Co-infection of Plasmodium falciparum and Plasmodium vivax with Acute Viral Hepatitis in Brothers: A Rare Clinical Encounter
Keywords:
Plasmodium falciparum, Plasmodium vivax,, hepatitis A, co-infection, immunogenetics.Abstract
Two brothers aged 14 and 17 years presented in our emergency department with complaints of fever
and yellowish discoloration of eyes and urine for 6 and 10 days, respectively. They had similar clinical
presentation, examination findings, laboratory biochemical derangements and positive results for rapid
tests of Plasmodium falciparum and vivax species along with IgM Enzyme-linked immunosorbent assay
(ELISA) test for hepatitis A virus. They also showed similar response to therapy and improved
simultaneously within two to three days. This suggests the role of immunogenetics in modifying the
natural course of disease. Moreover, triple infection by these hepatotropic pathogens lead to a
presentation that is much more severe than that caused by either of them alone. This could only be
explained by a synergistic interaction between these pathogens. This case foretells that co-infections
with two or more hepatotropic pathogens require immediate attention with an aggressive management
and role of immunogenetics along with co-infections in altering the phenotypic expression of a disease
