Congenital Malaria in England
Authors: S. B. Dimson
Journal: BMJ (1954)

and Queen Mary's (Stratford) Hospitals There is now general agreement that the foetus can be- come infected by the transmission of malaria parasites across the placenta, although such an event is acknow- ledged to be very uncommon.It is particularly rare in native populations living in hyperendemic regions, where the incidence of congenital malaria is 0.03% against 1-4% in infants born to European mothers (Covell, 1950).An even higher percentage was recorded by Jones (1950), who found three cases of congenital falci- parum (malignant tertian) malaria among 37 consecu- tive deliveries of non-African women at Lagos.Similar series have been reported from Albania and Italy.In Northern Europe, however, cases have been very scanty, and have usually arisen as a result of mothers with malaria coming home from the Tropics to have their babies.Only two cases were discovered in Belgium, both due to vivax (benign tertian) malaria; the first by Rodhain (1933) in a 9-weeks-old baby and the second by Glorieux (1952) in an infant 7 weeks old.Three of the four cases so far described in this country were caused by Plasmodium vivax, the diagnosis being made at 16 days (Jones and Brown, 1924), 34 days (Gammie, 1944), and 50 days (Tanner and Hewlett, 1935) after birth.The one case of falciparum malaria was diagnosed at the age of 7 weeks by Moffat (1907).The case of congenital malaria described below is the second to be reported in this country due to P. falci- parum, and was diagnosed on the eighth day after birth. Case ReportAn Englishwoman aged 24 was first seen in the antenatal clinic of Queen Mary's Hospital, Stratford, London, when she was five months pregnant with her second child (the first was born uneventfully at Huddersfield).She gave her London address on registration, but, giving her history, omitted to mention she had come from Lagos, Nigeria, and that she had contracted her first'attack of malaria one week before returning to this country by sea, with two possible mild relapses soon after her arrival here.At her first examination her temperature was 99.4' F. (37.4'C.), pulse 98, and haemoglobin 68% (10.6 g.).Her blood pressure and urine were normal ; Wassermann reaction and rhesus (Rh) factor negative.Her Hb averaged 60 to 65% throughout her pregnancy in spite of oral and intra- venous iron, folic acid, and vitamin B12.Agglutinins to D-antigen were consistently absent.Five weeks before delivery her Hb was 60% (8.9 g.), red cells 2,870,000 per c.mm., white cells 8,100 (polymorphs 73%, lymphocytes 23%, monocytes 3%, eosinophils 1%).After a first stage lasting 4 hours 50 minutes, she was admitted on November 13, 1952, in the second stage of labour, which lasted only seven minutes.She was passing a lot of liquor amnii heavily stained with meconium, and the foetal heart sounds were not heard.The baby, which was full-term, was delivered under gas-and-air analgesia.The placenta, battledore in type and weighing 1 lb.71 oz.(0.68 kg.), was delivered 13 minutes later and found to be ragged and infarcted with ragged and ?incomplete mem- branes.At the end of labour the mother's temperature was 97.6' F. (36.4'C.), pulse 76, respiration 18, and blood