Congenital malaria in a neonate born in a malaria-endemic area: a case report

Congenital malaria in a neonate born in a malaria-endemic area: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Congenital malaria in a neonate born in a malaria-endemic area: a case report Biniyam Demisse, Kebede Almaw This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4163225/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Malaria remains a significant public health concern, particularly in Africa, where children under 5 years of age are affected. While mosquito bites are the primary transmission route, congenital malaria caused by transplacental or perinatal transmission can also occur. This case report highlights the challenges in diagnosing congenital malaria and emphasizes the importance of considering it in neonates, especially those born in or with a travel history to endemic areas. Case presentation : A 48-hour-old male neonate born to an Ethiopian hospital with high malaria transmission rates presented with respiratory distress. Despite receiving antenatal care in a nonendemic zone, the mother delivered in this endemic area. The initial diagnosis was early-onset neonatal sepsis, but persistent fever prompted further investigation. Blood film microscopy revealed coinfection with Plasmodium falciparum and Plasmodium vivax , leading to a diagnosis of congenital malaria. The neonate received intravenous artesunate followed by oral artemisinin-lumefantrine, with a favorable clinical outcome. Conclusion : Despite the nonspecific symptoms, this case emphasizes the importance of considering congenital malaria in neonates, particularly those with a history of travel to endemic areas. Blood film microscopy confirmed coinfection and guided effective antimalarial therapy. Strengthening antenatal care services, including intermittent preventive treatment during pregnancy, is recommended to reduce the burden of congenital malaria. Congenital malaria neonate malaria endemicity case report Ethiopia Background Malaria remains a major public health challenge globally, particularly in Africa ( 1 ).. The World Health Organization (WHO) reports that in 2022 alone, there were an estimated 249 million cases and 608,000 deaths worldwide, with the majority of the burden in the WHO African Region. This region accounted for 94% of all cases and 95% of deaths, with children under 5 accounting for the majority (78%) of the deaths ( 2 , 3 ). Recently, five countries reported 5 million additional cases between 2021 and 2022, three of which were in Africa, including Ethiopia, Nigeria (+ 1.3 million each) and Uganda (+ 597,000) ( 4 ). In Ethiopia, malaria is a significant public health concern, with an estimated 5 million cases and 60% of the population living in areas at risk ( 4 , 5 ). The main causative agents of malaria globally are protozoan parasites of the genus Plasmodium, with five species known to infect humans, namely, P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi. Among these, P. falciparum and P. vivax are predominant, with P. falciparum being responsible for the most severe manifestations of the disease ( 6 , 7 ). In Ethiopia, more than 99% of malaria cases are attributed to P. falciparum and P. vivax , which are transmitted predominantly through the bites of infected female Anopheles mosquitoes. However, mosquito bites are not the only route of transmission ( 8 ). Congenital malaria is defined as the identification of asexual forms of the parasite in the peripheral blood of newborns within the first 24 hours to seven days of life, resulting from in-utero infection or transmission during birth ( 9 ). It is rare in countries that are endemic to malaria due to a high level of maternal antibodies ( 10 ). However, studies have reported that 6.9% of congenital malaria cases are reported throughout the world ( 11 ). The diagnosis of congenital malaria presents challenges, often leading to misdiagnosis due to nonspecific clinical manifestations, particularly when it presents alongside neonatal sepsis ( 12 ). This study reports a case of congenital malaria in an Ethiopian hospital and highlights the importance of considering this rare and critical problem in healthcare settings. Case presentation A 48-hour-old male neonate, born to a 23-year-old G1P1 mother, with respiratory distress, was admitted to the neonatal intensive care unit (NICU) at Dil-Fana Hospital in Arba Minch, southern Ethiopia. The mother's last menstrual period (LNMP) was unknown, but she reported 9 months of amenorrhea. Notably, she received antenatal care (ANC) follow-up at a healthcare facility in the Wolayta zone, an area not endemic for malaria. However, delivery occurred vaginally without complications at our hospital, which is located in an area with high malaria transmission rates. The neonates had APGAR scores of 7 and 9 at the 5th and 10th minutes, respectively. The neonate was initially diagnosed with early-onset neonatal sepsis due to