Prevalence of Malaria and Chikungunya Co-Infection in Febrile Patients: A Systematic Review and Meta-Analysis

Abstract

Co-infection with malaria and chikungunya (CHIKV) could exert a significant public health impact with infection misdiagnosis. Therefore, this study aimed to collect qualitative and quantitative evidence of malaria and CHIKV co-infection among febrile patients. Methods: Potentially relevant studies were identified using PubMed, Web of Science, and Scopus. The bias risk of the included studies was assessed using the checklist for analytical cross-sectional studies developed by the Joanna Briggs Institute. The pooled prevalence of malaria and CHIKV co-infection among febrile patients and the pooled prevalence of CHIKV infection among malaria patients were estimated with the random effect model. The odds of malaria and CHIKV co-infection among febrile patients were also estimated using a random effect model that presumed the heterogeneity of the outcomes of the included studies. The heterogeneity among the included studies was assessed using the Cochran Q test and I2 statistics. Publication bias was assessed using the funnel plot and Egger’s test. Results: Of the 1924 studies that were identified from the three databases, 10 fulfilled the eligibility criteria and were included in our study. The pooled prevalence of malaria and CHIKV co-infection (182 cases) among febrile patients (16,787 cases), stratified by diagnostic tests for CHIKV, was 10% (95% confidence interval (CI): 8–11%, I2: 99.5%) using RDT (IgM), 7% (95% CI: 4–10%) using the plaque reduction neutralization test (PRNT), 1% (95% CI: 0–2%, I2: 41.5%) using IgM and IgG ELISA, and 4% (95% CI: 2–6%) using real-time RT-PCR. When the prevalence was stratified by country, the prevalence of co-infection was 7% (95% CI: 5–10%, I2: 99.5%) in Nigeria, 1% (95% CI: 0–2%, I2: 99.5%) in Tanzania, 10% (95% CI: 8–11%) in Sierra Leone, 1% (95% CI: 0–4%) in Mozambique, and 4% (95% CI: 2–6%) in Kenya. The pooled prevalence of CHIKV infection (182 cases) among malaria patients (8317 cases), stratified by diagnostic tests for CHIKV, was 39% (95% CI: 34–44%, I2: 99.7%) using RDT (IgM), 43% (95% CI: 30–57%) using PRNT, 5% (95% CI: 3–7%, I2: 5.18%) using IgM and IgG ELISA, and 9% (95% CI: 6–15%) using real-time RT-PCR. The meta-analysis showed that malaria and CHIKV co-infection occurred by chance (p: 0.59, OR: 0.32, 95% CI: 0.6–1.07, I2: 78.5%). Conclusions: The prevalence of malaria and CHIKV co-infection varied from 0% to 10% as per the diagnostic test for CHIKV infection or the country where the co-infection was reported. Hence, the clinicians who diagnose patients with malaria infections in areas where two diseases are endemic should further investigate for CHIKV co-infection to prevent misdiagnosis or delayed treatment of concurrent infection.

Clinical characteristics, complications, and predictors of outcome of hospitalized adult Sudanese patients with COVID‐19 and malaria coinfection in Sudan: A multicenter retrospective cross‐sectional study

“…Tropical and subtropical countries experience high levels of infection with Dengue virus and Chikungunya virus during the monsoon season, and co‐occurrence has been documented 44 . Malaria and dengue virus coinfection, as well as malaria and Chikungunya virus coinfection have been reported in Sudan 43,45 . A co‐infection with any or all of malaria, dengue virus, and Chikungunya virus; with COVID19 is predicted during the rainy season due to favorable breeding conditions for the mosquitoes, at the same time as the COVID19 pandemic could have a significant impact on public health 46 …”

“…44 Malaria and dengue virus coinfection, as well as malaria and Chikungunya virus coinfection have been reported in Sudan. 43,45 A co-infection with any or all of malaria, dengue virus, and Chikungunya virus; with COVID19 is predicted during the rainy season due to favorable breeding conditions for the mosquitoes, at the same time as the COVID19 pandemic could have a significant impact on public health. 46 Fever, cough, and lethargy are frequent symptoms of COVID-19.…”

Clinical Characteristics, Complications and Predictors of Outcome of Hospitalized Adult Sudanese Patients with COVID-19 and Malaria Co-Infection in Sudan, a Multi-Center Retrospective Cross-sectional Study

“…Other COVID19 co-infections have been documented, for instance, the co-infection of Dengue virus and COVID19 has been reported 41 . Dengue and Chikinguniya -which are two zoonotic arboviral diseases -are endemic in Sudan, as well as malaria 42,43 .Tropical and subtropical countries experience high levels of infection with Dengue virus and Chikungunya virus during the monsoon season, and co-occurrence has been documented 44 .Malaria and dengue virus co-infection, as well as Malaria and Chikungunya virus co-infection have been reported in Sudan 43,45 .A co-infection with any or all of Malaria, Dengue virus, and Chikungunya virus; with COVID19 is predicted during the rainy season due to favorable breeding conditions for the mosquitoes, at the same time as the COVID19 pandemic could have a signi cant impact on public health 46 .…”

Leptospirosis and Coinfection: Should We Be Concerned?

“…Furthermore, most of the coinfected patients respond effectively to fluid therapy, doxycycline and closely monitoring of their platelet count and hematocrit [93,94]. However, in some leptospirosis coinfections, treatment could not be assessed due to the lack of data, and it is critical to determine these different of infections that can provide relevant treatment decisions for patients with coinfections [95].…”

“…Fever, chills, body aches, yellow urine, jaundice, vomiting, and headache were all significant symptoms for coinfection patients [107][108][109][110][111][112]. Thus, the clinical symptom of malaria and leptospirosis were similar, making accurate diagnosis difficult without any laboratory confirmation [95]. Failure to recognize acute leptospirosis co-infection may cause a delay in initiating proper therapy and leading to severe complications of leptospirosis such as hepatic and renal failure [110].…”