Neonatal malaria complicated by hypoglycaemia and hyperparasitaemia: Report of a case successfully treated with intravenous artesunate

Abstract

There is no established and widely accepted guidelines for clinical management of severe neonatal malaria. The aim of this paper is to raise the alertness of physicians regarding the occurrence of severe malaria in the neonatal period and to describe the treatment modality we adopted (in the absence of an internationally accepted guidelines for chemotherapeutic treatment of severe neonatal malaria). We report a case of a 26-day-old-female infant who presented with fever and poor feeding of 2 days duration. On examination, she was lethargic and pyrexial with a temperature of 38.7oC. She was in respiratory distress with a respiratory rate of 72 cycles/minute. The lung fields were clear on auscultation. The laboratory findings were falciparum malaria parasitaemia 3+, PCV 32%, and random blood glucose 1.9mmol/L. Blood, urine and cerebrospinal fluid cultures were sterile and chest  radiograph was normal. A diagnosis of severe neonatal malaria was made. The neonate was treated with intravenous artesunate followed by oral artesunate. The total duration of treatment was 7 days. This case highlights the successful use of intravenous artesunate followed by oral artesunate in the treatment of neonatal malaria complicated by hypoglycaemia and hyperparasitaemia (severe neonatal malaria), without apparent adverse effect. Although intravenous artesunate followed by oral artesunate appears safe and effective in the treatment of severe neonatal malaria, further data is required in order to develop evidence-based  treatment guidelines for such neonates.

Key words: malaria, neonate, hypoglycaemia, hyperparasitaemia, artesunate.