respiratory distress and subsequently received intravenous antibiotics, namely, ampicillin 50 mg/kg BID and gentamicin 4 mg/kg IV daily. Despite initial treatment for neonatal sepsis, the neonate's fever persisted, prompting further investigation. The neonate presented with vital signs indicating a pulse rate (PR) of 157 beats/minute, a respiratory rate (RR) of 68 breaths/minute, a temperature of 38.5°C, and an oxygen saturation of 92%. He weighed 3500 grams and exhibited pink conjunctiva. On examination, there was no splenomegaly, and he had a normal lymph glandular system, respiratory system, cardiovascular system, and genitalia. Neurological examination revealed intact neonatal reflexes. After 24 hours of admission, laboratory investigations revealed a hemoglobin level of 14.7 mg/dl (normal range: 12–20 mg/dl), a white blood cell (WBC) count of 9.9x10 9 /L (normal range: 9.0 to 16.0x10 9 /L), and a platelet count of 182 x10 9 /L (normal range: 150 to 400 × 10 9 /L). Blood group analysis indicated blood group A+, and blood film microscopy revealed coinfection with Plasmodium falciparum and Plasmodium vivax parasites. Radiological findings from X-ray imaging revealed clear lung fields, normal-sized and dense hila, sharp costophrenic angles, a normal cardiothoracic ratio, normal pulmonary vascularity, and a visibly normal thoracic cage structure. The conclusion drawn from the radiological assessment was that of normal findings. The combined findings of persistent fever, positive blood film for malaria parasites, a negative workup for bacterial infection and normal radiological findings led to the diagnosis of congenital malaria with coinfection of Plasmodium falciparum and Plasmodium vivax parasites , and the initial suspicion of neonatal sepsis was ruled out. Treatment and outcome Based on the results of the malaria test, the neonate's treatment regimen was switched to 3 mg/kg IV artesunate, which was administered at diagnosis and 12 hours and 24 hours later, following established protocols for neonatal malaria treatment. Following treatment initiation with artesunate, the patient’s fever subsided, and his clinical condition improved significantly within 24 hours. The resolution of the fever and improved respiratory status indicated a positive response to treatment. After completing the three doses of intravenous antimalarial therapy, the neonate's condition remained stable, and he was discharged from the hospital with a three-day course of fixed-dose combination oral artemisinin-lumefantrine (20/120 mg) pediatric flavored formulation, administered as 1 tablet twice daily. Discussion This case report describes a neonate who was diagnosed with congenital malaria caused by coinfection with Plasmodium falciparum and Plasmodium vivax in Ethiopia. As demonstrated in this case, a neonate born to a nonimmune mother in a malaria-endemic area can develop congenital malaria. This study also highlights the increased risk of transmission from nonimmune mothers in endemic areas ( 13 ). On the other hand, mothers residing in endemic areas develop partial immunity through repeated exposure ( 14 ), which offers some protection to their newborns via placental and breast milk antibodies ( 15 , 16 ). Geographical variations in disease transmission dynamics further emphasize the importance of considering travel history ( 17 ). The initial diagnosis in this patient was early-onset neonatal sepsis due to nonspecific symptoms such as fever and respiratory distress. This shows the challenge of differentiating congenital malaria from other neonatal infections with overlapping clinical presentations ( 18 ). However, further investigation of persistent fever despite antibiotic therapy was initiated, leading to the diagnosis of congenital malaria. A detailed travel history, including the mother's place of residence, and the use of diagnostic methods such as blood film microscopy are important for accurate diagnosis ( 19 , 20 ). The initiation of appropriate antimalarial therapy according to established protocols resulted in a positive clinical outcome, with fever subsiding and respiratory distress improving within 24 hours. Similar studies emphasize the importance of early recognition and prompt treatment to prevent progression to severe disease and adverse outcomes ( 21 , 22 ). The mother in this case received ANC services elsewhere, suggesting potential gaps in communication or education regarding malaria risks upon travel to endemic regions. However, studies suggest the importance of comprehensive services that address travel history and potential malaria exposure, in addition to maternal obstetric management ( 23 , 24 ). Additionally, intermittent preventive treatment (IPTp) with antimalarial drugs during pregnancy has been shown to be effective in reducing the risk of malaria ( 25 , 26 ). Conclusion In conclusion, this case report highlights the importance of considering congenital malaria as a differential diagnosis