Case Report: Delayed Diagnosis of Congenital Malaria by Plasmodium vivax in a Newborn of an Eritrean Woman with Varicella Infection.

Congenital malaria (CM) is uncommon in both malaria-endemic and non-endemic countries. It may be caused by any Plasmodium spp., although Plasmodium falciparum and Plasmodium vivax are the more frequent etiologic agents. We report a case of delayed diagnosis of CM by P. vivax in a newborn of an Eritrean primigravida. The mother developed pregnancy-related immunodepression and varicella-zoster viral infection 9 days before natural delivery; therefore, the child was admitted in the neonatal intensive care unit (NICU) to administer specific varicella-zoster immunoglobulin prophylaxis and for clinical monitoring. During the NICU stay, the newborn presented a febrile syndrome with vomiting, anemia, and thrombocytopenia. A P. vivax severe malaria diagnosis was made by detecting trophozoites in the thick and thin blood smears. The infant was successfully treated with intravenous artesunate and clindamycin. Our experience suggests that malaria diagnostic tests need to be included in routine blood analyses in newborns with febrile syndrome from mothers with an epidemiologic link to malaria-endemic areas.

Case Report: Severe Plasmodium vivax Malaria Mimicking Sepsis in a Neonate.

Severe congenital malaria associated with Plasmodium vivax is uncommon. In Indonesia, most congenital malaria cases are due to Plasmodium falciparum infections. Most cases of congenital or neonatal malaria in endemic areas are diagnosed from peripheral smear as part of routine sepsis workup. Differentiating congenital and acquired neonatal malaria is very difficult. The case presented in this study describes severe P. vivax malaria with cholestatic jaundice and sepsis-like signs and symptoms in neonates. The mother was asymptomatic and the neonate was successfully treated with intravenous artesunate. Severe P. vivax malaria with cholestatic jaundice in neonates is an uncommon condition that should be included in the differential diagnosis of infants displaying hemolytic anemia, thrombocytopenia, cholestatic jaundice, and hepatosplenomegaly in malaria-endemic zones. Early diagnosis can prevent the use of unnecessary antibiotics and mortality of neonates.

Congenital Malaria: A Rare Entity.

Congenital malaria is the presence of malarial parasites in the blood of newborns. The disease is acquired from mother either during pregnancy or perinatally at the time of birth. Congenital malaria in an endemic area can present without an obvious history of fever and parasitaemia in both mother and her infant. A case of Plasmodium vivax malaria in a 6-week infant is documented. Infant presented with pallor, jaundice and massive spleen. Laboratory tests revealed anaemia, thrombocytopenia and bilirubinemia. Peripheral smear examination revealed parasitaemia. Points favoring transplacental transmission are first born child, the presence of relatively high parasite count, gametocytemia and massive spleen. Peripheral smear examination should be done in all hospitalized patients. Prevention of malaria should be considered in all pregnant patients.

Congenital vivax malaria: rare or underdiagnosed infection.

Congenital malaria is a rare disease both in endemic and non-endemic areas. It is seldom suspected due to its rarity and the fact that its signs and symptoms may be similar to those with neonatal sepsis. Furthermore, clues such as a history of maternal travel to an endemic area during pregnancy or any malaria symptoms may not always be revealed. The situation is further complicated by subjective smear tests and an expensive rapid diagnostic test, especially in developing countries where affordability is an issue. We call attention to the need to consider the diagnosis of malaria in neonates who present with signs and symptoms often confused with sepsis, to enable a quick diagnosis and treatment in order to reduce mortality.

Prevalence of gestational, placental and congenital malaria in north-west Colombia.

