DOI: 10.36347/sjmcr.2016.v04i05.010

Pages: 315-317

Congenital malaria is thought to be rare in neonates even in malaria endemic regions. Recent reports from Africa suggest that the incidence of congenital / neonatal malaria is rising, possibly due to the increased resistance and virulence of the parasite resulting from altered antigenic determinants as well as increased reporting. The clinical features of congenital malaria are non-specific and overlap with those of sepsis. The typical malaria paroxysm is absent, with the infant instead having fever, refusal to suck, excessive crying and irritability, and anaemia. In contrast to unconjugated hyperbilirubinemia, which can be physiologic, cholestasis (conjugated bilirubin elevation of any degree) in the neonate is always pathologic and prompt differentiation is imperative the clinical features of any form of cholestasis are similar. In an affected neonate, the diagnosis of certain entities, such as galactosemia, sepsis, or hypothyroidism, is relatively simple. In most cases, the cause of cholestasis is more obscure. Differentiation among biliary atresia, idiopathic neonatal hepatitis, and intrahepatic cholestasis is particularly difficult. Congenital P.vivax malaria is generally not considered while evaluating a case of Neonatal cholestasis; however, the presenting signs and symptoms should also alert the clinician to consider congenital malaria in the appropriate clinical setting. Since many of the classic features of malaria such as chills and sweating may not be observed in these patients, the diagnosis of congenital malaria must be suspected and daily examination of thick and thin smears / malaria antigen rapid kit test should be done for evidence of intracellular parasites.