for febrile neonates, especially those with a history of travel or delivery in endemic areas. A detailed travel history combined with clinical evaluation and blood film microscopy is crucial for diagnosis. Prompt initiation of appropriate antimalarial therapy based on a confirmed diagnosis is essential for achieving optimal clinical outcomes. Furthermore, implementing effective preventive measures through strengthened antenatal care services, including intermittent preventive treatment (IPTp), can significantly reduce the burden of congenital malaria. Declarations Ethics approval and consent to participate This study was conducted following ethical principles, and ethical approval for this case report was obtained from the Institutional Review Board (IRB) of Arba Minch University. Consent for publication Written informed consent for the publication of this case report was obtained from the mother of the neonate after a detailed explanation of the study and its objectives. The mother was assured that anonymity would be maintained and that the report would not contain any identifiable information. Disclosure The authors declare that they have no conflicts of interest related to this work. Funding Not applicable Author Contribution The authors confirm the following contributions: KA conceived and designed the study. BD acquired and interpreted the data, and drafted the manuscript. Both authors reviewed and approved the final version of the manuscript and agreed to be accountable for their respective contributions, ensuring any questions regarding the work are appropriately addressed. Acknowledgments We acknowledge the dedicated staff of the Neonatal Intensive Care Unit at Dil-Fana Hospital, Arba Minch, Ethiopia, for their exceptional care and the information they provided for this report. We also express our gratitude to the mother of the neonate for her consent and cooperation. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. References World Health Organization. Malaria. https://www.who.int/news-room/fact-sheets/detail/malaria . Published December 4, 2023. Accessed March 19, 2024. United Nations International Children's Emergency Fund. Malaria in Africa. https://data.unicef.org/topic/child-health/malaria/ . Updated January 2024. Accessed March 22, 2024. World Health Organization. World Malaria Report 2022. https://www.who.int/publications/i/item/9789240064898 . Published December 8, 2022. Accessed March 19, 2024. World Health Organization. World Malaria Report 2023. https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023 . Published November 30, 2023. Accessed March 19, 2024. Yeshiwondim AK, Gopal S, Hailemariam AT, Dengela DO, Patel HP. Spatial analysis of malaria incidence at the village level in areas with unstable transmission in Ethiopia. Int J Health Geogr. 2009;8(1):5. 10.1186/1476-072X-8-5 . Crutcher JM, Hoffman SL, Malaria. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 83. https://www.ncbi.nlm.nih.gov/books/NBK8584/ . Buck E, Finnigan NA. Malaria. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK551711/ . Ethiopian Federal Ministry of Health. National Malaria Control and Elimination Program. http://repository.iifphc.org/bitstream/handle/123456789/1440/NATIONAL-MALARIA-GUIDELINES-UPDATED-2018.pdf?sequence=1&isAllowed=y . Published March 2018. Accessed March, 2024. Mohan K, Omar BJ, Chacham S. Malaria in newborn: A missed entity for primary care physician. J Family Med Prim Care. 2023;12(8):1511. 10.4103/JFMPC.JFMPC_2332_22 . Thapar RK, Saxena A, Devgan A. Congenital Malaria. Med J Armed Forces India. 2008;64(2):185. 10.1016/S0377-1237(08)80079-2 . Bilal JA, Malik EE, Al-Nafeesah A, Adam I. Global prevalence of congenital malaria: A systematic review and meta-analysis. Eur J Obstet Gynecol Reproductive Biology. 2020;252:534–42. 10.1016/J.EJOGRB.2020.06.025 . Ranjha R, Singh K, Baharia RK, Mohan M, Anvikar AR, Bharti PK. Age-specific malaria vulnerability and transmission reservoir among children. Global Pediatr. 2023;6:100085. 10.1016/J.GPEDS.2023.100085 . Harrington WE, Duffy PE. Congenital malaria: rare but potentially fatal. Ped Health. 2008;2(2):235. 10.2217/17455111.2.2.235 . Doolan DL, Dobaño C, Baird JK. Acquired Immunity to Malaria. Clin Microbiol Rev [Internet]. 2009 Jan [cited 2024 Mar 22];22(1):13. Available from:/pmc/articles/PMC2620631/ . LEKE RGF, NDANSI R, SOUTHERLAND NJ QUAKYIIA, TAYLOR DW. Identification of anti-Plasmodium falciparum antibodies in human breast milk. Scand J Immunol Suppl. 1992;11:17–22. 10.1111/J.1365-3083.1992.TB01612.X . Williams AIO, Mcfarlane H. Distribution of malarial antibody in maternal and cord sera. Arch Dis Child. 1969;44(236):511. 10.1136/ADC.44.236.511 . Anangwe Amimo F. Malaria Transmission Dynamics in East Africa [Internet]. Infectious Diseases. IntechOpen; 2023. http://dx.doi.org/10.5772/intechopen.113192 . Harrington WE, Duffy PE. Congenital malaria: Rare but potentially fatal. Ped Health. 2008;2(2):235–48. 