Tropical and Infectious Diseases Division, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia.
Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.
Malar J. 2022 Jun 23;21(1):199. doi: 10.1186/s12936-022-04215-5.
Coronavirus disease 2019 (COVID-19) often causes atypical clinical manifestations similar to other infectious diseases. In malaria-endemic areas, the pandemic situation will very likely result in co-infection of COVID-19 and malaria, although reports to date are still few. Meanwhile, this disease will be challenging to diagnose in areas with low malaria prevalence because the symptoms closely resemble COVID-19.
A 23-year-old male patient presented to the hospital with fever, anosmia, headache, and nausea 1 week before. He was diagnosed with COVID-19 and treated for approximately 10 days, then discharged to continue self-quarantine at home. 2 weeks later, he returned to the hospital with a fever raised intermittently every 2 days and marked by a chilling-fever-sweating cycle. A laboratory test for malaria and a nasopharyngeal swab for SARS CoV-2 PCR were conducted, confirming both diagnoses. The laboratory examination showed markedly elevated D-dimer. He was treated with dihydroartemisinin-piperaquine (DHP) 4 tablets per day for 3 days and primaquine 2 tablets per day for 14 days according to Indonesian National Anti-malarial Treatment Guidelines. After 6 days of treatment, the patient had no complaints, and the results of laboratory tests had improved. This report describes the key points in considering the differential diagnosis and prompt treatment of malaria infection during the pandemic of COVID-19 in an endemic country to prevent the worse clinical outcomes. COVID-19 and malaria may also cause a hypercoagulable state, so a co-infection of those diseases may impact the prognosis of the disease.
This case report shows that considering the possibility of a co-infection in a COVID-19 patient who presents with fever can prevent delayed treatment that can worsen the disease outcome. Paying more attention to a history of travel to malaria-endemic areas, a history of previous malaria infection, and exploring anamnesis regarding the fever patterns in patients are important points in making a differential diagnosis of malaria infection during the COVID-19 pandemic.
2019 年冠状病毒病（COVID-19）常引起类似于其他传染病的非典型临床表现。在疟疾流行地区，大流行情况极有可能导致 COVID-19 和疟疾的合并感染，尽管迄今为止的报告仍然很少。同时，由于这些疾病的症状与 COVID-19 非常相似，因此在疟疾患病率较低的地区，这种疾病的诊断将具有挑战性。
一名 23 岁男性患者，于 1 周前出现发热、嗅觉丧失、头痛和恶心。他被诊断为 COVID-19，并接受了大约 10 天的治疗，然后出院在家中继续自我隔离。2 周后，他因间歇性发热（每 2 天发热 1 次，表现为冷-热-汗周期）返回医院。进行了疟疾实验室检查和 SARS-CoV-2 鼻咽拭子 PCR 检查，均确诊。实验室检查显示 D-二聚体显著升高。根据印度尼西亚国家抗疟治疗指南，他每天接受 4 片双氢青蒿素-哌喹（DHP）和 14 天每天 2 片磷酸伯氨喹治疗。治疗 6 天后，患者无不适，实验室检查结果改善。本报告描述了在疟疾流行国家大流行期间 COVID-19 考虑疟疾感染的鉴别诊断和及时治疗的要点，以防止病情恶化。COVID-19 和疟疾也可能引起高凝状态，因此这两种疾病的合并感染可能会影响疾病的预后。
本病例报告表明，考虑到 COVID-19 患者发热时合并感染的可能性，可以防止因治疗延误而使病情恶化。更关注前往疟疾流行地区的旅行史、既往疟疾感染史，并探讨患者发热模式的病史，这对于在 COVID-19 大流行期间疟疾感染的鉴别诊断是重要的。
