No abstract

Malaria during first few months of life may be due to trans-placental transfer through a mother with parasitaemia. Congenital malaria has an occurrence rate of 0.3% in immune mothers and 7.4% in non-immune mothers. We report a case of 29 days old neonate, who presented with fever for 10 days, gross hepatosplenomegaly and anaemia (haemoglobin 6.0 gm/dl). Liver was palpable 3 cm below right subcostal margin with the span of 5.5 cm, non-tender, soft in consistency with regular margins and the spleen was palpable 3 cm below left subcostal margin. There were no signs of jaundice, dehydration and ascites and all other systems were normal. Peripheral blood films showed all stages of Plasmodium vivax. The baby was treated with initial boluses followed by intravenous (IV) fluids, and chloroquine was started at the standard cumulative dose of 10mg/kg, given in divided doses over 3 days. Four days after the treatment had been started; the baby's condition improved and was discharged. This report underlines that; diligent observation of blood film can accidentally reveal parasites, even when the diagnosis had not been previously suspected. Congenital malaria is a relatively rare condition that should be included in the differential diagnosis of neonatal infections, sepsis, and unexplained fever or in infants presenting with haemolytic anaemia, severe thrombocytopenia and hepatosplenomegaly in malaria endemic zones, even if the mother has no proven malarial episodes during the gestational period. It is therefore recommended that babies born to mothers with malaria should be screened for congenital malaria. The diagnosis should be considered in babies of mothers who have travelled to places where malaria is endemic, as maternal infection may be unrecognized, and the child may be asymptomatic at birth.