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Year : 2020  |  Volume : 12  |  Issue : 3  |  Page : 162-163
Co-infection with malaria and coronavirus disease-2019

1 Department of Pathology, Hematology Division, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India
2 Department of Microbiology, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India

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Date of Submission23-May-2020
Date of Acceptance03-Jun-2020
Date of Web Publication29-Aug-2020

How to cite this article:
Ray M, Vazifdar A, Shivaprakash S. Co-infection with malaria and coronavirus disease-2019. J Global Infect Dis 2020;12:162-3

How to cite this URL:
Ray M, Vazifdar A, Shivaprakash S. Co-infection with malaria and coronavirus disease-2019. J Global Infect Dis [serial online] 2020 [cited 2020 Nov 24];12:162-3. Available from:


Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is an ongoing global pandemic. Among the plethora of knowledge being garnered about the virus, the occurrence of co-infections and superinfections is also being reported.[1] Although SARS-CoV-2 is the first culprit to be suspected in symptomatic cases, it is important not to lose sight of the burden India faces with other infectious diseases. We report a case of malaria and COVID-19 co-infection.

A 67-year-old male, a known case of type 2 diabetes mellitus and heart disease, presented with complaints of fever and progressive exertional breathlessness for 4 days in the 1st week of May. He had no history of travel or contact with a COVID-19-confirmed case. On examination, his oxygen saturation was 96% on room air. Complete blood count revealed moderate thrombocytopenia of 71.0 × 109/L with normal hemoglobin and white blood cell counts. On peripheral blood examination, ring forms and trophozoites of Plasmodium vivax were seen, along with reactive lymphocytes [Figure 1]. Chest X-ray (anteroposterior view) showed haziness in both lung fields. The patient was started on intravenous injection artesunate, followed by artemether and lumefantrine, per oral. He responded well to the antimalarial treatment with symptomatic relief.
Figure 1: Peripheral blood smear showing ring form (red arrow) and trophozoite (white arrow) of Plasmodium vivax. A reactive lymphocyte is also seen (black arrow) (Leishman stain, ×400)

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Although his first nasopharyngeal swab for SARS-CoV-2 real-time reverse transcription–polymerase chain reaction test indicated the absence of the virus, repeat swabs sent on day 3 revealed positivity for the same. In the coming week, his platelet counts improved to normal levels, and he became clinically asymptomatic and stable.

Co-infections of COVID-19 are thought to be very common, as high as 80%, most commonly with seasonal respiratory pathogens.[1] With overlapping symptoms and travel history (significant for COVID-19 and malaria), co-infection diagnosis may be challenging.

India witnesses a temporal rise in water-borne and water-related diseases, including malaria, in the monsoon season, annually. With the ongoing pandemic, one can expect an increase in the rate of co-infections with COVID-19. It is important to investigate thoroughly in order to correctly identify a treatable infection as well as the presence of co-infections. While many clinical trials are ongoing for COVID-19 with no approved treatment regimen yet, there are already established antimalarial, antiviral, and antibiotic schemes for known infections. At present, the entire population, globally, is at very high risk of COVID-19. In 2018, it was reported that nearly half of the world population was at risk of malaria.[2] A single case of COVID-19 can potentially be infective to 3.58 susceptible individuals.[3] Likewise, an untreated case of malaria can lead to community spread. Furthermore, due to lockdowns and restricted mobility, there have been interruptions to health-care access and national malarial control programs. The World Health Organization is urging countries to ensure the continuity of malaria services in the context of the COVID-19 pandemic.[4] It is advisable that health-care professionals screen for malaria while they test for COVID-19.[5] This would help in timely identification of two infectious diseases having significant global impacts and reduce unnecessary morbidity and mortality.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Xing Q, Li GJ, Xing YH, Chen T, Li WJ, Ni W, et al. Precautions are Needed for COVID-19 Patients with Coinfection of Common Respiratory Pathogens. medRxiv; 2020.  Back to cited text no. 1
World Health Organization. World Malaria Report 2019. Geneva: World Health Organization; 2019.  Back to cited text no. 2
Chen TM, Rui J, Wang QP, Zhao ZY, Cui JA, Yin L. A mathematical model for simulating the phase-based transmissibility of a novel coronavirus. Infect Dis Poverty 2020;9:24.  Back to cited text no. 3
Malaria and COVID-19. Available from: [Last Accessed on 2020 May 19].  Back to cited text no. 4
Chanda-Kapata P, Kapata N, Zumla A. COVID-19 and malaria: A symptom screening challenge for malaria endemic countries. Int J Infect Dis 2020;94:151-3.  Back to cited text no. 5

Correspondence Address:
Dr. Manjusha Ray
Department of Laboratory Medicine, 3rd Floor, Kapol Niwas Building, Sir H. N. Reliance Foundation Hospital, Prarthana Samaj, Girgaum, Mumbai - 400 004, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jgid.jgid_160_20

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