BACKGROUND: The frequency of pregnancy-associated malaria is increasingly being documented in American countries. In Colombia, with higher frequency of Plasmodium vivax over Plasmodium falciparum infection, recent reports confirmed gestational malaria as a serious public health problem. Thick smear examination is the gold standard to diagnose malaria in endemic settings, but in recent years, molecular diagnostic methods have contributed to elucidate the dimension of the problem of gestational malaria. The study was aimed at exploring the prevalence of gestational, placental and congenital malaria in women who delivered at the local hospitals of north-west Colombia, between June 2008 and April 2011. METHODS: A group of 129 parturient women was selected to explore the prevalence of gestational, placental and congenital malaria in a descriptive, prospective and transversal (prevalence) design. Diagnosis was based on the simultaneous application of two independent diagnostic tests: microscopy of thick blood smears and a polymerase chain reaction assay (PCR). RESULTS: The prevalence of gestational malaria (thick smear /PCR) was 9.1%/14.0%; placental malaria was 3.3%/16.5% and congenital malaria was absent. A history of gestational malaria during the current pregnancy was significantly associated with gestational malaria at delivery. Plasmodium vivax caused 65% of cases of gestational malaria, whereas P. falciparum caused most cases of placental malaria. CONCLUSIONS: Gestational and placental malaria are a serious problem in the region, but the risk of congenital malaria is low. A history of malaria during pregnancy may be a practical indicator of infection at delivery.

Plasmodium vivax congenital malaria in an area of very low endemicity in Guatemala: implications for clinical and epidemiological surveillance in a malaria elimination context.

This is a report of the first Plasmodium vivax congenital malaria case in Guatemala and the first case in Latin America with genotypical, histological and clinical characterization. The findings show that maternal P. vivax infection still occurs in areas that are in the pathway towards malaria elimination, and can be associated with detrimental health effects for the neonate. It also highlights the need in very low transmission areas of not only maintaining, but increasing awareness of the problem and developing surveillance strategies, based on population risk, to detect the infection especially in this vulnerable group of the population.

Congenital malaria in a European country.

A newborn of 26 days, born in Lisbon, Portugal, presented with fever, anaemia and thrombocytopaenia. She was admitted considering neonatal sepsis, but Plasmodium vivax was identified in the second peripheral blood smear performed. Parenteral quinine was started with good evolution. Despite clinicians' unfamiliarity with congenital malaria in non-endemic areas, this diagnosis, although rare, should not be forgotten in the evaluation of newborns/infants born to women from endemic areas or with recent trip to these areas.

Malaria congénita: estudio rertrospectivo 2000-2011. Hospital "Menca de Leoni", ciudad guayana estado bolívar / Congenital malaria: a retrospective study from 2000 to 2011. Hospital

La Malaria denominada fiebre palúdica o paludismo constituye un problema de salud en gran parte de los países tropicales y subtropicales. El paludismo congénito es transmitido verticalmente desde la madre al niño durante el embarazo o en el momento delparto. Con la presente investigación se pretende actualizar el estudio literario sobre la malaria congénita y demostrar la incidencia de casos en la población Guayacitana. Se revisaron 8 casos con diagnostico de malaria congénita que ingresaron al Hospital “Menca de Leoni” en el periodo comprendido entre 2000 y 2011. Se estudiaron las variables sexo, edad, procedencia, intervalo entre elinicio de síntomas y el diagnóstico, manifestaciones clínicas, agente etológico, edad en el momento del diagnóstico, tiempo de gestaciónde la madre al momento de adquirir la infección, hallazgos hematológicos y tratamiento. El sexo mayormente afectado fue el masculino, todos los casos se presentaron en menores de 1 mes. La edad de gestación más frecuente al momento de adquirir lainfección fue el tercer trimestre. Las manifestaciones clínicas más frecuentes fueron fiebre y palidez cutánea. La forma parasitaria más frecuente fue el Plasmodium vivax. La mayoría de los niños recibió tratamiento con monoterapia antipalúdica a base de Cloroquina, con evolución clínica satisfactoria. La frecuencia del paludismo congénito se ha incrementado recientemente en nuestro país.La forma parasitaria más frecuente es la del Plasmodium vivax, por lo que el tratamiento indicado es la Cloroquina, con la cual se obtiene una respuesta favorable en la mayoría de los casos

