Title: A Study on Clinical Presentation and Outcome of Concurrent Malaria and Dengue Infection from a Malaria Endemic Zone of North India
Authors: Rajendra Kumar Verma, Richa Giri, Nirmala Singh, Chirag Gupta, Arisht Jain
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.132
Abstract
This study has been done to differentiate clinical and biological parameter of co-infections from infections alone and to find out whether patients infected by both malaria and dengue were more severe than either infection alone.
Material and Methods: All febrile adult patients (> 18 years of age) were investigated for malaria, dengue and other causes of fever. Patients of concurrent dengue and malaria (Group A) were compared with malaria mono-infection (Group B) and dengue mono-infection (Group C). Frequencies of alterations in clinical, biochemical, haematological parameters and outcome were determined in various groups. Data was analysed using appropriate statistical tests.
Results: Out of these 340 patients, there were 52 (15.29%), 132 (38.82%), and 156 (45.88%) patients in Groups A, B, and C respectively. Prevalence of co-infection in our study was 25%. Features like prolonged fever (7.18+/- 3.91), severe anemia (23.07%) and respiratory distress (7.69%) were comparable to malaria mono-infection whereas features like bleeding manifestations(15.38%), frontal or retro-orbital headache (80%), arthralgia (15.38%) and / elevated haematocrit were more like dengue mono-infection.
Conclusion: In endemic areas for dengue and malaria, prolonged fever, severe anemia and respiratory distress (in dengue patients) and bleeding manifestations, frontal or retro-orbital headache, arthralgia and / elevated haematocrit level (in malaria patients) should raise the suspicion of co-infection and since a high prevalence of co-infection was found in our geographical area. We recommend that all the patients suspected for dual infections should be treated concomitantly for dengue and malaria in malaria endemic areas.
Keywords: Malaria, Dengue, Co infection, India.
References
1. Charrel RN, Brouqui P, Foucault C, de Lamballerie X: Concurrent dengue and malaria. Emerg Infect Dis 2005, 11:1153–1154.
2. Arya CS, Mehta KL, Agarwal N, Agarwal BK, Mathai G, Moondhara A: Episodes of concurrent dengue and malaria. Dengue Bulletin2005, 29:208–209.
3. Manish Bhagat, Sujata Kanhere, Varsha Phadke, and Riya George: Concurrent Malaria and Dengue Fever: A Need for Rapid Diagnostic Methods. J Family Med Prim Care. 2014 Oct-Dec; 3(4): 446–448.doi: 10.4103/2249 863.148146 PMCID: PMC4311362.
4. Deresinski S: Concurrent Plasmodium vivax malaria and dengue. Emerg Infect Dis 1802, 2006:12.
5. Abbasi A, Butt N, Sheikh QH, Bhutto AR, Munir SM, Ahmed SM: Clinical features, diagnostic techniques and management of dual dengue and malaria infection. J Coll Physicians Surg Pak 2009, 19:25–29.
6. Ali N, Nadeem A, Anwar M, Tariq WU, Chotani RA: Dengue fever in malaria endemic areas. J Coll Physicians Surg Pak 2006, 16:340–342.
7. M.K. Mohapatra, P. Patra & R. Agrawala : Manifestation and outcome of concurrent malaria and dengue infection . J Vector Borne Dis 49, Dec 2012, pp. 262–265.
8. Ward DI: A case of fatal Plasmodium falciparum malaria complicated by acute dengue fever in East Timor. Am J Trop Med Hyg2006, 75:182–185.
9. Thangaratham PS, Jeevan MK, Rajendran R, Samuel PP, Tyagi BK: Dual infection by dengue virus and Plasmodium vivax in Alappuzha District, Kerala, India. Jpn J Infect Dis 2006, 59:211–212.
10. Carme B, Matheus S, Donutil G, Raulin O, Nacher M, Morvan J: Concurrent dengue and malaria in Cayenne Hospital, French Guiana.Emerg Infect Dis 2009, 15:668–671.
11. Loïc Epelboin, Matthieu Hanf, Philippe Dussart, Sihem Ouar Epelboin, Félix Djossou, Mathieu Nacher and Bernard Carme: Is dengue and malaria co-infection more severe than single infections? A retrospective matched-pair study in French Guiana. Malaria Journal201211:142 DOI: 10.1186/1475-2875-11-142.
