Association of Dengue Virus and <i>Leptospira</i> Co-Infections with Malaria Severity

Mandage, Rajendra; Kaur, Charandeep; Pramanik, Atreyi; Kumar, Vinod; Kodan, Parul; Singh, Adarsh; Saha, Sounak; Pandey, Shivam; Wig, Naveet; Pandey, Ravindra Mohan; Soneja, Manish; Acharya, Pragyan

doi:10.3201/eid2608.191214

Cited by 15 publications

(37 citation statements)

References 39 publications

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“…To the best of our knowledge, there are no reports about the interactions of these pathogens in coinfections in Venezuela, despite multiple infections may complicate malaria and lead to failure when it comes to treatment responsiveness. High prevalence of malaria coinfection was found in this study (34.2%), even higher than reported in Brazil (20%) [25]; but lower than that found in a recent study in India (60%) [29]. Thus, physicians should be suspicious of coinfection in malaria cases with inadequate treatment response or atypical manifestations.…”

Section: Discussioncontrasting

confidence: 70%

“…A study in Peru indicated Plasmodium/DENV coinfection was not associated with worse disease [26], similar to another study in India were the coinfection with DENV serotype 4 (DENV-4), even was associated with mild malaria. [29]. Differences in DENV serotypes or Plasmodium spp may explain the differences of the results.…”

Section: Discussionmentioning

confidence: 87%

“…The prevalence of malaria coinfection with DENV (24/161; 14.9%) was much higher than the found in a cross-sectional study in hospitalized patients with the acute febrile syndrome in the Brazilian Amazon (44/1578; 2.8%) [25] or in another study in Mumbai (16/156; 10.25%) [16], or during a dengue outbreak in India (27/367; 7.4%) [30]. In contrast, in Pakistan, the prevalence found was higher (26/78; 33.3%) [31], as well as in India (29/66; 44%), [29]. Thus, the prevalence of coinfection may uctuate, depending on local endemicity and the sensitivity of the diagnostic methods used.…”

Section: Discussionmentioning

confidence: 99%

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High Prevalence of viral and bacterial coinfections in malaria in Venezuela

Forero‐Peña¹,

Mora²,

Rodríguez

et al. 2021

Preprint

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Background Malaria remains a significant public health problem worldwide. Simultaneous infections with other pathogens complicate its diagnosis and can also change the clinical course of the disease. The similarities in the clinical presentation of malaria and other infections and the superimposed endemicity result in underdiagnosis of coinfections and increase mortality. No studies have focused on the presence of coinfections in patients with malaria in Venezuela. Methods Between June and November 2018, we conducted a cross-sectional study in patients with malaria who presented to any of the three reference medical centers in Ciudad Bolívar, Venezuela. A clinical and laboratory evaluation searching for coinfections with Dengue (DENV), Chikungunya (CHIKV), Viral Hepatitis (VH) (A, B, and C), and Leptospirosis (LEP) was performed using ELISA to test each patient. Results We studied a total of 161 patients of whom 106 (65.8%) presented P. vivax infection, 43 (26.7%) P. falciparum, and 12 (7.5%) had mixed malaria infections. Coinfections were found in 55/161 (34.2%) patients and were more frequent in patients with P. falciparum (48.8%) than in those with P. vivax (29.2%), or mixed infection (25%) [OR = 2.43; 95% CI = 1.39–4.25; p = 0.018]. The most prevalent coinfection was with DENV (14.9%), followed by HAV (11.8%), HBV (6.2%), CHIKV (5.5%), and LEP (3.7%). Coinfection with HCV was absent. Complicated malaria was significantly more frequent in coinfected individuals (56.4%) than those without coinfection (35.8%) [OR: 2.31; 95% CI = 1.18–4.92; p = 0.013]. Conclusion We found a high prevalence of coinfections in patients with malaria in this region, which was related to a worse outcome. Further prospective studies with samples at different points of infection and the use of molecular tools are needed.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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High Prevalence of viral and bacterial coinfections in malaria in Venezuela

Forero‐Peña¹,

Mora²,

Rodríguez

et al. 2021

Preprint

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“…Malaria diagnosis in the present study using microscopy and antigen detection using RDTs may underestimate the proportion of falciparum malaria cases among febrile patients, which can lead to inadequate detection of malaria as a mono- or co-infection as shown by recently published literature [ 37 – 40 ]. Therefore, the findings of this study should be interpreted cautiously in this context, and the underestimation of malaria in mono- and co-infected febrile patients could not be ruled out.…”

