Considering the diagnosis of malaria in infants presenting with non-specific symptoms in malaria endemic areas: case report and review

Background: Malaria in infantile age group, particularly under the age of 6 months is rare due to the protection conferred by the passive maternal antibodies. The clinical manifestation in neonates and young infants is nonspecific and differ from that of adults and older children. Diagnosing malaria
in this age group is important in order to avoid the high risk of death associated with missed
P. falciparum infection
Case Report: A 6-month-old female infant presented with history of cough, loose motion, irritability and
decreased oral acceptance of a short duration. Mother’s antenatal period was uneventful and she
was free of any symptoms of clinical illness. On examination, the baby was anemic, had tachycardia,
bilateral basal crepitations of lung fields and hepatosplenomegaly. Provisional clinical diagnosis
was sepsis with congenital infection and the baby was put on antibiotics. Blood investigations revealed anemia, leucocytosis and a raised ESR. Test for TORCH (Toxoplasma,Rubella, Cytomegalovirus and Herpes) group of organisms and VDRL were negative. Peripheral
blood film examination on the 5[sup]th[/sup] day of admission revealed evidence of infection by P. falciparum and P. vivax species of malarial parasite. Following a diagnosis of mixed malarial infection, baby was treated with antimalarials, and the antibiotics along with metranidazole were continued, to which she responded well with spectacular clinical improvement.
Conclusions: An awareness of non-specific clinical manifestation of malaria in neonates and young infants is essential to avoid it’s under diagnosis. This case highlights the importance of considering malaria in all ill neonates and infants living in malaria endemic areas, presenting with non-specific
symptoms. A mixed malarial infection is an uncommon event in this age group.

Keywords: Malaria, infantile, mixed infection