A Patient with Severe Malaria and COVID-19: How Do You Tell
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This is one of the first case reports of co-infection with COVID-19 and Plasmodium falciparum malaria. It is important to be aware of the clinical challenges of diagnosing the cause of fever in returned travellers.

A 47-year-old black male entrepreneur who frequently travelled between Portugal and Angola, returned from Africa 10 days before hospital presentation. He was admitted to the emergency department due to a 5-day history of diarrhoea (more than 5 episodes daily), worsening malaise, high fever, diaphoresis and occasional dry cough.

At hospital admission, the patient was conscious, febrile and tachycardic but haemodynamically stable. Physical examination was normal, without signs of dehydration, respiratory changes or abdominal discomfort. The initial blood work revealed mild anaemia (haemoglobin 12.1 g/dl), lymphopenia (lymphocytes 1260×109/l), thrombocytopenia (platelets 91×109/l) and elevated inflammatory parameters (C-reactive protein 25.1 mg/dl, ferritin 789 ng/ml), but no other abnormalities such as renal or hepatic changes. An HIV test was negative. A nasopharyngeal swab for SARS-CoV-2 PCR testing was positive, as were total antibody titres against SARS-CoV-2 detected using chemiluminescence assays (CLIA).

A chest x-ray did not show any pleural effusions, lung consolidation or interstitial patterns. After he was diagnosed with SARS-CoV-2 infection, the patient was admitted to a COVID ward for further observation and symptom control. On the third day, he was still myalgic, generally unwell and febrile, despite being on antipyretics. Given the epidemiological history and the persistence of symptoms, a rapid diagnostic test for malaria parasite antigens was requested, and showed a positive result. Blood smear identified trophozoites of Plasmodium falciparum with a parasitaemia of 3.1% (parasite level of 83,520 parasites/µl).

The patient did not meet any of the criteria for severe disease, and therapy with a combination of artemether and lumefantrine was administered. After 24 hours of treatment, symptoms completely resolved and the patient became afebrile. The platelet count normalized, and there was a consistent reduction in inflammatory parameters. Three days later, control microscopy revealed a parasitaemia of 0.3%, and on the sixth day the blood smear was negative for P. falciparum.

The patient did not show any progressive respiratory symptoms, including decreased oxygen levels, or radiographic findings suggestive of SARS-CoV-2 infection. He was discharged completely asymptomatic 14 days after COVID-19 diagnosis.

This case report highlights the danger of focusing only on a diagnosis of COVID-19, which may lead to rapid and fatal clinical worsening due to inadequate treatment of a different condition. It reminds us how important it is to consider the patient’s history, their travel history and the epidemiological context. Even in a pandemic, taking a good personal history is essential and alternative diagnoses should be considered.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/2007/2446
Dr. T●●●●z H●●●●●●i and 2 other likes this
Dr. S●●●●●●a M●●●r
Dr. S●●●●●●a M●●●r Internal Medicine
Excellent analysis and highlight on the importance of history taking..
Dec 18, 2020Like
Dr. J●i B●●●●i
Dr. J●i B●●●●i Obstetrics and Gynaecology
Perfect diagnosis,hence appropriate treatment was possible.
Dec 23, 2020Like