Case Report
Congenital Malaria

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Introduction

Congenital malaria is defined as malarial parasites demonstrated in the peripheral smear of the newborn from twenty four hours to seven days of life [1]. Clinically apparent congenital malaria is rare in areas in which malaria is endemic and levels of maternal antibody are high. Normally, symptoms occur 10 to 30 days postpartum [2]. The most common clinical features in 80% of cases are fever, anaemia, and splenomegaly [3]. Other signs and symptoms include hepatomegaly, jaundice, regurgitation, loose stools, and poor feeding. Occasionally, drowsiness, restlessness, and cyanosis may be seen [1, 2]. Respiratory distress, loose stools and hepatomegaly may also be present [4]. The diagnosis is frequently missed. Those with asymptomatic parasitemia at birth may either suppress this spontaneously, or present with clinical symptoms in the late neonatal period [5].

A preterm neonate born at 34 weeks of gestation presented with respiratory distress requiring continuous positive pressure ventilation. Plasmodium vivax was detected on two occasions in the peripheral blood smear and chloroquine therapy was given to the neonate.

Section snippets

Case Report

A male neonate was born to a 26 year old gravida three mother by an emergency caesarian, indicated for accidental placental haemorrhage (APH) at 34 weeks of gestation. Neonate required bag and mask ventilation for 30 seconds and weighed 2100 gms. Neonate developed respiratory distress after birth and required continuous positive airway pressure (CPAP) of 4-6cms of water for 54 hours with maximum FiO2 of 0.4. A clinical diagnosis of transient tachypnoea of newborn (TTNB) was made as skiagram

Discussion

Congenital malaria is rare with occurrence rate of 0.3 % in immune mothers and 7.4% in nonimmune mothers [6, 7, 8]. In a study of 46 infants, the mean age of onset of symptoms was 5.5 weeks[9]. All these children had fever and majority had hepato-splenomegaly, anemia, and thrombocytopenia. Santhanakrishnan et al [10], reported two cases of congenital malaria diagnosed in the first four months of life in a study of 221 children with malaria. In our case malarial parasite was detected

Conflicts of Interest

None identified

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Copyright © 2008 Director General, Armed Forces Medical Services. Published by Elsevier B.V. All rights reserved.