Congenital Malaria in a 2-Day-Old Neonate: A Case Report and Literature Review

Abstract

Congenital malaria is the presence of malaria parasites in a blood smear obtained from a neonate usually within 24 hours to 7 days of life. It has for long been regarded a rare condition. However, recent data indicate that congenital malaria complicates around 35.9% of live births globally, 0–37% in Sub-Saharan Africa and about 4–6.1% in Eastern Uganda. We present a 2-day-old neonate who presented with fever, irritability, and failure to breastfeed. Laboratory tests indicated that the neonate had a positive Giemsa-stained peripheral smear for Plasmodium falciparum, with a positive malaria rapid diagnostic test (MRDT) for P. falciparum malaria. The mother had a negative peripheral film for malaria and a negative MRDT. The neonate was managed with intravenous artesunate with improvement.

Congenital severe malaria: Artesunate for successful and safe treatment in neonates: A case report

“…6 The 2-day neonate from the recent report from Uganda received intravenous artesunate at admission, at 12 h and 24 h, then once a day for 5 days (doses not mentioned). 3 In our case, we administered intravenous artesunate 3 mg/kg for 4 days followed by oral artemether–lumefantrine (20/120 mg) one tablet for 3 days. None of these reports encountered any side effects of artesunate in neonates.…”

“…4 The mothers of early presenters had fever within 2 weeks of delivery while mothers of late presenters did not have any fever. 3 In other case reports, the age of neonates were 24 and 25 days, respectively, and the mother had no fever during pregnancy. 5, 6 The case series from Uganda used intravenous artesunate at a dose of 4 mg/kg at 0, 12 and 24 h and then daily for 7 days.…”

“…Congenital malaria is a mimicker of sepsis and therefore should be ruled out in all pyrexial neonates. 3 Evidence regarding the use of artemisinin-based combination therapy (ACT) in neonates with severe malaria is scarce. 2 In a case series of four neonates from Uganda, two presented early at days 1 and 2 of life while other two presented late at days 14 and 16.…”

“…5, 6 The case series from Uganda used intravenous artesunate at a dose of 4 mg/kg at 0, 12 and 24 h and then daily for 7 days. 3 The case from Nigeria used intravenous artesunate 2.4 mg/kg/dose at 0, 12, 24 and 48 h, and later changed to oral artemether–lumefantrine for 3 days. 5 The case from India used oral artesunate at a dose of 4 mg/kg on days 1 and 2 mg/kg for the next 6 days for the treatment of chloroquine unresponsive malaria.…”

Evaluation of the Risk Factors and Prevalence of Cerebral Malaria in Children below 10 Years in Kiryandogo General Hospital.

“…Each year, 300 to 500 million clinical cases of malaria occur, resulting in 1.5 to 2.7 million deaths. Most deaths caused by malaria occur in children younger than 5 years in sub-Saharan Africa [7,8]. In the United States, approximately 1000 cases of malaria are reported to the CDC every year.…”