Profile of malaria in Madras

CONGENITAL MALARIA IN A NEONATE

Congenital malaria isn’t common even though malaria is endemic in India. Here, we will be reporting about a neonate of age seven days with splenomegaly and fever diagnosed as congenital malaria. On smear study it was found to have malarial parasite incidentally. In a case of neonatal sepsis congenital malaria can be suspected. Early diagnosis and treatment is thus important in preventing neonatal mortality.

Congenital Malaria in Newborns Delivered to Malaria-infected Mothers in the Hilly Region of Northern India: Is it Deadly?

BACKGROUND

Malaria is endemic in many states of India. Though there are reports of maternal and congenital malaria from endemic areas, however, there remains a paucity of data from hilly terrains. The present study evaluated the prevalence, clinical and microbiological spectrum of maternal and congenital malaria at a tertiary health care facility in Northern India over a period of 18 months.

METHODS

In this observational study, mothers along with their newborns were evaluated for malaria by maternal, placental, and cord blood smear examination and rapid point-of-care diagnostic serological tests. Positive cases were confirmed by polymerase chain reaction. Mother-newborn duos were followed up till discharge from the hospital.

RESULTS

A total of 843 mothers delivered during the study period and were screened along with their newborns and placentae. A total of Ten (1.18%) mothers had evidence of malarial parasitemia (Plasmodium vivax, n=7 and Pl. falciparum, n=3), however, none of the placental and cord blood samples were positive for malaria. Overall, 127 (15.1%) neonates required admission in neonatal intensive care unit for various morbidities. Incidence of small for gestational age (SGA) was high (n=210; 24.9%). Multivariate logistic regression analysis demonstrated maternal malaria to be an independent contributor for SGA [Odds Ratio (95% Confidence Interval), 10.7 (2.06 - 49.72)]. However, only 2% variance of SGA could be explained by maternal malaria alone.

CONCLUSION

We report an encouragingly lower incidence of maternal malaria in mothers attending for delivery and a 'Zero' incidence for placental and congenital malaria during the study period as compared to national data (upto 7.4% in non-immune mothers), although maternal malaria could be a causative factor for SGA.

Congenital Malaria due to Plasmodium Vivax Infection in a Neonate

Although malaria is endemic in India, congenital malaria is not very common. Congenital malaria is a very rare condition in both endemic and nonendemic areas. We report a case of congenital malaria in a six-day-old neonate with fever and splenomegaly. The diagnosis was picked up accidentally on a peripheral smear examination. Congenital malaria should be kept as differential diagnosis of neonatal sepsis. Timely detection of this condition could lead to early diagnosis and treatment, thereby preventing neonatal mortality.

Congenital malaria in Calabar, Nigeria: the molecular perspective

Polymerase chain reaction (PCR) has been shown to be more sensitive in detecting low-level parasitemia than conventional blood film microscopy. We estimated the prevalence of congenital malaria using nested PCR amplification of the small subunit 18S RNA gene to detect low-level parasitemia and identify Plasmodium species in 204 mother-neonate pairs. Cord-blood parasitemia was detected in four babies by PCR, giving a prevalence of 2.0%. The newborns of primidgravidae were more susceptible to congenital malaria than those of multigravidae (P < 0.0001). There was a strong correlation between placental malaria and congenital malaria (odds ratio = 10.1, 95% confidence interval = 1.3-76.1, P = 0.0487). We conclude that the prevalence of congenital malaria in Calabar detected by PCR is lower than has been reported in this environment through microscopy.

AN EPIDEMIOLOGICAL SURVEY OF MALARIA AT AN AIR FORCE STATION

Increased incidence of malaria in an Air Force Station in western India in 1994 was investigated by means of an epidemiological survey. The survey was conducted from 17 October to 20 October 1994. It revealed that the station had ecological conditions and topography favouring mosquito breeding. For 1994 the annual parasite incidence was 3.29 and annual blood examination rate was 26.4 per cent. Active parasitological survey revealed 2 cases of asymptomatic parasitaemia. The survey also revealed that the outbreak was due to combination of natural forces and laxity in implementing existing anti-malaria activity.

Clinical profile of malaria in children--a prospective study from Aligarh (N. India)

In a prospective, hospital-based study in North India, malaria accounted for 1.5% of paediatric outpatient attendances during 1 year. A marked increase in the prevalence of malaria was noted during the post-monsoon months. Plasmodium falciparum was the causative species in 44.4% of cases, contrary to previous reports of low prevalence of this parasite in the area. Pyrexia with or without chills or rigor, vomiting, pallor and hepatosplenomegaly were the common presenting clinical features. Splenic and hepatic enlargement were seen more frequently with P. vivax than P. falciparum infections (P less than 0.001 and P less than 0.01, respectively). Convulsions were present in 20% of cases.