Clinical Case Study 1: Fever 6 months after a visit to Pakistan

A 44-year-old man is seen at a physician’s office in the United States, during a week-end, for suspected malaria.

The patient was born in Pakistan but has lived in the United States for the past 12 years. He travels frequently back to Pakistan to visit friends and relatives. His last visit there was for two months, returning 11 months before the current episode. He did not take malaria prophylaxis then.

Five weeks ago, he was diagnosed with malaria and treated at a local hospital. The blood smear at that time was reported by the hospital as positive for malaria, species undetermined. He was then treated with 2 days of IV fluids (nature unknown) and tablets (nature unknown), and recovered.

The patient now presents with a history of low grade fever for the past few days, with no other symptoms. A blood smear is taken and examined at a hospital laboratory by the technician (no pathologist is available on this week-end). Through a telephone discussion, the technician states that she sees 4 parasites per 1000 red blood cells, with rings, “other forms with up to four nuclei,” and that some of the infected red blood cells are enlarged and deformed.

Question 1: What is your most probable diagnosis?

Not Malaria

That is incorrect. Please, try another answer.

Plasmodium falciparum

Plasmodium vivax

That is correct.

This is the most probable diagnosis. The reported microscopic findings are compatible with P. vivax: some infected red cells are enlarged and deformed, and the “other forms with four nuclei” are compatible with the presence of schizonts. Plasmodium vivax does occur in Pakistan, where it is found in slightly more than 50% of malaria cases.

The history suggests a relapse of P. vivax malaria, following an earlier episode five weeks ago. The earlier treatment apparently did not include primaquine, thus allowing the persistence of hypnozoites which caused this relapse.

An alternate explanation would be that the earlier infection was caused by chloroquine-resistant P. vivax (which has been reported in Pakistan), with recrudescence of blood-stage parasites occurring after an unsuccessful earlier treatment (if indeed the earlier treatment included chloroquine). However, recrudescences usually occur within 28 days of the intial episode, rather than at five weeks as described here.

The other species are less likely:

  • While P. falciparum does occur in Pakistan (slightly less than 50% of malaria cases), this patient reportedly did not develop symptoms until 10 months after departure from the exposure area: most cases of P. falciparum would have become symptomatic earlier.
  • P. ovale occurs mainly in Africa and has been found only occasionally in Asia (in the western Pacific).
  • P. malariae occurs worldwide, but its distribution is spotty, and its frequency in Pakistan is low to negligible.
  • Babesia would not fit with the microscopic description; in addition, babesiosis has not been reported in Pakistan, although admittedly the disease might have escaped detection.

Plasmodium ovale

Plasmodium malariae

Question 2: What treatment approach would you recommend, based on this clinical history and on the fact that the microscopy findings will not be confirmed by a pathologist for at least 24 hours?

Do not start treatment until a formal microscopic diagnosis is made (in 12-24 hours)

Treat as if chloroquine-sensitive Plasmodium falciparum malaria

A reasonable option, signifying that in the absence of definitive microscopic diagnosis, you prefer to play it safe and treat the patient for the most dangerous and rapidly progressing infection possible.

The safest course of action is to initially admit all cases of proven or suspected P. falciparum to the hospital until one can begin treatment and ensure that they are improving clinically and parasitologically.

However in this case, if the patient is only minimally symptomatic, one might elect against hospitalization and instead treat as an outpatient provided that close follow-up can be arranged. Once the definitive microscopic diagnosis is made the following day, you can always switch treatment.

Treat as if chloroquine-resistant Plasmodium falciparum malaria

Treat as if Plasmodium vivax malaria

Plasmodium vivax schizont

P. Vivax schizont

The diagnosis of P. vivax malaria is later confirmed by review of a blood smear available from the first episode (Figure), and by a PCR positive for P. vivax on blood collected during the current episode.

The microscopic diagnosis  of P. vivax is based on the following:

  • The infected red cells are enlarged and deformed;
  • The schizont shown contains 20 merozoites (schizonts of P. malariae and P. ovale have fewer merozoites; and in P. falciparum , schizonts are not usually seen in the peripheral blood);
  • The round gametocyte shown, contained in an enlarged red cell. (In this case, the typical Schüffner’s dots were not visible, probably due to staining problems.)

Question 3. To prevent further relapses from dormant liver stages, what would you recommend?

No further measures needed

A lab test to determine if the patient has dormant liver stages

Treatment immediately with a drug that kills dormant liver stages

A lab test, followed by treatment with a drug that kills dormant liver stages

You should exclude G6PD deficiency first, then give the patient primaquine, 30 mg per day for 14 days.

In case of G6PD deficiency, consultation with an expert in infectious diseases or tropical medicine is advised to discuss options for relapse prevention. For some patients with partial G6PD deficiency, an alternative regimen of primaquine 45 mg weekly for 8 weeks can sometime be used. Alternatively, weekly chloroquine prophylaxis may also be considered. Treatment with primaquine is justified because this patient probably has already had a relapse, and is at risk for further relapses. No test exists to detect the presence of liver stage parasites.

Question 4. Should this patient have taken preventive measures against malaria for his visit to Pakistan, considering that he was born there?

Even to visit friends and relatives, preventive measures must be taken. Chloroquine-resistant Plasmodium falciparum occurs in Pakistan, and thus the drugs recommended would be atovaquone-proguanil (Malarone®), doxycycline or mefloquine. Other preventive measures against mosquito bites also apply. Even though the patient was born in Pakistan, whatever acquired immunity he has developed would most likely have waned; negligence of preventive measures often occurs in individuals visiting friends and relatives , a situation that needs to be remedied.

Main Points

Travelers to Pakistan (including those visiting friends and relatives) need to take prophylaxis (atovaquone-proguanil [Malarone®], doxycycline or mefloquine).

Clinical history and travel history, and careful microscopic examination, probably would have directed the diagnosis toward P. vivax during the earlier episode, so that the relapse could have been prevented.

P. vivax malaria should be treated with chloroquine, except when acquired in Papua New Guinea and Indonesia, areas with high prevalence of chloroquine-resistant P. vivax . After a normal G6PD test, patients should get a radical cure with primaquine (30 mg per day for 14 days).

To receive email updates about this page, enter your email address:

New! Locally Acquired Cases of Malaria in Florida, Texas, Maryland, and Arkansas

New! Update to Guidance for use of Artemether-Lumefantrine (Coartem®) in Pregnancy for Uncomplicated Malaria New! Discontinuation of CDC’s Distribution of Intravenous Artesunate as Commercial Drug Guidance for Malaria Diagnosis in Patients Suspected of Ebola Infection in the United States -->

See all Malaria Notices

  • New! Malaria is a Serious Disease
  • New!   La malaria (paludismo) es una enfermedad grave
  • Information for Specific Groups
  • How to Report a Case of Malaria
  • CDC Yellow Book
  • Red Pages: Malaria-endemic areas by country
  • Drugs for Prevention
  • Choosing a Drug to Prevent Malaria
  • Drugs for Treatment in the U.S.
  • Frequently Asked Questions (FAQs)
  • Blood Banks
  • How Can I Help?

Click here for contact information

Exit Notification / Disclaimer Policy

  • The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
  • Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
  • You will be subject to the destination website's privacy policy when you follow the link.
  • CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.
  • Support Our Work

The Smithsonian Institution's Human Origins Program

Malaria powerpoint slides final.

  • Climate Effects on Human Evolution
  • Survival of the Adaptable
  • Human Evolution Timeline Interactive
  • 2011 Olorgesailie Dispatches
  • 2004 Olorgesailie Dispatches
  • 1999 Olorgesailie Dispatches
  • Olorgesailie Drilling Project
  • Kanam, Kenya
  • Kanjera, Kenya
  • Ol Pejeta, Kenya
  • Olorgesailie, Kenya
  • Evolution of Human Innovation
  • Adventures in the Rift Valley: Interactive
  • 'Hobbits' on Flores, Indonesia
  • Earliest Humans in China
  • Bose, China
  • Anthropocene: The Age of Humans
  • Fossil Forensics: Interactive
  • What's Hot in Human Origins?
  • Instructions
  • Carnivore Dentition
  • Ungulate Dentition
  • Primate Behavior
  • Footprints from Koobi Fora, Kenya
  • Laetoli Footprint Trails
  • Footprints from Engare Sero, Tanzania
  • Hammerstone from Majuangou, China
  • Handaxe and Tektites from Bose, China
  • Handaxe from Europe
  • Handaxe from India
  • Oldowan Tools from Lokalalei, Kenya
  • Olduvai Chopper
  • Stone Tools from Majuangou, China
  • Middle Stone Age Tools
  • Burin from Laugerie Haute & Basse, Dordogne, France
  • La Madeleine, Dordogne, France
  • Butchered Animal Bones from Gona, Ethiopia
  • Katanda Bone Harpoon Point
  • Oldest Wooden Spear
  • Punctured Horse Shoulder Blade
  • Stone Sickle Blades
  • Projectile Point
  • Oldest Pottery
  • Pottery Fragment
  • Fire-Altered Stone Tools
  • Terra Amata Shelter
  • Qafzeh: Oldest Intentional Burial
  • Assyrian Cylinder Seal
  • Blombos Ocher Plaque
  • Ishango Bone
  • Bone and Ivory Needles
  • Carved Ivory Running Lion
  • Female torso in ivory
  • Ivory Horse Figurine
  • Ivory Horse Sculpture
  • Lady of Brassempouy
  • Lion-Man Figurine
  • Willendorf Venus
  • Ancient Shell Beads
  • Carved Bone Disc
  • Cro-Magnon Shell Bead Necklace
  • Oldest Known Shell Beads
  • Ancient Flute
  • Ancient Pigments
  • Apollo 11 Plaque
  • Carved antler baton with horses
  • Geometric incised bone rectangle
  • Tata Plaque
  • Mystery Skull Interactive
  • Shanidar 3 - Neanderthal Skeleton
  • Bison Figurine
  • Carved Horse-Head Bead
  • Carved Ivory Mammoth
  • Cuneiform Clay Tablet
  • Fired Clay Bison
  • Fired Clay Venus from Dolni Vestonice
  • Lespugue Venus
  • One Species, Living Worldwide
  • Human Skin Color Variation
  • Ancient DNA and Neanderthals
  • Human Family Tree
  • Swartkrans, South Africa
  • Shanidar, Iraq
  • Walking Upright
  • Tools & Food
  • Social Life
  • Language & Symbols
  • Humans Change the World
  • Introduction to Human Evolution
  • Nuts and bolts classification: Arbitrary or not? (Grades 6-8)
  • Comparison of Human and Chimp Chromosomes (Grades 9-12)
  • Hominid Cranial Comparison: The "Skulls" Lab (Grades 9-12)
  • Investigating Common Descent: Formulating Explanations and Models (Grades 9-12)
  • Fossil and Migration Patterns in Early Hominids (Grades 9-12)
  • For College Students
  • Why do we get goose bumps?
  • Chickens, chimpanzees, and you - what do they have in common?
  • Grandparents are unique to humans
  • How strong are we?
  • Humans are handy!
  • Humans: the running ape
  • Our big hungry brain!
  • Our eyes say it!
  • The early human tool kit
  • The short-haired human!
  • The “Nutcracker”
  • What can lice tell us about human evolution?
  • What does gut got to do with it?
  • Why do paleoanthropologists love Lucy?
  • Why do we have wisdom teeth?
  • Human Origins Glossary
  • Teaching Evolution through Human Examples
  • Frequently Asked Questions
  • Recommended Books
  • Exhibit Floorplan Interactive
  • Print Floorplan PDF
  • Reconstructions of Early Humans
  • Chesterfield County Public Library
  • Orange County Library
  • Andover Public Library
  • Ephrata Public Library
  • Oelwein Public Library
  • Cedar City Public Library
  • Milpitas Library
  • Spokane County Library
  • Cottage Grove Public Library
  • Pueblo City-County Library
  • Springfield-Greene County Library
  • Peoria Public Library
  • Orion Township Public Library
  • Skokie Public Library
  • Wyckoff Free Public Library
  • Tompkins County Public Library
  • Otis Library
  • Fletcher Free Library
  • Bangor Public Library
  • Payne Theological Seminary
  • Human Origins Do it Yourself Exhibit
  • Exhibit Field Trip Guide
  • Acknowledgments
  • Human Origins Program Team
  • Connie Bertka
  • Betty Holley
  • Nancy Howell
  • Lee Meadows
  • Jamie L. Jensen
  • David Orenstein
  • Michael Tenneson
  • David Haberman
  • Fred Edwords (Emeritus)
  • Elliot Dorff (Emeritus)
  • Francisca Cho (Emeritus)
  • Peter F. Ryan (Emeritus)
  • Mustansir Mir (Emeritus)
  • Randy Isaac (Emeritus)
  • Mary Evelyn Tucker (Emeritus)
  • Wentzel van Huyssteen (Emeritus)
  • Joe Watkins (Emeritus)
  • Tom Weinandy (Emeritus)
  • Members Thoughts on Science, Religion & Human Origins (video)
  • Science, Religion, Evolution and Creationism: Primer
  • The Evolution of Religious Belief: Seeking Deep Evolutionary Roots
  • Laboring for Science, Laboring for Souls:  Obstacles and Approaches to Teaching and Learning Evolution in the Southeastern United States
  • Public Event : Religious Audiences and the Topic of Evolution: Lessons from the Classroom (video)
  • Evolution and the Anthropocene: Science, Religion, and the Human Future
  • Imagining the Human Future: Ethics for the Anthropocene
  • Human Evolution and Religion: Questions and Conversations from the Hall of Human Origins
  • I Came from Where? Approaching the Science of Human Origins from Religious Perspectives
  • Religious Perspectives on the Science of Human Origins
  • Submit Your Response to "What Does It Mean To Be Human?"
  • Volunteer Opportunities
  • Submit Question
  • "Shaping Humanity: How Science, Art, and Imagination Help Us Understand Our Origins" (book by John Gurche)
  • What Does It Mean To Be Human? (book by Richard Potts and Chris Sloan)
  • Bronze Statues
  • Reconstructed Faces

