Congenital Malaria in a 20-Day-Old Neonate: A Case Report and Literature Review

Misganu Teshoma Regasa,1 Tesfaye Shibiru,2 Temesgen Tilahun,3 Gedefa Bayisa,4 Gemechis Kebede Negari2 1Department of Midwifery, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia; 2Department of Pediatrics and Child Health, School of Medicine, Wallaga University, Nekemte, Ethiopia; 3Department of Obstetrics & Gynecology, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia; 4Emergency Quality Officer, Wallaga. University Referral Hospital, Wallaga University, Nekemte, EthiopiaCorrespondence: Misganu Teshoma Regasa, Department of Midwifery, Institute of Health Sciences, Wallaga University, P.O Box: 395, Nekemte, Ethiopia, Tel +251917674952, Email [email protected]: Congenital malaria is a relatively rare condition where the Plasmodium parasite is transmitted from the mother to the fetus during pregnancy. It is associated with a high fatality rate if it is not promptly diagnosed and treated.Case Summary: We report an unusual case of a 20-day-old male baby with Plasmodium vivax malaria from Western Ethiopia, suspected primarily on the basis of positive maternal history that mother had attacks of malaria in the 3rd, 5th, and 8th months of gestation and was cured with artemether-lumefantrine therapy. Infant presented with vomiting and a high-grade fever. The blood film of the baby showed trophozoites stage of Plasmodium vivax with a parasite density of +3. The neonate had severe thrombocytopenia (49,000/micro liter) and Splenomegaly (spleen was palpable 2cm along its line of growth). The patient was admitted to the hospital and treated with artesunate for five days and discharged on the sixth day of admission in stable condition.Conclusion: Sick neonates born to mothers in malaria-endemic areas or with a history of malaria attack(s) in the index pregnancy should be promptly investigated for malaria.Keywords: congenital malaria, case, report, western Ethiopia, plasmodium viva

Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development