Is dengue and malaria co-infection more severe than single infections? A retrospective matched-pair study in French Guiana

Abstract

BackgroundDengue and malaria are two major arthropod-borne infections in tropical areas, but dual infections were only described for the first time in 2005. Reports of these concomitant infections are scarce and there is no evidence of more severe clinical and biological pictures than single infections.MethodsTo compare co-infections to dengue alone and malaria alone, a retrospective matched-pair study was conducted between 2004 and 2010 among patients admitted in the emergency department of Cayenne hospital, French Guiana.Results104 dengue and malaria co-infection cases were identified during the study period and 208 individuals were matched in two comparison groups: dengue alone and malaria alone. In bivariate analysis, co-infection clinical picture was more severe than separated infections, in particular using the severe malaria WHO criteria. In multivariate analysis, independent factors associated with co-infection versus dengue were: masculine gender, CRP level > 50 mg/L, thrombocytopaenia < 50 109/L, and low haematocrit <36% and independent factors significantly associated with co-infections versus malaria were red cells transfusion, low haematocrit < 36%, thrombocytopaenia < 50 109/L and low Plasmodium parasitic load < 0.001%.ConclusionsIn the present study, dengue and malaria co-infection clinical picture seems to be more severe than single infections in French Guiana, with a greater risk of deep thrombocytopaenia and anaemia.

Clinical Profile of Concurrent Dengue Fever and Plasmodium vivax Malaria in the Brazilian Amazon: Case Series of 11 Hospitalized Patients

“…Similarly, the presence of rash in malarial patients (as seen in Figure 1F) might suggest any exanthematous viral disease, e.g., dengue fever, parvovirus B19, or rubella. 18 A recent case-control retrospective study in French Guiana pointed to more severe anemia and thrombocytopenia in patients with the co-infection, 35 however, a larger series of cases in different settings are needed to validate this finding. Mild spontaneous bleeding, as seen in Figure 1C-E, was present in 6 of 11 patients in this study and only half of these patients had severe thrombocytopenia (also considered as a warning sign).…”

A case of cerebral malaria and dengue concurrent infection

“…Specific rate of concurrent infection of malaria and dengue from overall febrile patient is 0.99% as reported by Crame et al Concurrent infection is rare due to each infection has different mosquito vector, with different habitat, dengue mosquito vector has main habitat in cities whereas malaria has its habitat in forests and probable immunity to each infection in the endemic area is also preventing the concurrent infection [2,5,6] . Although there were no initial reports on the modification of nature of morbidity and mortality in con current infection, a retrospective study of 104 patients in French Guiana by Epelboin et al reported that concurrent infection is more severe than single infection [7] . They found that there is a greater risk of developing deep thrombocytopenia and anemia.…”

“…On reviewing literatures, there are only few studies done on concurrent of malaria and dengue infection in recent years and few reports from Southeast Asia and India [1][2][3][4][5][6][7] . In concurrent cerebral malaria and dengue infection both malaria and dengue infection exists in a patient at the same time.…”

Imported Dengue Infection in a Spanish Hospital with a High Proportion of Travelers from Africa: A 9-Year Retrospective Study

“…28 In addition, our data support the claim that coinfection malaria/dengue is not a rare event and may have clinical implications. 29 Our study has several limitations: First, no antibodyneutralizing test was performed to rule out cross-reaction with other circulating flaviviruses or with yellow fever vaccination. This is particularly relevant when using IgG dengue antibody for seroprevalence determination in non-European subjects, mainly African travelers, and may cause the rate to be overestimated.…”