Immunopaedia.org

  • Earn HPCSA and SACNASP CPD Points
  • I have spots and my skin burns
  • A case of a 10 year old boy with a 3 week history of diarrhoea, vomiting and cough
  • A case of fever and general malaise
  • A case of persistant hectic fever
  • A case of sudden rapid neurological deterioration in an HIV positive 27 year old female
  • A case of swollen hands
  • An unusual cause of fulminant hepatitis
  • Case of a right axillary swelling
  • Case of giant wart
  • Case of recurrent meningitis
  • Case of repeated apnoea and infections in a premature infant
  • Case of sudden onset of fever, rash and neck pain
  • Doctor, my sister is confused
  • Eight month old boy with recurrent infections
  • Enlarged Testicles
  • Failure to thrive despite appropriate treatment
  • Right Axillary Swelling
  • Severe anaemia in HIV positive child
  • The case of a floppy infant

Two year old with spiking fevers and depressed level of consciousness

  • 17 year old male with fever and decreased level of consciousness
  • 3 TB Vignettes
  • A 10 year old girl with a hard palate defect
  • A case of decreased joint function, fever and rash
  • Keep up while the storm is raging
  • Fireworks of autoimmunity from birth
  • My eyes cross at twilight
  • A case of a 3 month old infant with bloody urine and stools
  • A case of scaly annular plaques
  • Case of eye injury and decreased vision
  • My head hurts and I cannot speak?
  • TB or not TB: a confusing case
  • A 7 year old with severe muscle weakness and difficulty walking
  • Why can I not walk today?
  • 14 year old with severe hip pain
  • A 9 year old girl presents with body swelling, shortness of breath and backache
  • A sudden turn of events after successful therapy
  • Declining CD4 count, despite viral suppression?
  • Defaulted treatment
  • 25 year old female presents with persistent flu-like symptoms
  • A case of persistent bloody diarrhoea
  • I’ve been coughing for so long
  • A case of acute fever, rash and vomiting
  • Adverse event following routine vaccination
  • A case of cough, wasting and lymphadenopathy
  • A case of lymphadenopathy and night sweats
  • Case of enlarged hard tongue
  • A high risk pregnancy
  • A four year old with immunodeficiency
  • Young girl with recurrent history of mycobacterial disease
  • Immunodeficiency and failure to thrive
  • Case of recurrent infections
  • An 8 year old boy with recurrent respiratory infections
  • 4 year old boy with recurrent bacterial infections
  • Is this treatment failure or malnutrition
  • 1. A Snapshot of the Immune System
  • 2. Ontogeny of the Immune System
  • 3. The Innate Immune System
  • 4. MHC & Antigen Presentation
  • 5. Overview of T Cell Subsets
  • 6. Thymic T Cell Development
  • 7. gamma/delta T Cells
  • 8. B Cell Activation and Plasma Cell Differentiation
  • 9. Antibody Structure and Classes
  • 10. Central and Peripheral Tolerance
  • Introduction to Immuno-Chile 2023
  • Core Modules
  • Gut Mucosal Immunity
  • The Microbiome
  • Gut Inflammation
  • Viral Infections and Mucosal Immunity
  • Colorectal Cancer
  • Inflammatory Bowel Disease
  • Equity, Diversity, Inclusion in Academia
  • Grant Writing
  • Immuno-India 2023 Introduction
  • Principles of Epigenetic Regulation
  • Epigenetics Research in Systems Immunology
  • Epigenetic (De)regulation in Non-Malignant Diseases
  • Epigenetic (De)regulation in Immunodeficiency and Malignant Diseases
  • Immunometabolism and Therapeutic Applications of Epigenetic Modifiers
  • Immuno-Morocco 2023 Introduction
  • Cancer Cellular Therapies
  • Cancer Antibody Therapies
  • Cancer Vaccines
  • Immunobiology of Leukemia & Therapies
  • Immune Landscape of the Tumour
  • Targeting the Tumour Microenvironment
  • Flow Cytometry
  • Immuno-Zambia 2022 Introduction
  • Immunity to Viral Infections
  • Immunity to SARS-CoV2
  • Basic Immunology of HIV
  • Immunity to Tuberculosis
  • Immunity to Malaria
  • Immunity to Schistosomiasis
  • Immunity to Helminths
  • Equity, Diversity and Inclusion in Academia
  • Immuno-Argentina 2022 Introduction
  • Dendritic Cells
  • Trained Innate Immunity
  • Gamma-Delta T cells
  • Natural Killer Cell Memory
  • Innate Immunity in Viral Infections
  • Lectures – Innate Immunity
  • T cells and Beyond
  • Lectures – Cellular Immunity
  • Strategies for Vaccine Design
  • Lectures – Humoral Immunity
  • Lectures – Vaccine development
  • Lectures – Panel and Posters
  • Immuno-Tunisia 2021 Introduction
  • Basics of Anti-infectious Immunity
  • Inborn Errors of Immunity and Infections
  • Infection and Auto-Immunity
  • Pathogen-Induced Immune Dysregulation & Cancer
  • Understanding of Host-Pathogen Interaction & Applications (SARS-CoV-2)
  • Day 1 – Basics of Anti-infectious Immunity
  • Day 2 – Inborn Errors of Immunity and Infections
  • Day 3 – Infection and Auto-immunity
  • Day 4 – Pathogen-induced Immune Dysregulation and Cancer
  • Day 5 – Understanding of Host-Pathogen Interaction and Applications
  • Student Presentations
  • Roundtable Discussions
  • Orientation Meeting
  • Poster Information
  • Immuno-Cuba 2022 Introduction
  • Poster and Abstract Examples
  • Immuno-Colombia Introduction
  • Core Modules Meeting
  • Overview of Immunotherapy
  • Check-Points Blockade Based Therapies
  • Cancer Immunotherapy with γδ T cells
  • CAR-T, armored CARs and CAR-NK therapies
  • Anti-cytokines Therapies
  • Tumor-infiltrating Lymphocytes (TIL)
  • MDSC Promote Tumor Growth and Escape
  • Immunological lab methods for patient’s follow-up
  • Student Orientation Meeting
  • Lectures – Week 1
  • Lectures – Week 2
  • Research Project
  • Closing and Social
  • Introduction to Immuno-Algeria 2020
  • Hypersensitivity Reactions
  • Immuno-Algeria Programme
  • Online Lectures – Week 1
  • Online Lectures – Week 2
  • Student Presentations – Week 1
  • Student Presentations – Week 2
  • Introduction to Immuno-Ethiopia 2020
  • Neutrophils
  • Leishmaniasis – Transmission and Epidemiology
  • Leishmaniasis – Immune Responses
  • Leishmaniasis – Treatment and Vaccines
  • Immunity to Helminth Infections
  • Helminth immunomodulation on co-infections
  • Malaria Vaccine Progress
  • Immunity to Fungal Infections
  • How to be successful scientist
  • How to prepare a good academic CV
  • Introduction to Immuno-Benin
  • Immune Regulation in Pregnancy
  • Immunity in infants and consequence of preeclampsia
  • Schistosome infections and impact on Pregnancy
  • Infant Immunity and Vaccines
  • Regulation of Immunity & the Microbiome
  • TGF-beta superfamily in infections and diseases
  • Infectious Diseases in the Global Health era
  • Immunity to Toxoplasma gondii
  • A. melegueta inhibits inflammatory responses during Helminth Infections
  • Host immune modulation by Helminth-induced products
  • Immunity to HIV
  • Immunity to Ebola
  • Immunity to TB
  • Genetic susceptibility in Tuberculosis
  • Plant Extract Treatment for Diabetes
  • Introduction to Immuno-South Africa 2019
  • Models for Testing Vaccines
  • Immune Responses to Vaccination
  • IDA 2019 Quiz
  • Introduction to Immuno-Jaipur
  • Inflammation and autoinflammation
  • Central and Peripheral Tolerance
  • Autoimmunity and Chronic Inflammatory Diseases
  • Autoimmunity & Dysregulation
  • Novel Therapeutic strategies for Autoimmune Diseases
  • Strategies to apply gamma/delta T cells for Immunotherapy
  • Immune Responses to Cancer
  • Tumour Microenvironment
  • Cancer Immunotherapy
  • Origin and perspectives of CAR T cells
  • Metabolic checkpoints regulating immune responses
  • Transplantation
  • Primary Immunodeficiencies
  • Growing up with Herpes virus
  • Introduction to IUIS-ALAI-Mexico-ImmunoInformatics
  • Introduction to Immunization Strategies
  • Introduction to Immunoinformatics
  • Omics Technologies
  • Computational Modeling
  • Machine Learning Methods
  • Introduction to Immuno-Kenya
  • Viruses hijacking host immune responses
  • IFNs as 1st responders to virus infections
  • HBV/HCV & Hepatocellular Carcinoma
  • Cytokines as biomarkers for HCV
  • HTLV & T cell Leukemia
  • HCMV and Cancers
  • HPV and Cancers
  • EBV-induced Oncogenesis
  • Adenoviruses
  • KSHV and HIV
  • Ethics in Cancer Research
  • Sex and gender in Immunity
  • Introduction to Immuno-Iran
  • Immunity to Leishmaniasis
  • Breaking Tolerance: Autoimmunity & Dysregulation
  • Introduction to Immuno-Morocco
  • Cancer Epidemiology and Aetiology
  • Pathogens and Cancer
  • Immunodeficiency and Cancer
  • Introduction to Immuno-Brazil
  • 1. Systems Vaccinology
  • 2. Vaccine Development
  • 3. Adjuvants
  • 4. DNA Vaccines
  • 5. Mucosal Vaccines
  • 6. Vaccines for Neurodegenerative Diseases
  • Introduction to Immuno-Gambia
  • Immuno-Gambia Photos
