Malaria during pregnancy can cause miscarriages, fetal death, intrauterine growth retardation, low birth weight, and premature delivery. Women pregnant for the first time and in their third trimester are at particular risk for severe anemia and sometimes even death. The impact of malaria during pregnancy on infant and child development is unknown.

Malarial anemia is an important contributor to P. falciparum-associated morbidity and mortality. Because of the risk of transmitting the human immunodeficiency virus (HIV) and other blood-borne pathogens (including hepatitis B virus and the bacterium that causes syphilis) through contaminated blood, the treatment of malarial anemia with blood transfusions raises serious clinical and safety questions. This risk is of particular concern in areas where screening of donated blood for the presence of HIV and other pathogens is not routine and where blood transfusion equipment is reused without being sterilized.

Immunity

Assuming they survive childhood, people in areas of endemic malaria often acquire a moderate level of immunity to malaria by being infected repeatedly. Although they may experience mild symptoms of the disease, including recurrent fevers, they rarely suffer the more severe and potentially fatal consequences. Without repeated exposure, however, this immunity is relatively short-lived, and although it almost always protects against life-threatening malaria, it does not prevent occasional episodes of fever and chills.

Role of Genetics

Some population groups have genetic characteristics that render them resistant to certain forms of malaria. For example, persons of African descent who lack the so-called Duffy blood group surface antigens cannot be infected with P. vivax. The heterozygous sickle cell trait, often present in people of African descent, partially protects against infection with P. falciparum. Other hereditary abnormalities, such as glucose-6-phosphate dehydrogenase deficiency, are partially protective against malaria.

DIAGNOSIS

Medical personnel should suspect malaria in anyone with a fever who has recently been in a malaria-endemic region. A definitive diagnosis of malaria infection is made by microscopic examination of stained blood smears for the presence of parasites (Figure 2-2). In the early stages of infection and at all stages of infection with P. falciparum, when parasites



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