Transactions of the Royal Society of Tropical Medicine and Hygiene (2007) 101, 1048—1050 available at www.sciencedirect.com journal homepage: www.elsevierhealth.com/journals/trst CASE REPORT Concurrent dengue and malaria due to Plasmodium falciparum and P. vivax Rajeev M. Kaushik * , Amit Varma, Reshma Kaushik, Kunwar J.B.S. Gaur Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Nagar, P.O. Doiwala-248140, Dehradun, Uttarakhand, India Received 12 January 2007; received in revised form 25 April 2007; accepted 26 April 2007 Available online 12 June 2007 KEYWORDS Malaria; Plasmodium falciparum; Plasmodium vivax; Dengue; Infection; India Summary Concurrent infections of dengue and malaria are rare. We report a case of dengue fever with acute malaria due to Plasmodium falciparum and P. vivax in which the presence of mixed infection with P. vivax was overlooked and confirmed later on during recurrence of the fever that had initially responded to conventional antimalarial treatment and symptomatic treatment for dengue fever. We suggest that in concurrent infections of dengue and malaria, possibility of mixed infection with various Plasmodium species should be excluded to ensure a better treatment outcome. © 2007 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. 1. Introduction Concurrent infections of dengue and Plasmodium vivax/P. falciparum malaria have been reported rarely (Bhalla et al., 2006; Charrel et al., 2005; Ward, 2006). We report a unique case of concurrent dengue with acute malaria having both P. falciparum and P. vivax parasitemia, which, to the best of our knowledge, has not previously been described in the literature. 2. Case report A 26-year-old male patient presented to the Emergency Department of the Himalayan Institute Hospital, Dehradun, ∗ Corresponding author. Tel.: +91 135 2471283 (residential), +91 135 2471376 (hospital); fax: +91 135 2471317. E-mail address: rmkaushik1@rediffmail.com (R.M. Kaushik). Uttarakhand, India on 5 September 2006 with fever, headache, severe bodyaches and nausea for 10 days. Inter- mittently, there were spikes of fever following chills on alternate days. The patient had retrobulbar headache and severe aching of the body, particularly in the back and extremities. There was no cough, dysurea, vomiting or loose motions. The patient resided on a riverbank in an area infested with mosquitoes and there was an outbreak of dengue in the region at that time. Examination showed a conscious, febrile patient (oral temperature 38.6 ◦ C) with moderate pallor, occasional crepitations over the chest, mild hepatosplenomegaly and a few purpuric spots over the dor- sum of hands and forearms. Investigations showed: blood hemoglobin 8.6 g/dl; total leucocyte count 2580/mm 3 ; differential leucocyte count, neutrophils 65%, lymphocytes 34%, monocytes 1%; ery- throcyte sedimentation rate 106 mm/h; platelet count 20 000/mm 3 ; 7% parasitemia due to P. falciparum in the form of single and double rings in red blood cells in thick and thin blood films. Urinalysis showed traces of albumin. 0035-9203/$ — see front matter © 2007 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.trstmh.2007.04.017