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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 12  |  Issue : 1  |  Page : 43-44

A case of COVID-19 pneumonia coinfected with severe mixed complicated malaria


1 Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Medicine, Shree Hospital, Pune, Maharashtra, India

Date of Submission26-Feb-2022
Date of Acceptance31-Mar-2022
Date of Web Publication18-Apr-2022

Correspondence Address:
Shalendra Singh
Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune 411040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajoim.ajoim_4_22

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How to cite this article:
Singh S, Wadke R, Samel SS, Singh S U. A case of COVID-19 pneumonia coinfected with severe mixed complicated malaria. Assam J Intern Med 2022;12:43-4

How to cite this URL:
Singh S, Wadke R, Samel SS, Singh S U. A case of COVID-19 pneumonia coinfected with severe mixed complicated malaria. Assam J Intern Med [serial online] 2022 [cited 2022 May 21];12:43-4. Available from: http://www.ajimedicine.com/text.asp?2022/12/1/43/343434



Dear Editor,

Presently coronavirus disease-2019 (COVID-19) is a major global medical concern. Many symptoms of COVID-19 patients are similar to the coinfections which may occur concurrently.[1] Malaria is one of such common parasitic infection in India having a similar clinical presentation. We report a case of COVID-19 pneumonia coinfected with severe mixed complicated malaria.

A 39-year-old man with no previous co-morbidities admitted with a clinical history of fever, body ache for 4 days. On admission, the patient was febrile with a temperature of 100°F, blood pressure of 154/70mmHg, heart rate of 120 beats per minute, respiratory rate of 28 breaths per minute, and oxygen saturation of 95% on room air. He presented with peripheral cyanosis which improved subsequently with oxygen supplementation. Laboratory investigations revealed hemoglobin 10.8 g/dL, white blood cell count 2500/mm3, platelet count 10,000/cu mm, total bilirubin 7.31 mg/dL, indirect bilirubin 4.41 mg/dL, C-reactive protein 87.7 mg/L, procalcitonin 82.6 ng/L, serum Ferritin level 3000 ng/mL and high D-dimer 1832.3 ng/mL. Serum creatinine was raised to 2.60 mg/dL with blood urea of 118 mg/dL. The patient was investigated for malaria, leptospirosis, brucella, typhoid, and dengue to rule out other mixed infections causing febrile jaundice. Malaria smear was positive for plasmodium vivax and plasmodium falciparum with concomitant positive nasopharyngeal Real-time (RT)-PCR for SARS-COV2. Treatment was initiated with fluid resuscitation and 2 Fresh Frozen Plasma and 6 Random Donor Platelet for severe thrombocytopenia. Intravenous artesunate was administered at a dose of 2.4mg/kg at 0, 12 hours, and then once daily for 5 days along with intravenous(IV) antibiotics, oral doxycycline, and oral hydroxychloroquine 400 mg twice daily on day 1 followed by 200mg twice daily for 5 days. On day 2 of the admission patient complained of breathlessness, bilateral rhonchi, and crackles that were heard on chest auscultation. The results of arterial blood gas analysis were consistent with mixed respiratory alkalosis with metabolic acidosis. Chest x-ray showed bilateral fluffy alveolar opacities with ground glass appearance of both lungs suggestive of acute respiratory distress syndrome [Figure 1]. Oxygen supplementation by a non-rebreathing face mask was given. Steroids were started in the form of IV Dexamethasone. The patient received IV Remdesivir 200mg IV stat followed by 100mg once daily for 5 days after liver function tests settled. White blood cell count increased, platelets rebounded, chest X-ray clear, inflammatory markers gradually returned to normal indicating improved clinical condition by 10 days of hospital admission [Figure 1]. The patient was discharged to home with strict home isolation of 7 days and given primaquine for prevention of P.Vivax relapse after ruling out G6PD deficiency. COVID-19 nasopharyngeal RT-PCR repeated on the ninth day of admission was confirmed as negative.
Figure 1: (A) Chest X-ray (PA view) showing bilateral diffuse alveolar opacities with a normal cardiac shadow. (B) Chest X-ray 1 week after treatment showing complete resolution of infiltrates

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Recent literature revealed that the prevalence of secondary infections with COVID-19 amongst non-survivors could be as high as 50 %.[2] Due to similar clinical presentations, recent concerns regarding dual outbreaks of COVID-19 and malaria have surfaced. Therefore, clinicians must be vigilant to identify and appropriately manage cases in such syndemics promptly. It is beneficial to notice that in many cases severe presentation of malaria may be due to elevated pro-inflammatory response, an equivalent may also be true in many cases of COVID-19. Malaria and COVID-19 coinfection could then cause an elevated pro-inflammatory response to culminate in severe manifestations and poor prognosis.[3]

While recent studies have refuted the benefit of hydroxychloroquine for the treatment of COVID-19, concerns have arisen regarding the possible consequences of mass consumption of these medications in endemic malaria settings.[4] Artemisinins like Artesunate have lately drawn much attention within the management of COVID-19, due to their anti-viral and anti-inflammatory properties, likely attributed to inhibition of Nuclear Factor kappa B (NF-kB) downregulation and consequent disruption of viral replication in the early phase.[5]

Additional studies are also required to investigate whether patients with concurrent infections have a worse prognosis as compared to those with SARS-CoV-2 as the solely detected pathogen. Therefore enhanced sensitization on the potential of COVID-19/malaria coinfections and further guidance to clinicians on the importance of testing for other causes of illness are needed.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lansbury L, Lim B, Baskaran V, Lim WS Co-infections in people with COVID-19: A systematic review and meta-analysis. J Infect 2020;81:266-75.  Back to cited text no. 1
    
2.
Lai CC, Wang CY, Hsueh PR Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-cov-2 agents? J Microbiol Immunol Infect 2020;53:505-12.  Back to cited text no. 2
    
3.
Gutman JR, Lucchi NW, Cantey PT, Steinhardt LC, Samuels AM, Kamb ML, et al. Malaria and parasitic neglected tropical diseases: Potential syndemics with COVID-19? Am J Trop Med Hyg 2020;103:572-7.  Back to cited text no. 3
    
4.
Mvumbi DM Mass intake of hydroxychloroquine or chloroquine in the present context of the COVID-19 outbreak: Possible consequences in endemic malaria settings. Med Hypotheses 2020;143:109912.  Back to cited text no. 4
    
5.
Uzun T, Toptas O Artesunate: Could be an alternative drug to chloroquine in COVID-19 treatment? Chin Med 2020;15:54.  Back to cited text no. 5
    


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