The First Reported Case of COVID-19 and <i>Plasmodium ovale</i> Malaria Coinfection — Guangdong Province, China, January 2021

Abstract

The current coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to global health (1-3). The clinical symptoms of COVID-19 are similar to those of malaria, such as fever, myalgia, fatigue, headache, and gastrointestinal symptoms. Due to the heavy burden of medical services and the possible shortage of resources caused by the long-term COVID-19 pandemic, the risk of coinfection of malaria and COVID-19 is a matter of particular concern. Here we reported the first case of COVID-19 coinfection with Plasmodium ovale (P. ovale) malaria in a 47-year-old man who had been previously diagnosed with Plasmodium infection and incompletely treated with antimalarial drugs.The 47-year-old man worked from October 30, 2018 to December 16, 2020 in Masindi, Uganda, in an area dually affected by malaria and COVID-19. On December 19, 2020, the nasopharyngeal swab for COVID-19 virus testing using reverse transcriptase polymerase chain reaction (RT-PCR) and malaria rapid diagnostic testing (RDT) both had negative results when the patient returned from Uganda and entered Shenzhen City, Guangdong Province, China. However, on December 25, the nasopharyngeal swab for COVID-19 virus test result was positive, and the patient was admitted to a COVID-19 ward for further observation and symptom control on the next day. On December 29, the patient experienced chills, fever, muscle pain, and other clinical symptoms. On December 31, the results of blood smear test showed that the different blood stages of P. ovale, including trophozoites and schizonts, were consistent with P. ovale (Figure 1). In addition, the blood smear identified trophozoites of P. ovale with a parasitemia of 0.01%. The plasmodial ssrRNA (MW768131) and P. ovale sp. tryptophan-rich antigen (potra) (MW872056) gene were amplified by nested PCR, respectively (4-6). After sequencing, the protozoan was identified as P. ovale wallikeri (P. o. wallikeri).The patient's symptoms were mild and resolved completely after treatment with primaquine for 24

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