Clinico-hematological profile of children with Dengue and co-infection with Malaria: a hospital based study

Abstract

Background: The two most common vector borne diseases in the world are malaria and dengue. Co-infection infection is not unusual in a geographical region such as India, wherein both the vectors coexist. This study aimed to determine whether simultaneous malaria and dengue infection is serious in children than mono infection alone.Methods: In this study all children with fever of less than 7 days duration were included in the study. Clinical inspection and laboratory analysis were performed in all instances, following a detailed history. Children were categorized under 3 categories, malaria (M), dengue (D) and coinfection (DM). For any statistical difference between groups, their clinical as well as hematological parameters were analyzed. SPSS software was used for the statistical studies.Results: Malarial chills fever was also found in a substantial percentage of children with dengue. Superficial as well as profound bleeding were seen more often in the coinfected DM groups than D or M alone. In M group alone, jaundice and diarrhea were noted. In the segregated M and DM groups, the neurological indication, neurological involvement such as altered sensorium and seizure was noted at the same rate, whereas, there had been no occurrence in D group. Anemia was reported in all children, but M group showed the highest drop.Conclusions: Severity criteria, neurological involvement such as altered sensorium and seizures were reported at same rate both in malaria and coinfection, whereas, none of the patients with dengue showed signs of seizure. Anemia relative to hematologic parameters, was considerably more prevalent in the malaria patients. Presence of bleeding in malaria and jaundice in dengue patients, should be considerably investigated for a coinfection.

Prevalence of and risk factors for severe malaria caused by Plasmodium and dengue virus co-infection: a systematic review and meta-analysis

“…Overall, 9 studies met the eligibility criteria [ 11 , 13 – 15 , 25 – 29 ]. Additional searches through Google scholar retrieved four additional studies [ 30 – 33 ], resulting in 13 studies included in the present study.

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“… Ahmad et al, 2016, [ 25 ] India (2012–2013) Retrospective observational study Co-infection: 38.6 (16) Malaria: 35.7 (14.5) Dengue: 36.9 (14.9) Co-infection: male (8), female (1) Malaria: male (35), female (26) Dengue: male (38), female (20) 298 patients with febrile illness P. vivax (9) 11/58 Metabolic acidosis (2), shock (2), seizures (4), death (3) 8/61 Renal failure (2), shock (2), seizures (2), death (2) 1/9 Renal failure (1) 1/9 Renal failure (1), *hypotension (1) 2/9 2. Ahmad et al, 2019, [ 30 ] India (2017) Cross-sectional observational study Co-infection: 7.04 (5.01) Malaria: 5.67 (4.44) Dengue: 10.6 (2.82) Co-infection: male (10), female (3) Malaria: male (30), female (22) Dengue: male (47), female (27) 164 children with febrile illness P. falciparum (11), P. vivax (2) 9/74 Altered mental status (1), haematemesis or melaena (8), death (5), *hypotension (17) 19/52 Altered mental status (8), seizures (4), Jaundice (3), Hypotension (4), death (3) 4/13 Altered mental status (2), seizures (1), hypotension (1), death (1) 5/13 Altered mental status (2), seizures (1), haematemesis or melaena (2), death (1), *hypotension (1) 6/13 3. Assir et al, 2014, [ 26 ] Pakistan (2012) Cross-sectional observational study 22 years (range: 12–90 years) Male (64), female (21) 856 suspected cases of dengue fever P. falciparum (3), P. vivax (14) 2/5 Jaundice (2), *hypotension (0) 10/18 Impaired consciousness (1), hypotension (1), bleeding (3), renal failure (1), jaundice (4) 7/17 Hypotension (2), bleeding (5) 5/17 WHO grade 2 bleeding (5), *hypotension (2) 7/17 4.…”

“…The risk of bias in an individual study was assessed on the basis of the selection of the study groups, the comparability of the groups, and the ascertainment of exposure with a star system rating. Nine studies included in the meta-analysis were rated as “high quality” as they provided data for the primary and secondary outcomes of the present study [ 11 , 14 , 15 , 25 – 27 , 29 , 30 , 33 ]. The other four studies [ 13 , 28 , 31 , 32 ] were rated as “adequate quality” as they provided data for one outcome (Table 2 ).…”

“… Representativeness of the cases Selection of controls Definition of controls Ascertainment of exposure Same method of ascertainment for cases and controls Non-response rate 1. Ahmad et al, 2016, [ 25 ] ✵ ✵ ✵✵ ✵ ✵ ✵ 7 High 2 Ahmad et al, 2019, [ 30 ] ✵ ✵ ✵✵ ✵ ✵ ✵ 7 High 3. Assir et al, 2014, [ 26 ] ✵ ✵ ✵✵ ✵ ✵ ✵ 7 High 4.…”

“…3 ). Nine studies [ 11 , 14 , 15 , 25 – 27 , 30 , 31 , 33 ] were included in the meta-analysis comparing severe diseases due to co-infection and due to DENV mono-infection. The meta-analysis of nine studies demonstrated that patients with co-infection (146/297) and those with DENV mono-infection (669/1930) had a greater risk of developing a severe disease ( OR = 3.94, 95% CI : 1.96–7.95, I 2 = 72%) (Fig.…”