Malaria is a major health problem in many of the tropical and subtropical countries. Congenital malaria is transmitted vertically frommother to child during pregnancy or at delivery. The objectives of the present study are to update the literature study on congenital malaria and to show the incidence of cases in the population of Ciudad Guayana, Bolívar, Venezuela. Eight children who were admitted to the Hospital “Menca de Leoni” during 2000 to 2011 were included. Variables studied were: gender, age, interval between the beginning of de symptoms and diagnosis, clinical findings, etiologic agent, age at diagnosis, gestation age at the moment of acquiring the infection,hematologic findings and treatment. Boys were affected more frequently, all cases presented during the first month of age. The gestation age most frequent at the moment of acquiring the infection was the third trimester. Most frequent clinical findings were fever and skin pallor. The most frequent parasitic form was Plasmodium vivax. Treatment with chloroquine was indicated in most of children with good clinical outcome. Conclusions: The predominant symptom of congenital malaria in the studied children was fever and the highest percentage presented parasitaemia by Plasmodium vivax. Most patients received treatment with antimalarial monotherapy based on chloroquine, with satisfactory clinical outcome

A case of congenital plasmodium vivax malaria from a temperate region in Central China.

In February 2011, a rare case of congenital Plasmodium vivax malaria was diagnosed in a temperate region of Central China. An infant developed intermittent fever 20 days after delivery. Since this occurred during the non-transmission winter season in a low malaria endemic region and the infant's mother did not have a clear malaria history or showed malaria symptoms at the time of the delivery, malaria infection was not suspected at the beginning. Later, on suspicion of potential malignant haematological illness due to persistence of the fever, bone marrow smear was examined, which revealed infection by P. vivax parasite. This rare case of congenital vivax malaria underlines that malaria diagnosis might need to be included in the healthcare of neonates born in vivax-endemic areas.

Neonatal Plasmodium vivax malaria.

Congenital malaria is a condition rarely diagnosed, even in endemic countries. This tropical disease is associated with high mortality in the absence of timely recognition and prompt therapy, particularly when is due to Plasmodium falciparum, however Plasmodium vivax can also lead to relevant morbidity and mortality. We report an unusual case of a 19- day-old male newborn with neonatal vivax malaria, suspected primarily on the basis of positive maternal history, which presented with low birth weight, thrombocytopenia and a significant parasitemia. He responded satisfactorily to chloroquine antimalarial therapy, being successfully discharged 10 days after admission. Blood smears remained negative during the first 2 months of follow up. At 8 weeks of follow-up, she showed remarkable weight gain and was developing normally with age-appropriate anthropometry with no subsequent complications.

Highly effective therapy for maternal malaria associated with a lower risk of vertical transmission.

BACKGROUND: The epidemiology of congenital malaria was investigated in a hospital-based malaria surveillance study in Papua, Indonesia. METHODS: From April 2005 to January 2010, 4878 delivering women and their newborns underwent prospective clinical review and malaria screening by peripheral blood microscopy. FINDINGS: Congenital malaria occurred in 8 per 1000 (38/4884) live births, with Plasmodium falciparum accounting for 76.3% (29) and P. vivax for 15.8% (6) of infections. Maternal malaria at delivery (adjusted odds ratio [AOR], 9.5; 95% confidence interval [CI], 4.2-21.5; P < .001), age ≤ 16 years (AOR, 4; 95% CI, 1.4-12.1; P = .011), and prior malaria during pregnancy (AOR, 2.2; 95% CI, 1.1-4.4, P = .022) were independent risk factors for vertical transmission. Of 29 mothers and neonates with contemporaneous peripheral parasitemia, 17% (5) had discordant parasite species, suggesting possible antenatal malaria transmission. Newborns with malaria were at significantly greater risk of low birth weight (AOR, 2.8; 95% CI, 1.2-6.6; P = .002). Following introduction of dihydroartemisinin-piperaquine for uncomplicated malaria in the second and third trimesters of pregnancy, congenital malaria incidence fell from 3.2% to 0.2% (odds ratio, 0.07; 95% CI, .03-.15; P < .001). CONCLUSIONS: Congenital malaria is an important cause of neonatal morbidity in this region co-endemic for P. falciparum and P. vivax malaria. The introduction of artemisinin-combination therapy was associated with a significant risk reduction in the vertical transmission of malaria.

