Congenital Plasmodium ovale malaria in an infant born to HIV positive mother

We report a case of congenital Plasmodium ovale malaria in an infant born to an human immunodeficiency virus ositive Nigerian woman living in Italy throughout pregnancy. In the fifth week of life, while on prophylactic treatment with zidovudine (ZDV), 2 mg/kg/day, the baby developed marked anemia (Hemoglobin: 6.2 g/dL) without any other symptoms. Although ZDV was immediately stopped, the anemia worsened during a second determination (Hemoglobin: 5.4 g/dL), five days later when the mother could be contacted. Blood smear showed the presence of P. ovale , also confirmed by real-time polymerase chain reaction amplification and sequencing. The baby was hemotransfused and successfully treated with oral quinine sulphate (20 mg/kg/day) for five days and repeated blood smear became negative for malaria. Polymerase chain reaction and viral culture for human immunodeficiency virus at 4 months of age were negative. This report suggests that symptomatic congenital malaria may be present even in European countries and should be considered in the differential diagnosis of anemia in infants, born to human immunodeficiency virus positive immigrant mothers, receiving ZDV prophylaxis.