Back to Journals » International Medical Case Reports Journal » Volume 10

Early treatment failure in concurrent dengue and mixed malaria species infection with suspected resistance to artemisinin combination therapy from a tertiary care center in Delhi: a case report

Authors Saksena R, Matlani M, Singh V, Kumar A, Anveshi A, Kumar D, Gaind R

Received 15 April 2017

Accepted for publication 15 July 2017

Published 16 August 2017 Volume 2017:10 Pages 289—294

DOI https://doi.org/10.2147/IMCRJ.S139729

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Professor Ronald Prineas


Rushika Saksena,1 Monika Matlani,1 Vineeta Singh,2 Amit Kumar,2 Anupam Anveshi,1 Dilip Kumar,3 Rajni Gaind1

1Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India; 2Cell Biology Laboratory and Malaria Parasite Bank, National Institute of Malaria Research, Delhi, India; 3Department of Internal Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

Background: Concurrent dengue and mixed malaria infections in a single patient present with overlapping clinical manifestations which pose a diagnostic challenge and management dilemma in areas of common endemicities.
Methods: We report a case of a young male who tested positive for both Plasmodium vivax and Plasmodium falciparum along with dengue infection. He showed signs of early treatment failure to artemisinin combination therapy (artesunate with sulfadoxine+pyrimethamine). Molecular analysis for the drug resistance genes viz: chloroquine resistance (pfcrt), multidrug resistance (pfmdr-1), sulfadoxine (pfdhps), pyrimethamine (pfdhfr), and artemisinin resistance (keltch 13) was performed.
Results: A rise in parasitemia from <2% to 5% was observed after 3 days of treatment. Mutations in pfcrt, pfmdr-1, pfdhfr, and pfdhps genes were detected as a possible cause of treatment failure.
Conclusion: Increased severity, overlapping symptoms, and suspected resistance to treatment warrants a multidimensional diagnostic approach and diligent therapeutic monitoring.

Keywords: dengue, drug resistance genes, mixed malaria infections, treatment failure
 

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]