Malaria congénita por Plasmodium vivax: reporte de caso / Congenital malaria by Plasmodium vivax: case report

Resumen Se describe el caso de malaria congénita por Plasmodium vivax de un neonato de 25 días de nacido, el cual consulta por fiebre e ictericia persistente. La sospecha inicial orientaba a un diagnóstico de sepsis neonatal. El neonato residente en Cartagena (Colombia), presentaba antecedente perinatal de ictericia y antecedente materno de malaria gestacional diagnosticada al cuarto mes. La madre refirió haber vivido los primeros siete meses de su embarazo en Tierralta, Córdoba (Colombia), la cual es una zona endémica de malaria. Posterior a los resultados del extendido de sangre periférica del neonato se demostró la presencia de Plasmodium vivax. El tratamiento antimalárico fue realizado con cloroquina, con eficaz mejoría clínica. Se destaca la importancia de tener a la malaria congénita como diagnóstico diferencial en infecciones neonatales, sepsis, fiebre inexplicable o en lactantes que presenten anemia hemolítica, ictericia y hepatoesplenomegalia en pacientes provenientes de zonas endémicas de malaria.

Abstract We describe the case of congenital malaria by Plasmodium vivax of a neonate of 25 days of age, who consults for fever and persistent jaundice. The initial suspicion aimed to a diagnosis of neonatal sepsis. The neonate living in Cartagena (Colombia) had a perinatal history of jaundice and a maternal history of gestational malaria diagnosed at the fourth month. The mother reported having lived the first seven months of her pregnancy in Tierralta, Córdoba (Colombia), which is an endemic area of malaria. Subsequent to the results of the peripheral blood smear of the neonate, the presence of Plasmodium vivax was demonstrated. The antimalarial treatment was performed with chloroquine, with effective clinical improvement. The importance of having congenital malaria as a differential diagnosis in neonatal infections, sepsis and unexplained fever or in infants with hemolytic anemia, jaundice and hepatosplenomegaly in patients from malaria endemic areas is highlighted.

Congenital and neonatal malaria in Asian Indian population.

Background: Congenital malaria is defined as malarial parasites demonstrated in the peripheral blood smear of the newborn from twenty four hours to seven days of life. Malaria is endemic in India, neonatal disease is considered rare. Routine screening for malaria is essential for all neonates with fever in endemic areas. Early diagnosis and treatment of malaria could effectively prevent infant mortality. The aim of the present observational prospective study is to describe the occurrence and clinical spectrum of congenital vivax malaria in admitted neonates in Bikaner, India (low endemic region). Congenital malaria has been predominantly reported for P. falciparum from different parts of the world but the reports with P. vivax are very scanty. Methods: This prospective study was conducted on admitted neonate from January 2011 to December 2012. The species diagnosis was done by peripheral blood smear examination and rapid diagnostic test. The possibilities of other disease/infections causing similar illness were investigated thoroughly and stringently. A structured questionnaire was used to collect clinical data on newborn and maternal health during pregnancy. Results: A total of 1168 new born admitted in first week of life were screened. Out of them 23 (1.97%) had evidence of parasitaemia (P. vivax 17 and P. falciparum 6). The criteria for admission in these 17 neonates with congenital vivax malaria were LBW and prematurity (41.18%), septicemia (35.29%), perinatal asphyxia (17.65%), jaundice (17.65%) and seizures (5.88%). Conclusions: This study emphasizes the occurrence of P. vivax congenital malaria even in neonates in low transmission area and without typical manifestations. The emphasis is also on the relevance even in very low transmission areas of not only maintaining, but even increasing clinical and epidemiological awareness of this preventable and treatable disease in pregnancy and in the neonate.

Malaria congénita por plasmodium vivax / Congenital malaria by plasmodium vivax

Se describe un caso de malaria congénita en paciente masculino de 16 días de edad, ingresado en emergencia pediátrica del Hospital Dr. J. M. Casal Ramos, Acarigua estado Portuguesa, con diagnóstico de sepsis neonatal tardía. La madre del menor, residente de área minera del estado Bolívar, refirió síndrome febril que comenzó el día previo al parto 09/07/2013 hasta el 23/07/2013, cuando se le diagnosticó malaria por Plasmodium vivax, iniciando tratamiento con cloroquina, siguiendo la pauta nacional de tratamientos antimaláricos de Venezuela. Durante la investigación epidemiológica de la madre, no se le tomó al niño muestra hemática para malaria, esto impidió detectar oportunamente su infección, lo que hubiera evitado efectos de la malaria sobre sus condiciones generales de salud. La fiebre en el niño se manifestó el 26/07/2013, y el 29/07/2013 se le tomó muestra hemática para malaria, después que durante el interrogatorio de la madre, para indagar antecedentes del niño, ella refirió recibir tratamiento antimalárico. Esta muestra hemática del niño resulto positiva a P. vivax, iniciando tratamiento con cloroquina, según pautas oficiales. La situación presentada, obliga al personal de salud a establecer prioridades para diagnóstico de malaria, a todo febril de la consulta maternoinfantil, y evaluar la situación epidemiológica de la malaria en embarazadas de zonas endémicas, repercusión clínica en la madre y en el producto de la gestación. Debe extenderse la atención a embarazadas que residan o no en áreas endémicas, y que refieran visitas a zona endémica antes o después del embarazo.

