Congenital malaria in Urabá, Colombia

<p>Abstract</p> <p>Background</p> <p>Congenital malaria has been considered a rare event; however, recent reports have shown frequencies ranging from 3% to 54.2% among newborns of mothers who had suffered malaria during pregnancy. There are only a few references concerning the epidemiological impact of this entity in Latin-America and Colombia.</p> <p>Objective</p> <p>The aim of the study was to measure the prevalence of congenital malaria in an endemic Colombian region and to determine some of its characteristics.</p> <p>Methods</p> <p>A prospective, descriptive study was carried out in the mothers who suffered malaria during pregnancy and their newborns. Neonates were clinically evaluated at birth and screened for <it>Plasmodium spp</it>. infection by thick smear from the umbilical cord and peripheral blood, and followed-up weekly during the first 21 days of postnatal life through clinical examinations and thick smears.</p> <p>Results</p> <p>116 newborns were included in the study and 80 umbilical cord samples were obtained. Five cases of congenital infection were identified (four caused by <it>P. vivax </it>and one by <it>P. falciparum</it>), two in umbilical cord blood and three in newborn peripheral blood. One case was diagnosed at birth and the others during follow-up. Prevalence of congenital infection was 4.3%. One of the infected newborns was severely ill, while the others were asymptomatic and apparently healthy. The mothers of the newborns with congenital malaria had been diagnosed with malaria in the last trimester of pregnancy or during delivery, and also presented placental infection.</p> <p>Conclusions</p> <p>Congenital malaria may be a frequent event in newborns of mothers who have suffered malaria during pregnancy in Colombia. An association was found between congenital malaria and the diagnosis of malaria in the mother during the last trimester of pregnancy or during delivery, and the presence of placental infection.</p

Epidemiologia de la malaria falciparum complicada: estudio de casos y controles en Tumaco y Turbo, Colombia, 2003 The epidemiology of complicated falciparum malaria: case and controls study in Tumaco and Turbo, Colombia, 2003

OBJETIVOS: Identificar aspectos del hospedero, del parásito y del ambiente asociados con ocurrencia de malaria por Plasmodium falciparum complicada. MÉTODOS: Estudio de casos y controles en pacientes de Tumaco y Turbo (Colombia) aplicando los criterios de complicación de la Organización Mundial de la Salud. RESULTADOS: Entre noviembre 2002 y julio 2003 se captaron 64 casos (malaria complicada) y 135 controles (malaria no complicada). Las complicaciones fueron: hiperparasitemia (40%), falla hepática (36%), síndrome dificultad respiratoria aguda (7%), falla renal (4%), trombocitopenia grave (3%), anemia grave (2%), malaria cerebral (2%) e hipoglicemia grave (1%). Se encontraron como factores de riesgo para malaria falciparum complicada: a) Los antecedentes de malaria falciparum durante el último año fueron menores en los casos (OR= 7.0 (1.2-43.6) P=0.019); b) Mayor uso previo de antimaláricos en los casos (OR=2.2 (1.1-4.4) P=0.031) y c) mayor uso de cloroquina en los casos (OR=7.4 (1.1-7.8) P=0.017). Se hallaron los alelos MAD-20 y K1 del gen msp1 y FC-27 e IC-1 del gen msp2, cuya distribución de frecuencias fue similar entre casos y controles, aunque el alelo K1 mostró una variación importante entre grupos (casos: 9.4%, controles: 3.5%). La frecuencia de "signos de peligro" fue significativamente mayor en los casos (OR= 3.3, (1.5-7.4) P=0.001). Los criterios de complicación malárica de la Organización Mundial de la Salud se comparan con otros y se discuten algunas implicaciones. CONCLUSIÓN: Se identificaron como factores de riesgo para malaria falciparum complicada, la ausencia de antecedentes de malaria falciparum en el último año y el uso de antimaláricos antes de llegar al hospital.<br>OBJECTIVES: Aimed at identifying host and parasite aspects associated to the presence of Plasmodium falciparum complicated malaria. METHODS: Case and controls study in patients from Tumaco and Turbo (Colombia). We used the World Health Organization criteria to assess the presence of complicated malaria. RESULTS: A total 64 cases and 135 controls were included between November 2002 and July 2003. Observed complications were hyperparasitaemia (40%), liver failure (36%), adult respiratory distress syndrome (7%), renal failure (4%), severe thrombocytopenia (3%), severe anemia (2%), cerebral malaria (2%) and severe hypoglicemia (1%). Were identified as risk factors: a) falciparum malaria history in the previous year was lower in the cases (OR= 7.0 (1.2-43.6) P=0.019), b) the high use by the cases of antimalarials (OR=2.2, (1.1-4.4) P=0.031) and c) the high use of chloroquine by the cases (OR=7.4 (1.1-7.8), P=0.017) before attending to the hospital. Presence of P. falciparum alleles MAD-20 and K1 (msp1 gene), FC-27 and IC-1 (msp2 gene) was confirmed. No significant differences were observed in the presence of these alleles; however K1 was more frequent in cases (9.4%) than in controls (3.5%). The frequency of danger signs during the disease was significantly greater in the cases (OR= 3.3 (1.5-7.4) P=0.001). The World Health Organization criteria for complicated malaria are compared with others and some implications are discussed. CONCLUSION: They were identified as risk factors for complicated falciparum malaria, the absence of falciparum malaria antecedents in the last year and the use of antimalarials before attending to the hospital