcomes of pregnancy: A systematic review and meta-analysis. Bull World Health Organ 91: 217-226.
26. Mullick S, Watson Jones D, Beksinska M, Mabey D (2005) Sexually transmitted infections in pregnancy: Prevalence, impact on pregnancy outcomes and approach to treatment in developing countries. Sex Transm Infect 81: 294-302.
27. Hayes R, Watson-Jones D, Celum C, van de Wijgert J, Wasserheit J (2010) Treatment of sexually transmitted infections for HIV prevention: End of the road or new beginning? AIDS 24: S15-S26.
28. Mwapasa V, Rogerson SJ, Kwiek JJ, Wilson PE, Milner D, et al. (2006) Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi. AIDS 20: 1869-1877.
29. Dubey JP, Jones JL (2008) Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 38: 1257-1278.
30. Lopes FM, Gonçalves DD, Mitsuka-Breganó R, Freire RL, Navarro IT (2007) Toxoplasma gondii infection in pregnancy. Br J Infect Dis 11: 496-506.
31. Zemene E, Yewhalaw D, Abera S, Belay T, Samuel A, et al. (2012) Seroprevalence of Toxoplasma gondii and associated risk factors among pregnant women in Jimma town, Southwestern Ethiopia. BMC Infect Dis 12: 1-6.
32. Abamecha F, Awel H (2016) Seroprevalence and risk factors of Toxoplasma gondii infection in pregnant women following antenatal care at Mizan Aman General Hospital, Bench Maji Zone (BMZ), Ethiopia. BMC Infect Dis 16: 1-8.
33. Aqeely H, El-Gayar EK, Khan DP, Najmi A, Alvi A, et al. (2014) Seroepidemiology of Toxoplasma gondii amongst pregnant women in Japan province, Saudi Arabia. J Trop Med.
34. Kistiah K, Winiecka-Krusnell J, Barragan A, Karstaedt A, Frean J (2011) Seroprevalence of Toxoplasma gondii infection in HIV-positive and HIV-negative subjects in Gauteng, South Africa. South Afr J Epidemiol Infect 26: 225-228.
35. Flatt A, Shetty N (2013) Seroprevalence and risk factors for toxoplamosis among antenatal women in London: A re-examination of risk in an ethnically diverse population. Eur J Public Health 23: 648-52.
36. Nissapatorn V, Suwanrath C, Sawangjaroen N, Ling LY, Chandeying V (2011) Toxoplasmosis - Serological evidence and associated risk factors among pregnant women in Southern Thailand. Am J Trop. Med Hyg 85: 243-247.
37. Mwambe B, Mshana SE, Kidenya BR, Massinde AN, Mazigo HD (2013) Seroprevalence and factors associated with Toxoplasma gondii infection among pregnant women attending antenatal care in Mwanza, Tanzanie. Parasit Vectors 6.
38. Sroka S, Bartelheimer N, Winter A, Heukelbach J, Ariza L, et al. (2010) Prevalence and risk factors of toxoplasmosis among pregnant women in Fortaleza, north-eastern Brazil Am J Trop Med. Hyg 83: 528-533.
39. Ayi I, Edu SA, Apea-Kubi KA, Boamah D, Bosompem KM, Edoh D (2009) Sero-epidemiology of toxoplasmosis amongst pregnant women in the greater Accra region of Ghana. Ghana Med J 43: 107-114.
40. Goldenberg RL, Thompson C (2003) The infectious origins of stillbirth. Am J Obstet Gynecol 189: 861-873.
41. Gibbs RS (2002) The origins of stillbirth: Infectious diseases. Semin Perinatol 26: 75-78.
42. Onakewhor JU, Chiwuzie J (2011) Seroprevalence survey of rubella infection in pregnancy at the University of Benin Teaching Hospital Benin City, Nigeria. Niger J Clin Pract 14: 140-145.
43. Linguissi LS, Nagalo BM, Bisseye C, Kagoné TS, Sanou M, et al. (2012) Seroprevalence of toxoplamosis and rubella in pregnant women attending antenatal private clinic at Ouagadougou, Burkina Faso. Asian Pac J Trop Med 5: 810-813.
44. Chantler J, Tingle A (2001) Rubella virus. H.P.E: Knipe DM.
45. Lambert N, Strebel P, Orenstein W, Icenogle J, Poland GA (2015) Rubella. Lancet 85: 2297-2307.
46. Lindegren ML, Fehrs LJ, Hadler SC, Hinman AR (1991) Update: Rubella and congenital rubella syndrome, 1980-1990. Epidemiol Rev 13: 341-348.
47. Galazka A (1991) Rubella in Europe. Epidemiol Infect 107: 43-54.
48. Barreto J, Sacramento I, Robertson SE, Langa J, de Gourville E, et al. (2006) Antenatal rubella serosurvey in Maputo, Mozambique. Trop Med Int Health 11: 559-564.
49. Goodson JL, Masresha B, Dosseh A, Byabamazima C, Nshimirimana D, et al. (2011) Rubella epidemiology in Africa in the pre-vaccine era, 2002-2009. J Infect Dis 204: S215-225.
50. Proietti FA, Carneiro-Proietti AB, Catalan-Soares BC, Murphy EL (2005) Global epidemiology of HTLV-1 infection and associated diseases. Oncogene 24: 6058-6068.
51. Taylor GP, Monique B, Francois C, Georg P, Annarosa DM, et al. (2005) The seroepidemiology of human T-lymphotropic viruses: Types I and II in Europe: A prospective study of pregnant women. J Acquir Immune Defic Syndr 38: 104-109.
52. Gessain A, Mahieux R, de Thé G (1996) Genetic variability and molecular epidemiology of human and simian T cell leukemia/lymphoma virus type I. J Acquir Immune Defic Syndr Hum Retroviral 13: 132-145.
53. Verdonck K, González E, Van Dooren S, Vandamme AM, Vanham G, et al. (2007) Human T lymphotropic virus 1: Recent knowledge about an ancient infection. Lancet Infect Dis 7: 266-81.
54. Manns A, Hisada M, LaGranade L (1999) Human T-lymphotropic virus type 1. Lancet 353: 1951-1958.
55. Pegha Moukandja I, Ngoungou EB, Lemamy GJ, Bisvigou U, Gessain A, et al. (2017) Non-malarial infectious diseases of antenatal care in pregnant women in Franceville, Gabon. BMC Pregnancy Childbirth 17.
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