10.2217/17455111.2.2.235/ASSET . /IMAGES/LARGE/GRAPHIC22.JPEG . Svenson JE, MaClean JD, Gyorkos TW, Keystone J. Imported Malaria: Clinical Presentation and Examination of Symptomatic Travelers. Arch Intern Med. 1995;155(8):861–8. 10.1001/ARCHINTE.1995.00430080109013 . Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S. Malaria Diagnosis: A Brief Review. Korean J Parasitol. 2009;47(2):93. 10.3347/KJP.2009.47.2.93 . Olupot-Olupot P, Eregu EIE, Naizuli K, Ikiror J, Acom L, Burgoine K. Neonatal and congenital malaria: A case series in malaria endemic eastern Uganda. Malar J. 2018;17(1):1–5. 10.1186/S12936-018-2327-0/TABLES/1 . Rai P, Majumdar K, Sharma S, Chauhan R, Chandra J. Congenital malaria in a neonate: case report with a comprehensive review on differential diagnosis, treatment and prevention in Indian perspective. J Parasit Dis. 2015;39(2):345. 10.1007/S12639-013-0342-1 . Yukich JO, Taylor C, Eisele TP, et al. Travel history and malaria infection risk in a low-transmission setting in Ethiopia: A case control study. Malar J. 2013;12(1):1–9. 10.1186/1475-2875-12-33/TABLES/2 . Gutman JR, Mwesigwa JN, Arnett K, et al. Using antenatal care as a platform for malaria surveillance data collection: study protocol. Malar J. 2023;22(1):1–10. 10.1186/S12936-023-04521-6/FIGURES/1 . Peter AO. Effect of intermittent preventive treatment of malaria on the outcome of pregnancy among women attending antenatal clinic of a new Nigerian teaching hospital, Ado-Ekiti. Niger Med J. 2013;54(3):170. 10.4103/0300-1652.114582 . Vallely A, Vallely L, Changalucha J, Greenwood B, Chandramohan D. Intermittent preventive treatment for malaria in pregnancy in Africa: What’s new, what’s needed? Malar J. 2007;6(1):1–13. 10.1186/1475-2875-6-16/TABLES/1 . Additional Declarations No competing interests reported. Supplementary Files 2013CAREChecklist.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The World Health Organization (WHO) reports that in 2022 alone, there were an estimated 249\u0026nbsp;million cases and 608,000 deaths worldwide, with the majority of the burden in the WHO African Region. This region accounted for 94% of all cases and 95% of deaths, with children under 5 accounting for the majority (78%) of the deaths (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Recently, five countries reported 5\u0026nbsp;million additional cases between 2021 and 2022, three of which were in Africa, including Ethiopia, Nigeria (+\u0026thinsp;1.3\u0026nbsp;million each) and Uganda (+\u0026thinsp;597,000) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In Ethiopia, malaria is a significant public health concern, with an estimated 5\u0026nbsp;million cases and 60% of the population living in areas at risk (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe main causative agents of malaria globally are \u003cem\u003eprotozoan\u003c/em\u003e parasites of the genus Plasmodium, with five species known to infect humans, namely, \u003cem\u003eP. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi.\u003c/em\u003e Among these, \u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eP. vivax\u003c/em\u003e are predominant, with \u003cem\u003eP. falciparum\u003c/em\u003e being responsible for the most severe manifestations of the disease (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In Ethiopia, more than 99% of malaria cases are attributed to \u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eP. vivax\u003c/em\u003e, which are transmitted predominantly through the bites of infected female Anopheles mosquitoes. However, mosquito bites are not the only route of transmission (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCongenital malaria is defined as the identification of asexual forms of the parasite in the peripheral blood of newborns within the first 24 hours to seven days of life, resulting from in-utero infection or transmission during birth (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). It is rare in countries that are endemic to malaria due to a high level of maternal antibodies (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, studies have reported that 6.9% of congenital malaria cases are reported throughout the world (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The diagnosis of congenital malaria presents challenges, often leading to misdiagnosis due to nonspecific clinical manifestations, particularly when it presents alongside neonatal sepsis (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This study reports a case of congenital malaria in an Ethiopian hospital and highlights the importance of considering this rare and critical problem in healthcare settings.