Outcome of Adult Malarial Co-infections in Eastern India

Abstract

Introduction: Co-infection with different agents such as bacterial, viral, and Rickettsia is being increasingly recognized due to greater availability and utilization of the diagnostic tests among malaria patients. Methods: Consecutive admitted malarial cases were included and were subjected to test for general investigations, bacteria, typhoid, dengue, chikungunya, and rest for specific diagnosis. All patients were followed up till discharge or death and appropriate statistical tests were performed. Results: A total of 152 malaria patients were recruited and 27 (18.8%) had concurrent infections. It included 40.7% dengue only, 18.7% pneumonia, 11.1% urinary tract infection (UTI), 7.4% enteric fever, 3.7% leptospirosis, chikungunya, and tuberculous meningitis each, and 3.7% each of dengue with pneumonia and UTI. The organisms isolated were Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Salmonella typhi, and Mycobacterium tuberculosis. The mean duration of fever was 6.33 ± 3.63 days with a range of 3–20 days. Blood culture grew in 2 cases S. typhi and K. pneumonia,e. Dengue co-infections had significantly higher clinical and laboratory features of dengue and complications such as bleeding, jaundice, and cholecystitis, whereas rest concurrent infections had a significantly higher proportion of nausea and vomiting, convulsion, altered sensorium, productive cough, urinary symptoms, shock, acute kidney injury, anemia, and mean neutrophil count. There was significantly higher mortality among malaria–dengue concurrent infection group with 2 (15.4%) than malaria mono-infection group 3 (2.4%). Conclusion: Co-infections with malaria are not uncommon, especially dengue fever and other bacterial infections. The dominant clinical picture is of the superimposed infection. Decision should be clinically guided adjunct with specific diagnostic tests, and timely treatment has favorable outcome.

Case Report: Managing the Coinfection of Cerebral Malaria and Dengue in the Intensive Care Unit

“…24 Supportive care for this patient included daily routines such as analgosedation with daily sedation vacation, fever control, oral hygiene, prevention of nosocomial infections, and pressure ulcer prevention. [25][26][27][28][29][30] The patient's response improved with enhanced consciousness and adequate breathing efforts on the 6th day of ICU admission and continued to improve until the patient could be transferred to an intermediate room. Regular examination of sequential blood smears with parasite quantification is advised to monitor the response to therapy, focusing on the reduction in percent parasitemia and eventual parasite clearance.…”

There is a lack of quality clinical and laboratory data on co-infections among malaria patients despite several published systematic reviews of the literature

“…Our recent publication on concurrent infections among malaria cases described co-infections with dengue, chikungunya, typhoid, leptospira, tuberculosis, HIV, and bloodstream bacterial infections. 1 The study provided clinical-laboratory features of co-infections compared to malaria mono-infection and subsequent approaches for diagnosis. Building upon this study, we decided to devise a working protocol for diagnosing concurrent infections among malaria cases.…”