  • 1. Infant Immunity and Vaccines
  • 2. Dendritic Cells
  • 3. Conventional T Cells
  • 4. gamma/delta T Cells
  • 5. Immunity to Viral Infections
  • 6. Immunity to Helminth Infections
  • 7. Immunity to TB
  • 8. Immunity to Malaria
  • 9. Flow Cytometry
  • Introduction to Immuno-South Africa
  • 1. Introduction to Immunization Strategies
  • 2. Immune Responses to Vaccination
  • 3. Models for Testing Vaccines
  • 4. Immune Escape
  • 5. Grant Writing
  • Introduction to Immuno-Ethiopia
  • 1. Neutrophils
  • 3. Exosomes
  • 5. Immunity to Leishmania
  • 6. Immunity to HIV
  • 7. Immunity to Helminth Infections
  • 8. Immunity to TB
  • 9. Grant Writing
  • Introduction to ONCOIMMUNOLOGY-MEXICO
  • ONCOIMMUNOLOGY-MEXICO Photos
  • 1. Cancer Epidemiology and Etiology
  • 2. T lymphocyte mediated immunity
  • 3. Immune Responses to Cancer
  • 4. Cancer Stem Cells and Tumor-initiating cells.
  • 5. Tumor Microenvironment
  • 6. Pathogens and Cancer
  • 7. Cancer Immunotherapy
  • 8. Flow cytometry approaches in cancer
  • Introduction to the Immunology Course
  • Immuno-Tunisia Photo
  • 1. Overview of the Immune System
  • 2. Role of cytokines in Immunity
  • 3. Tolerance and autoimmunity
  • 4. Genetics, Epigenetics and immunoregulation
  • 5. Microbes and immunoregulation
  • 6. Inflammation and autoinflammation
  • 7. T cell mediated autoimmune diseases
  • 8. Antibody-mediated autoimmune diseases
  • Introduction to the Immunology Symposium
  • Immuno-South Africa Photo
  • 1. Antibody Generation by B cells
  • 2. Mucosal Immunity
  • 3. Immunity to TB
  • 4. Immunity to Malaria
  • 5. Immunity to HIV
  • 6. Defining a Biomarker
  • 7. Grant Writing Exercise
  • Immuno-Colombia Photo
  • 1. Overview of Complement
  • 2. Transplantation
  • 3. Immune Regulation in Pregnancy
  • 4. Breaking Tolerance: Autoimmunity & Dysregulation
  • 5. Mucosal Immunity & Immunopathology
  • 6. Regulation of Immunity & the Microbiome
  • 7. Epigenetics & Modulation of Immunity
  • 8. Primary Immunodeficiencies
  • 9. Anti-tumour Immunity
  • 10. Cancer Immunotherapy
  • 11th IDA 2022 Introduction
  • A Snapshot of the Immune System
  • The Innate Immune System
  • MHC & Antigen Presentation
  • Overview of T Cell Subsets
  • B Cell Activation and Plasma Cell Differentiation
  • Antibody Structure and Classes
  • Immunity to COVID-19
  • Fundamentals of Immunology
  • Fundamentals of Infection
  • Integrating Immunology & Infection
  • Infectious Diseases Symposium
  • EULAR Symposium
  • SUN Honours Introduction
  • Ontogeny of the Immune System
  • Cellular Immunity and Immunological Memory
  • Infectious Diseases Immunology
  • Vaccinology
  • Mucosal Immunity & Immunopathology
  • Central & Peripheral Tolerance
  • Epigenetics & Modulation of Immunity
  • T cell and Ab-mediated autoimmune diseases
  • Immunology of COVID-19 Vaccines
  • AfriBop 2021 Introduction
  • Adaptive Immunity
  • Fundamentals of Infection 2
  • Fundamentals of Infection 3
  • Host pathogen Interaction 1
  • Host pathogen Interaction 2
  • Student 3 minute Presentations
  • 10th IDA 2021 Introduction
  • Day 1 – Lectures
  • Day 2 – Lectures
  • Day 3 – Lectures
  • Day 4 – Lectures
  • Immune Escape by Pathogens
  • Immunity to Viral Infections Introduction
  • Flu, Ebola & SARS
  • Afribop 2020 Introduction
  • WT PhD School Lectures 1
  • EULAR symposium
  • WT PhD School Lectures 2
  • Host pathogen interaction 1
  • Host pathogen interaction 2
  • Bioinformatics
  • Introduction to VACFA Vaccinology 2020
  • Overview of Vaccinology
  • Basic Principles of Immunity
  • Adverse Events Following Immunization
  • Targeted Immunization
  • Challenges Facing Vaccination
  • Vaccine Stakeholders
  • Vaccination Questions Answered
  • Malaria Vaccines
  • Thymic T Cell Development
  • Immune Escape
  • Genetics, Epigenetics and immunoregulation
  • IDA 2018 Introduction
  • Vaccine Development
  • Antiretroviral Drug Treatments
  • Responsible Conduct in Research
  • Methods for Enhancing Reproducibility
  • 6. B Cell Activation and Plasma Cell Differentiation
  • 7. Antibody Structure and Classes
  • CD Nomenclature
  • 1. Transplantation
  • 2. Central & Peripheral Tolerance
  • 8. Inflammation and autoinflammation
  • 9. T cell mediated autoimmune diseases
  • 10. Antibody-mediated autoimmune diseases
  • 1. Primary Immunodeficiencies
  • Cancer Stem Cells and Tumour-initiating Cells
  • 6. Tolerance and Autoimmunity
  • Discovery of the Thymus as a central immunological organ
  • History of Immune Response
  • History of Immunoglobulin molecules
  • History of MHC – 1901 – 1970
  • History of MHC – 1971 – 2011
  • SAIS/Immunopaedia Webinars 2022
  • Metabolic control of T cell differentiation during immune responses to cancer
  • Microbiome control of host immunity
  • Shaping of anti-tumor immunity in the tumor microenvironment
  • The unusual COVID-19 pandemic: the African story
  • Immune responses to SARS-CoV-2
  • Adaptive Immunity and Immune Memory to SARS-CoV-2 after COVID-19
  • HIV prevention- antibodies and vaccine development (part 2)
  • HIV prevention- antibodies and vaccine development (part 1)
  • Immunopathology of COVID 19 lessons from pregnancy and from ageing
  • Clinical representation of hyperinflammation
  • In-depth characterisation of immune cells in Ebola virus
  • Getting to the “bottom” of arthritis
  • Immunoregulation and the tumor microenvironment
  • Harnessing innate immunity from cancer therapy to COVID-19
  • Flynn Webinar: Immune features associated natural infection
  • Flynn Webinar: What immune cells play a role in protection against M.tb re-infection?
  • JoAnne Flynn: BCG IV vaccination induces sterilising M.tb immunity
  • IUIS-Immunopaedia-Frontiers Webinar on Immunology taught by P. falciparum
  • COVID-19 Cytokine Storm & Paediatric COVID-19
  • Immunothrombosis & COVID-19
  • Severe vs mild COVID-19 immunity and Nicotinamide pathway
  • BCG & COVID-19
  • COVID-19 Vaccines
  • Antibody responses and serology testing
  • Flow Cytometry Part 1
  • Flow Cytometry Part 2
  • Flow Cytometry Part 3
  • Lateral Flow
  • Diagnostic Tools
  • Diagnostic Tests
  • HIV Life Cycle
  • ARV Drug Information
  • ARV Mode of Action
  • ARV Drug Resistance
  • Declining CD4 count
  • Influenza Guidelines
  • Meningococcal Disease Guidelines
  • Ambassador of the Month – 2023
  • North America
  • South America
  • Ambassador of the Month – 2022
  • The Day of Immunology 2022
  • AMBASSADOR SCI-TALKS
  • The Day of Immunology 2021
  • Ambassador of the Month – 2021
  • Ambassador of the Month-2020
  • Ambassador of the Month – 2019
  • Ambassador of the Month – 2018
  • Ambassador of the Month – 2017
  • Course Applications
  • OUR PROFILE
  • COLLABORATIONS

We will not share your details

image_pdf

Patient Presentation

Differential diagnosis, examination, investigations, final outcome.

  • Evaluation - Questions & answers

A 2 year old boy presented to a district hospital with decreased oral intake, listlessness and fever. On arrival he was adequately resuscitated but continued to have spiking fevers and a depressed level of consciousness.

Acknowledgement This case study was kindly provided by Barclay Stewart, Medical University of South Carolina, Fogarty International Clinical Research Scholar, Nairobi, Keny a

Six months ago the patient presented to the hospital with a two day history of irritability, decreased appetite, discomfort on lying down, recurrent fever, profuse sweating and diarrhea, no vomiting. On admission he was lethargic and dehydrated which worsened over a few hours and culminated in a seizure. He had no prior history of seizures. He was then diagnosed with severe malaria. He was treated appropriately and discharged 2 weeks later with no residual effects.

Past medical and surgical history

  • There is no additional significant medical or surgical history.
  • Road to health card shows all growth parameters to be within normal limits, with all vaccinations up to date.

Family and social history

  • He lives with his mother, father, and two older siblings who are all healthy.
  • His mother was recently tested and is HIV negative; his father has not been tested.
  • Their home, which has electricity and water, is located in a low-lying area near Musina, a town in South Africa’s Limpopo province. This is the country’s most northerly located town, with a seasonal high rate of malaria transmission from October through May.

Travel History No travel outside of Musina since birth.

  • Encephalitis
  • Gastroenteritis with severe dehydration
  • Toxic Shock Syndrome
  • Typhoid Fever
  • Brucellosis
  • Relapsing Fever
  • Katayama Fever
  • Urinary tract infection
  • Bacteraemia

On appearance the child is miserable and toxic looking.

