Abstract
BackgroundMalaria is one of the leading causes of acute febrile illness (AFI) in Africa. With the advent of malaria rapid diagnostic tests, misdiagnosis and co-morbidity with other diseases has been highlighted by an increasing number of studies. Although arboviral infections and malaria are both vector-borne diseases and often have an overlapping geographic distribution in sub-Saharan Africa, information about their incidence rates and concurrent infections is scarce.MethodsFrom July 2009 to March 2013 patients from seven healthcare facilities of the Kedougou region presenting with AFI were enrolled and tested for malaria and arboviral infections, i.e., yellow fever (YFV), West Nile (WNV), dengue (DENV), chikungunya (CHIKV), Crimean Congo haemorrhagic fever (CCHFV), Zika (ZIKV), and Rift Valley fever viruses (RVFV). Malaria parasite infections were investigated using thick blood smear (TBS) and rapid diagnostics tests (RDT) while arbovirus infections were tested by IgM antibody detection (ELISA) and RT-PCR assays. Data analysis of single or concurrent malaria and arbovirus was performed using R software.ResultsA total of 13,845 patients, including 7387 with malaria and 41 with acute arbovirus infections (12 YFV, nine ZIKV, 16 CHIKV, three DENV, and one RVFV) were enrolled. Among the arbovirus-infected patients, 48.7 % (20/41) were co-infected with malaria parasites at the following frequencies: CHIKV 18.7 % (3/16), YFV 58.3 % (7/12), ZIKV 88.9 % (8/9), DENV 33.3 % (1/3), and RVF 100 % (1/1). Fever ≥40 °C was the only sign or symptom significantly associated with dual malaria parasite/arbovirus infection.ConclusionsConcurrent malaria parasite and arbovirus infections were detected in the Kedougou region from 2009 to 2013 and need to be further documented, including among asymptomatic individuals, to assess its epidemiological and clinical impact.
Highlights
Malaria is one of the leading causes of acute febrile illness (AFI) in Africa
The malaria diagnosis procedure was performed using thick blood smear (TBS) and an rapid diagnostics tests (RDT) (Malaria Antigen P.f, Standard diagnostics, Ingbert, Germany) as previously described [21, 22], while IgM enzyme-linked immunosorbent assay (ELISA), real-time reverse transcription polymerase chain reaction (RT-PCR) and other viral infection detection methods [23,24,25,26] were used for detection of dengue virus (DENV), chikungunya virus (CHIKV), zika virus (ZIKV), Crimean-Congo haemorrhagic fever (CCHFV) or West Nile virus (WNV), yellow fever (YFV), and Rift Valley fever viruses (RVFV) infections
A case of confirmed arboviral infection was defined as any AFI that tested positive by any method used for detection of IgM and/or the genome of ZIKV, DENV, CHIKV, RVFV, YFV, Crimean Congo haemorrhagic fever (CCHFV), or WNV, while a confirmed malaria case was defined as any AFI testing positive for TBS
Summary
Malaria is one of the leading causes of acute febrile illness (AFI) in Africa. With the advent of malaria rapid diagnostic tests, misdiagnosis and co-morbidity with other diseases has been highlighted by an increasing number of studies. Arboviral infections and malaria are acute vector-borne diseases and concurrent infections are observed [1, 2], especially for dengue in American and Asian tropical regions where their endemic areas overlap extensively [3,4,5,6,7,8,9,10]. In Senegal, the introduction of malaria rapid diagnostics tests (RDT) in 2007 showed that the prevalence of malaria among acute febrile illnesses (AFI) was largely overestimated while other infections, such as bacteria and arbovirus illnesses were under-reported [17, 18]. Malaria prevalence and diagnostics as well as co-infections with dengue (DENV), chikungunya (CHIKV), zika (ZIKV), yellow fever (YFV), and Rift Valley fever viruses (RVFV) are reported from 2009 to 2013 in Kedougou region, Senegal, an area known to be endemic for many arboviruses
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