Is co-infection of Malaria and COVID-19 possible?

Introduction
COVID-19 has hit hard the healthcare infrastructure across the globe. The entire healthcare resources are facing unprecedented global health challenges. One of the significant challenges reported is diagnosing COVID-19 from other vector-borne diseases or other chronic health conditions with initial symptoms similar to COVID-19. Diseases like malaria and dengue have initial symptoms like fatigue, severe fever, headache, and myalgia, similar to COVID-19. Patients were overburdening the hospitals with other chronic diseases during the pandemic increased the chance of spreading the virus, thereby increasing the workload of healthcare professionals. People must take precautionary measures to curb the spread of the virus and stay safe from getting infected with vector-borne diseases like malaria, dengue, and chikungunya.
However, among all these challenges, many people question whether humans can get infected with COVID-19 if they are already suffering from vector-borne disease and vice versa? Also, what preventive measures should we take to be safe from COVID-19 and other vector-borne diseases? We have covered both of these questions in this article. Furthermore, since malaria cases have seen a rise in recent days amid the COVID-19 pandemic, we have tried to answer if co-infection of Malaria and COVID-19 is possible and the preventive measures one should take to curb the spread of both the disease.

Co-infection of COVID-19 and Plasmodium vivax malaria
Two scientific research studies published in journals answer the co-infection of COVID-19 and Plasmodium vivax malaria.

The first study is the first reported COVID-19 and malaria co-infection case in a 34-year-old man, published in the Journal ID Cases, Elsevier, 2020. The patient visited the hospital with a history of fever, muscle pain, vomiting, and pain in the abdomen. Upon diagnosis and laboratory investigation, the patient was found to have jaundice with significant signs for leukopenia, lymphopenia, and thrombocytopenia. In addition, the patient had a decrease in the platelet count and the levels of hepatoglobin, hyperbilirubinemia. Increased levels of C-reactive protein, procalcitonin, LDH, ferritin level, and D-dimer were also present.

The patient showed co-infection of malaria and COVID-19. The Microscopic diagnosis test confirmed the smear to be positive for Plasmodium vivax with parasitemia. The PCR test carried out on the nasopharyngeal sample was positive for SARS-CoV-2. The patient underwent treatment for malaria initially with intravenous artesunate and later with artemether-lumefantrine. Although the patient was COVID-19 positive, there was no sign of respiratory distress and need for oxygen supply during the period of hospitalization. The PCR test repeated seven days after hospitalization on the nasopharyngeal swab sample confirmed negative COVID-19. The patient’s health recovered gradually. The study showed that patients might have co-infection of COVID-19 and Malaria. Thus, diagnostic and laboratory tests should be carried out for both the diseases if a patient reports initial symptoms similar to Malaria and COVID-19. Extensive studies are needed to explore the management of COVID-19 with artemisinin since the patient with co-infection in the above case study recovered successfully.

The second study has been carried out with 135 COVID-19 positive patients and published in the Journal of Infectious Disease and Tropical Medicine, 2021. The objective was to determine the prevalence and risk factors for malaria and COVID-19 infection. For the study, the nasopharyngeal and oropharyngeal swab samples of the subjects were collected during their hospitalization. The subjects were confirmed COVID-19 positive after an RT-PCR test. Similarly, the malaria test of the subjects was carried out by the SD BIOLINE Malaria Ag P.f/Pan test after collecting their blood by the needle-prick method.

The study found the co-infection rate of COVID-19 and Malaria to be 7%. The typical symptom for COVID-19 and malaria was fever, which was considered to pose a diagnostic challenge. The significant risk factors for co-infection of COVID-19 and malaria were found to be age and CT values. The study’s outcome was a need for proper risk assessment and laboratory evaluation among patients showing symptoms similar to COVID-19 to take appropriate decisions for treatment and management of the diagnosed disease.

Preventive actions to prevent the spread of COVID-19 and malaria

Though vaccines are available for COVID-19, and every country is trying to vaccinate its citizens, people should not take things lightly. People are advised to follow the precautions mentioned below to curb the spread of COVID-19 and Malaria.

• Get vaccinated and spread awareness among fellow people to get vaccinated.
• Covering the face with a face mask is a must while going out of your home.
• Before going outside or entering the house, wash your hands with hand sanitizer or soap.
• Maintain social distancing, avoid crowded places, and prevent rubbing your eyes and putting your finger inside nostrils and mouth without washing your hand.
• Do not share your everyday bedding, towels, dishes, electronics, cups, and cutlery with others.
• Please take extra care while coughing and sneezing and throw the tissue paper in a dustbin.
• Eating raw or undercooked animal meat should be avoided entirely.
• Keep your surroundings clean. Please clean the area or notify the health authorities if you find open cans, tyres, large containers, coconut shells, broken clay pots, or vessels distributed as waste in open land. Because of the presence of stagnant water, mosquitoes lay their eggs in these areas.
• Avoid dumping garbage in the sewage.
• In malaria-endemic regions, one must use a mosquito repellent lotion containing chemicals such as DEET, IR3535, or picaridin when going outside early in the morning or late at night. In addition, lemon-grass oil and eucalyptus oil are natural insect repellents and are also highly effective at repelling mosquitoes. However, before using any mosquito repellent cream, please consult with your doctor and follow their recommendations.
• Cover your house’s doors and windows with nets and screens to keep mosquitos out.
• Use electric bats to kill the mosquitoes inside your home.
• If you have water storage containers, please make sure the lid is adequately covered. Call a pest control company every six months, and they will thoroughly clean your home and remove any mosquito eggs and larvae.
• Eat foods that boost immunity. Drink water to stay hydrated.
• Use mosquito nets while sleeping. It is crucial to ensure that each room in your home receives adequate sunshine.
• Wear full pants, full sleeve shirts, hats, and shoes to prevent mosquito bites.

References

1. Sardar, S., Sharma, R., Alyamani, T., & Aboukamar, M. (2020). COVID-19 and Plasmodium vivax malaria co-infection. IDCases, 21, e00879. https://doi.org/10.1016/j.idcr.2020.e00879
2. Fowotade A., Bamidele F. R., Adekanmbi O., Fasina O. N., Famuyiwa O., Alonge T. O. Malaria and COVID-19 co-infection: a symptom diagnostic challenge in a malaria endemic setting, Infectious Diseases & Tropical Medicine 2021; 7: e726 DOI:10.32113/idtm_20218_726