Severe Congenital Malaria Acquired in utero

Jeanne R. Poespoprodjo District Health Authority, Timika, Papua, Indonesia; Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Papua, Indonesia; Mitra Masyarakat Hospital, Timika, Papua, Indonesia; International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; National Institute of Health Research and Development, Jakarta, Indonesia; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Medicine, Royal Darwin Hospital, Darwin, Australia

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Afdal Hasanuddin District Health Authority, Timika, Papua, Indonesia; Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Papua, Indonesia; Mitra Masyarakat Hospital, Timika, Papua, Indonesia; International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; National Institute of Health Research and Development, Jakarta, Indonesia; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Medicine, Royal Darwin Hospital, Darwin, Australia

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Wendelina Fobia District Health Authority, Timika, Papua, Indonesia; Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Papua, Indonesia; Mitra Masyarakat Hospital, Timika, Papua, Indonesia; International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; National Institute of Health Research and Development, Jakarta, Indonesia; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Medicine, Royal Darwin Hospital, Darwin, Australia

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Paulus Sugiarto District Health Authority, Timika, Papua, Indonesia; Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Papua, Indonesia; Mitra Masyarakat Hospital, Timika, Papua, Indonesia; International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; National Institute of Health Research and Development, Jakarta, Indonesia; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Medicine, Royal Darwin Hospital, Darwin, Australia

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Enny Kenangalem District Health Authority, Timika, Papua, Indonesia; Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Papua, Indonesia; Mitra Masyarakat Hospital, Timika, Papua, Indonesia; International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; National Institute of Health Research and Development, Jakarta, Indonesia; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Medicine, Royal Darwin Hospital, Darwin, Australia

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Daniel A. Lampah District Health Authority, Timika, Papua, Indonesia; Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Papua, Indonesia; Mitra Masyarakat Hospital, Timika, Papua, Indonesia; International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; National Institute of Health Research and Development, Jakarta, Indonesia; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Medicine, Royal Darwin Hospital, Darwin, Australia

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Emiliana Tjitra District Health Authority, Timika, Papua, Indonesia; Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Papua, Indonesia; Mitra Masyarakat Hospital, Timika, Papua, Indonesia; International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; National Institute of Health Research and Development, Jakarta, Indonesia; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Medicine, Royal Darwin Hospital, Darwin, Australia

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Ric N. Price District Health Authority, Timika, Papua, Indonesia; Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Papua, Indonesia; Mitra Masyarakat Hospital, Timika, Papua, Indonesia; International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; National Institute of Health Research and Development, Jakarta, Indonesia; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Medicine, Royal Darwin Hospital, Darwin, Australia

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Nicholas M. Anstey District Health Authority, Timika, Papua, Indonesia; Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, Timika, Papua, Indonesia; Mitra Masyarakat Hospital, Timika, Papua, Indonesia; International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; National Institute of Health Research and Development, Jakarta, Indonesia; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom; Division of Medicine, Royal Darwin Hospital, Darwin, Australia

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Vertical transmission of Plasmodium falciparum is under-recognized and usually associated with asymptomatic low-level parasitemia at birth. We report symptomatic congenital malaria presenting as a neonatal sepsis syndrome. The presence at birth of a high asexual parasitemia, gametocytemia, and splenomegaly indicated in utero rather than intrapartum transmission. The neonate was successfully treated with intravenous artesunate followed by oral dihydroartemisinin-piperaquine, without apparent adverse effects.

Author Notes

*Address correspondence to Nicholas M. Anstey, International Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia. E-mail: anstey@menzies.edu.au

Financial support: Supported by the National Health and Medical Research Council and the Wellcome Trust.

Authors' addresses: Jeanne R. Poespoprodjo, District Health Authority, Timika, Papua, Indonesia and Menzies School of Health Research, Darwin, Australia, E-mail: didot2266@yahoo.com. Afdal Hasanuddin and Paulus Sugiarto, RS Mitra Masayarakat, Timika, Papua, Indonesia, E-mails: afdalhs_805@yahoo.co.id and paulus_sugiarto@yahoo.com. Wendelina Fobia, Enny Kenangalem, and Daniel A. Lampah, Menzies School of Health Research-National Institute of Health Research and Development Malaria Research Program, RS Mitra Masayarakat, Timika, Papua, Indonesia, E-mails: didot2266@yahoo.com, enny_timika@yahoo.co.id, and aditimika@yahoo.com. Emiliana Tjitra, National Institute of Health Research and Development, Jakarta, Indonesia, E-mail: emilt@litbang.depkes.go.id. Ric N. Price and Nicholas Anstey, International Health Division, Menzies School of Health Research, Darwin, Australia, E-mails: ric.price@menzies.edu.au and anstey@menzies.edu.au.

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