Concurrent infection with dengue and malaria [letter]

Concurrent infection with two infectious agents can result in an illness having overlapping symptoms resulting in a situation where both diagnosis and treatment of a patient may become difficult for a physician. We encountered one such case of concurrent infection with falciparum malaria and dengue virus in a young girl. This 21-year old girl a hosteller in New Delhi developed high grade fever with chills along with severe headache and backache. Two days later she developed multiple progressively increasing reddish macular spots over her legs. No other localizing signs were found on examination. In view of thrombocytopenia (platelet count 35000/mm3) and a positive IgM ELISA for dengue the diagnosis of dengue fever was made. She was treated symptomatically with antipyretics. The platelet count subsequently increased and the rash subsided but fever spikes persisted for which she had been referred to our hospital. On clinical examination she was found to have fading rashes on her legs with no pallor icterus nor any lymphadenopathy but the spleen was enlarged. Peripheral blood smear examination revealed a normal platelet count (159000/mm3) and presence of ring forms of Plasmodium falciparum with a parasite count of 0.5%. Repeat IgM for dengue on day seven was again positive. (excerpt)