  • Pulse – 166
  • Respiratory Rate – 34
  • Temperature – 39.8
  • Pulse-Oxygen – 95%

Height and weight were in the 65 percentile

  • Eyes were sunken and jaundiced.
  • No lymphadenopathy
  • Erythematous, non bulging tympanic membranes.
  • Non-inflamed nasal passage, no discharge.
  • Pale oral mucosa
  • No papilloedema
  • No retinal heamorrhages
  • Midline trachea
  • Chest shape normal in appearance, tachypnoea present
  • Mild subcostal retractions.
  • Clear on auscultation bilaterally.

Cardiovascular

  • Tachycardia with a regular rhythm.
  • Normal S1 and S2 with a 2/6 mid systolic murmur best auscultated over the upper left sternal border with minimal radiation.
  • Bounding pulses felt radially, femorally and dorsalis pedis
  • Capillary refill within 2 seconds.
  • Normal on inspection.
  • Bowel sounds diminished but present.
  • No hepatomegaly.
  • 4cm splenomegaly.

Neurological

  • Child listless though attempts to follow commands.
  • Not resisting or crying in response to aggravating stimuli.

malaria_Page_2

Human malaria infection is caused by four protozoa species of the genus Plasmodium. These are P.falciparum, P. malariae, P. vivax, and P. ovalae , of which the preponderance of severe malaria and mortality is due to P.falciparum . Children living in endemic areas typically have a primary malaria episode during their first few years of life and most toddlers and juveniles develop some degree of acquired immunity against severe disease but still experience periodic clinical episodes. Those who survive to adulthood are often clinically immune, however, low grade parasitaemia is often present but causes few symptoms. Adults in endemic areas maintain low-grade infections throughout the transmission season. Endemicity is typically defined as parasitaemia rates or palpable spleens in children aged 2-9 years. The categories include holoendemic where the rate is >75% (transmission of infection is year round and the bulk of mortality is seen in infants), hyperendemic where the rate is 51-75% (mortality is also mostly seen in infants), mesoendemic where the rate is 11-50% (regular seasonal transmission affecting infants, toddlers and adults who develop chronic ill health) and hypoendemic which is <10% (occasional epidemics, whole population is susceptible to severe and fatal disease). Clinical immunity also fails if a person moves away from an endemic area and during pregnancy.

plasmodium falciparum

The female Anopheles mosquito inoculates the host with 10 to 100 malaria sporozoites from her salivary glands during a blood meal. These microscopic motile forms of the malaria parasite are carried via the bloodstream to the liver. Within 30 minutes, those sporozoites not bound by previously formed antibodies, invade and begin replicating in hepatocytes. Parasites not destroyed by cytotoxic T lymphocytes in the liver replicate for 2-10 days creating merozoites. Tens of thousands of merozoites are released into the bloodstream as the hepatocyte bursts. Each merozoite is then able to bind, invade, and infect erythrocytes. After red blood cell (RBC) infection, each merozoite matures to form a highly metabolically active trophozoite, which replicates asexually to become multinucleate schizonts. As the schizonts enlarge they rupture erythrocytes 48 hours after their formation which results in 20-30 new merozoites which continue the cycle. Some sexual forms of the parasite develop during this erythrocytic stage; these gametocytes are responsible for infecting the salivary glands of female Anopheles mosquitoes. The gametes mature into ookinetes then into an oocyst. The oocyst ruptures and releases sporozoites which can then infect another host during a blood meal.

malaria_Page_3

A person’s first infection usually creates no symptoms for 7-10 days, which is followed first by nonspecific symptoms such as headache, fatigue, abdominal discomfort and muscle aches. This is then followed by fever. During this latent period, parasite maturation occurs in the liver and parasites undergo a cycle of blood stage replication. Symptoms begin when the parasites undergoing an asexual blood cycle, reach threshold density sufficient to initiate the host’s pathogenic immune response process. Fever, malaria’s hallmark, is due to parasite-derived molecules released from ruptured host cells. These molecules activate host inflammatory cells, such as macrophages, which secrete pro-inflammatory pyrogenic cytokines such as interleukin (IL)-1 and tumor necrosis factor (TNF)–α. As parasites synchronise their replication cycles the fever becomes periodic. Although childhood febrile convulsions can occur, generalised seizures are typically associated with P.falciparum infections and may herald cerebral malaria. Splenomegaly results from massive reticuloendothelial system activation to clear parasitised erythrocytes. Mild hepatomegally is common in young children, while mild jaundice is more common in adults. Anaemia is also common and is partly due to the phasic rupture of RBCs by mature schizonts, splenic sequestration of red blood cells and ineffective erythropoiesis.

malaria_Page_4

Cerebral Malaria Onset may be gradual or sudden following a convulsion. Features include obtundation, delirium, abnormal behaviour and coma. Focal neurologic signs and meningism do not typically occur. Fifteen percent of children who survive cerebral malaria, especially when associated with hypoglycaemia, coma and anaemia will have some residual neurologic deficit.

Hypoglycaemia Common complication that is associated with a poor prognosis, particularly in children and pregnant women. Hypoglycaemia is due to a failure of hepatic gluconeogenesis and an increase in glucose consumption by host and parasite. This may manifest as an added complication during treatment as Quinine is also a potent stimulator of insulin secretion.

malaria_Page_8

Haematologic Pathology Anaemia due to increased destruction and removal or red blood cells and dyserythropoesis. Mild thrombocytopaenia Mild coagulation abnormalities Bleeding and DIC in more severe cases

Renal pathology Interference in microcirculation resulting in tubular necrosis and acute renal failure, more common in adults.

Host Response-Immunology

malaria_Page_6

  • Antibody responses are induced during the sporozoite stage. Antibody bound sporozoites are prevented from invading hepatocytes.
  • CD8 + T cells have been shown to be cytotoxic against maturing sporozoite infected liver cells.
  • Both of these responses are potentially able to terminate the infection before the onset of clinical disease caused by the release of merozoites from hepatocytes and subsequent RBC invasion and rupture.
  • CD4 + T cells are a requisite for the production of merozoite neutralising antibodies by B cells and the activation of macrophages which secrete interferon (INF) –γ to enhance parasitized RBC.
  • The host is also able to develop transmission-blocking antibodies directed to gametocyte specific antigens. These antibodies hinder the development of the parasite within the mosquito vector, thereby preventing further infections. Though this immune response is not particularly valuable to the infected host, it does assist in reducing population level transmission.

malaria_Page_7

Download images for this case

Plasmodium falciparum malaria.

It is recommended that patients receive prompt and effective treatment. Ideally, treatment should be initiated in a hospital setting. The choice of chemotherapy for malaria is dependent on the severity of disease, the known or suspected resistance pattern of the parasite in the area where the malaria infection was acquired, the species of parasite, patient characteristics (age, pregnancy, co-morbidity, allergies, other medications) and the presence or absence of vomiting. In South Africa, malaria treatment varies in the different provinces due to differences in the resistance patterns. These treatment guidelines may not be appropriate for infections contracted in other countries with high levels of multi-drug resistance.

The patient was treated with IV artesunate and anti-pyretics for 3 days. IV antibiotics were started on admission as there was no confirmatory diagnosis at the time and culture results were not yet available. On the third day the child was markedly improved. He was started on a full course of mefloquine on receiving laboratory results which confirmed infection with P.falciparum. Upon discharge there were no neurologic sequelae. He and his family were counseled on the use of insecticide-treated bed nets and indoor residual spraying.

Guerin, P.J., et al. (2002). Malaria: current status of control, diagnosis, treatment, and a proposed agenda for research and development. Lancet Infect Dis. 2(9): p. 564-73.

Link to Abstract Ferreira, M.U et al. (2004). Antigenic diversity and immune evasion by malaria parasites. Clin Diagn Lab Immunol. 11(6): p. 987-95.

Link to Abstract May, J. et al. (1999). High rate of mixed and subpatent malarial infections in southwest Nigeria. Am J Trop Med Hyg. 61(2): p. 339-43.

Link to Abstract Rosenberg, R. et al. (1990). An estimation of the number of malaria sporozoites ejected by a feeding mosquito. Trans R Soc Trop Med Hyg. 84(2): p. 209-12.

Link to Abstract Ponnudurai, T. et al. (1982). Mosquito transmission of cultured Plasmodium falciparum. Trans R Soc Trop Med Hyg. 76(2): p. 278-9.

Link to Abstract Ferreira, M.U et al. (1998). The IgG-subclass distribution of naturally acquired antibodies to Plasmodium falciparum, in relation to malaria exposure and severity. Ann Trop Med Parasitol. 92(3): p. 245-56.

Link to Abstract Nardin, E.H et al. (1993). T cell responses to pre-erythrocytic stages of malaria: role in protection and vaccine development against pre-erythrocytic stages. Annu Rev Immunol. 11: p. 687-727.

Link to Abstract Nardin, E.H. et al. (1982). Circumsporozoite proteins of human malaria parasites Plasmodium falciparum and Plasmodium vivax. J Exp Med. 156(1): p. 20-30.

Link to Abstract Inselburg, J. (1983). Gametocyte formation by the progeny of single Plasmodium falciparum schizonts. J Parasitol. 69(3): p. 584-91.

Link to Abstract Aitman, T.J. et al. (2000). Malaria susceptibility and CD36 mutation. Nature. 405(6790): p. 1015-6.

Link to Abstract Jenkins, N. et al. (2007). Plasmodium falciparum intercellular adhesion molecule-1-based cytoadherence-related signaling in human endothelial cells. J Infect Dis. 196(2): p. 321-7.

Link to Abstract McCormick, C.J. et al. (1997). Intercellular adhesion molecule-1 and CD36 synergize to mediate adherence of Plasmodium falciparum-infected erythrocytes to cultured human microvascular endothelial cells. J Clin Invest. 100(10): p. 2521-9.

Link to Abstract

Miller, L.H. et al. (2002). The pathogenic basis of malaria. Nature. 415(6872): p. 673-9.

Abdel-Latif, M.S. et al. (2003). Antibodies to Plasmodium falciparum rifin proteins are associated with rapid parasite clearance and asymptomatic infections. Infect Immun. 71(11): p. 6229-33.

Good, M.F. et al. (1998). Pathways and strategies for developing a malaria blood-stage vaccine. Annu Rev Immunol. 16: p. 57-87.

Hoffman, S.L. et al. (1998). Sporozoite vaccine induces genetically restricted T cell elimination of malaria from hepatocytes. Science. 244(4908): p. 1078-81.

Link to Abstract Snewin, V.A et al. (1995). Transmission blocking immunity in Plasmodium vivax malaria: antibodies raised against a peptide block parasite development in the mosquito vector. J Exp Med. 181(1): p. 357-62.

Link to Abstract Hisaeda, H. et al. (2005). Malaria: immune evasion by parasites. Int J Biochem Cell Biol. 37(4): p. 700-6.

Link to Abstract Qari, S.H. et al. (1998). Predicted and observed alleles of Plasmodium falciparum merozoite surface protein-1 (MSP-1), a potential malaria vaccine antigen. Mol Biochem Parasitol. 92(2): p. 241-52.

