Romand S, Bourée P, Gelez J, Bader-Meunier B, Bisaro F, Dommergues J P
Unité de Parasitologie et Médecine tropicale, Hôpital de Bicêtre, Le Kremlin-Bicêtre.
Presse Med. 1994;23(17):797-800.
Even in endemic zones, congenital malaria, first described in 1876, is rarely encountered. The incidence has greatly increased however over the last 10 years suggesting several diagnostic problems. We observed a case of infected twins born to an asymptomatic mother which would throw some light on the pathophysiology involved in congenital transmission. A 2-month old infant was hospitalized for surgical cure of an umbilical hernia. Haemolytic anaemia (6.3 g/dl) and fever (39 degrees C) were observed during the postoperative period. A wide spectrum antibiotherapy was prescribed but the temperature remained at 39 degrees C. A blood swab cultured one week after the operation revealed Plasmodium falciparum. The infant's twin sister was in apparently good health but was also found to be anaemic (6.1 mg/dl Hg) and a blood sample was positive for P. falciparum. For the mother, the search for parasites was negative. Serology tests performed at diagnosis revealed anti-P. falciparum antibodies at 1/1600, 1/3200 and 1/6400 in the infant, his twin sister and the mother. Outcome was favourable. The mother had arrived in France from Togo 14 months earlier and had not returned to an endemic zone. She had had frequent episodes of fever in Togo and had taken quinine, but no episode of fever had occurred during the pregnancy or delivery. This twin case of vertical mother-infant transmission is the equivalent to transfusional malaria since red cells pass the placental barrier near the end of pregnancy, even when no placental lesion exists. Congenital transfusional malaria must however be dissociated from congenital infective malaria resulting from early primoinfection in endemic areas.
即使在疟疾流行区，1876年首次描述的先天性疟疾也很少见。然而，在过去10年中其发病率大幅上升，这提示了一些诊断问题。我们观察到一例感染双胞胎，其母亲无症状，这可能会为先天性传播所涉及的病理生理学提供一些线索。一名2个月大的婴儿因脐疝手术治疗而住院。术后观察到溶血性贫血（血红蛋白6.3 g/dl）和发热（39摄氏度）。给予了广谱抗生素治疗，但体温仍维持在39摄氏度。术后一周采集的血涂片培养发现恶性疟原虫。婴儿的双胞胎姐姐表面健康，但也被发现贫血（血红蛋白6.1 mg/dl），血液样本恶性疟原虫检测呈阳性。其母亲的寄生虫检测为阴性。诊断时进行的血清学检测显示，婴儿、其双胞胎姐姐和母亲的抗恶性疟原虫抗体分别为1/1600、1/3200和1/6400。预后良好。母亲14个月前从多哥抵达法国，此后未返回流行区。她在多哥时有频繁发热，曾服用奎宁，但孕期及分娩期间未出现发热。这种母婴垂直传播的双胞胎病例等同于输血性疟疾，因为即使不存在胎盘病变，红细胞在妊娠末期也会通过胎盘屏障。然而，先天性输血性疟疾必须与流行地区早期原发性感染导致的先天性感染性疟疾区分开来。
