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Clinical characteristics of neonatal malaria
1Department of Child Health, University of Benin, Nigeria.
Insights
Neonatal malaria, primarily congenital, affects 8% of infants in tropical Africa. Plasmodium falciparum is the main cause, with significant resistance to chloroquine and quinine treatments observed.
Area of Science:
- Medical Microbiology
- Tropical Medicine
- Pediatrics
Background:
- Neonatal malaria presents a significant challenge in tropical regions.
- Understanding its clinical spectrum and treatment responses is crucial for infant health.
Purpose of the Study:
- To document the clinical characteristics of neonatal malaria.
- To assess the prevalence and types of neonatal malaria.
- To evaluate drug resistance patterns in affected neonates.
Main Methods:
- Prospective documentation of 16 neonates with malaria parasitaemia.
- Diagnosis via Giemsa stained smears.
- Clinical feature recording and drug sensitivity testing.
Main Results:
- Prevalence of neonatal malaria was 8%, with 75% congenital.
- Plasmodium falciparum was identified in all cases.
- Common symptoms included fever, respiratory distress, pallor, and hepatomegaly.
- 25% showed chloroquine resistance; 19% of those were also quinine resistant.
- One case was fatal despite quinine treatment.
Conclusions:
- Neonatal malaria, predominantly congenital P. falciparum, exhibits concerning drug resistance.
- Clinical presentation often mimics other neonatal infections.
- Effective treatment strategies require careful consideration of drug resistance patterns.
Abstract:
The clinical characteristics of 16 neonates with malaria parasitaemia diagnosed on Giemsa stained smears were documented during a 3-month rainy season period in a tropical African city. The prevalence of neonatal malaria was 8 per cent. Seventy-five per cent of these neonates had congenital malaria, 13 per cent transfusional malaria, and 13 per cent had acquired malaria. Plasmodium falciparum was found in all positive smears. Bacterial cultures of blood, urine, and cerebrospinal fluid were sterile. The predominant clinical features were those of fever (88 per cent), respiratory distress (57 per cent), pallor and anaemia (38 per cent each), hepatomegaly (31 per cent), and jaundice and diarrhoea (25 per cent each). Twenty-five per cent of the neonates were resistant to chloroquine sulphate; 19 per cent of the chloroquine resistant babies were also resistant to quinine sulphate 13 per cent of whom responded to halofantrine hydrochloride. One died a day after completing a full course of quinine, with a post-mortem blood smear showing no change in the density of parasitaemia.