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.

Clínica de la malaria complicada debida a Plasmodiun falciparum: Estudio de casos y controles en Tumaco y Turbo (Colombia) / Clinical presentation of severe malaria due Plasmodiun falciparum: Case control study in Tumaco and Turbo (Colombia)

ANTECEDENTES Y PROBLEMA : son muy pocos los estudios latinoamericanos sobre malaria por Plasmodium falciparum (P falciparum) complicada y se requiere estudiarla para identificar un patrón propio. OBJETIVOS : Identificar las complicaciones presentes en pacientes de Tumaco (Nariño) y Turbo (Antioquia) en Colombia, con malaria por P falciparum. MÉTODOS : Diseño de casos y controles. Se aplicaron los criterios diagnósticos de complicación OMS-2000 (Organización Mundial de la Salud). RESULTADOS : Se captaron 64 casos (con malaria por P. falciparum complicada) y 135 controles (con malaria por P. falciparum no complicada). El tiempo de evolución de la enfermedad (promedio 5,6 días en los casos y 5,9 en los controles) y la frecuencia de síntomas fueron similares en ambos grupos (p>0,05), pero la dificultad respiratoria y la ictericia fueron más frecuentes en los casos que en los controles (p<0,05). Los valores promedio de glicemia y creatinina fueron similares en ambos grupos, pero los casos tuvieron hemoglobina y recuento de plaquetas menores que los controles (p<0,05) y mayores niveles de nitrógeno ureico, aspartatoaminotransferasa y bilirrubinas total y directa (p<0,05). Las complicaciones encontradas fueron hiperparasitemia en 48%, disfunción hepática en 44%, síndrome de dificultad respiratoria aguda en 9%, falla renal en 6%, trombocitopenia grave en 5%, anemia grave en 3%, malaria cerebral en 3% e hipoglicemia grave en 2%. Los criterios de complicación malárica de OMS se comparan con otros y se discuten las implicaciones.

BACKGROUND : Latin American studies on severe falciparum malaria are scarce, therefore, the pattern of complications of the region is uknown. OBJECTIVES : To identify characterize severe malaria in patients from Tumaco (Nariño) and Turbo (Antioquia) in Colombia . METHODS : The 2000 World Health Organization criteria for complicated malaria were applied in a cases and controls study. RESULTS : 64 cases ( P falciparum complicated malaria) and 135 controls ( P falciparum uncomplicated malaria) were included. The time of evolution of the disease (mean 5.6 days in cases and 5.9 in the controls) and the frequency of most symptoms were similar in both groups (p>0.05). However, respiratory distress and jaundice was more frequent in the cases (p<0.05). The mean glycemia and creatinina values were similar in both groups; hemoglobin and platelet count were lower in the cases (p<0.05) when compared to controls. On the other hand, blood ureic nitrogen, aspartatoaminotransferase, and total and direct bilirrubin were lower in controls (p<0.05). The frequency of complications in the cases was as follows: hyperparasitaemia 48%, liver dysfunction 44%, acute; respiratory distress syndrome 9%, kidney failure 6%, severe thrombocytopenia 5%, severe anemia 3%, cerebral malaria 3% and severe hipoglycemia 2%. The WHO criteria for severe malaria were compared with others and the implications are discussed.