International Journal of Research in Medical Sciences

Dhanya PR et al. Int J Res Med Sci. 2018 Jun;6(6):2111-2115

www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20182298
Original Research Article

A comparative study on dengue and malaria infections and analysis on

the prevalence of co-infection from a rural tertiary care hospital
Dhanya P. R., Shilpa K., Vivek Hittinahalli*

Department of Microbiology, East Point College Medical Sciences and Research Centre, Avalahalli, Bangalore,
Karnataka, India

Received: 09 April 2018

Accepted: 01 May 2018

*Correspondence:
Dr. Vivek Hittinahalli,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: To compare dengue fever and malaria infection cases from a rural tertiary care hospital.
Methods: Samples from January 2017 to February 2018 which had come to the Department of Microbiology at East
Point College of Medical Science and Research Centre were included in the study. Serological diagnosis of dengue
was done using the rapid dengue day 1 test which detects NS1, IgM and IgG. This test can be performed using serum,
plasma or whole blood. Malarial parasites were identified by peripheral smear for malaria by Leishman’s stain and
Jaswant Singh Battacharji (JSB) stain, rapid tests were performed by using advantage mal card, which detects
plasmodium falciparum and plasmodium vivax by using human whole blood.
Results: Monthly analysis is done for dengue samples and malaria samples were done during January 2017 to
February 2018. Positive samples are then analysed according to NS1 positive cases, IgM positive cases, IgG positive
cases, NS1 and IgM combined cases, NS1 and IgG combined cases and IgM and IgG combined cases for dengue. In
case of malaria vivax and falciparum cases were compared. Samples are then compared among different age groups.
Under 15 age- group there were 32 positive cases of NS1, 1 case of IgM and IgG combined positive and 1 case of P.
falciparum infection. In 16-50 age-group 244 cases were dengue NS1 positive, 1 case positive for NS1 and IgM
combined, 1 case for NS1 and IgG combined, 5 cases for IgM and IgG combined, 11 cases of P. vivax and 3 cases of
P. falciparum. Above 50 age-group had 27 NS1 positive cases and 1 case of IgM and IgG combined. NS1 and
Plasmodium vivax species positives were more from dengue and malaria infection.
Conclusions: From July 2017 to October 2017 dengue and malaria cases were drastically increased. Malariacases
drops from November to December 2017 and again raised from January to February 2018, which shows seasonal
variations. So, we conclude that viral and parasitic infection mainly occurs in July to September months and has to be
ruled by proper clinical diagnosis.

Keywords: Co-infection, Dengue NS1, IgM and IgG, Plasmodium falciparum, plasmodium vivax

INTRODUCTION cause high morbidity and mortality for many patients

around the world1. Dengue fever and malaria are the most
Mosquito is considered to be an important animal vector common arthropod-borne diseases in humans and
that can cause several diseases to human beings. represent major public health problems. Dengue virus
Mosquito borne infectious disease is accepted as (family Flaviridae, genus Flavivirus) and Plasmodium
important tropical infections and is the focused topic in parasites are widespread in American and Asian tropical
tropical medicine. There are several tropical mosquito regions and their endemic areas overlap extensively.2 The
borne infections. Malaria and dengue are the two dengue virus (DENV) is the major arbovirus responsible
common mosquito infections that are very important and for human disease in Brazil. The four serotypes cause a

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 Dhanya PR et al. Int J Res Med Sci. 2018 Jun;6(6):2111-2115