12. Dos Santos Santana V, Lavezzo LC, Mondini A, Terzian AC, Bronzoni RV, Rossit AR, Machado RL, Rahal P, Nogueira MC, Nogueira ML:Concurrent Dengue and malaria in the Amazon region. Rev Soc Bras Med Trop 2010, 43:508–511.
13. Belisa M. L. Magalhães, André M. Siqueira, Márcia A. A. Alexandre, Marcela S. Souza, João B. Gimaque,Michele S. Bastos, Regina M. P. Figueiredo,Gisely C. Melo, Marcus V. G. Lacerda, and Maria P. G. Mourão: P. vivax Malaria and Dengue Fever Co-infection: A Cross-Sectional Study in the Brazilian Amazon. PLoS Negl Trop Dis. 2014 Oct; 8(10): e3239. Published online 2014 Oct 23. doi: 10.1371/journal.pntd.0003239. PMCID: PMC4207662
14. Vitor R R Mendonça, Bruno B Andrade, Ligia C L Souza, Belisa M L Magalhães, Maria P G Mourão, Marcus V G Lacerda and Manoel Barral-Netto : Unravelling the patterns of host immune responses in Plasmodium vivax malaria and dengue co-infection. Malaria Journal 201514:315 DOI: 10.1186/s12936-015-0835-8.
15. Chaturvedi UC, Mathur A, Kapoor AK, Mehrotra NK, Mehrotra RML. Virological study of an epidemic of febrile illness with haemorrhagic manifestations at Kanpur, India, during 1968. Bull World Health Organ 1970; 43 : 289-93. 23.
16. Chaturvedi UC, Kapoor AK, Mathur A, Chandra D, Khan AM, Mehrotra RML. A clinical and epidemiological study of an epidemic of febrile illness with haemorrhagic manifestations which occurred at Kanpur, India in 1968. Bull World Health Organ 1970; 43 : 281-7
17. Gulati S, Maheshwari A (2007): Atypical manifestations of dengue. Trop Med Int Health 12: 1087–1095.
18. Abbasi ABN, Sheikh QH, Bhutto AR, Munir SM, Ahmed SM (2009): Clinical features, diagnostic techniques and management of dual dengue and malaria infection. J Coll Physicians Surg Pak 19: 25–29.
19. Magalhaes BM, Alexandre MA, Siqueira AM, Melo GC, Gimaque JB: Clinical profile of concurrent dengue fever and Plasmodium vivax malaria in the Brazilian Amazon: case series of 11 hospitalized patients. Am J Trop Med Hyg 87: 1119–1124.
20. Kochar DK, Das A, Kochar A, Middha S, Acharya J: Thrombocytopenia in Plasmodium falciparum, Plasmodium vivax and mixed infection malaria: a study from Bikaner (Northwestern India). Platelets 21: 623–627.
21. Lacerda MV, Mourao MP, Coelho HC, Santos JB (2011) Thrombocytopenia in malaria: who cares?Mem Inst Oswaldo Cruz 106 Suppl 1: 52–63.
22. Mourao MP, Lacerda MV, Macedo VO, Santos JB (2007) Thrombocytopenia in patients with dengue virus infection in the Brazilian Amazon. Platelets 18: 605–612.
23. Alonzo MT, Lacuesta TL, Dimaano EM, Kurosu T, Suarez LA, et al. (2012) Platelet apoptosis and apoptotic platelet clearance by macrophages in secondary dengue virus infections. J Infect Dis 205: 1321–1329.
24. Costa VV, Fagundes CT, Souza DG, Teixeira MM (2013) Inflammatory and Innate Immune Responses in Dengue Infection: Protection versus Disease Induction. Am J Pathol 182: 1950–1961.
25. WHO (2009) Dengue: Guidelines for diagnosis, treatment, prevention and control. Geneva, Switzerland.
26. Sen MK, Ojha UC, Chakrabarti S, Suri JC (1999) Dengue hemorrhagic fever (DHF) presenting with ARDS. Indian J Chest Dis Allied Sci 41: 115–119.
27. Lomar AV, Vidal JE, Lomar FP, Barbas CV, de Matos GJ, et al. (2005) Acute respiratory distress syndrome due to vivax malaria: case report and literature review. Braz J Infect Dis 9: 425–430.
