Malaria and dengue in Hodeidah city, Yemen: High proportion of febrile outpatients with dengue or malaria, but low proportion co-infected

Abstract

Background The emergence of dengue in malaria-endemic countries with limited diagnostic resources, such as Yemen, can be problematic because presumptive treatment of febrile cases as being malaria is a common practice. Co-infections with dengue and malaria are often overlooked and misdiagnosed as being a mono-infection because of clinical similarities. In Hodeidah city, Yemen, the capacity to conduct the diagnosis can be aggravated by the war context. To assess the magnitude of the problem, we determined the proportions of malaria, dengue and co-infection in relation to clinical characteristics among febrile outpatients. Methods This cross-sectional study included 355 febrile outpatients from Hodeidah city during the malaria transmission season (September 2018 –February 2019). Sociodemographic and clinical characteristics were collected using a pre-designed, structured questionnaire. Malaria was confirmed using microscopy and rapid diagnostic tests (RDTs), while dengue was confirmed using RDTs. Results Mono-infection proportions of 32.4% for falciparum malaria and 35.2% for dengue were found, where about two-thirds of dengue patients had a recent probable infection. However, co-infection with falciparum malaria and dengue was detected among 4.8% of cases. There was no statistically significant difference between having co-infection and mono-infection with malaria or dengue in relation to the sociodemographic characteristics. On the other hand, the odds of co-infection were significantly lower than the odds of malaria among patients presenting with sweating (OR = 0.1, 95% CI: 0.05–0.45; p <0.001), while the odds of co-infection were 3.5 times significantly higher than the odds of dengue among patients presenting with vomiting (OR = 3.5, 95% CI: 1.20–10.04; p <0.021). However, there were no statistically significant differences between having co-infection and mono-infection (malaria or dengue) in relation to other clinical characteristics. Conclusions Mono-infection with malaria or dengue can be detected among about one-third of febrile outpatients in Hodeidah, while almost 5.0% of cases can be co-infected. Sociodemographic and clinical characteristics cannot easily distinguish malaria patients from dengue-infected or co-infected ones, reinforcing the necessity of laboratory confirmation and avoidance of treating febrile patients as being presumed malaria cases.

Prospective case-control study of dengue infection in some malaria and non-malaria patients consulting at the Bertoua Regional Hospital, East-Cameroon

“…This result suggests that the prevalence of dengue is lower in malaria patients than in asymptomatic patients. These findings are consistent with those of Abdul-Ghani et al who reported a coinfection rate of 4.8% versus a dengue mono-infection seroprevalence of 35.2% in outpatients from Hodeidah city in Yemen [27]. Likewise, Rao et al found that of 745 dengue-positive cases identified in the Angul of Odisha district in India, only 3% were shown to possess denguemalaria coinfection [28].…”

Dengue and malaria coinfection: the first case report in Nepal

“…The typical rise of temperature daily at a similar time, jaundice and anemia gave a clue of coinfection with malaria. The coinfections may get missed because of the similar clinical picture of mono-infection of these two conditions [ 6 ]. It has been observed that presence of jaundice in a case of dengue and presence of spontaneous bleeding in a case of malaria suggests coinfection [ 7 ].Usually, in acute febrile illness, we often forget to look after the coinfections once one of the conditions is diagnosed [ 3 ].…”

Ionic Disorders in Malaria and Dengue Co-Infection

“…In a study at Thaïlande, on 194 dengue patients, no association with malaria has been found (Singhsilarak et al, 2006). Even if the phenomenon of co-infection seems to be rare in terms of frequency (Abdul-Ghani et al, 2021), it is often described in the literature. Thus, Im et al identified in their study 39 cases of co-infection in 2762 patients, i.e.…”