Congenital cerebral malaria: a masquerader in a neonate

• Published in: Malaria journal Vol. 21; no. 1; p. 34
• Main Authors: Nwaneli, Ezinne I, Nri-Ezedi, Chisom A, Okeke, Kenneth N, Edokwe, Emeka S, Echendu, Sylvia T, Iloh, Kenechukwu K
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.02.2022; BioMed Central; BMC
• Subjects: Anaemia; Anemia; Antibodies; Artemisinin; Artesunate; Asexuality; Blood; Blood & organ donations; Blood pressure; Blood transfusions; Case Report; Coma; Complicated malaria; Congenital diseases; Dehydrogenases; Demographic aspects; Diagnosis; Disease transmission; Diseases; Early onset neonatal sepsis; Female; Fetal Diseases; Fetuses; Glucose; Hemoglobin; Human diseases; Humans; Illnesses; Infant, Newborn; Infants (Newborn); Infections; Infectious Disease Transmission, Vertical; Literature reviews; Malaria; Malaria, Cerebral - diagnosis; Male; Meningitis; Microscopy; Mortality; Neonatal meningitis; Neonates; Neurological diseases; Newborn; Parasites; Peripheral blood; Placenta; Pregnancy; Risk factors; Seizures; Sepsis; Vector-borne diseases; Nigeria; Africa; Early onset neonatal sepsis; Complicated malaria; Newborn; Neonatal meningitis; Seizures
• ISSN: 1475-2875; 1475-2875
• 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.