Abstract
Congenital malaria diagnosis is challenging due to frequently observed low parasite density infections, while their clinical relevance during early infancy is not well characterized. In Nanoro health district (Burkina Faso), we determined the prevalence of congenital malaria by real-time quantitative PCR and we assessed the performance of rapid diagnosis test (RDT) and light microscopy (LM) to detect Plasmodium falciparum infections in cord-blood samples. In addition, we examined the usefulness of P. falciparum Histidine Rich Protein2 (PfHRP2) as surrogate biomarker of infection and explored association between congenital malaria and clinical outcomes. A prevalence of congenital malaria by qPCR of 4% (16/400) was found, which increased to 10% among newborns from mothers infected at delivery. RDT and LM showed poor performances indicating limited utility for congenital malaria screening in cord blood. Because PfHRP2 detection in cord blood could be affected by transplacental passage of parasite antigens, PfHRP2 might not be used as a surrogate biomarker of congenital malaria infections. There was no evidence of a significant clinical impact of congenital malaria on infant’s health from birth to 59 days of life. Case control studies including long-term follow up may provide additional understanding on the relevance of neonatal malaria infections.
Highlights
Congenital malaria is defined as the presence of Plasmodium asexual stages in newborn’s cord or peripheral blood during the first week of life as a result of materno-fetal transfer of malaria parasites[1]
We determined the prevalence of congenital malaria, defined as cord-blood malaria infections as detected by quantitative PCR and we assessed the performance of a HRP2 rapid diagnostic test (RDT) in plasma and light microscopy (LM) to detect Plasmodium falciparum infections in cord blood samples
In order to assess the appropriateness of using P. falciparum Histidine Rich Protein2 (PfHRP2) as a biomarker for detection of congenital P. falciparum malaria infection, we investigated whether neonatal PfHRP2 levels in plasma were associated with the parasite densities in cord blood
Summary
Congenital malaria is defined as the presence of Plasmodium asexual stages in newborn’s cord or peripheral blood during the first week of life as a result of materno-fetal transfer of malaria parasites[1]. Even though consequences of congenital malaria may be life-threatening little is known about the impact of these infections on the infant’s health, especially during the neonatal period (from birth to 28 days)[2, 13, 18, 19]. In Burkina Faso, three studies have investigated the prevalence of congenital malaria by LM: two independent cross-sectional studies reported prevalences of 1.4–2.8% in cord blood samples[20, 21], while a third study performed on hospitalized neonates during the first week of life reported a prevalence of 24.4%9. We determined the prevalence of congenital malaria, defined as cord-blood malaria infections as detected by quantitative PCR (qPCR) and we assessed the performance of a HRP2 RDT in plasma and LM to detect Plasmodium falciparum infections in cord blood samples. We explored the association between cord-blood malaria infections as detected by qPCR and clinical outcomes
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