Skip to main content

Acute febrile hepato-renal dysfunction in the tropics: co-infection of malaria and leptospirosis

Abstract

Malaria and leptospirosis are both common in the tropics. Simultaneous infections are possible, although not frequently reported. We report two cases of malaria from India with compelling serologic evidence of coexistent acute leptospirosis. One was a case of infection with Plasmodium falciparum with acute and convalescent microscopic agglutination test titers for Leptospira serovar icterohaemorrhagiae of 1:200 and 1:1600, respectively. The other was a case of infection with Plasmodium vivax that seroconverted to a titer of 1:3200 for Leptospira serovar batavia. Both patients finally improved with cephalosporins and doxycycline after no significant clinical/biochemical improvement with antimalarials standalone. It is proposed that febrile patients with hepato-renal dysfunction should be considered possible co-infection of malaria and leptospirosis.

This is a preview of subscription content, access via your institution.

References

  1. Greenwood BM, Bojang K, Whitty CJM, Targett GAT. Malaria. Lancet. 2005;365:1487–98.

    PubMed  Article  CAS  Google Scholar 

  2. Ravindran B, Sahoo PK, Dash AP. Lymphatic filariasis and malaria: concomitant parasitism in Orissa, India. Trans R Soc Trop Med Hyg. 1998;92:21–3.

    PubMed  Article  CAS  Google Scholar 

  3. Graham SM, Walsh AL, Molyneux EM, Phiri AJ, Molyneux ME. Clinical presentation of non-typhoidal Salmonella bacteraemia in Malawian children. Trans R Soc Trop Med Hyg. 2000;94:310–4.

    PubMed  Article  CAS  Google Scholar 

  4. Flatau E, Reichman N, Elias M, Raz R. Malaria and Borrelia co-infection. J Travel Med. 2000;7:98–9.

    PubMed  Article  CAS  Google Scholar 

  5. Wongsrichanalai C, Murray CK, Gray M, Miller RS, McDaniel P, Liao WJ, et al. Co-infection of malaria and leptospirosis. Am J Trop Med Hyg. 2003;68:583–5.

    PubMed  Google Scholar 

  6. Suzuki A, Kumashiro R, Shirachi M, Kuroki M, Suzuki H, Tanikawa K, et al. Markedly prolonged jaundice from simultaneous infection with hepatitis E virus and leptospira. Kurume Med J. 2003;50:155–9.

    PubMed  Article  Google Scholar 

  7. Karande S, Gandhi D, Kulkarni M, Bharadwaj R, Pol S, Thakare J, et al. Concurrent outbreak of leptospirosis and dengue in Mumbai, India, 2002. J Trop Pediatr. 2005;51:174–81.

    PubMed  Article  Google Scholar 

  8. LaRocque RC, Breiman RF, Ari MD, Morey RE, Japan FA, Hayes JM, et al. Leptospirosis during dengue outbreak, Bangladesh. Emerg Infect Dis. 2005;11:766–9.

    PubMed  Google Scholar 

  9. Kudesia G, Christie P, Walker E, Pinkerton I, Lloyd G. Dual infection with Leptospira and hantavirus (letter). Lancet. 1988;331:1397.

    Article  Google Scholar 

  10. Bhattacharya P, Chakraborthy A, Ahmed S, Bharati S. Coexistence of leptospirosis with Falciparum malaria. Indian J Crit Care Med. 2007;11(2):102–3.

    Article  Google Scholar 

  11. Sulzer AJ, Sulzer KR, Cantella RA, Colichon H, Latorre CR, Welch M. Study of coinciding foci of malaria and leptospirosis in the Peruvian Amazon area. Trans R Soc Trop Med Hyg. 1978;72:76–83.

    PubMed  Article  CAS  Google Scholar 

  12. Magill AJ. Fever in the returned traveler. Infect Dis Clin N Am. 1998;12:445–69.

    Article  CAS  Google Scholar 

  13. Sharma A, Mahajan S, Gupta ML, Kanga A, Sharma V. Investigation of an outbreak of scrub typhus in the Himalayan region of India. Jpn J Infect Dis. 2005;58:208–10.

    PubMed  Google Scholar 

  14. Chaudhry R, Premlatha MM, Mohanty S, Dhawan B, Singh KK, Dey AB. Emerging leptospirosis, North India. Emerg Infect Dis. 2002;8:1527.

    Google Scholar 

  15. Vinetz JM. Leptospirosis. Curr Opin Infect Dis. 2001;14:527–38.

    PubMed  Article  CAS  Google Scholar 

  16. Panaphut T, Domrongkitchaiporn S, Thinkamrop B. Prognostic factors of death in leptospirosis: a prospective cohort study in Khon Kaen, Thailand. Int J Infect Dis. 2002;6:52–9.

    PubMed  Article  Google Scholar 

  17. White NJ, South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) Group. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet. 2005;366:717–25.

    PubMed  Article  Google Scholar 

  18. Riddle MS, LJackson J, Sanders JW. Exchange transfusion as an adjunct therapy in severe Plasmodium falciparum malaria: a meta-analysis. Clin Infect Dis. 2002;34:1192–8.

    PubMed  Article  Google Scholar 

  19. Pasvol G. Management of severe malaria: interventions and controversies. Infect Dis Clin N Am. 2005;19:211–40.

    Article  Google Scholar 

  20. Srinivas R, Agarwal R, Gupta D. Severe sepsis due to severe falciparum malaria and leptospirosis co-infection treated with activated protein C. Malar J. 2007;6:42.

    PubMed  Article  Google Scholar 

  21. Kumar SS, Shareek PS. Diagnosis of leptospirosis utilizing modified Faine’s criteria. J Assoc Physician India. 2004;52:678–9.

    Google Scholar 

  22. Gupta N, Sambasiva RR, Bhalla P, Agarwal SK. Serodiagnosis of leptospirosis in Delhi using IgM enzyme linked immunosorbent assay. Indian J Med Res. 2004;120:557–8.

    PubMed  CAS  Google Scholar 

  23. Hoontrakoon S, Suputtamongkol Y. Exchange transfusion as an adjunct to the treatment of severe falciparum malaria. Trop Med Int Health. 1998;3:156–61.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yanamandra Uday.

About this article

Cite this article

Baliga, K.V., Uday, Y., Sood, V. et al. Acute febrile hepato-renal dysfunction in the tropics: co-infection of malaria and leptospirosis. J Infect Chemother 17, 694–697 (2011). https://doi.org/10.1007/s10156-011-0220-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10156-011-0220-7

Keywords

  • Malaria
  • Leptospira
  • Hepato-renal dysfunction