Section: Discussionmentioning

confidence: 85%

Malaria and dengue in Hodeidah city, Yemen: High proportion of febrile outpatients with dengue or malaria, but low proportion co-infected

et al. 2021

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Background The emergence of dengue in malaria-endemic countries with limited diagnostic resources, such as Yemen, can be problematic because presumptive treatment of febrile cases as being malaria is a common practice. Co-infections with dengue and malaria are often overlooked and misdiagnosed as being a mono-infection because of clinical similarities. In Hodeidah city, Yemen, the capacity to conduct the diagnosis can be aggravated by the war context. To assess the magnitude of the problem, we determined the proportions of malaria, dengue and co-infection in relation to clinical characteristics among febrile outpatients. Methods This cross-sectional study included 355 febrile outpatients from Hodeidah city during the malaria transmission season (September 2018 –February 2019). Sociodemographic and clinical characteristics were collected using a pre-designed, structured questionnaire. Malaria was confirmed using microscopy and rapid diagnostic tests (RDTs), while dengue was confirmed using RDTs. Results Mono-infection proportions of 32.4% for falciparum malaria and 35.2% for dengue were found, where about two-thirds of dengue patients had a recent probable infection. However, co-infection with falciparum malaria and dengue was detected among 4.8% of cases. There was no statistically significant difference between having co-infection and mono-infection with malaria or dengue in relation to the sociodemographic characteristics. On the other hand, the odds of co-infection were significantly lower than the odds of malaria among patients presenting with sweating (OR = 0.1, 95% CI: 0.05–0.45; p <0.001), while the odds of co-infection were 3.5 times significantly higher than the odds of dengue among patients presenting with vomiting (OR = 3.5, 95% CI: 1.20–10.04; p <0.021). However, there were no statistically significant differences between having co-infection and mono-infection (malaria or dengue) in relation to other clinical characteristics. Conclusions Mono-infection with malaria or dengue can be detected among about one-third of febrile outpatients in Hodeidah, while almost 5.0% of cases can be co-infected. Sociodemographic and clinical characteristics cannot easily distinguish malaria patients from dengue-infected or co-infected ones, reinforcing the necessity of laboratory confirmation and avoidance of treating febrile patients as being presumed malaria cases.

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“…Of the 125 articles examined for full text, 111 articles were excluded for the following reasons: 55 had no data on co-infection of malaria and leptospirosis, 25 had no malaria cases, 13 were review articles, 9 were case reports or case series for malaria and leptospirosis, and 9 had no leptospirosis cases. Fourteen articles [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] met the eligibility criteria and were included in the qualitative synthesis. Additional searches on reference lists and Google Scholar found one article [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Malaria and Leptospirosis Co-Infection among Febrile Patients: A Systematic Review and Meta-Analysis

et al. 2021

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Malaria and leptospirosis are important cosmopolitan infections that have emerged with overlapping geographic distribution, especially in tropical and subtropical regions. Therefore, co-infection with malaria and leptospirosis may occur in overlapping areas. The present study aimed to quantify the prevalence of malaria and leptospirosis co-infection among febrile patients. The association between malaria and leptospirosis infections was also investigated. Relevant studies that had reported malaria and leptospirosis co-infection were identified from PubMed, Scopus, and Web of Science. The risk of bias of the studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tool. The pooled prevalence of malaria and leptospirosis co-infections among febrile patients and the pooled prevalence of leptospirosis infection among malaria patients were estimated using random effect models. The association between malaria and leptospirosis infection among febrile patients was estimated using random effect models. The outcomes of each study were shown in a forest plot in point estimate and 95% confidence interval (CI). Heterogeneity among the included studies was assessed using Cochran’s Q and quantified using I-squared statistics. For leptospirosis, subgroup analyses of countries, diagnostic tests, and participants’ age groups were performed to specify prevalence in each subgroup. Publication bias was assessed by funnel-plot visualization. Of the 2370 articles identified from the databases, 15 studies met the eligibility criteria and were included for qualitative and quantitative syntheses. Most of the included studies were conducted in India (5/15, 33.3%), Thailand (3/15, 20%), and Cambodia (2/15, 13.3%). Most of the enrolled cases were febrile patients (5838 cases) and malaria-positive patients (421 cases). The meta-analysis showed that the pooled prevalence of malaria and leptospirosis co-infection (86 cases) among febrile patients was 1% (95% CI: 1–2%, I2: 83.3%), while the pooled prevalence of leptospirosis infection (186 cases) among malaria patients was 13% (95% CI: 9–18%, I2: 90.3%). The meta-analysis showed that malaria and leptospirosis co-infections occurred by chance (p: 0.434, OR: 1.4, 95% CI: 0.6–3.28, I2: 85.2%). The prevalence of malaria in leptospirosis co-infection among febrile patients in the included studies was low. Co-infection was likely to occur by chance. However, as clinical symptoms of leptospirosis patients were non-specific and not distinguishable from symptoms of malaria patients, clinicians caring for febrile patients in an area where those two diseases are endemic should maintain a high index of suspicion for both diseases and whether mono-infections or co-infections are likely. Recognition of this co-infection may play an important role in reducing disease severity and treatment duration.

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Association of Dengue Virus and Leptospira Co-Infections with Malaria Severity

Cited by 15 publications

References 39 publications

High Prevalence of viral and bacterial coinfections in malaria in Venezuela

High Prevalence of viral and bacterial coinfections in malaria in Venezuela

Malaria and dengue in Hodeidah city, Yemen: High proportion of febrile outpatients with dengue or malaria, but low proportion co-infected

Prevalence of Malaria and Leptospirosis Co-Infection among Febrile Patients: A Systematic Review and Meta-Analysis

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