Introduction:
Congenital malaria is one of the rare forms of malaria, and it could be fatal. The mortality rate is high if the newborns born to nonimmune women are affected by the Plasmodium falciparum parasite. But semi-immune women (immigrant families or those who acquired infection during travel) transmit malaria less likely. Their children exhibit less severe symptoms, usually weeks after delivery. In asymptomatic women, the absence of fever or prophylactic measures taken for malaria during pregnancy does not prevent congenital malaria from happening in a newborn. It can occur in newborns due to any of the below-mentioned causes.
What Causes Congenital Malaria?
During pregnancy, there is increased susceptibility to Plasmodium falciparum and vivax, but the susceptibility to Plasmodium malariae and ovale remains unchanged, and all four human malarial parasites are known to cause congenital malaria.
Erythrocytic-stage of malarial parasites cause congenital malaria, and they are transmitted from mother to child. The pre-erythrocytic stage of malarial parasites (sporozoite) and the hepatocytes that develop during the first week of infection are not known to cross the placenta or cause congenital malaria. The treatment in case of congenital malaria is given to newborns to eradicate blood-stage parasites and not liver-stage parasites.
Sometimes, a mother’s history can also be misleading for clinicians to assess an infant with congenital malaria because malarial parasites can also be seen in asymptomatic individuals. Congenital malaria can also occur in newborns whose mothers reported having malaria prophylaxis during travel or residence in endemic areas. In addition, the transmission may also occur across the placental barrier during labor or can also result when the newborn contacts the infected maternal blood during parturition. Thus, it is totally uncertain how the mode of parasite transmission occurs from mother to newborn.
What Are the Symptoms of Congenital Malaria?
Though congenital malaria is defined as the presence of malaria in a newborn baby, the parasites will start to increase significantly within the first 24 hours to 7 days. Hence the symptoms will begin to appear usually between the 10th day and the 30th day after the child is born. The most common set of symptoms that are observed in 80 % of the cases are:
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Anemia (lack of healthy red blood cells).
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Fever.
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Splenomegaly (enlargement of the spleen).
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Regurgitation (bringing up swallowed food or digested food).
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Loose stools.
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Poor feeding.
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Restlessness.
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Drowsiness.
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Cyanosis (bluish discoloration of the child's skin).
Also, in some cases, it is possible for the child to have:
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Hepatomegaly (enlargement of the liver).
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Certain distress during respiration.
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Passing watery stools.
How Is Congenital Malaria Diagnosed?
Congenital malaria might often be fatal. Hence proper diagnosis is required to help save the newborn's life. Though congenital malaria is very rare, it is still considered a life-threatening condition. While diagnosing a child who is having fever and thrombocytopenia (decreased blood platelet count), the doctor will inquire about the previous medical conditions related to any exposure to malaria with the mother, as it is one of the major factors that contribute to this condition in a child.
If the doctor suspects that the child has congenital malaria, then the laboratory findings help in confirming the suspicion. The blood is drawn from the child to make use of the Giemsa-stained blood smear test, and it makes use of both thick and thin blood smears. This blood smear test will help in identifying the presence of the parasite in the red blood cell using the microscope, but more than one blood smear is needed to diagnose congenital malaria because of the low parasite density, so the chances of detecting the parasite on a single smear are low.
The other test that helps in diagnosing the presence of parasites is the cord blood test, which utilizes the blood cells from the cord instead of the peripheral blood of the infant. This test avoids the extraction of blood from the newborn, but it does not help arrive at a definitive diagnosis because of the fact that the cord blood might be infected with the contaminated maternal blood.
On a separate note, HIV (human immunodeficiency virus) increases the risks of congenital malaria. If the doctor has some suspicions of the newborn having malarial parasites, then the doctor will ask the patient for a proper HIV assessment and suggest adequate preventive measures based on the newborn's indication.
How Is Congenital Malaria Treated?
There has been very little study and research about the pharmacokinetics and pharmacodynamics of the parasites. Hence there is no standard treatment procedure for congenital malaria. The treatment guidelines rely on the previous case reports and extrapolation methods from previously affected children. Treating malaria in the newborn also depends on:
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Parasite species.
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The region from where the infection is acquired.
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The severity of the disease.
Early treatment is essential, but the pediatric preparations of the medicines are not available. The suggested adult medications require dissolving to make them consumable for the baby. In major cases, the perfect go-to medicine for:
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The presence of a chloroquine-sensitive strain of Plasmodium falciparum or Plasmodium vivax is Chloroquine.
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Uncomplicated chloroquine-resistant Plasmodium falciparum is Quinine sulfate plus Clindamycin.
The dosage is based on the child's weight, and it is important to monitor the glucose level as these drugs might lead to hypoglycemia.
In severe cases of congenital malaria, where there are associated complications of seizures, breathing difficulties, hyperparasitemia, or severe anemia, intravenous Quinidine gluconate in combination with Clindamycin should also be prescribed. Also, if the child is highly anemic, transfusion might be required to help manage the condition.
Conclusion:
Congenital malaria is extremely rare and might become fatal for the child if not assessed properly during the early stages. The presence of fever during pregnancy is one of the most presenting symptoms that the baby might become affected by the parasite. Hence it is always essential to discuss your health condition with the doctor throughout the pregnancy period so that it would be safe and healthy for the baby as well.