Prolonged Fever and Exaggerated Hypercoagulopathy in Malaria Vivax Relapse and COVID-19 Co-infection: A Case Report (preprint)

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) often causes atypical clinical manifestations similar to other infectious diseases. In malaria-endemic areas, the pandemic situation will very likely result in co-infection of COVID-19 and Malaria, although reports to date are still few. Meanwhile, in areas with low malaria prevalence, this disease will be challenging to diagnose because the symptoms closely resemble COVID-19.Case presentationA 23-year-old male patient presented to hospital with fever, anosmia, headache, and nausea since one week before. He was diagnosed with COVID-19 and treated for approximately ten days then discharged to continue self-quarantine at home. Two weeks later, he came back to the hospital with fever that was raised intermittently every two days, and was marked by a chilling-fever-sweating cycle. We conducted a laboratory test for malaria and nasopharyngeal swab for SARS CoV-2 PCR which confirmed both of the diagnosis. The laboratory examination showed markedly elevated D-dimer. He was treated with Dihydroartemisinin-Piperaquine (DHP) 4 tablets per day for three days and Primaquine 2 tablets per day for 14 days according to Indonesian national anti-malarial treatment guidelines. After six days of treatment, the patient had no complaints, and the results of laboratory tests had improved. This report describes the key points in considering the differential diagnosis and prompt treatment of malaria infection during the pandemic of COVID-19 in an endemic country to prevent the worse clinical outcomes. COVID-19 and malaria may also cause hypercoagulable state, so a co-infection of those diseases may impact on the prognosis of the disease.ConclusionThis case report shows that considering the possibility of a co-infection in COVID-19 patient who presents with fever can prevent delayed treatment that can worsen the disease outcome. Paying more attention to a history of travel to malaria-endemic areas, a history of previous malaria infection, and exploring anamnesis regarding the fever patterns in patients are important points in making a differential diagnosis of malaria infection during the COVID-19 pandemic.