Does Malaria Co-Infection Alter the Clinical Course in Children Infected with Dengue? Analysis from 623 Indian Children Admitted with Dengue Infection

Abstract

Background Dengue and malaria co-infection has been reported in several case reports. We aim to study effect of malaria co-infection on clinical outcomes of dengue infection. Methods Records of 623 children with dengue infection, based on NS-1 antigen and IgM ELISA testing, were collected. Malaria co-infection was identified in 20 cases, based on peripheral blood smear examination. Clinical and hematological parameters were compared in two groups (malaria co-infection vs. dengue mono-infection). Results Duration of hospitalization was significantly higher in co-infected group. Significantly higher proportion of malaria co-infection cases had hepatosplenomegaly, hemoglobin ≤8 g/dl, serum albumin ≤3 g/dl, serum bilirubin ≥1 mg/dl, serum aspartate aminotransferase ≥500 U/l and serum alanine aminotransferase ≥300 U/l. Number of transfusions (PRBC and platelets) required in malaria co-infection group was higher. Conclusion Malaria co-infection in dengue impacts clinical presentation, hematological parameters, requirement of blood transfusion and morbidity. High index of suspicion is warranted while evaluating febrile patients.

Codetection of Plasmodium falciparum in Children Hospitalized With Dengue Fever in the Dominican Republic

“…Among available literature, the prevalence of coinfections varies widely by study location, methodology, case ascertainment and Plasmodium species, ranging from <1% to 33% of hospitalized adults and children. [8][9][10][11][12][13][14] These studies report conflicting findings on the association between coinfections with the degree of laboratory value abnormalities or severity of clinical disease. 12,[14][15][16][17] Understanding the interaction between dengue and malaria and how it changes disease presentation and severity is crucial to informing our ability to clinically recognize both pathogens and also to implement public health programs and surveillance strategies.…”

“…Among available literature, the prevalence of coinfections varies widely by study location, methodology, case ascertainment and Plasmodium species, ranging from <1% to 33% of hospitalized adults and children. 8–14 These studies report conflicting findings on the association between coinfections with the degree of laboratory value abnormalities or severity of clinical disease. 12,14–17…”