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 48-hour-old male neonate, born to a 23-year-old G1P1 mother, with respiratory distress, was admitted to the neonatal intensive care unit (NICU) at Dil-Fana Hospital in Arba Minch, southern Ethiopia. The mother's last menstrual period (LNMP) was unknown, but she reported 9 months of amenorrhea. Notably, she received antenatal care (ANC) follow-up at a healthcare facility in the Wolayta zone, an area not endemic for malaria. However, delivery occurred vaginally without complications at our hospital, which is located in an area with high malaria transmission rates. The neonates had APGAR scores of 7 and 9 at the 5th and 10th minutes, respectively.\u003c/p\u003e \u003cp\u003eThe neonate was initially diagnosed with early-onset neonatal sepsis due to respiratory distress and subsequently received intravenous antibiotics, namely, ampicillin 50 mg/kg BID and gentamicin 4 mg/kg IV daily. Despite initial treatment for neonatal sepsis, the neonate's fever persisted, prompting further investigation. The neonate presented with vital signs indicating a pulse rate (PR) of 157 beats/minute, a respiratory rate (RR) of 68 breaths/minute, a temperature of 38.5\u0026deg;C, and an oxygen saturation of 92%. He weighed 3500 grams and exhibited pink conjunctiva. On examination, there was no splenomegaly, and he had a normal lymph glandular system, respiratory system, cardiovascular system, and genitalia. Neurological examination revealed intact neonatal reflexes.\u003c/p\u003e \u003cp\u003eAfter 24 hours of admission, laboratory investigations revealed a hemoglobin level of 14.7 mg/dl (normal range: 12\u0026ndash;20 mg/dl), a white blood cell (WBC) count of 9.9x10\u003csup\u003e9\u003c/sup\u003e/L (normal range: 9.0 to 16.0x10\u003csup\u003e9\u003c/sup\u003e/L), and a platelet count of 182 x10\u003csup\u003e9\u003c/sup\u003e/L (normal range: 150 to 400 \u0026times; 10\u003csup\u003e9\u003c/sup\u003e/L). Blood group analysis indicated blood group A+, and blood film microscopy revealed coinfection with \u003cem\u003ePlasmodium falciparum\u003c/em\u003e and \u003cem\u003ePlasmodium vivax\u003c/em\u003e parasites.\u003c/p\u003e \u003cp\u003eRadiological findings from X-ray imaging revealed clear lung fields, normal-sized and dense hila, sharp costophrenic angles, a normal cardiothoracic ratio, normal pulmonary vascularity, and a visibly normal thoracic cage structure. The conclusion drawn from the radiological assessment was that of normal findings.\u003c/p\u003e \u003cp\u003eThe combined findings of persistent fever, positive blood film for malaria parasites, a negative workup for bacterial infection and normal radiological findings led to the diagnosis of congenital malaria with coinfection of \u003cem\u003ePlasmodium falciparum\u003c/em\u003e and \u003cem\u003ePlasmodium vivax parasites\u003c/em\u003e, and the initial suspicion of neonatal sepsis was ruled out.\u003c/p\u003e\n\u003ch3\u003eTreatment and outcome\u003c/h3\u003e\n\u003cp\u003eBased on the results of the malaria test, the neonate's treatment regimen was switched to 3 mg/kg IV artesunate, which was administered at diagnosis and 12 hours and 24 hours later, following established protocols for neonatal malaria treatment. Following treatment initiation with artesunate, the patient\u0026rsquo;s fever subsided, and his clinical condition improved significantly within 24 hours. The resolution of the fever and improved respiratory status indicated a positive response to treatment. After completing the three doses of intravenous antimalarial therapy, the neonate's condition remained stable, and he was discharged from the hospital with a three-day course of fixed-dose combination oral artemisinin-lumefantrine (20/120 mg) pediatric flavored formulation, administered as 1 tablet twice daily.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case report describes a neonate who was diagnosed with congenital malaria caused by coinfection with \u003cem\u003ePlasmodium falciparum\u003c/em\u003e and \u003cem\u003ePlasmodium vivax\u003c/em\u003e in Ethiopia.\u003c/p\u003e \u003cp\u003eAs demonstrated in this case, a neonate born to a nonimmune mother in a malaria-endemic area can develop congenital malaria. This study also highlights the increased risk of transmission from nonimmune mothers in endemic areas (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). On the other hand, mothers residing in endemic areas develop partial immunity through repeated exposure (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), which offers some protection to their newborns via placental and breast milk antibodies (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Geographical variations in disease transmission dynamics further emphasize the importance of considering travel history (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe initial diagnosis in this patient was early-onset neonatal sepsis due to nonspecific symptoms such as fever and respiratory distress. This shows the challenge of differentiating congenital malaria from other neonatal infections with overlapping clinical presentations (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, further investigation of persistent fever despite antibiotic therapy was initiated, leading