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Concurrent malaria and enteric fever in Pakistan.
1Department of Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan. mohammad.aslam@aku.edu
Singapore Medical Journal
|October 18, 2005
Summary
Concurrent malaria and enteric fever are common in Pakistan. Patients with malaria presenting with significant gastrointestinal symptoms or persistent fever may have dual infections, requiring investigation for enteric fever.
Area of Science:
- Infectious Diseases
- Tropical Medicine
- Clinical Epidemiology
Background:
- The incidence of concurrent malaria and enteric fever is largely unknown globally, with no prior data from Asia.
- Both malaria and enteric fever are hyperendemic in Pakistan, necessitating research into their co-occurrence.
Purpose of the Study:
- To determine the frequency and epidemiological characteristics of dual malaria and enteric fever infections.
- To identify the clinical and laboratory features distinguishing dual infections from uncomplicated malaria.
Main Methods:
- A retrospective case-control study was conducted over ten years.
- 1,891 patients hospitalized with malaria were analyzed, identifying 21 with concurrent culture-proven enteric fever.
Main Results:
- Dual infection cases exhibited more gastrointestinal symptoms (nausea, vomiting, diarrhea), continuous fever patterns, and delayed defervescence compared to controls.
- Cases also showed lower white blood cell counts, higher platelet counts, elevated ALT levels, and prolonged hospital stays.
- Negative predictive values for gastrointestinal symptoms, continuous fever, and delayed defervescence were 80%, 72%, and 74% respectively.
Conclusions:
- Patients with malaria and significant gastrointestinal symptoms, continuous fever, or fever persisting >24 hours post-treatment should be evaluated for concurrent enteric fever.
- The absence of these specific clinical features can reassure physicians against co-existing typhoid fever in malaria patients.
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