Link to Abstract Burns, J.M. et al. (1989). A protective monoclonal antibody recognizes a variant-specific epitope in the precursor of the major merozoite surface antigen of the rodent malarial parasite Plasmodium yoelii. J Immunol. 142(8): p. 2835-40.

Link to Abstract Smith, J.D. et al. (1995). Switches in expression of Plasmodium falciparum var genes correlate with changes in antigenic and cytoadherent phenotypes of infected erythrocytes. Cell. 82(1): p. 101-10.

Link to Abstract Flick, K. et al. (2004). var genes, PfEMP1 and the human host. Mol Biochem Parasitol. 134(1): p. 3-9.

Link to Abstract Williamson, W.A. et al. (1978). Impairment of the immune response to vaccination after acute malaria. Lancet. 1(8078): p. 1328-9.

Link to Abstract Takeda, K. et al. (2003). Toll-like receptors. Annu Rev Immunol. 21: p. 335-76.

Link to Abstract Urban, B.C. et al. (1999). Plasmodium falciparum-infected erythrocytes modulate the maturation of dendritic cells. Nature. 400(6739): p. 73-7.

Link to Abstract Ocana-Morgner, C. et al. (2003). Malaria blood stage suppression of liver stage immunity by dendritic cells. J Exp Med. 197(2): p. 143-51.

Link to Abstract Omer, F.M et al. (2003). Differential induction of TGF-beta regulates proinflammatory cytokine production and determines the outcome of lethal and nonlethal Plasmodium yoelii infections. J Immunol. 171(10): p. 5430-6.

Link to Abstract Shevach, E.M. (2002). CD4+ CD25+ suppressor T cells: more questions than answers. Nat Rev Immunol. 2(6): p. 389-400.

Hisaeda, H. et al. (2004). Escape of malaria parasites from host immunity requires CD4+ CD25+ regulatory T cells. Nat Med. 10(1): p. 29-30.

Evaluation – Questions & answers

What is the diagnosis?

With regards to parasitized erythrocytes which endothelial receptors do they bind to resulting in occlusion of microvessels?

What are the three ways that infected erythrocytes can bind to occlude microvessels?

What is the benefit of occlusion of microvessels?

Which organs are most affected by occlusion of microvessels?

Describe the immune response required to neutralize malaria parasites at each stage during their development.

International Union of Immunological Societies

© 2004 - 2024 Immunopaedia.org.za Sitemap - Privacy Policy - Cookie Policy - PAIA - Terms & Conditions

Website designed by Personalised Promotions in association with SA Medical Specialists .

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License .

Creative Commons License

  • CLINICAL CASES
  • ONLINE COURSES
  • OUR AMBASSADORS
  • TREATMENT & DIAGNOSTICS
  • MONTHLY NEWSLETTER

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings
  • Advanced Search
  • Journal List
  • Case Rep Infect Dis
  • v.2021; 2021

Logo of crimid

Congenital Malaria in a 2-Day-Old Neonate: A Case Report and Literature Review

Dickson kajoba.

1 Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Kampala, Uganda

Walufu Ivan Egesa

Habonimana jean petit, muhiadin omar matan, goretty laker, william mugowa waibi, daniel asiimwe.

2 Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University, Kampala, Uganda

Congenital malaria is the presence of malaria parasites in a blood smear obtained from a neonate usually within 24 hours to 7 days of life. It has for long been regarded a rare condition. However, recent data indicate that congenital malaria complicates around 35.9% of live births globally, 0–37% in Sub-Saharan Africa and about 4–6.1% in Eastern Uganda. We present a 2-day-old neonate who presented with fever, irritability, and failure to breastfeed. Laboratory tests indicated that the neonate had a positive Giemsa-stained peripheral smear for Plasmodium falciparum , with a positive malaria rapid diagnostic test (MRDT) for P . falciparum malaria. The mother had a negative peripheral film for malaria and a negative MRDT. The neonate was managed with intravenous artesunate with improvement.

1. Introduction

Uganda remains a highly malaria-endemic country, one of the 6 most affected countries contributing 5% to the global malaria burden [ 1 ]. Children under 5 years and pregnant women are the most affected with children under 5 years contributing an estimated 70% of malaria-related deaths in the country [ 2 ].

Congenital malaria (CM) is defined as a positive blood smear for malaria in a neonate from 24 hours to 7 days of life. This is usually due to maternofoetal transfer of malaria parasites. On the other hand, neonatal malaria is defined by the presence of malaria parasites in peripheral blood within 28 days of life, usually attributable to mosquito bites [ 3 , 4 ]. The maternofoetal transfer of malaria parasites can be reduced if mothers routinely take their intermittent presumptive treatment of malaria during pregnancy with sulfadoxine/pyrimethamine which reduces neonatal mortality by approximately 60% [ 5 ].

CM presents with nonspecific signs and symptoms of fever, anaemia, jaundice, vomiting, lethargy, convulsions, irritability, tachypnoea, respiratory distress, and hepatosplenomegaly which overlap with sepsis syndrome [ 6 ]. Due to a low index of suspicion and nonspecific presentations, it is often wrongly managed as neonatal sepsis, which contributes to mortality and morbidity among neonates [ 7 ].

Neonates have some level of protection from malaria due to passive immunisation from maternal antibodies, presence of foetal haemoglobin, and low iron levels which do not favour growth of plasmodium [ 3 ]. However, as maternal IgG and HbF wane, there is a surge in malaria parasitaemia among the infants [ 8 , 9 ]. The prevalence of congenital malaria may be under-reported due to its nonspecificity in presentation and delay in onset of symptoms. Only 34% of affected neonates become symptomatic within 72 hours of life, while others may present after 3 weeks of life [ 8 ].

Currently, it is estimated that there is a 33.7% global burden of congenital malaria [ 10 ] with Sub-Saharan Africa having a prevalence of 0 to 37% [ 11 ] and a prevalence of 4–6.1% in Eastern Uganda [ 12 , 13 ]. In order to reduce the malaria case incidence and death rate to at least 90%, the World Health Organisation (WHO) came up with Global Technical Strategy for Malaria, 2016–2030. The program launched in 2015 was geared towards eliminating malaria in at least 35 countries and to prevent its reintroduction in all countries that eliminated it [ 14 ].

2. Case Report

We report a case of a male neonate delivered at term by spontaneous vaginal delivery from a lower level health centre, with a birthweight of 3.7 kg. Apgar score was not documented, but the neonate cried immediately after birth. Labour lasted about 8 hours and membranes ruptured just before delivery. Breastfeeding was initiated within the 1 st hour of life and the neonate was suckling well. He passed meconium and urine within the first 24 hours of life.

The neonate was born to a 29-year-old G2P1 + 0 who attended antenatal care 6 times, starting at 3 months. She had been screened for HIV, syphilis, hepatitis B, and urinalysis, and all were negative, with a blood group of A Rhesus D negative. She received tetanus toxoid, Fansidar for malaria prophylaxis, haematinics, and deworming. She reported that the pregnancy was uneventful.

About 36 hours after delivery, the neonate developed a high-grade fever, irritability, poor breastfeeding, and yellowing of eyes and skin. The neonate was managed with unknown oral medication before referral to Jinja Regional Referral Hospital for further management.

At admission, the neonate was conscious, with an axillary temperature of 38.0°C, and jaundice (Kramer stage 2). There was no respiratory distress, no pallor, no dehydration, and no dysmorphic features noted. The systemic physical examination was unremarkable.

Investigations done were as follows:

  • Malaria rapid diagnostic test (MRDT) for P . falciparum was positive; thin blood smear showed P . falciparum malaria species with 1.846 ∗ 10 3 malaria-infected red blood cells.
  • Complete blood count was normal with Hb of 15.2 g/dl, white blood cells 11.79 ∗ 103/ul, and platelet count 244 ∗ 103/ul.
  • Blood group was A Rhesus D negative.
  • Total serum bilirubin was 200.33 umol/l with direct bilirubin 7.48 umol/l.
  • The rapid diagnostic test for P . falciparum was negative, and no haemoparasites were seen on the peripheral smear of maternal blood.

The neonate was initiated on intravenous artesunate at admission, 12 hr and 24 hr later, then once a day for 5 days. Intravenous empiric antibiotics (cloxacillin and cefotaxime) for presumed neonatal sepsis were also administered. After 48 hours of antibiotics, C-reactive protein (CRP) was done and it was nonreactive, and the antibiotics were stopped. Blood culture and sensitivity was not performed for this patient. A peripheral blood smear done on day 5 of antimalarial treatment revealed no malaria parasites. The neonate was discharged after 5 days of artesunate with great improvement. We were not able to follow up the patient after discharge.

3. Discussion

Malaria is a parasitic disease that is transmitted by an infectious female Anopheles mosquito during a blood meal. This is caused by a parasitic protozoan of the genus plasmodium which has 5 different species, with P . falciparum being the most predominant in the Sub-Saharan region [ 1 ]. In this case report, the neonate had P . falciparum as the causative plasmodium species.

In 2019, there were 229 million cases of malaria, with over 94% of an estimated 409,000 deaths globally. More than 94% of all cases and deaths occurred in Sub-Saharan Africa. Children under 5 years are the most vulnerable, and in 2019, they accounted for 67% (274000) of all malaria deaths worldwide [ 15 ].

Congenital malaria is defined as the presence of malarial parasites in the peripheral blood smear of the new born from 24 hours to 7 days of life. However, it can occur beyond 28 days of life confounding with neonatal malaria [ 3 , 6 ]. CM is acquired from the mother, while neonatal malaria is by mosquito inoculation [ 6 ]. Unfortunately, due to its nonspecific presentations and low index of suspicion, CM is often managed as neonatal sepsis, which unwittingly increases hospital stay and neonatal morbidity and mortality [ 7 ].

Babies are believed to have partial protection from malaria in the first few months of life, owing to passively acquired maternal IgG antibodies, the predominance of haemoglobin F (HbF) in their erythrocytes, and the low levels of iron and para-amino benzoic acid (both required for parasite growth) in breast milk [ 3 ]. Despite these factors, newborns and infants less than 12 months of age are one of the most vulnerable groups affected by malaria [ 16 ].

Globally, there is a 33.7% prevalence of congenital malaria with Africa having 39.5%. Furthermore, it is estimated that 40 neonates per 1000 live births will experience clinical malaria during the first 7 days of life [ 10 ]. In Sub -Saharan Africa, the prevalence is estimated to be between 0 and 37% [ 4 ], while in Eastern Uganda, the prevalence of CM is reported to range from 4 to 6.1% [ 12 , 13 ].

The true burden of congenital malaria may be underestimated due to absence of routine screening of newborns with fever, low index of suspicion, absence of specific signs, and symptoms, coupled with the late symptom presentation. Only one-third (34%) of the affected neonates present within 72 hours of life [ 9 , 13 ]. This was the case with our patient who presented with CM within 48 hours of life. On the other hand, delayed presentation of CM has been reported up to 2 months after delivery [ 3 ]. A case report by Rai and colleagues documented a 21-day-old neonate with congenital malaria in Burundi [ 17 ]. This is because transplacentally acquired maternal antibodies delay the onset of symptoms, with symptom occurrence coinciding with half-life of maternal IgG antibodies [ 17 ].