variety of clinical presentation in humans, ranging from samples for malaria. In the month of February 2017, 12
acute self-limited febrile illness to severe and fatal forms. (0.87%) dengue and 5 (1.01%) of malaria samples came
Regarding malaria the Brazilian Amazon reports 50% of to the lab. In the month of March 2017, 32 (2.34%)
episodes in the Americas. In 2012, 241,806 cases were dengue and 10 (2.02%) malaria samples received. In
reported, with 86.9% of them due to P. vivax. Malaria April 2017 dengue samples received were 12 (0.87%)
and dengue are endemic in similar tropical regions, and and malaria were 5 (1.01%). In May 2017 dengue
therefore, may result in the possibility of co-infection. samples received were 30 (2.19%) and malaria were 16
Urban demographic expansion, deforestation and (3.23%). 59 (4.31%) dengue samples and 32 (6.47%)
agricultural settlements in peri-urban areas, are known malaria samples were received in the month of June
causes of the increase in the probability of concurrent 2017. 174 (12.73%) dengue samples and 54 (10.93%)
infection of these two diseases. malaria samples were received in July 2017. In August
2017, 230 (16.83%) dengue samples and 50 (10.12%) of
METHODS malaria samples came. September month showed 235
(17.20%) dengue samples and 59 (11.94%) malaria
The present study was conducted on January 2017 to samples. 235 (17.20%) dengue samples and 39 (7.89%)
February 2018 at East Point College Medical Sciences malaria samples received in October 2017. In November
and Research Centre, Avalahalli, Bengaluru: a rural 2017 it was 156 (11.42%) dengue samples and 44
tertiary care hospital, to compare the sero-prevalence, (8.90%) malaria samples. In December 2017 there were
seasonal variation of outbreaks and the incidence of viral 86 (6.29%) dengue and 22 (4.45%) malaria samples. 45
and parasitic fever in seropositive dengue and malaria (3.29%) dengue and 70 (14.17%) malaria samples were
patients. Samples were obtained from 1355 suspected received in January 2018. And finally in February 2018
cases of dengue and 494 cases of malaria infections. 48 (3.51%) dengue and 88 (17.81%) malaria samples
Serological diagnosis was done using the rapid Dengue were received.
Day 1 Test which detects NS, IgM and IgG, the test can
be performed using serum, plasma or whole blood. Table 1: Monthly samples of dengue and malaria
from January 2017 to February 2018.
Malarial parasites were identified by peripheral smear for
malaria by Leishman’s stain and Jaswant Singh Month Dengue Malaria
Battacharji (JSB) stain. Rapid tests were performed by Jan-17 22 0
using Advantage Mal card, which detects plasmodium Feb-17 12 5
falciparum and plasmodium vivax by using human whole Mar-17 32 10
blood. The diagnosis of malaria was established on thick Apr-17 12 5
and thin blood film microscopy. May-17 30 16
Jun-17 59 32
RESULTS Jul-17 174 54
Aug-17 230 50
Samples from January 2017 to February 2018 which had
come to the Department of Microbiology at East Point Sep-17 292 59
College of Medical Science and Research Centre were Oct-17 235 39
included in the study. Monthly analysis is done for Nov-17 156 44
dengue samples and malaria samples received during this Dec-17 86 22
period (Table 1). A total of 1366 samples had received Jan-18 45 70
for dengue and 494 for malaria. In the month of January Feb-18 48 88
2017, 22 (1.61%) dengue samples were received but no Total 1366 494

Table 2: Age-wise distribution of dengue, malaria and co-infection cases.

Age Dengue Malaria Co-
NS1 IgG IgM NS1 IgG NS1 IgM IgG IgM Plasmodium vivax Plasmodium falciarum infection
<=15 32 0 0 0 0 1 0 1 2
16-50 244 0 0 1 1 5 11 3 3
>50 27 0 0 0 0 1 0 0 0
Total 303 0 0 1 1 7 11 4 5

Positive samples are then analysed according to NS1 case of malaria vivax and falciparum cases were
positive cases, IgM positive cases, IgG positive cases, compared. Samples are then compared among different
NS1 and IgM combined cases, NS1 and IgG combined age groups. (Table 2). Under 15 age- group there were 32
cases and IgM and IgG combined cases for dengue. In positive cases of NS1, 1 case of IgM and IgG combined

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 Dhanya PR et al. Int J Res Med Sci. 2018 Jun;6(6):2111-2115

positive and 1 case of P. falciparum infection. In 16-50 no cases of either IgG or IgM positives. One sample
age group 244 cases were dengue NS1 positive, 1 case (female) was positive for NS1 and IgG combined and one
positive for NS1 and IgM combined, 1 case for NS1 and (female) for NS1 and IgM combined case. For IgG and
IgG combined, 5 cases for IgM and IgG combined, 11 IgM combined cases 3 male samples and 4 female
cases of P. vivax and 3 cases of P. falciparum. Above 50 samples were positive which shows a total of 7 positive
age-group had 27 NS1 positive cases and 1 case of IgM cases. Plamodium vivax positive cases were 11 in which
and IgG combined. Sex-wise analysis of dengue and 8 were males and 3 were females. 4 cases of P.
malaria infection shows a total 295 NS1 positive cases in falciparum were received in which 3 were males and 1
which 203 were males and 100 were females. There were was female. (Table 3).