to the diagnosis of congenital malaria. A detailed travel history, including the mother's place of residence, and the use of diagnostic methods such as blood film microscopy are important for accurate diagnosis (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe initiation of appropriate antimalarial therapy according to established protocols resulted in a positive clinical outcome, with fever subsiding and respiratory distress improving within 24 hours. Similar studies emphasize the importance of early recognition and prompt treatment to prevent progression to severe disease and adverse outcomes (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe mother in this case received ANC services elsewhere, suggesting potential gaps in communication or education regarding malaria risks upon travel to endemic regions. However, studies suggest the importance of comprehensive services that address travel history and potential malaria exposure, in addition to maternal obstetric management (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Additionally, intermittent preventive treatment (IPTp) with antimalarial drugs during pregnancy has been shown to be effective in reducing the risk of malaria (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this case report highlights the importance of considering congenital malaria as a differential diagnosis for febrile neonates, especially those with a history of travel or delivery in endemic areas. A detailed travel history combined with clinical evaluation and blood film microscopy is crucial for diagnosis. Prompt initiation of appropriate antimalarial therapy based on a confirmed diagnosis is essential for achieving optimal clinical outcomes. Furthermore, implementing effective preventive measures through strengthened antenatal care services, including intermittent preventive treatment (IPTp), can significantly reduce the burden of congenital malaria.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis study was conducted following ethical principles, and ethical approval for this case report was obtained from the Institutional Review Board (IRB) of Arba Minch University.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eWritten informed consent for the publication of this case report was obtained from the mother of the neonate after a detailed explanation of the study and its objectives. The mother was assured that anonymity would be maintained and that the report would not contain any identifiable information.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eDisclosure\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflicts of interest related to this work.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe authors confirm the following contributions: KA conceived and designed the study. BD acquired and interpreted the data, and drafted the manuscript. Both authors reviewed and approved the final version of the manuscript and agreed to be accountable for their respective contributions, ensuring any questions regarding the work are appropriately addressed.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eWe acknowledge the dedicated staff of the Neonatal Intensive Care Unit at Dil-Fana Hospital, Arba Minch, Ethiopia, for their exceptional care and the information they provided for this report. We also express our gratitude to the mother of the neonate for her consent and cooperation.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Malaria. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/malaria\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/malaria\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published December 4, 2023. Accessed March 19, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited Nations International Children's Emergency Fund. Malaria in Africa. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://data.unicef.org/topic/child-health/malaria/\u003c/span\u003e\u003cspan address=\"https://data.unicef.org/topic/child-health/malaria/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Updated January 2024. Accessed March 22, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. World Malaria Report 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240064898\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240064898\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published December 8, 2022. Accessed March 19, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. World Malaria Report 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published November 30, 2023. Accessed March 19, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeshiwondim AK, Gopal S, Hailemariam AT, Dengela DO, Patel HP. Spatial analysis of malaria incidence at the village level in areas with unstable transmission in Ethiopia. Int J Health Geogr. 2009;8(1):5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1476-072X-8-5\u003c/span\u003e\u003cspan address=\"10.1186/1476-072X-8-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrutcher JM, Hoffman SL, Malaria. