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      Severe coinfection of dengue and malaria: A case report

      case-report

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          Abstract

          Key Clinical Message

          In countries like Sudan, where several infectious diseases are prevalent, health care providers should not be satisfied with initial detection of a single pathogen and whenever it is feasible, they should investigate coinfections. Infections with high mortality or severe morbidity should be prioritized during the differential diagnosis particularly for diseases with similar clinical manifestations to reduce the death and disability rates. However, this requires substantial improvement in the diagnostic capacity.

          Abstract

          Here we report a case of dengue and malaria coinfection from the southeast region of Sudan, bordering Ethiopia and Eritrea. A 25‐year‐old male from Sudan presented with symptoms of fever, chills, vomiting, and muscle and joint pain. Laboratory investigations confirmed a coinfection of dengue and malaria, which is assumingly not uncommon in areas heavily syndemic with several diseases but it is severely under‐detected, underreported, and underestimated. The case has fully recovered after the supportive care for dengue and chemotherapy treatment for malaria. In such a case, it was important to monitor the patient's recovery and the treatment outcome through clinical indicators and laboratory parameters to update the treatment course whenever needed, according to response. The increasing burden and outbreaks of vector‐borne diseases including dengue and malaria in Sudan, indicates the need for improving the implementation of the global vector control response that established by the World Health Organization. Additionally, the increasing prevalent of coinfections is urging substantial improvement in the diagnostic capacity in endemic countries.

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          Most cited references45

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          Intravenous Artesunate for Severe Malaria in Travelers, Europe

          Multicenter trials in Southeast Asia have shown better survival rates among patients with severe malaria, particularly those with high parasitemia levels, treated with intravenous (IV) artesunate than among those treated with quinine. In Europe, quinine is still the primary treatment for severe malaria. We conducted a retrospective analysis for 25 travelers with severe malaria who returned from malaria-endemic regions and were treated at 7 centers in Europe. All patients survived. Treatment with IV artesunate rapidly reduced parasitemia levels. In 6 patients at 5 treatment centers, a self-limiting episode of unexplained hemolysis occurred after reduction of parasitemia levels. Five patients required a blood transfusion. Patients with posttreatment hemolysis had received higher doses of IV artesunate than patients without hemolysis. IV artesunate was an effective alternative to quinine for treatment of malaria patients in Europe. Patients should be monitored for signs of hemolysis, especially after parasitologic cure.
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            Is dengue and malaria co-infection more severe than single infections? A retrospective matched-pair study in French Guiana

            Background Dengue 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. Methods To 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. Results 104 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%. Conclusions In 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.
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              Global prevalence and distribution of coinfection of malaria, dengue and chikungunya: a systematic review

              Background Malaria, Dengue and Chikungunya are vector borne diseases with shared endemic profiles and symptoms. Coinfections with any of these diseases could have fatal outcomes if left undiagnosed. Understanding the prevalence and distribution of coinfections is necessary to improve diagnosis and designing therapeutic interventions. Methods We have carried out a systematic search of the published literature based on PRISMA guidelines to identify cases of Malaria, Dengue and Chikungunya coinfections. We systematically reviewed the literature to identify eligible studies and extracted data regarding cases of coinfection from cross sectional studies, case reports, retrospective studies, prospective observational studies and surveillance reports. Results Care full screening resulted in 104 publications that met the eligibility criteria and reported Malaria/Dengue, Dengue/Chikungunya, Malaria/Chikungunya and Malaria/Dengue/Chikungunya coinfections. These coinfections were spread over six geographical locations and 42 different countries and are reported more frequently in the last 15 years possibly due to expanding epidemiology of Dengue and Chikungunya. Few of these reports have also analysed distinguishing features of coinfections. Malaria/Dengue coinfections were the most common coinfection followed by Dengue/Chikungunya, Malaria/Chikungunya and Malaria/Dengue/Chikungunya coinfections. P. falciparum and P. vivax were the commonest species found in cases of malaria coinfections and Dengue serotype-4 commonest serotype in cases of dengue coinfections. Most studies were reported from India. Nigeria and India were the only two countries from where all possible combinations of coinfections were reported. Conclusion We have comprehensively reviewed the literature associated with cases of coinfections of three important vector borne diseases to present a clear picture of their prevalence and distribution across the globe. The frequency of coinfections presented in the study suggests proper diagnosis, surveillance and management of cases of coinfection to avoid poor prognosis of the underlying etiology. Electronic supplementary material The online version of this article (10.1186/s12889-018-5626-z) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                ayman.ame.ahmed@gmail.com
                Journal
                Clin Case Rep
                Clin Case Rep
                10.1002/(ISSN)2050-0904
                CCR3
                Clinical Case Reports
                John Wiley and Sons Inc. (Hoboken )
                2050-0904
                11 June 2024
                June 2024
                : 12
                : 6 ( doiID: 10.1002/ccr3.v12.6 )
                : e9079
                Affiliations
                [ 1 ] Faculty of Medical Laboratory Sciences University of Khartoum Khartoum Sudan
                [ 2 ] Department of Medical Microbiology and Infectious Diseases ErasmusMC, University Medical Center Rotterdam Rotterdam The Netherlands
                [ 3 ] Molecular Biology Unit Sirius Training and Research Centre Khartoum Sudan
                [ 4 ] Swiss Tropical and Public Health Institute (Swiss TPH) Allschwil Switzerland
                [ 5 ] Faculty of Science University of Basel Basel Switzerland
                [ 6 ] Institute of Endemic Diseases University of Khartoum Khartoum Sudan
                Author notes
                [*] [* ] Correspondence

                Ayman Ahmed, Institute of Endemic Diseases, University of Khartoum, Khartoum 11111, Sudan.

                Email: ayman.ame.ahmed@ 123456gmail.com

                Author information
                https://orcid.org/0000-0001-6314-7374
                https://orcid.org/0000-0001-6843-3361
                https://orcid.org/0000-0002-9516-9508
                Article
                CCR39079 CCR3-2023-10-2338.R1
                10.1002/ccr3.9079
                11166561
                38868112
                0df63a41-c229-4331-97d9-38b0142f70ce
                © 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 29 May 2024
                : 22 October 2023
                : 31 May 2024
                Page count
                Figures: 1, Tables: 1, Pages: 6, Words: 3400
                Categories
                Dermatology
                Infectious Diseases
                Toxicology
                Acute Medicine
                Pathology and Laboratory Medicine
                Public Health
                Case Report
                Case Report
                Custom metadata
                2.0
                June 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.4.4 mode:remove_FC converted:11.06.2024

                arboviral diseases,coinfection,global vector control response,malaria,sudan,vector‐borne diseases

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