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.

Congenital malaria--a case report from a non-endemic area.

Eighteen day old neonate presented with features of early neonatal sepsis. History of mother revealed a travel from non-endemic area of malaria to endemic area, and on the 7th gestational age mother detected as having malaria. She was treated with quinine and cured. Baby was also evaluated for congenital malaria in first few neonatal days and discharged. Now the baby on evaluation shows anemia, hepatosplenomegaly and diagnosed with a Plasmodium vivax infection on peripheral smear. The quinine failed to prevent transplacental transmission. Prolonged interval between birth and onset of symptoms may be explained by transmission late in pregnancy or during delivery or by presence of transplacentally acquired maternal antibody (IgG). Mother acquired malarial infection after travel to an endemic area and transmitted to the baby. A high level of suspicion is warranted in babies of malaria infected mothers even when the neonate peripheral smear shows no evidence of infection.

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 Plasmodium vivax malaria mimicking neonatal sepsis: a case report.

Although malaria in pregnancy can cause very significant neonatal morbidity, congenital malaria is a very rare condition in both endemic and non-endemic areas. A case of congenital malaria by Plasmodium vivax, initially mistaken for neonatal sepsis, is described. The correct diagnosis was accidentally done, as congenital malaria had been missed in the initial differential diagnosis.Vivax malaria is the leading species in congenital infections in Europe. This condition should be included in the differential diagnosis of neonatal sepsis even if the mother has no proven malarial episodes during the gestational period.

Congenital malaria--a case report from a non-endemic area

Eighteen day old neonate presented with features of early neonatal sepsis. History of mother revealed a travel from non-endemic area of malaria to endemic area, and on the 7th gestational age mother detected as having malaria. She was treated with quinine and cured. Baby was also evaluated for congenital malaria in first few neonatal days and discharged. Now the baby on evaluation shows anemia, hepatosplenomegaly and diagnosed with a Plasmodium vivax infection on peripheral smear. The quinine failed to prevent transplacental transmission. Prolonged interval between birth and onset of symptoms may be explained by transmission late in pregnancy or during delivery or by presence of transplacentally acquired maternal antibody (IgG). Mother acquired malarial infection after travel to an endemic area and transmitted to the baby. A high level of suspicion is warranted in babies of malaria infected mothers even when the neonate peripheral smear shows no evidence of infection.

Congenital malaria in neonates: two case reports and review of the literature.

UNLABELLED: Congenital malaria is uncommon in nonendemic countries. We describe two cases involving neonates hospitalized with fever, anaemia and thrombocytopaenia. Thick and thin blood smears were positive for Plasmodium vivax (P. vivax) and P. ovale, respectively. These two cases were discussed regarding the literature and potential implications of HIV coinfection in the mother. CONCLUSION: Consistent data in the literature suggest that peripheral blood films should be performed in HIV-positive women who travelled to an endemic area or with a history of malaria prior to gestation. With today's travelling patterns, congenital malaria should be considered as an important differential diagnosis of neonatal sepsis.

Congenital malaria, an important differential diagnosis to consider when evaluating febrile infants of immigrant mothers.

Congenital malaria is reported rarely in the United States and almost exclusively affects infants of immigrant mothers. Because of its nonspecific presentation with fever during the first 3 months of life, it is an important differential diagnosis when evaluating such infants with fever in the pediatric emergency department. A complete and accurate travel and residency history on the infant's family should be sought during evaluation. As intercontinental travel and immigration increases, emergency department physicians should be alert to the diagnosis of malaria in ill neonates and young infants. We discuss a case of congenital malaria in a 26-day-old infant and review the clinical features of previously reported cases in the United States.