Congenital Malaria in a Neonate: A Case Report from a Tertiary Hospital in South-South Nigeria

Background: Congenital malaria may occur when malaria parasites are transmitted from mother to infant during pregnancy or delivery. Its clinical presentation can overlap with other causes of neonatal illness, creating diagnostic difficulty. Case Presentation: This report describes a 9-day-old female neonate admitted to the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria, with respiratory distress and persistent fever. She was born to a 25-year-old primigravida who had received antenatal care and was treated for Plasmodium falciparum malaria nine days before delivery. On examination, the neonate weighed 3,300 g, had a temperature of 38 °C and a respiratory rate of 70 breaths/min, and had an oxygen saturation of 90% on room air. A provisional diagnosis of neonatal sepsis prompted treatment with intravenous ceftriaxone, but the fever persisted. Blood film microscopy subsequently identified Plasmodium falciparum parasitaemia. Bacterial cultures were negative, and the chest radiograph was reported as normal. At the time of the neonate's diagnosis, the mother was asymptomatic and had negative malaria rapid diagnostic and microscopy results. Treatment with intravenous artesunate followed by oral artemisinin–lumefantrine was associated with clinical recovery. Conclusion: This case illustrates the importance of including malaria in the differential diagnosis of a febrile neonate when maternal malaria has been documented during pregnancy. Careful maternal history-taking and prompt parasitological investigation may support appropriate management.