India’s first case of quadruple malaria has been detected in a 12-year-old tribal kid in the Bastar forest of Chhattisgarh. Quadruple malaria is when a patient is patently coinfected with all 4 known human malaria species, Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale. Diagnostic erythrocytic stages of all 4 species are clearly seen in the peripheral blood.
The past decade has seen tremendous progress in malaria control worldwide, as 57 out of 106 countries have shown a sharp reduction of about 75% in malaria incidence but this discovery by medical researchers demonstrates that the battle against malaria is far from being over as new challenges crop up.
A 12-year-old boy from a very remote village attended the Darbha CHC hospital with the complaint of repeated history of fever with no other complications.
At the time of admission, he gave history of 4 days’ fever and his body temperature was recorded as 100.8°F. His pulse rate was 101/min and his respiratory rate was 28/m. The laboratory findings of blood test at the time of admission were Hb≤10 gm/dL, blood glucose = 88 mg/dL, total leukocyte count (TLC) = 4,000/mm3, differential leukocyte count (DLC) = neutrophils (52%), lymphocyte (45%), eosinophils (2%), monocyte (1%), and serum creatinine = 0.5 mg/dL. The bivalent RDT showed the presence of P. falciparum only. Subsequently, peripheral blood smear was found positive for P. falciparum along with some doubtful structures, which a microscopist was unable to identify. He was given oral artesunate plus sulphadoxine/pyrimethamine (AS+SP). As fever was not coming down and Hb had lowered to <8 gm/dL, the patient was referred to district hospital where he was treated with intravenous antimalarial (quinine 20 mg/kg body weight on admission followed by maintenance dose of 10 mg/kg 8 hourly) along with other supportive treatment, as per the duty physician.
However, he did not take the complete treatment and left hospital against medical advice. Follow-up of the patient was not possible due to inaccessibility of the area.
Krishna S et al. reported the case in journal of Public Library of Sciences points stating that it was a case of mixed infection of 4 Plasmodium species was found, which is very rare, and this is the first report of such a case in India.They further added that microscopy is the gold standard for malaria diagnosis, but in case of mixed infection, 1 or more species may be missed, especially in case of low parasitemia.
Therefore in the study high proportion of mixed infection was shown by molecular methods.High proportion of mixed infections signifies the need of adequate training of health staff involved in malaria diagnosis, which is prerequisite for malaria elimination,the researchers added.
For further reading
Krishna S, Bhandari S, Bharti PK, Basak S, Singh N (2017) A rare case of quadruple malaria infection from the highly malaria-endemic area of Bastar, Chhattisgarh, India. PLoS Negl Trop Dis 11(7): e0005558. doi:10.1371/journal.pntd.0005558