[13] Anemia is found more commonly in parasitemic women.[6] All our patients had hemolytic anemia, as judged on the basis of undetectable haptoglobin and elevated

lactate dehydrogenase levels, and increased reticulocyte count. The parasites cause anemia in the mother in a number of ways[14]: erythrocyte destruction, splenic sequestration of non-parasitized erythrocytes, and bone marrow dysfunction. The oxygen transport to the unborn child becomes impaired. Placental malaria contributes to premature deliveries, low birth Venetoclax purchase weight, and increased risk of infant death.[13] The prevention of malaria will reduce all these risks to a substantial degree. Accordingly, WHO recommends intermittent preventive treatment in pregnancy (IPTp) to all pregnant women at risk of P falciparum infection in countries in sub-Saharan Africa with stable malaria transmission given at the first and second scheduled antenatal care visits after the first noted movement of the fetus.[15] The US Centers for Disease Control and Prevention (CDC) recommend pre-departure presumptive treatment without malaria tests to

all refugees (not all immigrants) from highly endemic countries, excluding pregnant or lactating women—in these groups only confirmed malaria is treated.[9] However, conventional thick films have been reported to significantly underestimate learn more placental malaria,[4, 5] which leads to a failure to identify malaria as a cause of fetal impairment. Rapid diagnostic

tests are considered more sensitive than conventional thick films.[4, 5] PCR, the most sensitive diagnostic tool,[4, 5] is rarely available. After immigrating to non-endemic areas, pregnant women from regions with high malaria endemicity no longer benefit from the IPTp programs carried out in their native country. In the new home, their malaria tends to be neglected, as both the possibility of asymptomatic malaria and the persistence of parasites in semi-immune individuals are poorly known. Most Western countries have no recommendations on screening for malaria in pregnant immigrants, even though persistent parasitemia is a health risk for unborn children. A negative blood smear does not rule out the disease, which should be emphasized when training health care personnel. They should also be aware of the possibility of malaria in anemic Decitabine in vivo pregnant immigrants from areas with high endemicity even years after the immigration. Diagnostic tests including rapid tests or, when possible, PCR should be made, and, if positive, treatment should be started without delay. Obviously, all immigrants from high malaria endemicity areas would benefit from screening. The authors thank Elisabet Tyyni, HUSLAB, Helsinki University Central Hospital, Finland, for her contribution in laboratory work. The authors state they have no conflicts of interest to declare. “
“Dengue virus (DENV) infection is a major health threat for travelers.