Congenital malaria in one non-identical twin.

Congenital malaria in one non-identical twinOnly seven cases of congenital malaria have been reported in Britain.'I The case described here is believed to be the first to be reported in a binovular twin. Case historyShortly after her arrival in England from India in 1974, the mother, a 23-year-old primigravida, was found to have pulmonary tuberculosis, which was treated with streptomycin, rifampicin, and isoniazid.She became pregnant in September 1975, and her treatment was changed to para- aminosalicylic acid and isoniazid.Twin pregnancy was diagnosed radiologically in April 1976.The mother was admitted to hospital later that month in premature labour and delivered live male twins on 26 April 1976.The placenta and membranes were normal and consistent with the twins being binovular, Twin I was deliecred as a vertex presentation using Wriglev's forceps.Apart from transient anaemia his progress was uneventful.Repeated blood films showed no evidence of malaria.Twin II was found to have a transverse lie.External version was unsuccess- ful.The membranes ruptured spontaneously and a hanid prolapsed.He was subsequently delivered by internal version and breech extractioni under general anaesthesia.He weighed 2-3 kg and wvas estimated to be of 35 weeks' gestation.A mild degree of Erb's palsy on the left soon resolved.He became jaundiced in the neonatal period, the serum bilirubin level reaching 229 timol/l (13 4 mg/100 ml) on the fifth day, then rapidly subsiding.He continued to thrive until 42 days, when he became febrile with a rectal temperature of 38-2 C.There was no obvious cause for this and he was feeding well, though he was noticed to be pale.The pulse rate was 160/min and there was a soft systolic ejection murmur at the apex.The liver and