Demographic, clinical and laboratory features of leptospirosis–malaria co-infections in Peninsular Malaysia

Abstract

Introduction. Co-infection of leptospirosis–malaria is not uncommon due to their overlapping geographical distribution in the tropics. Aim. This study aimed to describe and compare the demographic, clinical and laboratory features of leptospirosis–malaria co-infection (LMCI) against leptospirosis mono-infection (LMI) in Peninsular Malaysia. Methodology. Data of patients admitted to various hospitals in Peninsular Malaysia from 2011 to 2014 diagnosed with leptospirosis in our laboratory were obtained from their admission records. Co-infections with malaria were identified via blood film for malaria parasites (BFMP). Description with inferential statistics analysis and multiple logistic regressions were used to distinguish features between dual and mono-infections. Results. Of 111 leptospirosis-positive patients, 26 (23.4 %) tested positive for malaria. Co-infections were predominant among male patients with a mean age of 33 years and were prevalent among immigrant populations who had settled in high-density suburban areas. Chills and rigor with splenomegaly were the only significant distinguishing clinical features of LMCI while leukocytosis and raised transaminases were significant laboratory parameters. Only chills and rigor demonstrated a predictive value for LMCI from analysis of multiple logistic regressions. No death was attributed to co-infection in this study, in contrast to LMI (11.8 %, n=10). Conclusion. The significant prevalence of LMCI found in this study with overlapping demographic, clinical and laboratory parameters makes diagnosis of co-infection challenging. It is essential to evaluate co-infection in endemic areas. Strengthened awareness of LMCI, comprehensive diagnostic services and further prospective studies are warranted.

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

“…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 ].…”

“…Additional searches on reference lists and Google Scholar found one article [ 42 ]. Finally, 15 articles [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ] were included in the qualitative and quantitative syntheses ( Figure 1 ).…”

“…All studies were published between the years 2003–2021. Most of the included studies were conducted in India (5/15, 33.3%) [ 32 , 34 , 36 , 37 , 41 ], Thailand (3/15, 20%) [ 30 , 38 , 40 ], Cambodia (2/15, 13.3%) [ 33 , 35 ], Bangladesh [ 39 ], Jamaica [ 31 ], Malaysia [ 26 ], Tanzania [ 29 ], and Venezuela [ 42 ]. Most studies enrolled febrile patients (5838 cases) (10/15, 66.7%) [ 29 , 30 , 31 , 33 , 34 , 36 , 37 , 39 , 40 , 41 ], malaria-positive patients (421 cases) [ 32 , 38 , 42 ], and one study enrolled both febrile and non-febrile individuals (1193 cases) [ 35 ].…”

“…Most studies enrolled febrile patients (5838 cases) (10/15, 66.7%) [ 29 , 30 , 31 , 33 , 34 , 36 , 37 , 39 , 40 , 41 ], malaria-positive patients (421 cases) [ 32 , 38 , 42 ], and one study enrolled both febrile and non-febrile individuals (1193 cases) [ 35 ]. Most of the included studies enrolled adult patients (7/15, 46.7%) [ 26 , 30 , 34 , 37 , 38 , 41 , 42 ], all age groups (5/15, 33.3%) [ 31 , 33 , 35 , 36 , 39 ], and age not specified, by Mandage et al [ 32 ]. For malaria diagnosis, most of the included studies used a gold standard “microscopy” alone (8/15, 53.3%) [ 26 , 29 , 30 , 33 , 36 , 38 , 41 , 42 ], microscopy/RDT/PCR (3/15, 20%) [ 32 , 35 , 39 ], microscopy/RDT [ 34 ] ELISA [ 31 ] microscopic agglutination test (MAT) [ 40 ], and RDT [ 37 ].…”

“…Malaria and leptospirosis are important cosmopolitan infections that have emerged with overlapping geographic distribution, especially in tropical and subtropical regions [ 26 ]. Therefore, co-infection with malaria and leptospirosis may occur in overlapping areas.…”