28. World Health Organization (2006) Guidelines for the treatment of malaria. Geneva, Switzerland.
29. Ward DI (2006): A case of fatal Plasmodium falciparum malaria complicated by acute dengue fever in East Timor. Am J Trop Med Hyg 75: 182–185.
30. Misra UK, Kalita J, Syam UK, Dhole TN : Neurological manifestations of dengue virus infection. J Neurol Sci. 2006 May 15; 244(1-2):117-22.
31. Cho Naing, Maxine A. Whittaker, Victor Nyunt Wai, and Joon Wah Mak. Is Plasmodium vivax Malaria a Severe Malaria?: A Systematic Review and Meta-Analysis. PLoS Negl Trop Dis. 2014 Aug; 8(8): e3071. Published online 2014 Aug 14. doi: 10.1371/journal.pntd.0003071 PMCID: PMC4133404.
32. Singh H, Parakh A, Basu S, Rath B. Plasmodium vivax malaria: is it actually benign?. J Infect Public Health. 2011 Jun;4(2):91-5. doi: 10.1016/j.jiph.2011.-03.002. Epub 2011 May 26.
33. Vivek B. Kute, Hargovind L. Trivedi, Aruna V. Vanikar, Pankaj R. Shah, Manoj R. Gumber, Himanshu V. Patel,Jitendra G. Goswami, and Kamal V. Kanodia. Plasmodium vivax Malaria–associated Acute Kidney Injury, India, 2010–2011. Emerg Infect Dis. 2012 May; 18(5): 842–845. PMCID: PMC3358071.
34. D. K. Kochar, A. Das, S. K. Kochar et al., “Severe Plasmodium vivax malaria: a report on serial cases from Bikaner in northwestern India,” American Journal of Tropical Medicine and Hygiene, vol. 80, no. 2, pp. 194–198, 2009.
35. Verma RK, Giri R, Singh N,Verma S, Srivastav V : A Study ON Clinical Presentation and Outcome of Malaria from an Underreported, P.vivax Predominant Region of North India. Sch. J. App. Med. Sci., 2016; 4(1C):233-243.
36. Costa AP, Bressan CS, Pedro RS, Valls-de-Souza R, Silva S, et al. (2010) Delayed diagnosis of malaria in a dengue endemic area in the Brazilian extra-Amazon: recent experience of a malaria surveillance unit in state of Rio de Janeiro. Rev Soc Bras Med Trop 43: 571–574.
37. Ward DI (2006) A case of fatal Plasmodium falciparum malaria complicated by acute dengue fever in East Timor. Am J Trop Med Hyg 75: 182–185.
38. Simmons CP, Farrar JJ, Nguyen vV, Wills B (April 2012). "Dengue". N Engl J Med366 (15): 1423–32. doi:10.1056/NEJ-Mra1110265.PMID 22494122.
39. Lizarraga KJ, Nayer A: Dengue-associated kidney disease. J Nephropathol. 2014;3 (2):57-62. doi: 10.12860/jnp.2014.13. Epub 2013 Dec 28. Review. PMID: 24772398.
40. Yong KP, Tan BH, Low CY: Severe falciparum malaria with dengue coinfection complicated by rhabdomyolysis and acute kidney injury: an unusual case with myoglobinemia, myoglobinuria but normal serum creatine kinase. BMC Infect Dis.2012 Dec 20;12:364.doi: 0.1186/1471-2334-12-364. PubMed PMID: 23256803; PubMed Central PMCID: PMC3557149.
41. Anand AC, Puri P (2005): Jaundice in malaria. J Gastroenterol Hepatol 20: 1322–1332.
42. Seneviratne SL, Malavige GN, de Silva HJ (2006): Pathogenesis of liver involvement during dengue viral infections. Trans R Soc Trop Med Hyg 100: 608–614.
43. Gulati S, Maheshwari A (2007): Atypical manifestations of dengue. Trop Med Int Health 12: 1087–1095.
44. Varatharaj A: Encephalitis in the clinical spectrum of dengue infection. Neurol India. 2010 Jul-Aug; 58(4):585-91.
45. Malaria, National Vector Borne Disease Control Programme (NVBDCP). Available from: http://www.nvbdcp.gov.i-n/malaria3.html. [Last accessed on 2015 Dec 27].