Malaria grave en gestante con trombocitopenia severa y afectación placentaria: manejo en zona no endémica. A propósito de un caso

Abstract

Introduction

Malaria presents a significant challenge during pregnancy, even in non-endemic environments like Spain. Pregnant women face severe complications due to placental parasite accumulation, leading to conditions such as severe anemia, miscarriage, intrauterine growth restriction, and perinatal death. In this article, we present a clinical case illustrating the complexities and successful management strategies of malaria during pregnancy in a non-endemic setting.

Major symptoms and clinical findings

A 37-week pregnant woman from Equatorial Guinea presents with fever and hemoptoic sputum. Laboratory analysis reveals severe thrombocytopenia, anemia, and hyperbilirubinemia, prompting suspicion of malaria.

Major diagnoses, therapeutic interventions and outcomes

P. falciparum antigen is detected in the blood, meeting criteria for severe malaria based on clinical and analytical findings. Treatment with intravenous artesunate results in rapid parasitemia reduction. On the second day, the patient enters labor and undergoes a eutocic delivery, giving birth to a healthy baby girl with negative P. falciparum antigen. Parasites are found in the placental intervillous space upon analysis. Postpartum oral therapy with dihydroartemisinin-piperaquine proceeds without incident. Discharge occurs three days later.

Conclusions

Effective management of malaria during pregnancy requires early suspicion, a multidisciplinary approach, and targeted treatment to optimize maternal-fetal outcomes. Vaginal birth at term is recommended to mitigate perinatal complications and promote maternal recovery. Oral dihydroartemisinin-piperaquine therapy emerges as a promising option for postpartum preventive treatment, yielding favorable short- and long-term results.