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
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
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