新生儿疟疾的临床血液学特征及治疗结果：来自印度北部的九年分析

Mohan Kriti, Omar B J, Singh Rupa D, Maithani M M, Chaurasia R N

MLN Medical College Allahabad& Consultant, Mohan Children Hospital, Kanpur. Previously Assistant Professor, Department of Pediatrics, G.S.V.M. Medical College, Kanpur, India, UP, 208002, India.

Curr Pediatr Rev. 2016;12(4):286-291. doi: 10.2174/1871526516666161020165951.

BACKGROUND

Malaria is an important cause of death and illness in children worldwide. Most cases of neonatal malaria are misdiagnosed because of lack of specific symptoms and general lack of awareness. Nothing much is known in literature about the hematological changes during malaria infection and outcome of disease in neonates. Neonatal malaria is an underdiagnosed entity. So this hospital based observational study aims to assess diagnostic features of neonatal malaria.

METHODS

From August 2004 to August 2013, information of all slide positive for malaria cases aged 0 to 28 days admitted to our pediatric hospital was collected and analysed.

RESULTS

28 slide positive cases of neonatal malaria were studied, four out of them were congenital malaria. Fever (93%) was the most common symptom followed by pallor (72%) and diarrhoea (50%). We also found respiratory distress in four (14%) cases. Apart from anemia and atypical lymphocytosis, We also found thrombocytopenia and low hematocrit, MCV and RBC count. Two cases with bleeding manifestations expired during course of treatment.

DISCUSSION

Malaria in the first few months of life can simulate transplacentally or postnatally acquired infection such as TORCH, syphilis, neonatal hepatitis and septicemia all having an important symptom complex of fever jaundice, hepatosplenomegaly and anemia. Although in our cases clinical presentation has been similar to septicemia but culture of blood, CSF and urine were sterile. The dilemma of distinguishing neonatal malaria alone versus neonatal sepsis or both existing does not seem to be easily resolved by the use of clinical features alone. The laboratory diagnosis of parasitemia in neonates require special attention in Giemsa staining as well as the technical skill involved in malaria microscopy because parasite densities are low. So high degree of suspicion is needed to diagnose malaria in newborns presenting with fever and anemia.

背景

疟疾是全球儿童死亡和患病的重要原因。由于缺乏特异性症状且普遍认识不足，大多数新生儿疟疾病例被误诊。关于疟疾感染期间新生儿的血液学变化及疾病转归，文献中所知甚少。新生儿疟疾是一个诊断不足的病种。因此，这项基于医院的观察性研究旨在评估新生儿疟疾的诊断特征。

方法

收集并分析了2004年8月至2013年8月期间入住我院儿科的所有0至28天龄疟疾血涂片阳性病例的信息。

结果

对28例新生儿疟疾血涂片阳性病例进行了研究，其中4例为先天性疟疾。发热（93%）是最常见症状，其次是面色苍白（72%）和腹泻（50%）。我们还发现4例（14%）有呼吸窘迫。除贫血和非典型淋巴细胞增多外，还发现血小板减少以及血细胞比容、平均红细胞体积和红细胞计数降低。2例有出血表现的患儿在治疗过程中死亡。

讨论

出生后最初几个月的疟疾可模拟经胎盘或出生后获得性感染，如TORCH感染、梅毒、新生儿肝炎和败血症，所有这些感染都有发热、黄疸、肝脾肿大和贫血等重要症状组合。尽管在我们的病例中临床表现与败血症相似，但血液、脑脊液和尿液培养均无菌。仅靠临床特征似乎难以轻易解决区分单纯新生儿疟疾与新生儿败血症或两者并存这一难题。新生儿疟原虫血症的实验室诊断在吉姆萨染色以及疟疾显微镜检查所涉及的技术方面需要特别注意，因为寄生虫密度较低。因此，对于出现发热和贫血的新生儿，需要高度怀疑以诊断疟疾。