Abstract
BackgroundCo-infection with both Plasmodium and dengue virus (DENV) infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment. The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection, the risk of severe diseases due to co-infection, and to describe the complications of severe malaria and severe dengue among patients with co-infection.MethodsRelevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved through a search of the ISI Web of Science, Scopus, and MEDLINE. The pooled prevalence and 95% confidence interval (CI) of severe malaria among patients with Plasmodium and DENV co-infection was estimated with a random-effects model to take into account the between-study heterogeneity of the included studies. The risks of severe malaria and severe diseases due to co-infection were estimated with the pooled odds ratio (OR) and 95% CI with a random-effects model.ResultsOf the 5653 articles screened, 13 studies were included in the systematic review and meta-analysis. The results demonstrated that the pooled prevalence estimate of severe malaria among patients with co-infection was 32% (95% CI: 18–47%, I2 = 92.3%). Patients with co-infection had a higher risk of severe diseases than those with DENV mono-infection (odds ratio [OR] = 3.94, 95% CI: 1.96–7.95, I2 = 72%). Patients with co-infection had a higher risk of severe dengue than those with DENV mono-infection (OR = 1.98, 95% CI: 1.08–3.63, I2 = 69%). The most severe complications found in severe dengue were bleeding (39.6%), jaundice (19.8%), and shock/hypotension (17.9%), while the most severe complications found in severe malaria were severe bleeding/bleeding (47.9%), jaundice (32.2%), and impaired consciousness (7.43%).ConclusionsThe present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection. Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications, but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection.Trial registrationThe protocol of this study was registered at PROSPERO: CRD42020196792.
Highlights
Co-infection with both Plasmodium and dengue virus (DENV) infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment
Severe dengue is classified by the 2009 World Health Organization (WHO) criteria according to levels of severity and includes severe plasma leakage, severe bleeding, and organ failure [6]
Of these 103 articles, 94 were excluded for the following reasons (Fig. 1): 24 were reviews, 24 were case reports, 18 did not evaluate severe malaria in co-infections, 11 were experimental studies, 6 did not report on co-infection, 5 did not have a full text available, 3 were letters to the editor, 2 were knowledge, attitude and practice surveys, and 1 study was not written in English
Summary
Co-infection with both Plasmodium and dengue virus (DENV) infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment. Five species of Plasmodium can cause malaria in humans, including P. falciparum, P. vivax, P. malaria, P. ovale, and P. knowlesi [3], whereas four serotypes of DENVs can cause dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) [4]. DENV causes a wide spectrum of diseases, ranging from subclinical disease to severe dengue caused by cross-immunity to other serotypes of dengue virus during secondary infection [2]. Severe malaria is classified by the 2015 WHO criteria and includes impaired consciousness, multiple convulsions, prostration, shock, hypoglycaemia, jaundice, pulmonary oedema, bleeding, metabolic acidosis or acute respiratory distress, severe anaemia, and acute renal failure [8]
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