Early treatment failure in concurrent dengue and mixed malaria species infection with suspected resistance to artemisinin combination therapy from a tertiary care center in Delhi: a case report

Abstract

BackgroundConcurrent dengue and mixed malaria infections in a single patient present with overlapping clinical manifestations which pose a diagnostic challenge and management dilemma in areas of common endemicities.MethodsWe report a case of a young male who tested positive for both Plasmodium vivax and Plasmodium falciparum along with dengue infection. He showed signs of early treatment failure to artemisinin combination therapy (artesunate with sulfadoxine+pyrimethamine). Molecular analysis for the drug resistance genes viz: chloroquine resistance (pfcrt), multidrug resistance (pfmdr-1), sulfadoxine (pfdhps), pyrimethamine (pfdhfr), and artemisinin resistance (keltch 13) was performed.ResultsA rise in parasitemia from <2% to 5% was observed after 3 days of treatment. Mutations in pfcrt, pfmdr-1, pfdhfr, and pfdhps genes were detected as a possible cause of treatment failure.ConclusionIncreased severity, overlapping symptoms, and suspected resistance to treatment warrants a multidimensional diagnostic approach and diligent therapeutic monitoring.

Worldwide distribution, symptoms and diagnosis of the coinfections between malaria and arboviral diseases: a systematic review

“… Blood smear, RDT/ ELISA Plasmodium sp., and DENV (no serotype) 43 69 India, Asia Analytical cross-sectional studies 1980 22 1.11% Ages between 5 and > 15 years Febrile illness (38.3-39.4°C / 100.94-102.92°F), headache, retro-orbital pain, fever for 2-15 days. Blood smear, RDT, ELISA(IgM/ IgG, NS1) RT-PCR Plasmodium vivax , P. falciparum and DENV (no serotype) 44 47 India, Asia Case report 1 1 100% 17 years Fever, chills in the last 5-6 days, abdominal pain, and vomiting. RMAT, PCR, ELISA(IgM) Plasmodium vivax , P. falciparum and DENV (no serotype) 45 48 Brazil, South America Analytical cross-sectional studies 111 2 1.80% Ages > 18 years Episodes of fever, headache, and shivering.…”

Novel Cinchona Alkaloid Derivatives as Potential Antimalarial Agents through Receptor–Inhibitor Interaction Fingerprint and Biosynthesis Design

“…There are three families of drugs currently used for eradicating malaria disease, such as antifolates (pyrimethamine, sulfadoxine), quinolones (chloroquine, primaquine, quinine, mefloquine) and artemisinin derivatives. However, these drugs have limitation due to high cost and high resistance rate to malaria endemic causing frequent chemotherapy failure [9][10][11][12] . Understanding the resistance mechanisms could enhance new therapies [13][14][15] .…”