Association of Dengue Virus and Leptospira Co-Infections with Malaria Severity

Rajendra Mandage,Shivam Pandey,Charandeep Kaur,Naveet Wig,Pragyan Acharya,Ravindra Mohan Pandey,Manish Soneja,Sounak Saha,Adarsh Singh,Parul Kodan,Vinod Kumar,Atreyi Pramanik

doi:10.3201/eid2608.191214

Abstract

Plasmodium infections are co-endemic with infections caused by other agents of acute febrile illnesses, such as dengue virus (DENV), chikungunya virus, Leptospira spp., and Orientia tsutsugamushi. However, co-infections may influence disease severity, treatment outcomes, and development of drug resistance. When we analyzed cases of acute febrile illness at the All India Institute of Medical Sciences, New Delhi, India, from July 2017 through September 2018, we found that most patients with malaria harbored co-infections (Plasmodium mixed species and other pathogens). DENV was the most common malaria co-infection (44% of total infections). DENV serotype 4 was associated with mild malaria, and Leptospira was associated with severe malaria. We also found the presence of P. knowlesi in our study population. Therefore, in areas with a large number of severe malaria cases, diagnostic screening for all 4 DENV serotypes, Leptospira, and all Plasmodium species should be performed.

Highlights

Plasmodium infections are co-endemic with infections caused by other agents of acute febrile illnesses, such as dengue virus (DENV), chikungunya virus, Leptospira spp., and Orientia tsutsugamushi
P. knowlesi was detected in 18% (12/66) of infections (Table 1); P. malariae and P. ovale were not detected in our study
Association of Co-infecting Pathogens with Malaria Severity We found that co-infection with DENV serotype 4 (DENV-4) was associated with mild malaria, whereas infection with Leptospira or O. tsutsugamushi was associated with severe malaria

Summary

Introduction

Plasmodium infections are co-endemic with infections caused by other agents of acute febrile illnesses, such as dengue virus (DENV), chikungunya virus, Leptospira spp., and Orientia tsutsugamushi. When we analyzed cases of acute febrile illness at the All India Institute of Medical Sciences, New Delhi, India, from July 2017 through September 2018, we found that most patients with malaria harbored co-infections (Plasmodium mixed species and other pathogens). In areas with a large number of severe malaria cases, diagnostic screening for all 4 DENV serotypes, Leptospira, and all Plasmodium species should be performed. Lack of adequate data on co-infections in clinical and field settings can misdirect the field of drug and vaccine development Pathogens such as malaria parasites, DENV, and Orientia spp. have host immune-modulatory effects [21].

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Conclusion