The authors declare that they have no competing interests.
BCJ, JMRG and GRM designed the study. All authors complied data and contributed to the bibliographic research. BCJ, JMRG, GRM created the database and interpreted the results. BCJ performed the statistical analysis and drafted the article and JMRG, GRM, PCT and JCG revised it critically. All authors approved the final manuscript.
Malaria in pregnancy is associated with maternal and foetal morbidity and mortality in endemic areas, but information on imported cases to non-endemic areas is scarce.
The aim of this study was to describe the clinical and epidemiological characteristics of malaria in pregnancy in two general hospitals in Madrid, Spain.
Retrospective descriptive study of laboratory-confirmed malaria in pregnant women at the Fuenlabrada University Hospital and the Príncipe de Asturias University Hospital, in Madrid, over a six- and 11-year period, respectively. Relevant epidemiological, clinical and laboratory data was obtained from medical records.
There were 19 pregnant women among 346 malaria cases (5.4%). The average age was 27 years. The gestational age (trimester) was: 53% 3rd, 31% 1st, 16% 2nd. All but one were multigravidae. Three were HIV positive. All were sub-Saharan immigrants: two were recently arrived immigrants and seventeen (89%) had visited friends and relatives. None had taken prophylaxis nor seeked pre-travel advice. Presentation: 16 symptomatic patients (fever in fourteen, asthenia in two), three asymptomatic. Median delay in diagnosis: 7.5 days. Laboratory tests: anaemia (cut off Hb level 11 g/dl) 78.9% (mild 31.6%, moderate 31.6%, severe 15.8%) thrombocytopaenia 73.7%, hypoglycaemia 10.5%. All cases were due to Plasmodium falciparum, one case of hyperparasitaemia. Quinine + clindamycin prescribed in 84%. Outcomes: no severe maternal complications or deaths, two abortions, fifteen term pregnancies, no low-birth-weight newborns, two patients were lost to follow-up.
Though cases of malaria in pregnancy are uncommon, a most at risk group is clearly defined: young sub-Saharan mothers visiting friends and relatives without pre-travel counselling and recently-arrived immigrants. The most common adverse maternal and foetal effects were anaemia and stillbirth. Given that presentation can be asymptomatic, malaria should always be considered in patients with unexplained anaemia arriving from endemic areas. These findings could help Maternal Health programme planners and implementers to target preventive interventions in the immigrant population and should create awareness among clinicians.
Wetsteyn JC, de Geus A: Falciparum malaria, imported into The Netherlands, 1979-1988. I. Epidemiological aspects. Trop Geogr Med. 1995, 47: 53-60. PubMed
Servicio de Epidemiología de la Comunidad de Madrid: Informe EDO. Boletin Epidemiológico de la Comunidad de Madrid. 2010, 16:
Thwing J, Skarbinski J, Newman RD, Barber AM, Mali S, Roberts JM, Slutsker L, Arguin PM: Centers for Disease Control and Prevention: Malaria surveillance-United States 2005. MMWR Surveill Summ. 2007, 56: 23-38. PubMed
TropnetEurop: Report March 10 Falciparum Malaria 2009. [ http://www.tropnet.net/reports_friends/reports_friends_index.html]
Mayor A, Serra-Casas E, Bardají A, Sanz S, Puyol L, Cisteró P, Sigauque B, Mandomando I, Aponte JJ, Alonso P, Menendez C: Sub-microscopic infections and long-term recrudescence of Plasmodium falciparum in Mozambican pregnant women. Malar J. 2009, 8: 9-10.1186/1475-2875-8-9. PubMedCentralCrossRefPubMed
UNICEF/UNU/WHO: Iron deficiency anemia: assessment, prevention, and control. 2001, Geneva: World Health Organization
Brabin BJ, Hakimi M, Pelletier D: An analysis of anemia and pregnancy-related maternal mortality. J Nutr. 2001, 131: 604-615.
WHO: WHO guidelines for the treatment of malaria. 2010, Geneva: World Health Organization
Adegnika AA, Verweij JJ, Agnandji ST, Chai SK, Breitling LP, Rambarter M, Frolich M, Issifou S, Kremsner PG, Yazdanbakhsh M: Microscopic and sub-microscopic Plasmodium falciparum infection, but not inflammation caused by infection, is associated with low birth weight. Am J Trop Med Hyg. 2006, 75: 798-803. PubMed
Naniche D, Lahuerta M, Bardaji A, Sigauque B, Romagosa C, Berenguera A, Mandomando I, David C, Sanz S, Aponte J, Ordi J, Alonso P, Menendez C: Mother-to-child transmission of HIV-1: association with malaria prevention, anemia and placental malaria. HIV Med. 2008, 9: 757-764. 10.1111/j.1468-1293.2008.00626.x. CrossRefPubMed
- Imported malaria in pregnancy in Madrid
Beatriz C Jiménez
Jose M Ruiz-Giardin
Juan V San Martín
Ana M Barrios
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II