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(contributed by Prof. Jacques Le Bras, Hôpital Bichat - Claude Bernard,
Paris, France)
A
30 year-old woman, HIV-positive, delivers by planned cesarean section
an apparently normal female baby, weight 3.2 kg (7 lbs). At delivery
AZT is administered IV for 7 hours. The mother is a native of the Democratic
Republic of Congo (DRC) who came to France 2 years ago and has not traveled
outside France since then. The only abnormality found in the baby at
delivery is an anemia (12.3 g/dL hemoglobin) attributed to antiretroviral
drugs toxicity (ARV given to mother?)
At
6 weeks post-delivery, the infant is brought in for a fever of one-day
duration. She is found to have a temperature of 38.5°C and both
hepatomegaly (3 cm) and splenomegaly (3 cm). Serologic tests for HBs
and HCV are negative, and PCR, DNA and RNA for HIV are negative. More
routine laboratory exams show: hemoglobin 6.4 g/dL, platelets 122,000/µL,
LDH 1080 IU/mL, and blood smears showing the following:
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Question
1. What is your diagnosis?
A
transfusion of 125 mLs of
blood (serologically negative for CMV)
is given to the child.
Question
2. What antimalarial drug would you administer to the infant?
Following treatment with the orally administered antimalarial drug,
parasitemia drops to 1% by day 3. At day 7, some parasite remnants are
found and the child is afebrile. Drug testing in vitro of the parasite
shows it to be sensitive to chloroquine.
Question
3. What test(s) would you perform to confirm current infection of the
mother?
A
thick blood smear of the mother, taken 5 days after that of the infant,
is indeed positive, while on the thin smear no parasites can be detected.
Main
Points
- Congenital malaria should be considered in febrile newborns and
infants from women who could have been parasitemic during their
pregnancy.
- Malaria parasitemia during pregnancy can result because the mother
became infected during her pregnancy, but it can also result from an
infection acquired months or years before.
- The woman in this case probably was infected in DR Congo more than
2 years before delivery. Untreated Plasmodium malariae infection
can persist >40 years and remain relatively asymptomatic.
- Plasmodium vivax and P. ovale can similarly cause
malaria several months or years after the original infection, by reactivation
of dormant liver stage parasites.
- Diagnostic procedures for detecting active malaria infection are,
in order of increasing sensitivity: thin blood smear, thick blood smear,
and PCR. Serology does not detect active infection, but measures
past (and current) experience with malaria.
See Congenital
Malaria as a Result of Plasmodium malariae - North Carolina,
2000.
Page last modified : April 23, 2004
Content source: Division of Parasitic Diseases
National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ZVED)
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