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK8584/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK8584/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuck E, Finnigan NA. Malaria. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK551711/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK551711/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEthiopian Federal Ministry of Health. National Malaria Control and Elimination Program. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://repository.iifphc.org/bitstream/handle/123456789/1440/NATIONAL-MALARIA-GUIDELINES-UPDATED-2018.pdf?sequence=1\u0026amp;isAllowed=y\u003c/span\u003e\u003cspan address=\"http://repository.iifphc.org/bitstream/handle/123456789/1440/NATIONAL-MALARIA-GUIDELINES-UPDATED-2018.pdf?sequence=1\u0026amp;isAllowed=y\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published March 2018. Accessed March, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohan K, Omar BJ, Chacham S. Malaria in newborn: A missed entity for primary care physician. J Family Med Prim Care. 2023;12(8):1511. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/JFMPC.JFMPC_2332_22\u003c/span\u003e\u003cspan address=\"10.4103/JFMPC.JFMPC_2332_22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThapar RK, Saxena A, Devgan A. Congenital Malaria. Med J Armed Forces India. 2008;64(2):185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0377-1237(08)80079-2\u003c/span\u003e\u003cspan address=\"10.1016/S0377-1237(08)80079-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBilal JA, Malik EE, Al-Nafeesah A, Adam I. Global prevalence of congenital malaria: A systematic review and meta-analysis. Eur J Obstet Gynecol Reproductive Biology. 2020;252:534\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/J.EJOGRB.2020.06.025\u003c/span\u003e\u003cspan address=\"10.1016/J.EJOGRB.2020.06.025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRanjha R, Singh K, Baharia RK, Mohan M, Anvikar AR, Bharti PK. Age-specific malaria vulnerability and transmission reservoir among children. Global Pediatr. 2023;6:100085. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/J.GPEDS.2023.100085\u003c/span\u003e\u003cspan address=\"10.1016/J.GPEDS.2023.100085\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarrington WE, Duffy PE. Congenital malaria: rare but potentially fatal. Ped Health. 2008;2(2):235. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2217/17455111.2.2.235\u003c/span\u003e\u003cspan address=\"10.2217/17455111.2.2.235\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoolan DL, Doba\u0026ntilde;o C, Baird JK. Acquired Immunity to Malaria. Clin Microbiol Rev [Internet]. 2009 Jan [cited 2024 Mar 22];22(1):13. Available \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003efrom:/pmc/articles/PMC2620631/\u003c/span\u003e\u003cspan address=\"http://from:/pmc/articles/PMC2620631/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLEKE RGF, NDANSI R, SOUTHERLAND NJ QUAKYIIA, TAYLOR DW. Identification of anti-Plasmodium falciparum antibodies in human breast milk. Scand J Immunol Suppl. 1992;11:17\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/J.1365-3083.1992.TB01612.X\u003c/span\u003e\u003cspan address=\"10.1111/J.1365-3083.1992.TB01612.X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams AIO, Mcfarlane H. Distribution of malarial antibody in maternal and cord sera. Arch Dis Child. 1969;44(236):511. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/ADC.44.236.511\u003c/span\u003e\u003cspan address=\"10.1136/ADC.44.236.511\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnangwe Amimo F. Malaria Transmission Dynamics in East Africa [Internet]. Infectious Diseases. IntechOpen; 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.5772/intechopen.113192\u003c/span\u003e\u003cspan address=\"10.5772/intechopen.113192\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarrington WE, Duffy PE. Congenital malaria: Rare but potentially fatal. Ped Health. 2008;2(2):235\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2217/17455111.2.2.235/ASSET\u003c/span\u003e\u003cspan address=\"10.2217/17455111.2.2.235/ASSET\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e/IMAGES/LARGE/GRAPHIC22.JPEG\u003c/span\u003e\u003cspan address=\"http:///IMAGES/LARGE/GRAPHIC22.JPEG\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSvenson JE, MaClean JD, Gyorkos TW, Keystone J. Imported Malaria: Clinical Presentation and Examination of Symptomatic Travelers. Arch Intern Med. 1995;155(8):861\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/ARCHINTE.1995.00430080109013\u003c/span\u003e\u003cspan address=\"10.1001/ARCHINTE.1995.00430080109013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTangpukdee N, Duangdee C, Wilairatana P, Krudsood S. Malaria Diagnosis: A Brief Review. Korean J Parasitol. 