Abstract
In this issue Pengsaa reviews the problem of congenital malaria in Thailand and highlights its importance in the differential diagnosis of infection in the 1st months of life for infants born in malaria-endemic areas. As with many congenital infections the clinical features are usually fever and hepatosplenomegaly with an associated anaemia. In the Thai series there was nearly always a maternal history of symptomatic malaria. As the findings in infants are nonspecific the clinical distinction from other congenital infections rests primarily on the absence of a skin rash and a maternal history of exposure to malaria. The detection of malaria parasites in the infants blood is essential for diagnosis although blood smears can be negative if there are low parasite counts (< 50/microliters blood). Pengsaa considers that three repeated smears over 48 hours should be reported negative before excluding the diagnosis. This is a useful guide although with low-grade infection and the possible influence of antimalarials in the infants blood acquired either transplacentally or via breast-milk even three negative smears might be inadequate for detection in an early onset of infection. The infant of the Cambodian mother is an example of this. (excerpt)
Published Version
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