It is recommended therefore that malaria parasite testing be included in the routine screening of febrile babies with suspected septicaemia in malaria-endemic regions [ 18 ]. To maximise the chances of detection, some authors suggest malaria screening irrespective of clinical presentation at delivery, followed by weekly follow up with repeated blood smear up to 4 weeks if the mother was known to have malaria 7 days before delivery [ 9 ]. Neonates with severe illness and parasitaemia should have blood samples taken for culture and, in any case, should be treated with antibiotics as well as antimalarial drugs [ 3 ].

Use of peripheral blood smear with microscopy is the routinely used diagnostic modality for diagnosis of malaria in developing countries [ 13 ], but with the introduction of malaria rapid diagnostic testing (MRDT), there has been found a useful alternative with good sensitivity and specificity for malaria diagnosis including pregnant women and newborns. Polymerase chain reaction (PCR) may have a higher sensitivity for CM. However, it is not readily available in developing countries, except in research settings [ 19 ]. In this case, the MRDT and blood smear for maternal and neonatal blood were negative and positive for P . falciparum, respectively. PCR could have been useful in differentiating between congenital or neonatal malaria since it is very sensitive compared to MRDT and peripheral smear.

Malaria due to P . falciparum should be treated, be it symptomatic or asymptomatic because it is associated with high mortality and morbidity [ 20 ]. However, there are no clear guidelines for treatment of CM [ 9 , 10 ]. Artemisinin-based combination therapy (ACT) is the regimen by WHO, yet there are limited clinical trials particularly in neonates for ACT, and many carry labels restricting its use [ 9 ]. WHO recommends use of same dosages for neonates below 5 kgs as the dosage for neonates weighing 5 kgs [ 16 ]. This however caries a risk of drug over dose in these neonates. Additionally, there is no well-established pharmacokinetics and pharmacodynamics of these antimalarial drugs in neonates with still rapidly evolving physiology. Therefore, parenteral treatment is preferred in neonates and young infants [ 9 ], as was the case in this neonate, where parenteral artesunate was considered.

The prognosis of congenital malaria is variable, depending on when intervention is initiated. In Burkina Faso, Nagalo and colleagues reported that 11.8% of CM-related deaths occurred within an average of 4.8 days from admission, of which 55% of these deaths occurred within 24 hours of admission [ 21 ]. However, timely intervention of the newborn may prevent neonatal morbidity and mortality [ 17 ], as was the case in this neonate.

4. Conclusion

Congenital malaria should be considered as a differential for sepsis in neonates presenting with unexplained fever and failure to breastfeed. There is need to raise awareness of this condition so as to increase diagnostic suspicion and investigatory habit among patients suspected for neonatal sepsis.

Conflicts of Interest

None of the authors have any conflicts of interest.

Got any suggestions?

We want to hear from you! Send us a message and help improve Slidesgo

AI presentation maker

Top searches

Trending searches

case presentation on malaria ppt

black history month

32 templates

case presentation on malaria ppt

27 templates

case presentation on malaria ppt

22 templates

case presentation on malaria ppt

35 templates

case presentation on malaria ppt

15 templates

case presentation on malaria ppt

21 templates

International Malaria Day

International malaria day presentation, free google slides theme and powerpoint template.

Malaria is a disease, often fatal, transmitted by parasites that reach humans through the bite of the female Anopheles mosquito. However, despite its seriousness, it is a preventable and curable condition. Hence the importance of International Malaria Day, a date that serves to raise awareness that the fight to prevent this disease must be constant. Now you can talk about this international day with this creative template that is full of very visual illustrations that will catch the attention of everyone who sees your presentation.

Features of this template

  • 100% editable and easy to modify
  • 35 different slides to impress your audience
  • Contains easy-to-edit graphics such as graphs, maps, tables, timelines and mockups
  • Includes 500+ icons and Flaticon’s extension for customizing your slides
  • Designed to be used in Google Slides and Microsoft PowerPoint
  • 16:9 widescreen format suitable for all types of screens
  • Includes information about fonts, colors, and credits of the resources used

How can I use the template?

Am I free to use the templates?

How to attribute?

Attribution required

Related posts on our blog.

How to Add, Duplicate, Move, Delete or Hide Slides in Google Slides | Quick Tips & Tutorial for your presentations

How to Add, Duplicate, Move, Delete or Hide Slides in Google Slides

How to Change Layouts in PowerPoint | Quick Tips & Tutorial for your presentations

How to Change Layouts in PowerPoint

How to Change the Slide Size in Google Slides | Quick Tips & Tutorial for your presentations

How to Change the Slide Size in Google Slides

Related presentations.

World Malaria Day presentation template

Premium template

Unlock this template and gain unlimited access

International Teachers' Day presentation template

  • Case report
  • Open access
  • Published: 20 April 2018

Neonatal and congenital malaria: a case series in malaria endemic eastern Uganda

  • Peter Olupot-Olupot 1 , 2 , 3 ,
  • Emma I. E. Eregu 1 ,
  • Ketty Naizuli 1 ,
  • Julie Ikiror 1 ,
  • Linda Acom 1 &
  • Kathy Burgoine 1 , 2  

Malaria Journal volume  17 , Article number:  171 ( 2018 ) Cite this article

16k Accesses

12 Citations

2 Altmetric

Metrics details

Congenital malaria is the direct infection of an infant with malaria parasites from their mother prior to or during birth. Neonatal malaria is due to an infective mosquito bite after birth. Neonatal and congenital malaria (NCM) are potentially life-threatening conditions that are believed to occur at relatively low rates in malaria endemic regions. However, recent reports suggest that the number of NCM cases is increasing, and its epidemiology remains poorly described. NCM can mimic other neonatal conditions and because it is thought to be rare, blood film examinations for malaria are not always routinely performed. Consequently, many cases of NCM are likely to be undiagnosed. A retrospective chart review for all neonates admitted with suspected sepsis between January and July 2017 was conducted and noted four cases of NCM since routine malaria testing was introduced as part of standard of care for suspected sepsis at Mbale Regional Referral Hospital Neonatology Unit. This description highlights the need to conduct routine malaria diagnostic testing for febrile neonates in malaria endemic areas, and supports the urgent need to undertake pharmacological studies on therapeutic agents in this population.

Case presentation

Four cases (two congenital malaria cases and two neonatal malaria cases) are described after presenting for care at the Mbale Regional Referral Hospital Neonatal Unit (Mbale RRH-NNU). The maternal age was similar across the cases, but both neonatal malaria cases were born to primigravidae. At presentation three cases had fever and history of fever, but one was hypothermic (34.8 °C) and no history of fever. One case of congenital malaria had low birth weight, while the other was born to an HIV positive mother. Both cases of congenital malaria presented with poor feeding, in addition one of them had clinical jaundice. The neonatal malaria cases presented in the third week compared to the congenital malaria cases that presented within 48 h after birth. All of the cases of NCM were treated with intravenous artesunate. The admitting clinicians also instituted a course of antibiotics empirically to cover against possible bacterial co-infections. All four cases recovered and were discharged alive.

At the Mbale RRH-NNU, the finding of cases of NCM was not expected, therefore, neonates presenting with features of suspected sepsis in malaria endemic settings should be routinely screened for NCM. There is currently a lack of appropriate guidelines for treatment of NCM in the era of artemisinin-based combination therapy (ACT), therefore, efforts to establish the safety profile and efficacy of ACT anti-malarials in neonates to guide development of evidence-based treatment guidelines for NCM are needed.

Uganda remains a malaria high burden country, with eastern Uganda experiencing perennial high malaria transmission with > 100 infective bites per person per year [ 1 , 2 ]. In endemic areas where mothers have acquired considerable immunity to malaria, infection with Plasmodium falciparum during pregnancy does not always cause symptomatic illness [ 3 ]. Congenital malaria results from transplacental transmission of malaria parasites from the mother to the baby in utero or during delivery. Its diagnosis is based upon detection of asexual forms of malaria parasites on a blood smear of the peripheral blood of the newborn, or later if there is no possibility of postpartum infection through infective mosquito bites [ 4 ]. However, these definitions are not precise if time is not tagged to them to enable differentiate congenital from neonatal malaria. Furthermore, precision of definitions would be achieved by using temporal relationship with PCR testing for malaria in the mother and their neonate. The reported incidence of congenital malaria in endemic regions varies widely from 0 to 37% [ 5 , 6 , 7 ]. It is widely believed that the placenta acts as an effective barrier preventing transfer of malaria parasites. However, even in the absence of congenital malaria, placental malaria significantly increase the risk of perinatal morbidity and mortality including low birth weight, intrauterine growth restriction, preterm labour and intrauterine fetal death [ 8 ]. Malaria in pregnancy is estimated to account for 100,000 neonatal deaths annually [ 3 ]. Maternal malaria can be prevented during pregnancy with intermittent presumptive treatment of malaria in pregnancy (IPTp) using sulfadoxine–pyrimethamine, and can reduce neonatal mortality by up to 61% [ 9 ].

It is also possible that maternal immunity to malaria may confer protection to the fetus through transmission of immunoglobulin G antibodies (IgG) against malaria [ 10 ]. The presence of fetal haemoglobin (HbF) in the neonate also prevents high parasitaemia [ 11 ]. However as maternal IgG and HbF in infants diminish with age, the infant’s susceptibility to P. falciparum increases. It is possible that this passive immunity may delay the onset or modify severity of symptoms by up to 6 weeks after birth making it hard to differentiate between congenital and neonatal malaria [ 12 ]. To maximize the chances of early detection of congenital malaria, neonates born to mothers with malaria in the last 7 days before delivery should be investigated with a blood film for malaria parasites irrespective of the clinical picture and weekly thereafter for the first month.

In the eastern region of Uganda, despite perennial malaria transmission, NCM is a rarely reported condition presumably because of low index of suspicion among clinicians, and greater emphasis on the diagnosis and treatment of neonatal sepsis (NS). Although it is recommended that neonates be routinely tested if mother was known to suffer from malaria in the 7 days before delivery, in practice it is often not routine to test neonates for malaria and, therefore, many cases may be missed. In neonates, the historical and most common symptom of malaria is fever [ 13 ]. Other symptoms and signs differ from those in older children with malaria, the clinical features of neonatal and congenital malaria overlap with sepsis syndromes [ 14 ]. Other symptoms can include anaemia, jaundice, diarrhoea, vomiting, lethargy, convulsions, irritability, tachypnoea, respiratory distress, hepatosplenomegaly [ 14 ]. Clinical descriptions and outcomes of NCM remain poorly documented even in malaria endemic areas where descriptions in infants, older children and adults have over the times progressed. More comprehensive descriptions inclusive of NCM are needed, especially from areas with intense transmission, and serially over time.

At Mbale Regional Referral Hospital IPTp is routinely administered to pregnant mothers, however, not all pregnant mothers in the region served by this hospital attend antenatal care. At the hospital NNU there are estimated 200 admissions per month. During the study period June–December 2017 routine blood slides for malaria for all neonates admitted with fever had been introduced. This report is on four cases of NCM that highlight the presenting clinical features and their outcomes in a perennially malaria high transmission area in eastern Uganda. This has shown that malaria is a potentially missed diagnosis or co-morbidity in neonatal illnesses in malaria endemic areas.

