Abstract
BackgroundCongenital malaria is the direct infection of an infant with malaria parasites from their mother prior to or during birth. Neonatal malaria is due to an infective mosquito bite after birth. Neonatal and congenital malaria (NCM) are potentially life-threatening conditions that are believed to occur at relatively low rates in malaria endemic regions. However, recent reports suggest that the number of NCM cases is increasing, and its epidemiology remains poorly described. NCM can mimic other neonatal conditions and because it is thought to be rare, blood film examinations for malaria are not always routinely performed. Consequently, many cases of NCM are likely to be undiagnosed. A retrospective chart review for all neonates admitted with suspected sepsis between January and July 2017 was conducted and noted four cases of NCM since routine malaria testing was introduced as part of standard of care for suspected sepsis at Mbale Regional Referral Hospital Neonatology Unit. This description highlights the need to conduct routine malaria diagnostic testing for febrile neonates in malaria endemic areas, and supports the urgent need to undertake pharmacological studies on therapeutic agents in this population.Case presentationFour cases (two congenital malaria cases and two neonatal malaria cases) are described after presenting for care at the Mbale Regional Referral Hospital Neonatal Unit (Mbale RRH-NNU). The maternal age was similar across the cases, but both neonatal malaria cases were born to primigravidae. At presentation three cases had fever and history of fever, but one was hypothermic (34.8 °C) and no history of fever. One case of congenital malaria had low birth weight, while the other was born to an HIV positive mother. Both cases of congenital malaria presented with poor feeding, in addition one of them had clinical jaundice. The neonatal malaria cases presented in the third week compared to the congenital malaria cases that presented within 48 h after birth. All of the cases of NCM were treated with intravenous artesunate. The admitting clinicians also instituted a course of antibiotics empirically to cover against possible bacterial co-infections. All four cases recovered and were discharged alive.ConclusionAt the Mbale RRH-NNU, the finding of cases of NCM was not expected, therefore, neonates presenting with features of suspected sepsis in malaria endemic settings should be routinely screened for NCM. There is currently a lack of appropriate guidelines for treatment of NCM in the era of artemisinin-based combination therapy (ACT), therefore, efforts to establish the safety profile and efficacy of ACT anti-malarials in neonates to guide development of evidence-based treatment guidelines for NCM are needed.
Highlights
Congenital malaria is the direct infection of an infant with malaria parasites from their mother prior to or during birth
At the Mbale RRH-NNU, the finding of cases of Neonatal and congenital malaria (NCM) was not expected, neonates presenting with features of suspected sepsis in malaria endemic settings should be routinely screened for NCM
It is a reminder that NCM still exists despite IPTp and other malaria preventive measures, and its diagnosis may be missed especially when malaria screening measures are not put in place in NNUs in malaria endemic areas
Summary
NCM is an important diagnosis to consider in any newborn with clinical features of NS to a mother in a malaria-endemic area. It is possible that in the absence of routine malaria testing many neonates are dying before malaria is diagnosed. In areas with malaria endemicity the burden of NCM may be underestimated. Malaria test should be incorporated as routine test in neonates with suspected sepsis so as not to miss NCM. For pregnant mothers who test malaria positive in their late gestational period weekly malaria testing of their babies as follow up mechanism for surveillance of NCM should be done. Author details 1 Neonatal Unit, Mbale Regional Referral Hospital, P.O. Box 1966, Mbale, Uganda. Mbale Clinical Research Institute, Mbale, Uganda. Busitema Univer‐ sity, Faculty of Health Sciences, Mbale Campus, Mbale, Uganda Box 1966, Mbale, Uganda. 2 Mbale Clinical Research Institute, Mbale, Uganda. 3 Busitema Univer‐ sity, Faculty of Health Sciences, Mbale Campus, Mbale, Uganda
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