Congenital cerebral malaria: a masquerader in a neonate

Abstract

Background Congenital malaria, which is caused by vertical transmission of malaria parasites, is a potentially fatal condition. Despite Africa’s high malaria burden, congenital malaria is not routinely screened for, and thus may go undiagnosed. Malaria, if not treated promptly, can quickly progress to severe forms and result in death. Severe congenital malaria is believed to be uncommon in neonates due to maternal antibodies, fetal haemoglobin, and the placenta’s sieving effect. The majority of reported cases were classified as having severe anaemia. Following a thorough review of the literature, only one case of congenital cerebral malaria (CCM) has been reported, and it was misdiagnosed. Case presentation A 5-day-old Nigerian neonate born to an apparently healthy mother initially displayed characteristics consistent with neonatal sepsis and severe neonatal hyperbilirubinaemia. He quickly developed characteristics consistent with meningitis. Surprisingly, the peripheral blood film revealed evidence of malaria parasites, which was immediately confirmed by Giemsa-stained thick and thin blood film microscopy for malaria. The patient was diagnosed with congenital cerebral malaria. The medication was modified to parenteral artesunate followed by oral artemisinin combination therapy. The neonate recovered fully and had no neurological deficits on follow up. Conclusion Because CCM and infant meningitis have similar clinical presentations, CCM could be misdiagnosed and lead to death if there isn’t a high index of suspicion.

Systematic Review: Prevalensi dan Dampak Infeksi Malaria pada Wanita Hamil dan Neonatal

“…Sebuah laporan kasus di Nigeria melaporkan kasus malaria kongenital pada bayi berusia 5 hari, terlebih lagi laporan kasus menunjukkan adanya manifestasi malaria cerebral. 8 Infeksi malaria pada wanita hamil dapat menyebabkan beberapa kondisi yang memperburuk kehamilan diantaranya adalah anemia berat pada kehamilan yang disebabkan perubahan fisiologis pada sistem imunitas ibu hamil yang menyebabkan wanita hamil lebih rentan terhadap infeksi parasit termasuk malaria. 9 Anemia yang tidak tertangani dapat berlanjut pada persalinan yang juga dapat menyebabkan perdarahan postpartum.…”

“…Efek infeksi malaria pada wanita hamil bervariasi dari asimptomatis, anemia berat, gagal ginjal, malaria serebral bahkan sampai dengan kematian ibu. 8,24,14 Anemia didefinisikan sebagai menurunnya kadar Hb kurang dari 11 gr/dl. Dari 10 artikel yang dilakukan telaah 6 diantaranya melaporkan dampak anemia pada ibu hamil dengan infeksi malaria.…”