Table 3: Sex-wise distribution of dengue and malaria infections.

Sex Dengue Malaria Co-
NS1 IgG IgM NS1 IgG NS1 IgM IgG IgM Plasmodium vivax Plasmodium falciparum infection
Male 203 0 0 0 0 3 8 3 4
Female 100 0 0 1 1 4 3 1 1
Total 303 0 0 1 1 7 11 4 5

came in the month of February 2017, one in August 2017,

2.5 2 in October 2017 and one in December 2017.
2
DISCUSSION
1.5
1 The study was a comparative analysis of dengue and
malaria cases from rural tertiary care centre. We found
0.5 out prominent seasonal variation of the cases while
0 analysing the data. According to our study the cases start
rising during the beginning of monsoon (July), hikes and
Feb/17

May/17
Jun/17

Sep/17

Feb/18
Jan/17

Mar/17

Jan/18
Dec/17
Jul/17

Oct/17
Apr/17

Aug/17

Nov/17

reaches its peak during September and ceases along with

the season (November). This is because of spread of
mosquitoes during monsoon.
co-infection
Overall, increased incidence rates were observed between
July and December during the study period. Our findings
Figure 1: Seasonal distribution of co-infection.
provide insight into understanding the seasonal pattern
and associated climate risk factors in each province. This
1.50% study may be another way of providing evidence to aid
4.51%
clinicians when making a diagnosis and foresee the
timing of outbreaks, therefore may be utilized to raise
public awareness during the high peak seasons in order to
prevent or reduce further potential outbreaks or onwards
transmission during an outbreak.4

Age-wise analysis of positive cases revealed that both

93.17% dengue and malaria infection were the most among 16-50
age group. Hence according to our studies middle-aged
group in our area are more prone to these infections. We
also analysed the data sex-wise and found out that
Dengue Malaria Co-infection positive cases were more in males than females. Similar
study by Smita T et al, also showed higher percentage of
Figure 2: Percentage wise distribution of positive male cases than females with a ratio of 1.55:1.5 Co-
cases. infection cases were analysed separately and it showed
that only 1.5% of the total cases were positive for dengue
Analysis of the data based on the prevalence of co- and malaria co-infection. Even though there is no clear
infection of dengue and malaria showed that 5 samples pattern in the monthly distribution of co-infection cases,
were positive for both dengue and malaria infection out of 5 total cases 3 were during the time of monsoon.
(Figure 1 and 2). Out of 332 positive samples 5 (1.5%) This could be because of increased number of cases
were positive for both dengue and malaria. One case during this time.

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 Dhanya PR et al. Int J Res Med Sci. 2018 Jun;6(6):2111-2115

Due to similar clinical presentations of malaria and CONCLUSION

dengue, these co-infections may give rise to an incorrect
diagnosis. Moreover, the treatment regimens for these co- Seasonal variations in the infection cases are clearly
infections are not the same as those for mono-infections. observed and found out to be more during monsoon
Hence, a delay in implementing the appropriate treatment season with an increased incidence among middle-aged
regimen for these concurrent infections due to poor group. Males were infected more than females in the
diagnosis can be fatal.6 study. Even though rate is very less, the chances of
getting dengue and malaria co-infection cannot be
Dengue is one of the re-emerging viral infections. India is neglected and proper laboratory diagnosis is required to
now being affected with several outbreaks every year, differentiate between dengue mono-infection, malaria
increase in the number of cases reported and also mono-infection and co-infection cases for effective
showing an increase in the severity of the disease. As treatment.
there is no specific drug available and since the vaccine is
still in the developmental stage, treatment is still only Funding: No funding sources
supportive, therefore the control measures should be Conflict of interest: None declared
aimed at the vector control. There is an urgent need to Ethical approval: The study was approved by the
strengthen national programmes for preventing Dengue Institutional Ethics Committee
and DHF. This will also help us to control other mosquito
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