The management of a pregnant patient with malaria in West Texas
Abstract
Travel associated infectious disease, such as malaria, should be considered in returning travelers from an endemic area presenting with fever. Malaria in pregnancy has a high maternal and fetal morbidity and mortality burden. Early diagnosis is essential to improve maternal and fetal outcomes by providing maternal supportive measures and anti-malarial medication.
We present a patient with severe acute febrile illness with mental status changes at 32 weeks gestation. She became acutely symptomatic including high grade fever while visiting West Texas from Nigeria. Despite initial diagnostic uncertainty, a multidisciplinary team successfully diagnosed and treated her severe malaria. She delivered at term with no long lasting maternal or fetal sequelae from her malarial infection. In an age of globalization, travel associated infectious diseases should be considered in the differential of acute febrile illness in pregnant women.
Keywords: obstetrics, malaria, critical care in pregnancy
Downloads
References
Angelo KM, Libman M, Caumes E, et al. Malaria after international
travel: a GeoSentinel analysis, 2003–2016. Malar J
;16(1):293.
Imperato PJ. The convergence of a virus, mosquitoes, and
human travel in globalizing the Zika epidemic, 2016. J Community
Health; 41(3):674–9.
Harvey K, Esposito DH, Han P, et al. Surveillance for travelrelated
disease-GeoSentinel Surveillance System, United
States, 1997-2011. MMWR Surveill Summ 2013;62:1–23.
Whitty CJ, Edmonds S, Mutabingwa TK. Malaria in pregnancy.
BJOG 2005;112(9):1189–95.
Espinoza E, Hidalgo L, Chedraui P. The effect of malarial
infection on maternal-fetal outcome in Ecuador. J Matern
Fetal Neonatal Med 2005;18(2):101–5.
Granja AC, Machungo F, Gomes A, et al. Malaria-related
maternal mortality in urban Mozambique. Ann Trop Med
Parasitol 1998;92(3):257–63.
Severe malaria. Trop Med Int Health 2014;19 Suppl 1:7–131.
Burger RJ, van Eijk AM, Bussink M, et al. Artemisinin-based
combination therapy versus quinine or other combinations for
treatment of uncomplicated Plasmodium falciparum malaria in
the second and third trimester of pregnancy: a systematic review
and meta-analysis. Open Forum Infect Dis. 2016;12;3(1): ofv170.
Newman RD, Hailemariam A, Jimma D, et al. Burden of
malaria during pregnancy in areas of stable and unstable
transmission in Ethiopia during a nonepidemic year. J Infect
Dis 2003;187(11):1765–72.
Uneke CJ. Congenital Plasmodium falciparum malaria in
sub-Saharan Africa: a rarity or frequent occurrence? Parasitol
Res 2007;101(4):835–42.
Griffin JB, Lokomba V, Landis SH, et al. Plasmodium falciparum
parasitaemia in the first half of pregnancy, uterine and
umbilical artery blood flow, and foetal growth: a longitudinal
Doppler ultrasound study. Malar J 2012;11:319.
Kattenberg JH, Ochodo EA, Boer KR, et al. Systematic
review and meta-analysis: rapid diagnostic tests versus placental
histology, microscopy and PCR for malaria in pregnant
women. Malar J 2011;10:321.
Malaria. World Health Organization. http://www.who.int/
malaria/en/. Accessed 11/30/2018.
White NJ, Pukrittayakamee S, Hien TT, et al. Malaria. Lancet
;383(9918):723–35.
Frean J. Improving quantitation of malaria parasite burden
with digital image analysis. Trans R Soc Trop Med Hyg 2008;
(11):1062–3.
Peixoto HM, Marchesini PB, de Oliveria MR. Efficacy
and safety of artesunate-mefloquine therapy for treating
uncomplicated Plasmodium falciparum malaria: systematic
review and meta-analysis. Trans R Soc Trop Med Hyg
Guidelines for Treatment of Malaria in the United States.
Centers for Disease Control. https://www.cdc.gov/malaria/
resources/pdf/treatmenttable.pdf. Accessed 11/30/2018.
Mehta SR, Das S. Management of malaria: recent trends.
J Commun Dis 2006;38(2):130–8.
Olliaro P. Mode of action and mechanisms of resistance for
antimalarial drugs. Pharmacol Ther 2001;89(2):207–19.
Rosenthal PJ. Antiprotozoal drugs. In: Katzung BG, Masters
SB, Trevor AJ, editors. Basic & Clinical Pharmacology, 14e
New York, NY: McGraw-Hill; 2017.
Olliaro P. Mode of action and mechanisms of resistance for
antimalarial drugs. Pharmacol Ther 2001;89(2):207–19.
Artesunate is available to treat severe malaria in the United
States. Centers for Disease Control. https://www.cdc.gov/malaria/
diagnosis_treatment/artesunate.html. Accessed 11/30/2018.
Mace KE, Arguin PM, Tan KR. Malaria Surveillance—United
States, 2015. MMWR Surveill Summ 2018;67(No. SS-7):
–28. DOI: http://dx.doi.org/10.15585/mmwr.ss6707a1
Critical care in pregnancy. Obstet Gynecol 2016;128(4):
e147–54.