Congenital Plasmodium vivax in a 3-day-old neonate
Congenital plasmodium vivax malaria is a rare clinical infectious disease. It is linked to a high death rate if it is not identified and treated promptly. However, it is brought on by vertical parasite transmission from mother to child during pregnancy or delivery. It is also seen in newborns with a positive blood smear of malaria between 24 and 7 days of life.
In addition, it is a rare disorder that can progress to a major sickness that can kill neonates or cause significant morbidity. Congenital malaria is caused by Plasmodium falciparum. However, Plasmodium vivax and Plasmodium malaria can also cause it. Because of its vague symptoms and low index of suspicion. It is frequently misdiagnosed as neonatal sepsis, raising the risk of baby mortality and morbidity.
This is a unique case of a 4-day-old child from Gondar, Ethiopia. He was cured of Plasmodium vivax malaria with artemether-lumefantrine therapy. The mother’s history of positive malaria episodes during the seventh month of pregnancy was the primary reason for the suspicion.
Case report
This is the case of a three-day-old baby boy from Gondar, Ethiopia. He was transferred to the University of Gondar Comprehensive Specialized Hospital from the primary hospital due to fever, decreased sucking, and poor mentation. He was born to a 28-year-old para 4-alive mother who had been experiencing amenorrhea for 9 months. She had four antenatal care (ANC) follow-ups and received regular treatment such as iron and folic acid supplementation, as well as a tetanus vaccine. She was tested for retroviral infection and sexually transmitted diseases, which all came back negative. Spontaneous labor was induced, giving birth to a healthy male newborn weighing 3300 grams.
The baby cried instantly and received Apgar ratings of 8 and 9 in the first and fifth minutes, respectively. However, following delivery, the infant did not feed and had three episodes of aberrant body movements as well as impaired mentation
Physical Examination Findings
Physical examination revealed the following vital signs: an apical heart rate of 169 beats per minute, a respiratory rate of 53 breaths per minute, and a temperature of 38.3 degrees Celsius. The neonate’s birth anthropometry measures were within acceptable limits, and his respiratory and cardiac exams were normal. However, the abdominal exam revealed a palpable spleen (2 cm) and a palpable liver (3 cm). Neonatal responses such as sucking and the Moro reflex were not maintained. However, the tone was normal. Because of these symptoms, early-onset newborn sepsis was suspected, and intravenous antibiotics (ceftriaxone and ampicillin) were administered.
Management
Furthermore, a blood culture was performed, which revealed no abnormalities. The random blood sugar level was tested at 79 mg/dl, and an electrolyte imbalance was found. However, the kidney function test was within normal limits. A complete blood count and cerebrospinal fluid (CSF) analysis were performed; the results were normal. The neonate did not improve, and a blood film revealed P. vivax with a parasite load of +2. The mother had a history of fever, arthralgia, myalgia, and loss of appetite, thus a blood test was performed, P. vivax was identified, and oral antimalarial medication was taken.
The neonate was treated with intravenous artemether-lumefantrine 3 mg/kg (at 0 hours, at admission, 12 hours, 24 hours, and 48 hours, then daily for two days) and improved.
Conclusion
This case report describes congenital malaria in a setting where routine newborn malaria testing was implemented for neonates from malaria-endemic areas. In Ethiopia, the most frequent plasmodium protozoa are P. vivax and P. falciparum. The discovery indicated that a four-day-old infant had congenital malaria.
In 2019, there were 229 million malaria cases, accounting for more than 94% of the estimated 409,000 deaths globally. Sub-Saharan Africa was responsible for more than 94% of all cases and deaths. Children under the age of five are the most vulnerable, accounting for 67% (274,000) of all malaria fatalities worldwide in 2019.
Congenital malaria occurs when a mother has active malaria while pregnant and the parasite crosses the placenta to infect the fetus. In our case, the mother had one bout of malaria infection and came from a malaria-endemic location.
Newborns are thought to have partial malaria protection in the first few months of life due to passively acquired maternal immunoglobulin G (IgG) antibodies, the predominance of hemoglobin F (HbF) in their erythrocytes, and low levels of iron and para-aminobenzoic acid (both required for parasite growth) in breast milk. However, moms target the most vulnerable window for transmission during fetal gestation.