2009;47(2):93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3347/KJP.2009.47.2.93\u003c/span\u003e\u003cspan address=\"10.3347/KJP.2009.47.2.93\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlupot-Olupot P, Eregu EIE, Naizuli K, Ikiror J, Acom L, Burgoine K. Neonatal and congenital malaria: A case series in malaria endemic eastern Uganda. Malar J. 2018;17(1):1\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12936-018-2327-0/TABLES/1\u003c/span\u003e\u003cspan address=\"10.1186/S12936-018-2327-0/TABLES/1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRai P, Majumdar K, Sharma S, Chauhan R, Chandra J. Congenital malaria in a neonate: case report with a comprehensive review on differential diagnosis, treatment and prevention in Indian perspective. J Parasit Dis. 2015;39(2):345. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S12639-013-0342-1\u003c/span\u003e\u003cspan address=\"10.1007/S12639-013-0342-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYukich JO, Taylor C, Eisele TP, et al. Travel history and malaria infection risk in a low-transmission setting in Ethiopia: A case control study. Malar J. 2013;12(1):1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1475-2875-12-33/TABLES/2\u003c/span\u003e\u003cspan address=\"10.1186/1475-2875-12-33/TABLES/2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGutman JR, Mwesigwa JN, Arnett K, et al. Using antenatal care as a platform for malaria surveillance data collection: study protocol. Malar J. 2023;22(1):1\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12936-023-04521-6/FIGURES/1\u003c/span\u003e\u003cspan address=\"10.1186/S12936-023-04521-6/FIGURES/1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeter AO. Effect of intermittent preventive treatment of malaria on the outcome of pregnancy among women attending antenatal clinic of a new Nigerian teaching hospital, Ado-Ekiti. Niger Med J. 2013;54(3):170. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0300-1652.114582\u003c/span\u003e\u003cspan address=\"10.4103/0300-1652.114582\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVallely A, Vallely L, Changalucha J, Greenwood B, Chandramohan D. Intermittent preventive treatment for malaria in pregnancy in Africa: What\u0026rsquo;s new, what\u0026rsquo;s needed? Malar J. 2007;6(1):1\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1475-2875-6-16/TABLES/1\u003c/span\u003e\u003cspan address=\"10.1186/1475-2875-6-16/TABLES/1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Congenital malaria, neonate, malaria endemicity, case report, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-4163225/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4163225/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Malaria remains a significant public health concern, particularly in Africa, where children under 5 years of age are affected. While mosquito bites are the primary transmission route, congenital malaria caused by transplacental or perinatal transmission can also occur. This case report highlights the challenges in diagnosing congenital malaria and emphasizes the importance of considering it in neonates, especially those born in or with a travel history to endemic areas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e: A 48-hour-old male neonate born to an Ethiopian hospital with high malaria transmission rates presented with respiratory distress. Despite receiving antenatal care in a nonendemic zone, the mother delivered in this endemic area. The initial diagnosis was early-onset neonatal sepsis, but persistent fever prompted further investigation. Blood film microscopy revealed coinfection with \u003cem\u003ePlasmodium falciparum \u003c/em\u003eand\u003cem\u003e Plasmodium vivax\u003c/em\u003e, leading to a diagnosis of congenital malaria. The neonate received intravenous artesunate followed by oral artemisinin-lumefantrine, with a favorable clinical outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Despite the nonspecific symptoms, this case emphasizes the importance of considering congenital malaria in neonates, particularly those with a history of travel to endemic areas. Blood film microscopy confirmed coinfection and guided effective antimalarial therapy. Strengthening antenatal care services, including intermittent preventive treatment during pregnancy, is recommended to reduce the burden of congenital malaria.\u003c/p\u003e","manuscriptTitle":"Congenital malaria in a neonate born in a malaria-endemic area: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-29 06:09:26","doi":"10.21203/rs.3.rs-4163225/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7eb3ce34-babb-4286-98dc-750704bf7315","owner":[],"postedDate":"March 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-02T08:30:40+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-29 06:09:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4163225","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4163225","identity":"rs-4163225","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}