Congenital malaria in Thailand, an appraisal of previous cases

Congenital Malaria in Newborns Presented at Tororo General Hospital in Uganda: A Cross-Sectional Study

Despite recent large-scale investments, malaria remains a major public health concern. Few studies have examined congenital malaria, defined as the presence of malaria parasitemia within the first 7 days of life, in endemic areas. This study aimed to determine the prevalence, to describe the clinical presentation, and to examine factors associated with congenital malaria in newborns aged up to 7 days attending Tororo General Hospital in Uganda. A total of 261 mother/baby pairs were recruited in this cross-sectional study. Giemsa-stained thick blood smears for malaria parasites and rapid malaria diagnostic tests were performed on capillary blood samples from all newborns and mothers, as well as on placental and cord samples from newborns delivered in the hospital. The prevalence of congenital malaria in the newborns was 16/261 (6.1%). No single clinical feature was associated with congenital malaria. However, there were associations between congenital malaria and maternal parasitemia (P < 0.001), gravidity of one (P = 0.03), maternal age < 19 years (P = 0.01), cord blood parasitemia (P = 0.01), and placental malaria (P = 0.02). In conclusion, congenital malaria is not rare in Uganda and there are no obvious clinical features associated with it in the newborn. Based on these findings, we recommend strengthening malaria prevention during pregnancy to reduce the occurrence of congenital malaria in newborns.

Congenital malaria in a neonate: case report with a comprehensive review on differential diagnosis, treatment and prevention in Indian perspective

Although malaria in pregnancy, lactation and congenital malaria can be a disease burden in the endemic zones of Africa and Indian sub-continent, it is still epidemiologically less investigated in India. As it may lead to considerable maternal and perinatal morbidity and mortality, awareness and timely intervention is necessary for desirable outcome and prevention of the condition. Very few reports of congenital malaria are available in the literature from an endemic country like India. Herein we describe a case of congenital malaria from north India in a 21-day neonate. Clinical presentation of this condition in the neonate may offer a considerable diagnostic challenge, and differentiation from vector borne malaria in infants may be important from the management point of view. Hence a review of the differential diagnosis, management and prevention of congenital malaria has been attempted in the Indian perspective.

Malaria in pregnancy in the Asia-Pacific region

Most pregnant women at risk of for infection with Plasmodium vivax live in the Asia-Pacific region. However, malaria in pregnancy is not recognised as a priority by many governments, policy makers, and donors in this region. Robust data for the true burden of malaria throughout pregnancy are scarce. Nevertheless, when women have little immunity, each infection is potentially fatal to the mother, fetus, or both. WHO recommendations for the control of malaria in pregnancy are largely based on the situation in Africa, but strategies in the Asia-Pacific region are complicated by heterogeneous transmission settings, coexistence of multidrug-resistant Plasmodium falciparum and Plasmodium vivax parasites, and different vectors. Most knowledge of the epidemiology, effect, treatment, and prevention of malaria in pregnancy in the Asia-Pacific region comes from India, Papua New Guinea, and Thailand. Improved estimates of the morbidity and mortality of malaria in pregnancy are urgently needed. When malaria in pregnancy cannot be prevented, accurate diagnosis and prompt treatment are needed to avert dangerous symptomatic disease and to reduce effects on fetuses.

Congenital malaria in Urabá, Colombia

Background

Congenital malaria has been considered a rare event; however, recent reports have shown frequencies ranging from 3% to 54.2% among newborns of mothers who had suffered malaria during pregnancy. There are only a few references concerning the epidemiological impact of this entity in Latin-America and Colombia.

Objective

The aim of the study was to measure the prevalence of congenital malaria in an endemic Colombian region and to determine some of its characteristics.

Methods

A prospective, descriptive study was carried out in the mothers who suffered malaria during pregnancy and their newborns. Neonates were clinically evaluated at birth and screened for Plasmodium spp. infection by thick smear from the umbilical cord and peripheral blood, and followed-up weekly during the first 21 days of postnatal life through clinical examinations and thick smears.

Results

116 newborns were included in the study and 80 umbilical cord samples were obtained. Five cases of congenital infection were identified (four caused by P. vivax and one by P. falciparum), two in umbilical cord blood and three in newborn peripheral blood. One case was diagnosed at birth and the others during follow-up. Prevalence of congenital infection was 4.3%. One of the infected newborns was severely ill, while the others were asymptomatic and apparently healthy. The mothers of the newborns with congenital malaria had been diagnosed with malaria in the last trimester of pregnancy or during delivery, and also presented placental infection.

Conclusions

Congenital malaria may be a frequent event in newborns of mothers who have suffered malaria during pregnancy in Colombia. An association was found between congenital malaria and the diagnosis of malaria in the mother during the last trimester of pregnancy or during delivery, and the presence of placental infection.

