Plasmodium Falciparum neonatal malaria with atypical presentation: A case series from southwestern Ethiopia

Abstract

Abstract Introduction: Neonatal malaria detection of asexual stages of plasmodium species within the first 28 days of life. It can be congenital or acquired through mosquito bites or blood transfusions. Neonatal malaria is generally considered to be rare due to the multiple innate and acquired physiological protective effects present in neonates. However, in areas where malaria is endemic, the prevalence of malaria in neonates is high. The predominant clinical feature of malaria in neonates is fever. respiratory distress, pallor and anemia, hepatomegaly, refusal to feed, jaundice and diarrhea can be manifestations. Atypical presentations without fever can lead to inaccurate diagnosis and contribute to neonatal morbidity and mortality. Neonates from endemic areas with any of the above symptoms should be screened for malaria. Case presentation: We present a series of three cases of Neonatal plasmodium falciparum malaria Presented atypically without febrile episodes, who were diagnosed at Mizan-Tepi University Teaching Hospital between July and September 2023. The first patient presented with vomiting, refusal to feed, pallor, severe anemia, and splenomegaly. The second patient presented with an inconsolable cry, failure to pass feces, abdominal distention, and anemia. The third patient presented with vomiting and anemia. All patients received a 7-day course of intravenous artesunate; the first patient also received a blood transfusion. All patients recovered and were discharged. Conclusions Partial immunity resulting from repeated malaria infections in endemic regions may result in the transfer of high levels of maternal Immunoglobulin G (IgG) antibodies through the placenta, which bind to various plasmodial components and can produce different atypical clinical presentations. In malaria-endemic areas, neonates presenting with any of the presenting signs and symptoms of malaria, including afebrile presentation, require malaria screening to avoid delays in diagnosis.