In this study congenital was differentiated from neonatal malaria based on the time of presentation from birth. Congenital malaria, as was previously defined, was used to classify cases 1 and 2 (Table  1 ). However, this description modified the definition for neonatal malaria that was applied by Runsewe-Abiodun et al. in Nigeria [ 15 ]. Therefore, for cases 3 and 4 (Table  1 ), this study considered symptoms attributable to malaria with evidence of ring forms of malaria parasite in the erythrocyte of an infant within the 8th–28th days of life. The maternal age was similar across all the 4 cases, range 24–28 years. The two neonatal malaria cases (3 and 4) were born to primigravidae who had no recent history of fever in the 14 days to delivery. Three of the cases presented with fever or history of fever, while one of the congenital cases was hypothermic (34.8 °C), possibly due to the concurrent prematurity. This same infant was also born to an HIV+ mother. Whereas there are many risk factors for preterm deliveries, it is possible that in this mother either the HIV [ 16 ], or antiretroviral drugs [ 17 ], may have contributed to both prematurity and susceptibility to malaria in this baby. The other congenital malaria case had clinical jaundice and pyogenic meningitis. The jaundice in this case 1 was attributed to a number of possible factors including neonatal jaundice, sepsis, malaria or a combination of these. Poor breastfeeding was noted in both congenital cases. All of the cases of NCM were treated with intravenous artesunate 4 mg/kg at 0, 12, 24 h then daily for 7 days. Since sepsis could not be excluded due to lack of laboratory investigative capacity, the admitting clinicians also instituted a course of broad-spectrum antibiotics empirically to cover against possible bacterial infections. All cases recovered and were discharged alive.

Discussion and conclusions

In this case series, a description is made of both congenital and neonatal malaria in a setting that introduced routine neonatal malaria testing in a malaria endemic area. This case series shows that NCM malaria is more common than previously thought [ 18 ]. It is also a reminder that NCM still exists despite IPTp and other malaria preventive measures, and its diagnosis may be missed especially when malaria screening measures are not put in place in NNUs in malaria endemic areas. Other reports suggest that the incidence of NCM may be increasing. Proper descriptions of NCM are important to ensure more comprehensive understanding of the clinical spectrum and outcomes of malaria in neonates. Malaria endemicity has been suggested to play a role in the prevalence of NCM. There are reports suggesting in hyperendemic areas the prevalence of NCM is higher [ 5 , 15 ], while others are contrary [ 7 ]. It is however, plausible epidemiologically that in settings of intense perennial transmission the mothers have developed herd immunity, their newborn babies have protective antibodies to the disease, and therefore the prevalence is negligible [ 10 ]. Some underlying factors may be responsible for the equipoise observed in this case series. For instance, primigravidae are known to have a high risk for malaria compared to multigravidae [ 19 ]. In addition, the role of maternal malaria in congenital malaria infections has been traced to infections in the third trimester [ 15 ]. It is also possible that co-morbidity that damages the placenta in utero may contribute to the risk of the congenital malaria. HIV co-infected pregnant women may have impaired antibody response and have been shown to have a significantly increased risk of placental malaria [ 20 ]. This is consistent with some reports suggesting that HIV increases the chances of vertical transmission of malaria [ 16 , 20 ]. Maternal low age has been reported to influence congenital malaria [ 19 ]. In this series, all the mothers were within the same age range, but their parities differed.

Although rapid malaria tests have been used for the diagnosis of NCM, the gold standard for the diagnosis of NCM is the detection of parasites in the Giemsa-stained peripheral blood smear [ 21 ]. The Mbale RRH-NNU recently introduced routine testing for malaria using blood smears in neonates reporting with signs of sepsis. Consequently, all cases identified with NCM were managed with good outcomes.

On treatment, amodiaquine, chloroquine and sulfadoxine–pyrimethamine have all been successfully used in Nigeria to treat neonates with malaria [ 22 ]. Although artemisinin-based combination therapy (ACT) is the recommended treatment for uncomplicated malaria in infants, the neonates have been largely excluded from ACT clinical trials. There are, therefore, limited data available on the use of ACT in neonates and many of them carry label restrictions for neonates [ 23 ]. For infants weighing less than 5 kg with uncomplicated P. falciparum , the World Health Organization (WHO) recommends treatment with ACT at the same mg/kg body weight dose as for children weighing 5 kg. The WHO acknowledges too that most anti-malarials lack infant formulations, which can lead to either under or over dosing. In addition, infants can deteriorate rapidly therefore there should be a low threshold for parenteral treatment. Many anti-malarials are frequently used off-label based on the dosing schedule for older children [ 24 ], but have not reported evidence of serious toxicity [ 23 ].

Due to the physiological immaturity and rapid changes that occur in neonates, the pharmacokinetic and dynamic (PK/PD) profiles of anti-malarial drugs are likely to be different to older children. Slow gastric emptying, villous formation and intestinal motor activity, which do not mature until week 20 of life, affect the enteral absorption of most medications [ 25 ]. Parenteral treatment is preferable for neonates and young infants. Differentiating congenital from neonatal malaria based on temporal relationship to birth may be strengthened by inclusion of DNA PCR for both the mother and her newborn to determine the source of the infection. But in resource limited areas there are no routine DNA PRC testing services due to prohibitive capital, running and maintenance costs, except in research settings. The temporal characteristic would help interpret the role of physiological immaturity in neonates for future PK/PD studies on anti-malarial drugs in this age group, and how these determine treatment outcomes.

Limitations

This is only a case series with case definitions based on temporal relationships from birth to case presentation. A larger study with capacity to conduct molecular, parasite count and PK/PD testing, and long term follow up would help better refine definitions, outcomes and interpretation of these findings. Nonetheless, this report has been able to demonstrate that NCM still exists. The definitions used have set pace in appropriate description of the spectrum of disease in this age group and will strengthen interpretation of anti-malarial PK/PD studies in this population in relation to the physiological immaturity.

In summary, NCM is an important diagnosis to consider in any newborn with clinical features of NS to a mother in a malaria-endemic area. It is possible that in the absence of routine malaria testing many neonates are dying before malaria is diagnosed. In areas with malaria endemicity the burden of NCM may be underestimated. Malaria test should be incorporated as routine test in neonates with suspected sepsis so as not to miss NCM. Early and correct diagnosis of NCM is crucial as infants are at increased risk of rapid disease progression, severe malaria and death. Additional efforts are needed to establish the safety profile and efficacy of ACT in neonates to guide the development of evidence-based treatment guidelines for NCM. Furthermore, for pregnant mothers who test malaria positive in their late gestational period weekly malaria testing of their babies as follow up mechanism for surveillance of NCM should be done.

Katureebe A, Zinszer K, Arinaitwe E, Rek J, Kakande E, Charland K, et al. Measures of malaria burden after long-lasting insecticidal net distribution and indoor residual spraying at three sites in Uganda: a prospective observational study. PLoS Med. 2016;13:e1002167.

Article   PubMed   PubMed Central   Google Scholar  

Kilama M, Smith DL, Hutchinson R, Kigozi R, Yeka A, Lavoy G, et al. Estimating the annual entomological inoculation rate for Plasmodium falciparum transmitted by Anopheles gambiae s.l. using three sampling methods in three sites in Uganda. Malar J. 2014;13:111.

Eisele TP, Larsen DA, Walker N, Cibulskis RE, Yukich JO, Zikusooka CM, et al. Estimates of child deaths prevented from malaria prevention scale-up in Africa 2001–2010. Malar J. 2012;11:93.

Menendez C, Mayor A. Congenital malaria: the least known consequence of malaria in pregnancy. Semin Fetal Neonatal Med. 2007;12:207–13.

Article   PubMed   Google Scholar  

Ekanem AD, Anah MU, Udo JJ. The prevalence of congenital malaria among neonates with suspected sepsis in Calabar, Nigeria. Trop Doct. 2008;38:73–6.

Article   CAS   PubMed   Google Scholar  

Lehner PJ, Andrews CJ. Congenital malaria in Papua New Guinea. Trans R Soc Trop Med Hyg. 1988;82:822–6.

Quinn TC, Jacobs RF, Mertz GJ, Hook EW 3rd, Locklsey RM. Congenital malaria: a report of four cases and a review. J Pediatr. 1982;101:229–32.

Osungbade KO, Oladunjoye OO. Prevention of congenital transmission of malaria in sub-Saharan African countries: challenges and implications for health system strengthening. J Trop Med. 2012;2012:648456.

Menendez C, Bardaji A, Sigauque B, Sanz S, Aponte JJ, Mabunda S, et al. Malaria prevention with IPTp during pregnancy reduces neonatal mortality. PLoS ONE. 2010;5:e9438.

Riley EM, Wagner GE, Akanmori BD, Koram KA. Do maternally acquired antibodies protect infants from malaria infection? Parasite Immunol. 2001;23:51–9.

Billig EM, McQueen PG, McKenzie FE. Foetal haemoglobin and the dynamics of paediatric malaria. Malar J. 2012;11:396.

Mohan K, Mr BJ, Singh RD, Maithani MM, Chaurais RN. The clinico-hematological features and management outcome in neonatal malaria: a nine years analysis from North India. Curr Ped Rev. 2016;12:286–91.

Article   Google Scholar  

Covell G. Congenital malaria. Trop Dis Bull. 1950;47:1147–67.

CAS   PubMed   Google Scholar  

D’Alessandro U, Ubben D, Hamed K, Ceesay SJ, Okebe J, Taal M, et al. Malaria in infants aged less than six months—is it an area of unmet medical need? Malar J. 2012;11:400.

Runsewe-Abiodun IT, Ogunfowora OB, Fetuga BM. Neonatal malaria in Nigeria—a 2 year review. BMC Pediatr. 2006;6:19.

Zack RM, Golan J, Aboud S, Msamanga G, Spiegelman D, Fawzi W. Risk factors for preterm birth among HIV-infected Tanzanian women: a prospective study. Obstet Gynecol Int. 2014;2014:261689.

Powis KM, Kitch D, Ogwu A, Hughes MD, Lockman S, Leidner J, et al. Increased risk of preterm delivery among HIV-infected women randomized to protease versus nucleoside reverse transcriptase inhibitor-based HAART during pregnancy. J Infect Dis. 2011;204:506–14.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Mukhtar M. The growing incidence of neonatal malaria–a situational review in developing countries. Niger J Med. 2007;16:25–30.

Kochar DK, Thanvi I, Joshi A, Subhakaran, Aseri S, Kumawat BL. Falciparum malaria and pregnancy. Indian J Malariol. 1998;35:123–30.

Perrault SD, Hajek J, Zhong K, Owino SO, Sichangi M, Smith G, et al. Human immunodeficiency virus co-infection increases placental parasite density and transplacental malaria transmission in Western Kenya. Am J Trop Med Hyg. 2009;80:119–25.

PubMed   PubMed Central   Google Scholar  

Falade C, Mokuolu O, Okafor H, Orogade A, Falade A, Adedoyin O, et al. Epidemiology of congenital malaria in Nigeria: a multi-centre study. Trop Med Int Health. 2007;12:1279–87.

