ABSTRACT
Background: Microscopic detection is the conventional method for detecting malaria parasites. Although it is efficient and inexpensive, it has its limitations. In recent years, polymeras chain reaction (PCR) has been considered superior to microscopy in detecting mixed Plasmodium infections or infections with low parasite density. To determine whether microscopic or nested PCR (nPCR) is better at detecting congenital malaria (CM). Methods: Blood smear examination and nPCR were performed with blood samples taken from mothers and their newborns, who were likely to be suffering from CM and in whom one of the symptoms was low birth weight (LBW). The sensitivity and specificity of each method were then compared. Results: During one year of study, the prevalence of CM among 92 LBW newborns was determined to be 6.8% using microscopy and 7.8% using nPCR. Among the 92 mother–infant paired subjects, CM was detected in 34 subjects (37%) by microscopy and in 39 subjects (42.4%) by nPCR. nPCR was more sensitive (76.5% vs 66.7%) but less specific (77.6% vs 84.9%) than microscopy. When the two methods were compared, nPCR gave significantly better results in diagnosing CM (AUC = 0.770; P < 0.001). Conclusion: Although microscopy remains the most appropriate method for the diagnosis of CM in remote areas, nPCR can be considered a complementary test.
ABSTRACT
Congenital malaria is assumed to be a risk factor for infant morbidity and mortality in endemic areas like Maumere, Indonesia. Infected infants are susceptible to its impact such as premature labor, low birth weight, anemia, and other unspecified symptoms. The aim of this study was to investigate the prevalence of congenital malaria and the influence of mother-infant paired parasite densities on the clinical outcome of the newborns at TC Hillers Hospital, Maumere. An analytical cross sectional study was carried out in newborns which showed criteria associated with congenital malaria. A thick and thin blood smear confirmed by nested PCR was performed in both mothers and infants. The association of congenital malaria with the newborn's health status was then assessed. From 112 mother-infant pairs included in this study, 92 were evaluated further. Thirty-nine infants (42.4%) were found to be infected and half of them were asymptomatic. Infected newborns had a 4.7 times higher risk in developing anemia compared to uninfected newborns (95% CI, 1.3-17.1). The hemoglobin level, erythrocyte amount, and hematocrit level were affected by the infants' parasite densities (P<0.05). Focusing on newborns at risk of congenital malaria, the prevalence is almost 3 times higher than in an unselected collective. Low birth weight, anemia, and pre-term birth were the most common features. Anemia seems to be significantly influenced by infant parasite densities but not by maternal parasitemia.