Congenital Malaria in Newborns Delivered to Mothers with Malaria-Infected Placenta in Blue Nile State, Sudan

Abstract

Diagnosis of congenital malaria is complicated by the low density of the parasite circulating in the cord blood and/or the peripheral blood of the newborns. Molecular techniques are significantly more sensitive than blood smears in detecting low-level parasitemia. This study investigated the prevalence of congenital malaria by the use of the real-time polymerase chain reaction (real-time PCR) in 102 babies born to mothers with microscopically confirmed infected placenta from Blue Nile state, Sudan. At delivery time, placental, maternal peripheral and cord blood samples in addition to samples collected from the newborns’ peripheral blood were examined for malaria infection using Giemsa-stained thick smear and parasite DNA detection by real-time PCR. The overall prevalence of congenital malaria includes the total babies with cord blood parasitaemia and peripheral blood parasitaemia was 18.6 and 56.8% using microscopy and real-time PCR, respectively. Even though all the neonates were aparasitaemic by microscopy, 19 (18.6%) of the babies had congenital malaria detected by real-time PCR, 15 (25.9%) of the babies with congenital malaria were born to mothers with both placental and peripheral blood malaria infections detected using the two techniques. Congenital malaria was significantly associated with cord blood malaria infections, maternal age and maternal haemoglobin level (p < 0.001). This first study investigating congenital malaria in Blue Nile state, Sudan shows that malaria-infected placenta resulted in infant and cord blood infections.

Congenital malaria: Frequency and epidemiology in Colombia, 2009-2020

“…In this study, a frequency of 12.2% (95%CI = 9.4-14.9) was found, which is lower than those reported in studies from Africa that used a similar case definition, that is, positive by TBS or PCR in peripheral or cord blood samples, in which prevalences between 18.6% and 56.8% were reported [7,11]. It is also totally different from studies that evaluated both blood samples with TBS, which reported frequencies of 6.1% [9] and 26.5% [10], and also from the figures of a meta-analysis in which no cases were reported for the Colombian studies (although this figure of 0.0 is consistent with the TBS results of the current study) [13].…”

“…In contrast, others indicate that no clinical features were associated with CM (birth weight, gestational age, APGAR, length at birth, temperature, anemia), reporting association only with maternal parasitaemia, pregnancies (higher in primigravidae), maternal age (higher in those under 19 years of age) and placental malaria [9]. Other studies found an association with maternal age and hemoglobin, but not with parity, educational level, use of a mosquito net, area of residence, or neonatal weight [11]. While other authors only reported an association with the use of mosquito net [10].…”

“…In epidemiological terms, CM frequency is highly heterogeneous between and within countries, with figures ranging between 0.3% and 37% [6,8]. For example, an incidence of 42.4% [7] was found in 112 Indonesian mother-child pairs by TBS or PCR (Polymerase Chain Reaction); In Uganda, a cross-sectional study of 261 mother-newborn pairs using TBS from umbilical cord blood found an incidence of 6.1% [9]; in Niger, in 249 neonates where peripheral and cord blood were tested, the incidence was 26.5% [10]; and in Sudan, including positives in newborn peripheral or umbilical cord blood, it was 18.6% by TBS and 56.8% by qPCR (quantitative) [11].…”

Diagnostic performance of a rapid whole blood-based RT-LAMP method for malaria diagnosis among apparently healthy blood donors and febrile neonates in Cameroon

“…Vector transmission of malaria parasites that occurs during the blood meal of an infected female anopheles mosquito is the most common mode of transmission [1,2]. However, other modes of transmission exist, including vertical transmission from infected mothers to their unborn babies (congenital malaria) [3][4][5][6], and horizontal transmission from infected blood donors to their recipients (transfusion-transmitted malaria) [7][8][9]. In fact, both congenital and transfusion-transmitted malarias are common and represent significant public health problems, particularly in areas with high stable transmission of Plasmodium falciparum [5,7,9,10].…”

Lessons Learned for Pathogenesis, Immunology, and Disease of Erythrocytic Parasites: Plasmodium and Babesia

“…As a result, another devastating consequence of P. falciparum infection in pregnant women is congenital malaria that remains a major global problem especially in the endemic regions ( Bilal et al., 2020 ; Danwang et al., 2020 ). Congenital malaria is defined as the presence of intraerythrocytic malaria parasites in the cord blood and/or the peripheral blood of an infant within the first week of birth, independent of display of the clinical symptoms ( Omer et al., 2020 ). Infected newborns often show nonspecific, sepsis-like clinical manifestations in which early treatment can result in diminished risk of complicated malaria.…”