Congenital malarial disease due to Plasmodium falciparum in high-infectious-risk newborn

The aim of this work was to differentiate in an endemic area congenital mal aria diseases (CMD) from congenital malaria infestations (CMI) or other mat ernal-fetal infections. Methods. - Four hundred and seventy-five newborn (0-7 d) suspected of infec tion were prospectively studied. CMD was diagnosed when clinical manifestat ions were associated with positive thick and thin blood films in a mother a nd her newborn. The diagnosis of CMI was retained when despite positive par asitemia, no clinical manifestations were observed. Results. - Forty newborns (1.7% of the cases of maternal malaria) were diag nosed as CMD and ninety-one (19% of live births) were considered as CMI. Th e main clinical manifestations were related to cerebral (100%), respiratory (95%) and hemodynamic (90%) systems. Hematologic signs were present in 95% of cases. The level of parasitemia varied from 700 to 3,000 parasites/mL i n CMD and from 360 to 870 parasites/mL in CMI. Death occurred in ten cases (25%) of CMD. Conclusion. - In this malaria-endemic area, neither clinical manifestions n or parasitemia allow one to distinguish CMD from CMI associated with bacter ial materno-fetal infections. Studying placental or systemic immunity and a ntimalaria IgM in the newborn could be of interest to clarify this problem. (C) 2000 Editions scientifiques et medicales Elsevier SAS.