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. 2022 Jun 29;14(2):57-63.
doi: 10.4103/jgid.jgid_279_21. eCollection 2022 Apr-Jun.

Outcome of Adult Malarial Co-infections in Eastern India

Saurabh Pandey  1 , Priyanka Rai  1 , Subhasish Kamal Guha  1 , Ardhendu Maji  1 , Subir Ghosh  1 , Prantiki Halder  1 , Manoj Kumar Gupta  1 , Soumen Nath Halder  1 , Dolanchampa Modak  1
Affiliations

Outcome of Adult Malarial Co-infections in Eastern India

Saurabh Pandey et al. J Glob Infect Dis. .

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.

Keywords: Bacterial; Eastern India; co-infection; concurrent; dengue; leptospirosis; malaria.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Recruitment of subjects in the study
Figure 2
Figure 2
Algorithm for symptom based diagnosis of concurrent infections with malaria. #Blood culture should be sent in these conditions in all diagnosed cases of malaria. $Presence of rash without organ involvement can be attributed to dengue, chikungunya, leptospirosis, scrub typhus as common etiology tested in tropical countries. *Rising or persistent jaundice and hepatitis can be feature of acute fulminant hepatic failure also
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