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Cited by 63Malaria Research and ControlDigital Imaging for Blood DiseasesBird parasitology and diseases

Polarisation microscopy increases the sensitivity of hemozoin and Plasmodium detection in the histological assessment of placental malaria

Romagosa, Cleofé, Menendez, Clara, Ismail, Mamudo R., Quintó, Llorenç, Ferrer, Berta, Alonso, Pedro L., Ordi, Jaume·2004·Acta Tropica
DOI 10.1016/j.actatropica.2004.02.003
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Abstract

The histological study of the placenta is useful in the diagnosis of malaria during pregnancy. However, the scarcity of parasites and pigment in many malarial infections renders their identification difficult. We have tested the accuracy of standard and polarisation microscopy in the evaluation of 500 placental specimens from an area of high malarial endemicity in Tanzania. Standard microscopy showed a low sensitivity (50.3% for parasites, 40.5% for pigment), due to poor detection rates in cases with scant parasites (12.7% for <1%; 97.8% for >5% parasitised erythrocytes, P < 0.001 ) or minimal pigment deposition (42.4% versus 84.5% when severe, P < 0.001 ). The use of polarisation microscopy significantly increased the sensitivity of detection of pigment to 100% and parasites to 98.1% because of the marked birefringence of hemozoin present in mature stage parasites which accumulate in the placenta. Formalin pigment shares many properties with hemozoin, but the use of neutral buffered formalin prevented the formation of formalin pigment in placentas even after long periods of fixation. In conclusion, polarisation microscopy is a simple tool that markedly increases the sensitivity of the detection of malaria infection in the placenta and has good specificity when used on tissues fixed in neutral formalin. This method can be useful to investigators working in the malaria field.

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  • Histopathology results depend on the quality of the sample, and formalin pigment can be confused with hemozoin, leading to diagnostic errors.

    “its results depend on the quality of the sample, and the formalin pigment can be confused with hemozoin, leading to diagnostic errors [5,52,53,54]”

    From Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia (2023) · cites this paper as [54]

  • Formalin pigment has similar optical properties to malaria pigment and can lead to misclassification in placental histopathology.

    “since formalin pigment has similar optical properties to malaria pigment and can lead to misclassification [6].”

    From Diagnosis of placental malaria in poorly fixed and processed placental tissue (2016) · cites this paper as [6]

  • The quality of placental histopathology is very dependent on obtaining high-quality specimens.

    “The quality of histopathology is very dependent on obtaining high-quality specimens, since formalin pigment has similar optical properties to malaria pigment and can lead to misclassification [6].”

    From Diagnosis of placental malaria in poorly fixed and processed placental tissue (2016) · cites this paper as [6]

  • In placental samples, polarized microscopy has aided in detecting low placental parasitemia, and in the absence of parasitemia indicates past infection.

    “In placental samples, polarized microscopy has aided in detecting low placental parasitemia, and in the absence of parasitemia indicates past infection [51].”

    From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [51]

  • Artifacts such as formalin pigment and dust particles can mimic hemozoin and can result in misdiagnosis.

    “However, artifacts such as formalin pigment and dust particles can mimic hemozoin [51] and can result in misdiagnosis (see below).”

    From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [51]

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Authors
Romagosa, C., Menendez, C., Ismail, M. R., Quintó, L., Ferrer, B., Alonso, P. L., & Ordi, J.
Affiliations
  • Hospital Clínic de Barcelona (ES)
  • Eduardo Mondlane University (MZ)
Corresponding author
Romagosa, Cleofé
ORCID
Venue
Acta Tropica
Publisher
Elsevier BV
Published
2004-05
Volume
90
Issue
3
Pages
277-284
ISSN
0001-706X (ISSN-L)
DOI
10.1016/j.actatropica.2004.02.003
OpenAlex
W2030098791
Cited by
63
References
25
Citations by year
2026: 1 · 2025: 2 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 4 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 7 · 2014: 5 · 2013: 5 · 2012: 4
FWCI
2.72
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Acta Tropica (publishedVersion)
  • PubMed (publishedVersion)
Funders
Direktion für Entwicklung und Zusammenarbeit
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Digital Imaging for Blood Diseases
  • Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
Keywords
placental malaria, hemozoin, Plasmodium, malaria in pregnancy, histopathological diagnosis, neutral buffered formalin, parasite detection sensitivity, birefringence, placenta
MeSH terms
Animals, Female, Hemeproteins, Humans, Microscopy, Pigments, Biological, Placenta, Plasmodium falciparum, Predictive Value of Tests, Pregnancy, Sensitivity and Specificity, Tanzania, Pregnancy Complications, Parasitic, Malaria, Falciparum

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