Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria.
Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
Malar J. 2022 Feb 5;21(1):34. doi: 10.1186/s12936-022-04056-2.
Congenital malaria, which is caused by vertical transmission of malaria parasites, is a potentially fatal condition. Despite Africa's high malaria burden, congenital malaria is not routinely screened for, and thus may go undiagnosed. Malaria, if not treated promptly, can quickly progress to severe forms and result in death. Severe congenital malaria is believed to be uncommon in neonates due to maternal antibodies, fetal haemoglobin, and the placenta's sieving effect. The majority of reported cases were classified as having severe anaemia. Following a thorough review of the literature, only one case of congenital cerebral malaria (CCM) has been reported, and it was misdiagnosed.
A 5-day-old Nigerian neonate born to an apparently healthy mother initially displayed characteristics consistent with neonatal sepsis and severe neonatal hyperbilirubinaemia. He quickly developed characteristics consistent with meningitis. Surprisingly, the peripheral blood film revealed evidence of malaria parasites, which was immediately confirmed by Giemsa-stained thick and thin blood film microscopy for malaria. The patient was diagnosed with congenital cerebral malaria. The medication was modified to parenteral artesunate followed by oral artemisinin combination therapy. The neonate recovered fully and had no neurological deficits on follow up.
Because CCM and infant meningitis have similar clinical presentations, CCM could be misdiagnosed and lead to death if there isn't a high index of suspicion.
先天性疟疾是由疟原虫垂直传播引起的，是一种潜在致命的疾病。尽管非洲疟疾负担沉重，但先天性疟疾并未常规筛查，因此可能未被诊断。如果不及时治疗，疟疾可能迅速发展为严重形式并导致死亡。由于母体抗体、胎儿血红蛋白和胎盘的筛检作用，严重先天性疟疾在新生儿中被认为不常见。在对文献进行全面审查后，仅报告了一例先天性脑型疟疾（CCM）病例，且被误诊。
一名 5 天大的尼日利亚新生儿，出生于看似健康的母亲，最初表现出符合新生儿败血症和严重新生儿高胆红素血症的特征。他很快出现符合脑膜炎的特征。令人惊讶的是，外周血涂片显示有疟原虫的证据，这立即通过吉姆萨染色厚、薄血片显微镜检查疟原虫得到证实。该患者被诊断为先天性脑型疟疾。药物治疗改为青蒿琥酯静脉给药，然后改为口服青蒿素联合疗法。该新生儿完全康复，随访时无神经功能缺损。
由于 CCM 和婴儿脑膜炎的临床表现相似，如果没有高度怀疑，CCM 可能被误诊并导致死亡。