A congenital malaria case by Plasmodium vivax is described in a 16 day old male newborn, admitted to Dr. J.M. Casal Ramos Hospital, Acarigua, Portuguesa state, he was initially diagnosed as a late neonatal sepsis. The boy's mother, who lives in the mining area of Bolivar state, referred febrile syndrome that began the day before the birth 09/07/2013 until 23/07/2013, when she was diagnosed with malaria by P. vivax, initiating treatment with chloroquine following the General treatment for malaria infections in Venezuela. It notes that in the epidemiological investigation of the mother, no Blood smears for malaria parasites was taken to the child; this prevented the timely detection of infection, which would have prevented effects of malaria on their general health. The fever began in the child on July 26, 2013 and the Blood smears for malaria parasites was taken on July 29, 2013, then during the interrogation of the mother to investigate background of the child, she referred to receive antimalarial treatment. The Blood smears for malaria parasites was indicative of malaria parasites P. vivax, initiating treatment with chloroquine, according to official guidelines. The reported situation obliges health personnel to prioritize malaria diagnosis in every child with fever in the infant-maternal ward and assess the epidemiological situation of malaria in pregnant women in endemic areas, and the clinical impact in mother and the new born.

Complicated congenital malaria due to Plasmodium vivax / Paludismo congénito complicado debido a Plasmodium vivax

La malaria congénita es una enfermedad que aparece en el período neonatal y que, si no se trata oportunamente, puede tener consecuencias fatales para el recién nacido. Según las estadísticas publicadas en el Informe del Estado Mundial de la Infancia 2009, actualmente mueren 3.7 millones de niños menores de 28 días en todo el mundo. El 8% de los casos corresponden a niños menores de 5 años con malaria (1). De manera similar, los estudios en áreas endémicas han reportado incidencias de malaria congénita de entre 0.83 y 5.93% (2). Aquí, presentamos un caso de malaria congénita en un lactante de un mes de edad cuya madre recibió tratamiento para la malaria por Plasmodium vivax (P. vivax) durante la gestación pero sufrió una recaída con el consiguiente compromiso del bebé en el útero. Es necesario reconocer la alta prevalencia de esta enfermedad en nuestro contexto y saber cómo vigilar y tratar la enfermedad en casos especiales como los de las madres gestantes y los recién nacidos con infecciones congénitas.

Congenital malaria is a disease that appears in the neonatal period and that, if not treated in a timely manner, may have fatal consequences for the newborn. According to statistics published in The State of the World Children 2009 Report, 3.7 million children under the age of 28 days die annually around the world at present. 8% of cases correspond to children under 5 years of age with malaria (1). Similarly, studies in endemic areas have reported incidences of congenital malaria of between 0.83 and 5.93% (2). Here, we present a case of congenital malaria in a one-month-old nursing infant whose mother received treatment for malaria from Plasmodium vivax (P. vivax) during gestation but suffered a relapse with a consequent compromise of the infant in utero. There is a need to recognize the high prevalence of this disease in our context and to know how to monitor and treat the disease in special cases like those of gestating mothers and newborn infants with congenital infections.

Prevalence of Congenital Malaria in Port Harcourt, Nigeria.

Aim: To determine the prevalence of congenital malaria among newborn babies delivered at University of Port Harcourt Teaching Hospital, Nigeria. Study Design: Cross-sectional study. Place and Duration of Study: Antenatal clinic and labour ward of the University of Port Harcourt Teaching Hospital, Nigeria between January and September 2010. Methodology: This study was conducted among 281 pregnant women attending antenatal services at the hospital. Socio-demographic and obstetric information of the mothers was collected. Samples of cord blood smears of babies were stained with Giemsa and examined for malaria parasites. Results: Plasmodium falciparum was the only malaria parasite species. The prevalence of congenital malaria among newly born was 9.6%. This was more prevalent in women of Para 0 (5.3%) compared to other parities (4.3%) (P = 0.048). Malaria parasite was found in 4(16.7%) of preterm and 23(8.9%) of term deliveries (P>0.05). Conclusion: Congenital malaria is still common in Port Harcourt, Nigeria. It is important that blood smear from neonates are taken and examined for malaria parasite soon after birth. Malaria prevention measures such as intermittent preventive treatment, prompt management of all malaria cases and use of insecticide treated bed nets should be emphasized for all pregnant women.