Hyacinth HI, Oguche S, Yilgwan CS. Summary description of 24 cases of neonatal malaria seen at a tertiary health center in Nigeria. Iran J Pediatr. 2012;22:87–91.

World Health Organization. Guidelines for the treatment of malaria. Geneva: World Health Organization; 2010.

Google Scholar  

Larru B, Molyneux E, Ter Kuile FO, Taylor T, Molyneux M, Terlouw DJ. Malaria in infants below six months of age: retrospective surveillance of hospital admission records in Blantyre, Malawi. Malar J. 2009;8:310.

Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental pharmacology—drug disposition, action, and therapy in infants and children. N Engl J Med. 2003;349:1157–67.

Download references

Authors’ contributions

EIEE, KN, JI, LA and KB—collected the data and participated in writing the manuscript; P-OO—conceived the idea and wrote the manuscript. All authors read and approved the final manuscript.

Acknowledgements

The authors acknowledge Mbale Regional Referral Hospital, Mbale Clinical Research Institute and all staff at the Mbale RRH-NNU for their various contributions to this work.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The study data is available on personal request to the corresponding author.

Consent to publish

The Mbale Clinical Research Institute (MCRI, http://www.mcri.ac.ug ), a research entity affiliated to the Uganda National Health Research Organization (UNHRO), permits the publication of this manuscript.

Ethics approval and consent to participate

The Mbale Regional Referral Hospital Research & Ethics Committee (MRRH-REC) approved the study and local permission to conduct the study was obtained from Mbale Regional Referral Hospital.

This study was conducted within the provisions of ethical standards in Uganda.

This study was not funded.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author information

Authors and affiliations.

Neonatal Unit, Mbale Regional Referral Hospital, P.O. Box 1966, Mbale, Uganda

Peter Olupot-Olupot, Emma I. E. Eregu, Ketty Naizuli, Julie Ikiror, Linda Acom & Kathy Burgoine

Mbale Clinical Research Institute, Mbale, Uganda

Peter Olupot-Olupot & Kathy Burgoine

Busitema University, Faculty of Health Sciences, Mbale Campus, Mbale, Uganda

Peter Olupot-Olupot

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Peter Olupot-Olupot .

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Olupot-Olupot, P., Eregu, E.I.E., Naizuli, K. et al. Neonatal and congenital malaria: a case series in malaria endemic eastern Uganda. Malar J 17 , 171 (2018). https://doi.org/10.1186/s12936-018-2327-0

Download citation

Received : 15 February 2018

Accepted : 18 April 2018

Published : 20 April 2018

DOI : https://doi.org/10.1186/s12936-018-2327-0

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Congenital malaria
  • Neonatal malaria
  • Clinical features

Malaria Journal

ISSN: 1475-2875

case presentation on malaria ppt

IMAGES

  1. Malaria KS5 Powerpoint

    case presentation on malaria ppt

  2. Malaria Presentation PPT Template and Google Slides

    case presentation on malaria ppt

  3. Get Now! Malaria PowerPoint Presentation Templates Slide

    case presentation on malaria ppt

  4. Malaria Disease PPT Template For Google Slides Presentation

    case presentation on malaria ppt

  5. Elegant World Malaria Day PPT Template Slide Design

    case presentation on malaria ppt

  6. Malaria PowerPoint Presentation Free Download Google Slides

    case presentation on malaria ppt

COMMENTS

  1. Malaria Case Study Presentation

    Download the "Malaria Case Study" presentation for PowerPoint or Google Slides. A clinical case is more than just a set of symptoms and a diagnosis. It is a unique story of a patient, their experiences, and their journey towards healing. Each case is an opportunity for healthcare professionals to exercise their expertise and empathy to help ...

  2. A Case of Plasmodium Falciparum Malaria Presentation : Medicine

    Malaria is a frequent parasitic infection prevalent in Africa. Around 300 million are infected annually in Africa by malaria and 1 to 2 million will die from the disease. 1 Of the 4 human parasitic species that have been identified, Plasmodium falciparum has been known to cause significant morbidity and mortality, particularly in children and ...

  3. Case Report: An 11-year-old boy with Plasmodium falciparum malaria and

    Case presentation. An 11-year-old boy from the northern part of Thailand near the Thai-Burmese border was admitted to the Chiang Mai University Hospital (CMUH) due to sustained fever for 10 days prior to admission. ... This is the first case report of malaria and dengue co-infection reported in Thailand. 11 12 In this case, we recognised this ...

  4. CDC

    Clinical Case Study 1: Fever 6 months after a visit to Pakistan. A 44-year-old man is seen at a physician's office in the United States, during a week-end, for suspected malaria. The patient was born in Pakistan but has lived in the United States for the past 12 years. He travels frequently back to Pakistan to visit friends and relatives.

  5. Malaria Disease Google Slides theme & PowerPoint template

    Free Google Slides theme and PowerPoint template. If you want to explain some details about malaria, use this medical presentation. Provide some explanations about its diagnosis, recommendations, pathology, treatments and conclusions. It's very creative and full of cartoons.

  6. PDF Malaria

    Disease Burden •Between 2000 and 2015, malaria incidence fell by 37% globally; during the same period, malaria mortality rates decreased by 60%. An estimated 6.2 million malaria deaths have been averted globally since 2000. •Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden. In 2015, the region was home to 89% of malaria cases and 91% of ...

  7. PDF Review of Malaria Diagnosis and Treatment in the United States

    Clinical characteristics of locally acquired mosquito-transmitted malaria — U.S., May-July 2023. All 8 individuals were adults and had fever. 7/8 (88%) individuals were hospitalized. All 8 individuals received oral antimalarial treatment. All received treatment to prevent future disease relapse.

  8. A 38-year-old man with fever and a history of malaria

    The clinical presentation in this patient raises concern for infection with P. vivax, which is the most common species causing symptomatic malaria that presents six months or more after a patient leaves an endemic area. 1, 2 Plasmodium vivax caused nearly 20% of all cases of malaria in patients presenting to travel clinics in Canada 6 and 24% ...

  9. A Case of Plasmodium Falciparum Malaria Presentation

    Malaria is a frequent parasitic infection prevalent in Africa. Around 300 million are infected annually in Africa by malaria and 1 to 2 million will die from the disease. 1 Of the 4 human parasitic species that have been identified, Plasmodium falciparum has been known to cause significant morbidity and mortality, particularly in children and ...

  10. PDF A framework for malaria elimination

    Reduce malaria case incidence globally compared with 2015 >40% >75% >90% 3. Eliminate malaria from countries in which malaria was transmitted in 2015 At least 10 countries ... PowerPoint Presentation Author: PILLON, Camille Created Date: 5/26/2017 1:30:25 PM ...

  11. Pest-Borne Diseases: Malaria

    Whether the presentation is dedicated to medical professionals or an informative presentation, this simple but effective template will help you. The cream-toned, decorated slides of malaria-transmitting mosquitoes (those infected by the Plasmodium parasite) are full of resources to organize your content. And if you need help, read the included ...

  12. PDF TRAINING MODULE ON MALARIA ELIMINATION

    from the rates in 2015 and eliminating malaria from 10 countries in 2020, 20 countries in 2025 and 30 countries in 2030. Elimination of malaria is defined as the reduction to 0 of the incidence of locally acquired infection from human malaria parasites in a defined geographical area as a result of deliberate efforts.

  13. A Case of Plasmodium falciparum Malaria Treated with Artesunate in a 55

    Her GCS score after 3 h of presentation was 10/15 (E2V3M3), and she had to be intubated and mechanically ventilated in the ED for acute hypoxemic respiratory failure and transferred to the Intensive Care Unit (ICU). ... The patient presented in this case had severe malaria, specifically cerebral malaria, 18 days after returning to the United ...

  14. Malaria powerpoint slides FINAL

    Malaria powerpoint slides FINAL. Malaria powerpoint slides FINAL_5.2.2015.pptx.

  15. Severe P.falciparum Malaria Case Study

    Patient Presentation. A 2 year old boy presented to a district hospital with decreased oral intake, listlessness and fever. On arrival he was adequately resuscitated but continued to have spiking fevers and a depressed level of consciousness. ... These manifestations, which were also seen in this clinical case, include: Cerebral Malaria Onset ...

  16. Congenital Malaria in a 2-Day-Old Neonate: A Case Report and Literature

    1. Introduction. Uganda remains a highly malaria-endemic country, one of the 6 most affected countries contributing 5% to the global malaria burden [].Children under 5 years and pregnant women are the most affected with children under 5 years contributing an estimated 70% of malaria-related deaths in the country [].Congenital malaria (CM) is defined as a positive blood smear for malaria in a ...

  17. Presentation: Malaria Champions, rethinking process

    This year (2022), the Malaria Champions Committee has reviewed the initiative to better respond to current and future challenges, taking into account the new Malaria Elimination Action Plan 2021-2025. The need to promote more sustained actions, stimulate greater diversity of champions and greater appropriation by different actors in the countries, as well as promote improvements in the use of ...

  18. Malaria Powerpoint by alfred nerida

    MALARIA. -Research scientists have been trying to develop an effective vaccine for more than 50 years. -Malaria is cause by a one-celled organism called Plasmodium. -Some symptoms of malaria isfever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting,diarrhea ,and may cause anemia. -Discovered ...

  19. International Malaria Day

    Free Google Slides theme and PowerPoint template. Malaria is a disease, often fatal, transmitted by parasites that reach humans through the bite of the female Anopheles mosquito. However, despite its seriousness, it is a preventable and curable condition. Hence the importance of International Malaria Day, a date that serves to raise awareness ...

  20. Neonatal and congenital malaria: a case series in malaria endemic

    In this study congenital was differentiated from neonatal malaria based on the time of presentation from birth. Congenital malaria, as was previously defined, was used to classify cases 1 and 2 (Table 1).However, this description modified the definition for neonatal malaria that was applied by Runsewe-Abiodun et al. in Nigeria [].Therefore, for cases 3 and 4 (Table 1), this study considered ...

  21. Guideline WHO Guidelines for malaria

    1.ABBREVIATIONS 2. EXECUTIVE SUMMARY. 2.1 . Guideline Translations. 3. INTRODUCTION 4.PREVENTION 4.1 Vector control 4.1.1 Interventions recommended for large-scale deployment

  22. Analysis, Interpretation, and Presentation of Malaria Data

    Module 8: Analysis, Interpretation, and Presentation of Malaria Data 95 Ratio Definition: A ratio is a comparison of two numbers, expressed in one of the following ways: "a to b," "a per b," or "a:b." Examples: • Two household members per (one) mosquito net • Women are slightly more likely to sleep under an ITN than men, with a ratio of 1.2:1.

  23. 5 Of The Best AI Presentation Tools To Replace PowerPoint In 2024

    Read on for a round-up of five of the best AI-powered presentation design tools: 1. Beautiful.ai. Beautiful.ai is a software that enables you to create stunning presentations without it being time ...

  24. Malaria Presentation by Sidney Patel

    Malaria is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness. Malaria was eliminated from the United States in the early 1950's but approximately 1,500-2,000 ...