MIS-C and co-infection with P. vivax and P. falciparum in a child: a clinical conundrum

Abstract

Background The ongoing Coronavirus Disease 2019 (COVID-19) epidemic represents an unprecedented global health challenge. Many COVID-19 symptoms are similar to symptoms that can occur in other infections. Malaria should always be considered in patients with SARS-CoV-2 infection returning from endemic areas. Case presentation We present the first case of multisystem inflammatory syndrome (MIS-C) and Plasmodium vivax-falciparum and SARS-CoV2 coinfection in children. Despite clearance of parassitaemia and a negative COVID-19 nasopharyngeal PCR, the patient’s clinical conditions worsened. The World Health Organization (WHO) criteria were used to make the diagnosis of MIS-C. Treatment with intravenous immunoglobulins and methylprednisolone was effective. Conclusions This case emphasizes the importance of considering malaria diagnosis in patients returning from endemic areas, even in the COVID 19 era. Malaria and SARS-CoV2 co-infection may increase the risk of MIS-C, for which early detection is critical for proper management.

COVID-19 and malaria co-infection: a systematic review of clinical outcomes in endemic areas

“…Three studies used RT-PCR in addition to blood smear ( Konozy et al, 2022 ; Muyinda et al, 2022 ; Caglar et al, 2021 ). Plasmodium falciparum and vivax were identified as causative types in six studies for each, respectively ( Konozy et al, 2022 ; Guha et al, 2021 ; Huang et al, 2022 ; Boonyarangka et al, 2022 ; Forero-Peña et al, 2022 ; Achan et al, 2022 ; Hussein et al, 2022 ; Scalisi et al, 2022 ; Ahmed et al, 2022 ; Caglar et al, 2021 ; Indari et al, 2021 ; Chen et al, 2021 ), while in three studies, both species were detected ( Lee, Hong & Kim, 2022 ; Muyinda et al, 2022 ; Suarez et al, 2022 ). Plasmodium ovale was reported in two other studies ( Shahid et al, 2021 ; Pusparani, Henrina & Cahyadi, 2021 ), and one study reported it as non- falciparum spp .…”

“…As there is no age restriction, all age groups were included. Scalisi et al (2022) , Muyinda et al (2022) , Kishore et al (2020) and Indari et al (2021) reported the outcomes of COVID-19 and malaria infection in pediatric patients; however, in one study, age was not specified ( Konozy et al, 2022 ). In the case series, one patient was an infant, and one was pregnant ( Huang et al, 2022 ).…”

“…Regarding the outcomes, the duration of hospital stay ranged from 3 to 18 days. However, the disease ran a benign course in seven studies ( Konozy et al, 2022 ; Guha et al, 2021 ; Forero-Peña et al, 2022 ; Hussein et al, 2022 ; Scalisi et al, 2022 ; Pusparani, Henrina & Cahyadi, 2021 ; Indari et al, 2021 ), and patients were discharged with a complete recovery. Furthermore, in their cohort study in Uganda observed that patients with COVID-19 and Malaria co-infection had faster recovery and a lower admission rate than those without malaria ( Asmarawati et al, 2022 ).…”

“…The commonest co-morbidities recorded within the studies were diabetes Mellitus (DM) ( Boonyarangka et al, 2022 ; Lee, Hong & Kim, 2022 ; Asmarawati et al, 2022 ; Suarez et al, 2022 ; Scalisi et al, 2022 ; Chen et al, 2021 ), hypertension (HTN) ( Boonyarangka et al, 2022 ; Forero-Peña et al, 2022 ; Lee, Hong & Kim, 2022 ; Asmarawati et al, 2022 ; Suarez et al, 2022 ; Chen et al, 2021 ), cardiovascular disease (CVD), ( Boonyarangka et al, 2022 ; Lee, Hong & Kim, 2022 ; Chen et al, 2021 ), respiratory disorders that include chronic obstructive pulmonary disease (COPD), asthma, and tuberculosis ( Boonyarangka et al, 2022 ; Suarez et al, 2022 ; Chen et al, 2021 ). Obesity and dyslipidemia were reported in two studies ( Boonyarangka et al, 2022 ; Forero-Peña et al, 2022 ), immune deficiency, including human immunodeficiency virus (HIV) ( Boonyarangka et al, 2022 ; Suarez et al, 2022 ), and malignancy was reported in two other studies ( Lee, Hong & Kim, 2022 ; Suarez et al, 2022 ).…”