Clinical and laboratory features of congenital malaria in Nigeria
Article type: Research Article
Authors: Orogade, Adeola A. | Falade, Catherine O. | Okafor, Henrietta U. | Mokuolu, Olugbenga A. | Mamman, Aisha I. | Ogbonu, Tagbo A. | Ogunkunle, Oluwatoyin O. | Ernest, Kolade S. | Callahan, Michael V. | Hamer, David H.;
Affiliations: Department of Pediatrics, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria | Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria | Department of Pediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria | Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria | Department of Hematology, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria | Department of Pediatrics, University College Hospital, Ibadan, Nigeria | Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA | Center for International Health and Development, Boston University School of Public Health, Boston, MA, USA | Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
Note: [] Correspondence: Dr. Adeola A. Orogade, Department of Pediatrics, Ahmadu Bello University Teaching Hospital, P.O. Box 10142 Kaduna, Nigeria. Tel.: +234 802 840 4204; Fax: +234 62 240 631; E-mail: [email protected]
Abstract: Since congenital malaria had previously been thought to be rare, blood film examination for malaria parasites is still sometimes not routinely performed in ill neonates in malaria-endemic regions. Because of increasing published reports of congenital malaria in Nigeria, there is a need to characterize the clinical and laboratory manifestations associated with malaria parasitemia within the first few hours of life. In a 12-month (April 2003-March 2004), multicenter study in Nigeria, thin and thick blood smears made from maternal (finger prick), placental aspirates, cord blood and neonate (heel prick taken within 4 hours of life) were Giemsa-stained and examined by light microscopy for asexual stages of Plasmodium. Parasitemic neonates were closely monitored for clinical and laboratory features of symptomatic malaria. Plasmodium falciparum was found in 5.1% (95/1875) of neonatal heel pricks; mean parasite density was low (mean = 48/μL, range 8–200/&μL). Antepartum maternal and placental parasitemia were the most important risk factors for congenital parasitemia (P < 0.001 and P < 0.001). Prolonged labor and prolonged rupture of membranes were also significant factors in the symptomatic neonates. Sixty-one percent (58/95) of parasitemic babies were asymptomatic, while 38.9% (37/95) of them exhibited signs of possible infection. The presence of any symptom was significantly related to parasitemia (P < 0.001). Among the symptomatic parasitemic babies the most common symptoms were, fever (temperature >37.5�) within the first 24 hours of life (100%) and refusal to suck (10.8%). Anemia at birth (hematocrit <42%) was found in 15.7% (15/95) of parasitemic babies as compared to 9.2% in the non-parasitemic ones. (P = 0.03, OR = 1.84). The mean hematocrit of parasitemic neonates within 4 hours of life was 49.5 ± 6.4 as compared to 52.6 ± 8.2 in non-parasitemic babies (P = 0.001). Furthermore, the mean hematocrit was 44.0 ± 5.5% in the symptomatic parasitemic babies. All symptomatic babies were treated with oral chloroquine with a cure rate of 89.1%. Treatment failures subsequently received oral sulfadoxine-pyrimethamine with good outcome. The febrile newborn should be evaluated for malaria especially if there is a history of prolonged labor or in the presence of maternal malaria infection. Efforts should be intensified to reduce the burden of maternal, placental malaria and therefore congenital malaria.
Keywords: Congenital malaria, Nigeria, clinical features, laboratory features
Journal: Journal of Pediatric Infectious Diseases, vol. 3, no. 3, pp. 181-187, 2008