The impact of maternal malaria on newborns

BACKGROUND

Each year, malaria threatens 125 million pregnancies, and gestational malaria is responsible for up to 200,000 infant deaths in sub-Saharan Africa. With advancing knowledge of malaria in pregnancy and its impact on newborns, improved preventive and therapeutic interventions are possible.

METHODS

We reviewed and, by consensus, evaluated published literature relevant to malaria and newborns. Important findings are summarised.

RESULTS

Pregnant women are more likely than others to be inoculated with and infected by malaria parasites. Poor outcomes are particularly common in primigravid women and their offspring. The placenta is affected through cellular adhesion, cytokine production and mononuclear cell infiltrates. As a result, newborns may have low birthweight owing to intrauterine growth retardation or prematurity. Recent evidence suggests that a subset of these infants is also at higher risk of malaria infections later in life. Preventive strategies to improve maternal and fetal outcomes include intermittent preventive treatment and insecticide-treated bed nets. Asymptomatic malaria infection is not uncommon in newborns, and symptomatic disease occurs. Fever and death are possible during the early days of life, and presentation with a sepsis-like illness can occur during the 1st 2 months of life. Malaria-affected infants face higher than usual risks of infantile anaemia, subsequent malaria infection and death during the 1st year of life.

CONCLUSIONS

Malaria is common during pregnancy and can have serious consequences for neonatal health. Neonatal morbidity and mortality can be significantly reduced by proper implementation of insecticide-treated nets and intermittent preventive treatment.

Congenital malaria due to chloroquine-resistant Plasmodium vivax: a case report

The clinical manifestation of malaria in neonates and young infants is non-specific and differs from that of adults and older children. So a high index of suspicion is needed to diagnose malaria in early infancy. Chloroquine is the first-line treatment for Plasmodium vivax malaria in most parts of the world. This case report details a case of chloroquine-resistant malaria due to P. vivax by transplacental transmission from mother with mixed infection of P. falciparum and P. vivax in a 26-day-old young infant who presented with moderate grade fever and reviews the literature of malaria in infantile and neonatal age groups. And we concluded that high suspicion of malaria is needed to diagnose congenital malaria. Primigravida women with placental malaria pose high risk for congenital infection in baby and emerging chloroquine-resistant P. vivax in congenital malaria.

Congenital malaria: rare but potentially fatal

Congenital malaria is rare and usually indolent but can be fatal. Mortality risk is high in newborns with Plasmodium falciparum born to nonimmune women, who typically present at birth or soon thereafter. Semi-immune women are less likely to transmit malaria, and their children often become ill weeks after delivery with less severe symptoms. Cases in the USA usually trace to semi-immune immigrant mothers whose last exposure to malaria may have preceded the pregnancy, leading to misdiagnoses. Congenital malaria may be under-recognized in malaria-endemic areas since parasitemia occurring after the first week of life is usually attributed to mosquito transmission. Malaria prophylaxis and the absence of fever during pregnancy do not preclude congenital malaria in a newborn. Quinine plus clindamycin is commonly used to treat P. falciparum congenital malaria, and chloroquine is used to treat other malaria parasites, such as Plasmodium vivax. Severe cases should be managed with intravenous quinine (available as its enantiomer quinidine in the USA) or with intravenous artesunate, which was recently approved for investigational use by the US FDA. Primaquine is not required for infants with congenital P. vivax or Plasmodium ovale, but should be offered to their mothers after excluding G6PD deficiency.

Congenital malaria with atypical presentation: a case report from low transmission area in India

BACKGROUND

Malaria during first few months of life may be due to transplacental transfer of parasitized maternal erythrocytes. Although IgG and IgM antimalarial antibodies can be detected in maternal blood, only IgG antibodies are present in the infant's blood. These antibodies can delay and modify the onset of clinical manifestations.

CASE PRESENTATION

An infant is described who presented with irritability and feeding problems. Clinical examination and investigations revealed that the infant was afebrile, had jaundice, hepatosplenomegaly and haemolytic anaemia. Peripheral smear demonstrated Plasmodium vivax. While the mother had significant levels of immunoglobulin G (IgG), the infant was found negative for IgG and had low immunoglobulin M (IgM) levels. The mother had a history of febrile illness during pregnancy and her peripheral smear was also positive for P. vivax. Both were successfully treated with chloroquine in the dose of 25 mg/kg/day over three days.

CONCLUSION

The case emphasizes the importance of considering the diagnosis of malaria even in infants in low transmission area, who may not present with typical symptoms of malaria, such as fever, but have other clinical manifestations like jaundice and haemolytic anaemia.