Congenital malaria with atypical presentation: a case report from low transmission area in India.
BACKGROUND
Malaria during first few months of life may be due to transplacental transfer of parasitized maternal erythrocytes. Although IgG and IgM antimalarial antibodies can be detected in maternal blood, only IgG antibodies are present in the infant's blood. These antibodies can delay and modify the onset of clinical manifestations.


METHODS
An infant is described who presented with irritability and feeding problems. Clinical examination and investigations revealed that the infant was afebrile, had jaundice, hepatosplenomegaly and haemolytic anaemia. Peripheral smear demonstrated Plasmodium vivax. While the mother had significant levels of immunoglobulin G (IgG), the infant was found negative for IgG and had low immunoglobulin M (IgM) levels. The mother had a history of febrile illness during pregnancy and her peripheral smear was also positive for P. vivax. Both were successfully treated with chloroquine in the dose of 25 mg/kg/day over three days.


CONCLUSIONS
The case emphasizes the importance of considering the diagnosis of malaria even in infants in low transmission area, who may not present with typical symptoms of malaria, such as fever, but have other clinical manifestations like jaundice and haemolytic anaemia.
Valecha
Neena
N
National Institute of Malaria Research, 22-Sham Nath Marg, Delhi, India. neenavalecha@gmail.com
Bhatia
Sunita
S
Mehta
Sadhna
S
Biswas
Sukla
S
Dash
Aditya P
AP
D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use; D002738:Chloroquine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007194:India; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016780:Malaria, Vivax / Q000151:congenital* / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission; D008297:Male; D010966:Plasmodium vivax; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000469:parasitology
D000962:Antimalarials; D002738:Chloroquine