BackgroundCongenital malaria is usually defined as the detection of asexual forms of Plasmodium spp. in a blood sample of a neonate during perinatal age if there is no possibility of postpartum infection by a mosquito bite. The incidence of congenital malaria is highly variable and seems related to several factors, such as different diagnostic methods for Plasmodium spp. detection, and area in which the epidemiologic analyses are performed. In non-endemic countries, cases of congenital malaria are rare. Hereby, a case of a congenital malaria in an HIV exposed child is reported.Case presentationA 2-month-old male child was admitted to Bambino GesU Children's Hospital due to anaemia and exposure to HIV. He was born prematurely in Italy by cesarean section at 34weeks' gestation after a bicorial, biamniotic pregnancy by a migrant woman from Nigeria. He was the first of non-identical twins. Combined with anaemia, spleen and liver enlargement was noted, malaria was hypothesized. Malaria laboratory panel was performed on the newborn, mother and other twin blood samples, as follows: (i) malaria rapid diagnostic test (RDT); (ii) Giemsa-stained thick and thin blood smears for Plasmodium spp. identification and parasitaemia titration; (iii) molecular screening and typing of Plasmodium spp. by multiplex qualitative PCR assay based on 18S rRNA gene. Genotyping of Plasmodium falciparum isolates from mother and child was performed by neutral microsatellite and highly polymorphic marker amplification.ConclusionsThe maternal RDT sample was negative, while the infant RDT was positive; in both cases microscopy of blood smears and PCR showed infection with P. falciparum. Two of the genotypic molecular markers displayed different allelic variants between the two samples. This difference could imply infection multiplicity of the mother during the pregnancy, possibly harbouring more than one isolate, only one of them being transmitted to the newborn while the other persisting in the mother's blood. Because of the increasing number of pregnant women coming from endemic areas for malaria, an accurate anamnesis of infant's mother, and the inclusion of Plasmodium spp. research into TORCH screenings for mother-infant pair at birth, aiming at reducing morbidity and mortality associated to the disease might be suitable.

Romani, L., Pane, S., Severini, C., Menegon, M., Foglietta, G., Bernardi, S., et al. (2018). Challenging diagnosis of congenital malaria in non-endemic areas 11 Medical and Health Sciences 1108 Medical Microbiology. MALARIA JOURNAL, 17(1) [10.1186/s12936-018-2614-9].

Challenging diagnosis of congenital malaria in non-endemic areas 11 Medical and Health Sciences 1108 Medical Microbiology

Pane S.;Palma P.;
2018-01-01

Abstract

BackgroundCongenital malaria is usually defined as the detection of asexual forms of Plasmodium spp. in a blood sample of a neonate during perinatal age if there is no possibility of postpartum infection by a mosquito bite. The incidence of congenital malaria is highly variable and seems related to several factors, such as different diagnostic methods for Plasmodium spp. detection, and area in which the epidemiologic analyses are performed. In non-endemic countries, cases of congenital malaria are rare. Hereby, a case of a congenital malaria in an HIV exposed child is reported.Case presentationA 2-month-old male child was admitted to Bambino GesU Children's Hospital due to anaemia and exposure to HIV. He was born prematurely in Italy by cesarean section at 34weeks' gestation after a bicorial, biamniotic pregnancy by a migrant woman from Nigeria. He was the first of non-identical twins. Combined with anaemia, spleen and liver enlargement was noted, malaria was hypothesized. Malaria laboratory panel was performed on the newborn, mother and other twin blood samples, as follows: (i) malaria rapid diagnostic test (RDT); (ii) Giemsa-stained thick and thin blood smears for Plasmodium spp. identification and parasitaemia titration; (iii) molecular screening and typing of Plasmodium spp. by multiplex qualitative PCR assay based on 18S rRNA gene. Genotyping of Plasmodium falciparum isolates from mother and child was performed by neutral microsatellite and highly polymorphic marker amplification.ConclusionsThe maternal RDT sample was negative, while the infant RDT was positive; in both cases microscopy of blood smears and PCR showed infection with P. falciparum. Two of the genotypic molecular markers displayed different allelic variants between the two samples. This difference could imply infection multiplicity of the mother during the pregnancy, possibly harbouring more than one isolate, only one of them being transmitted to the newborn while the other persisting in the mother's blood. Because of the increasing number of pregnant women coming from endemic areas for malaria, an accurate anamnesis of infant's mother, and the inclusion of Plasmodium spp. research into TORCH screenings for mother-infant pair at birth, aiming at reducing morbidity and mortality associated to the disease might be suitable.
2018
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA
English
Congenital malaria
HIV
Bicorial
biamniotic pregnancy
Malaria laboratory panel
Plasmodium falciparum genotyping
Romani, L., Pane, S., Severini, C., Menegon, M., Foglietta, G., Bernardi, S., et al. (2018). Challenging diagnosis of congenital malaria in non-endemic areas 11 Medical and Health Sciences 1108 Medical Microbiology. MALARIA JOURNAL, 17(1) [10.1186/s12936-018-2614-9].
Romani, L; Pane, S; Severini, C; Menegon, M; Foglietta, G; Bernardi, S; Tchidjou, Hk; Onetti Muda, A; Palma, P; Putignani, L
Articolo su rivista
File in questo prodotto:
File Dimensione Formato  
Challenging diagnosis of congenital malaria in non-endemic areas 11 Medical and Health Sciences 1108 Medical Microbiology.pdf

solo utenti autorizzati

Licenza: Copyright dell'editore
Dimensione 1.37 MB
Formato Adobe PDF
1.37 MB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/281483
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 5
  • ???jsp.display-item.citation.isi??? 4
social impact