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

Malária congênita: descrição de um caso e revisão da literatura / Congenital malaria: description of a case and review of the literature

Os autores ressaltam a importância do diagnóstico adequado da malária congênita, atualizam os conhecimentos atuais acerca da moléstia ? etiologia, fisiopatologia, quadro clínico, diagnóstico e tratamento ? e apresentam um caso de observação pessoal.

Incidencia de las malarias gestacional, congénita y placentaria en Urabá (Antioquia, Colombia), 2005-2007 / Incidence of gestational, congenital and placental malaria in Urabá (Antioquia, Colombia), 2005-2007

Introducción: en Colombia se ignora la frecuencia de malarias gestacional (MG), congénita (MC) y placentaria (MP) y la mortalidad asociada a ellas, así como el cuadro clínico de la MG. Objetivos: calcular la prevalencia e incidencia de MG, MP y MC, la mortalidad por MG y MC, y describir y comparar entre mujeres con y sin MG, los síntomas, signos y las características de la MG. Metodología: estudio descriptivo con componente longitudinal (cohorte) y transversal, con gestantes de 15 a 44 años, sus placentas e hijos. Las gestantes se captaron en las consultas prenatales y salas de parto de tres municipios de Urabá (Antioquia, Colombia), entre 2005 y 2007. Resultados: se captaron 2117 gestantes: a) cohorte: n=1927 mujeres con mínimo dos exámenes de gota gruesa; b) grupo transversal: n=190 mujeres con solo un examen de gota gruesa (en consulta prenatal o en parto). Hubo 220 casos de MG. Según la gota gruesa para Plasmodium las frecuencias fueron: prevalencia MG: 10,39%; proporción de incidencia MG: 9,28%; tasa de incidencia de MG: 9,01 por 100 mujeres/semana; proporción MC: 2,7%; prevalencia de MP: 11,7%. P. vivax causó 76% de MG, P. falciparum 22%, ambas especies 2%. Los síntomas y signos hallados en las gestantes con MG concordaron con los referidos para gestantes y no gestantes. No hubo muertes entre las 220 gestantes que presentaron malaria ni entre los cinco niños que presentaron MC. Conclusiones: las frecuencias de MG, MC y MP indican que esas entidades son problemas de salud pública en la población de gestantes y neonatos de Urabá.

Introduction: gestational (GM), congenital (CM) and placental malaria (PM) and associated mortality frequency in Colombia remains unknown, as does GM’s clinical features. Objectives: estimating GM, PMand CM prevalence and incidence and mortality caused by GM and CM and describing GM’s symptoms and signs. Methodology: this was a descriptive study of pregnant women aged 15-44, their children and placentas; it had longitudinal (cohort) and cross-sectional components. The pregnant women were recruited during their prenatal visits and in the delivery rooms of three towns in Urabá (Antioquia, Colombia) from 2005-2007. Results: 2,117 pregnant women were evaluated: a) cohort: n=1,927 women with at least two reviews of thick smear; b) cross-sectional group: n=190 women having had just a thick smear examination (during prenatal consultation or childbirth). There were 220 cases of GM according to thick smear for Plasmodium (76% P. vivax, 22% P. falciparum, 2% mixed malaria). GM prevalence was 10.395, GM incidente 9.28%, 9.01 per 100 women per week GM incidence rate, 2.7% CM and 11.7% PM prevalence. The symptoms and signs found in pregnant women suffering from GM agreed with those for pregnant and non-pregnant women. There were no deaths amongst the 220 pregnant women who had malaria or amongst the five children who presented CM. Conclusions: GM, CM and PM frequencies indicated that these types of malaria are public health problems amongst pregnant women and infants in Uraba.

Two Cases of Malarial Infection in Pregnancy / 대한주산의학회잡지

Recently, in Korea, the number of malarial infections from endemic countries are in increasing and occasionally domestic infections are reported. But the malarial infection during pregnancy is rare case. We have experienced two cases of malarial infected pregnant women. They did not traveling in malaria endemic area and transfusion history. One had been treated during antepartum and delivered a healthy baby at term and her baby did not have any evidence of congenital malarial infection. But another pregnant woman has not been treated antepartum and treated after delivery. Her baby was infected with congenital malaria. Thus, we present these two cases with a brief review of literatures.

A Case of Congenital Malaria

Malaria is known to have been eradicated for a few decades through the persistent efforts of the national health program in South Korea. However, malaria caused by Plasmodium vivax has started to reappear incidiously among military personnel near to the De-militarized Zone since 1993. From that time on the number of malarial cases have increased abruptly year by year. However, congenital malaria in a neonate is extreamly rare in Korea. We experienced one case of malaria in a neonate who was born from a mother affected by malaria. This neonate was born at 33(+3) weeks of gestational age. Here we present this case with a brief review of the literature.