Department of Child Health, University of Ghana Medical School, PO Box 4236, Accra, Ghana.
Malar J. 2013 Jan 11;12:17. doi: 10.1186/1475-2875-12-17.
Congenital malaria is defined as malaria parasitaemia in the first week of life. The reported prevalence of congenital malaria in sub-Saharan Africa is variable (0 - 46%). Even though the clinical significance of congenital malaria parasitaemia is uncertain, anti-malarial drugs are empirically prescribed for sick newborns by frontline health care workers. Data on prevalence of congenital malaria in high-risk newborns will inform appropriate drug use and timely referral of sick newborns.
Blood samples of untreated newborns less than 1 week of age at the time of referral to Korle Bu Teaching hospital in Accra, Ghana during the peak malaria seasons (April to July) of 2008 and 2010 were examined for malaria parasites by, i) Giemsa-stained thick and thin blood smears for parasite count and species identification, ii) histidine-rich protein- and lactic dehydrogenase-based rapid diagnosis tests, or iii) polymerase chain reaction amplification of the merozoite surface protein 2 gene, for identification of sub-microscopic parasitaemia. Other investigations were also done as clinically indicated.
In 2008, nine cases of Plasmodium falciparum parasitaemia were diagnosed by microscopy in 405 (2.2%) newborns. All the nine newborns had low parasite densities (≤ 50 per microlitre). In 2010, there was no case of parasitaemia by either microscopy or rapid diagnosis tests in 522 newborns; however, 56/467 (12%) cases of P. falciparum were detected by polymerase chain reaction.
Congenital malaria is an uncommon cause of clinical illness in high-risk untreated newborns referred to a tertiary hospital in the first week of life. Empirical anti-malarial drug treatment for sick newborns without laboratory confirmation of parasitaemia is imprudent. Early referral of sick newborns to hospitals with resources and skills for appropriate care is recommended.
先天性疟疾定义为生命的第一周内出现疟原虫血症。据报道，撒哈拉以南非洲地区先天性疟疾的患病率各不相同（0-46%）。尽管先天性疟疾寄生虫血症的临床意义尚不确定，但一线医护人员会根据经验为患病的新生儿开抗疟药物。高危新生儿先天性疟疾患病率的数据将为合理用药和及时转诊患病新生儿提供信息。
在加纳阿克拉科勒布教学医院，于 2008 年和 2010 年疟疾高发季节（4 月至 7 月），对前来就诊且年龄不满一周的未治疗新生儿采集血样，通过以下方法检查疟原虫：i）厚、薄血涂片吉姆萨染色进行寄生虫计数和种属鉴定，ii）基于组氨酸丰富蛋白和乳酸脱氢酶的快速诊断检测，或 iii）环子孢子蛋白 2 基因聚合酶链反应扩增，以确定亚微观寄生虫血症。根据临床指征还进行了其他检查。
2008 年，405 名新生儿中有 9 名（2.2%）经显微镜检查诊断为恶性疟原虫寄生虫血症。所有 9 名新生儿的寄生虫密度均较低（≤50 个/微升）。2010 年，522 名新生儿中无论是显微镜检查还是快速诊断检测均未发现寄生虫血症，但聚合酶链反应检测出 56/467（12%）例恶性疟原虫。
在生命的第一周被转诊至三级医院的高危未治疗新生儿中，先天性疟疾是临床疾病的罕见原因。对于没有寄生虫血症实验室确认的患病新生儿，经验性使用抗疟药物治疗是不明智的。建议将患病新生儿及早转诊至有适当治疗资源和技能的医院。
