Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : July | Volume : 15 | Issue : 7 | Page : DC15 - DC18 Full Version

Co-existence of Malaria and Dengue: An Incidental Observation


Published: July 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49909.15085
Bharat Singh, Saurabh Jayant, Ranjana Dehariya, Chandra Pratap Singh Rathore, Hariom Sharan, Trupti Bajpai

1. Assistant Professor, Department of Microbiology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India. 2. Assistant Professor, Department of Microbiology, LN Medical College, Bhopal, Madhya Pradesh, India. 3. Postgraduate, Department of Microbiology, MGM Medical College, Indore, Madhya Pradesh, India. 4. Postgraduate, Department of Microbiology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India. 5. Professor and Head, Department of Microbiology, Autonomous State Medical College, Firozabad, Uttar Pradesh, India. 6. Assistant Professor, Department of Microbiology, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India.

Correspondence Address :
Dr. Trupti Bajpai,
Assistant Professor, Department of Microbiology, Sri Aurobindo Medical College and PG Institute, MR-10 Crossing, Indore-Ujjain Road, Indore, Madhya Pradesh, India.
E-mail: truptiu@rediffmail.com

Abstract

Introduction: Malaria and dengue are two most important arthropod borne diseases responsible for high morbidity and mortality across the globe. Both these communicable diseases have been a major threat to the public health not only in India but also in other tropical and sub-tropical regions of the world.

Aim: To study the prevalence of Dengue and Malaria along with the cases of co-infection among the patients visiting a tertiary care hospital located in central India.

Materials and Methods: The present prospective study was conducted for a period of two years from January 2019 to December 2020, in the serology section of the Department of Microbiology of a teaching tertiary care hospital. Three to five millilitres (mL) of venous blood samples from 1519 patients were tested for both dengue (NS1 antigen, IgM and IgG antibodies) by Enzyme-linked Immunosorbent Assay (ELISA) method and malaria peripheral smear and antigen by immunochromatographic method. All demographic parameters were simultaneously analysed. Statistical analysis was performed with the help of Chi-square test.

Results: Out of 1519 blood samples tested, 267 (17.5%) samples were positive for dengue and 6 (0.39%) samples were positive for malaria. No case of co-infection was detected. Maximum dengue cases were detected during post monsoon period while malaria cases were detected in monsoon and post monsoon period. Among the various dengue positive cases, 185 (69.2%) patients were diagnosed with recent primary infection while 20 (7.49%) patients had primary infection.

Conclusion: The present study concluded that seroprevalence of dengue was high in our geographical region with malaria being negligible. Present study incidentally recorded the fact that the two diseases may coexist in an individual but both the vectors rarely share the same geographical site.

Keywords

Co-infection, Dengue virus, Enzyme linked immunosorbent assay, Malaria parasite, Seroprevalence

Malaria and dengue are two most common communicable diseases causing threat to public health in India and other tropical and sub-tropical regions of the globe (1),(2). Both are known to be vector borne diseases causing febrile illness and playing a significant role in terms of morbidity and mortality on account of its ease in globalised travel (1),(3),(4). Among these two infections, malaria can become chronic in contrast to dengue (5).

Malaria is a parasitic infection caused by a protozoan parasite Plasmodium while dengue is known to be caused by a single-stranded Ribonucleic Acid (ssRNA) arbovirus called as Dengue Virus (DENV). Plasmodium is known to exist in form of five different species i.e Plasmodium vivax (P. vivax), P. falciparum, P. malaria, P. ovale and P. knowlesi. While, dengue virus exists in the form of four different serotypes i. e DEN-1, 2, 3 and 4. Malaria is known to be transmitted through female Anopheles mosquito while DENV is known to be transmitted through a female Aedes aegpti mosquito (4),(6),(7). The typical transmission cycle of both malaria and dengue follows the human-vector-human cycle with rare chances of DENV shifting from an animal transmission cycle to human transmission cycle. The cumulative burden of these diseases have increased recently especially due to frequent outbreaks of dengue in several parts of the world including India (4).

Malaria parasitic infection has not been documented in the Indore city of Central India since several years however a dengue outbreak was first known to be documented in the year 2009 (8). Infections from each of these is quite infuriating even if present independently. Now the question arises, can these two infections be present in a certain geographical area simultaneously? There are several published reports from different parts of the world indicating synchronous infection of both malaria and dengue in the same individual (1),(2),(3),(4),(5),(9). The severity of co-infection is always known to be greater than the monoinfection (9). Also, according to the World Health Organisation (WHO), such co-infections in an individual is regarded as a ‘severe malaria case’ (10). Superimposed infection may complicate the diagnosis and result into more severe form of combined disease since either of the pathogen may induce severe manifestations in form of thrombocytopenia, central nervous symptoms and cytokine storm (11). Therefore, a more specific diagnosis is advised in either of the cases.

The present study was conducted to find out the seroprevalence of dengue and malaria along with the cases of co-infection among the patients visiting a tertiary care hospital in Indore, Madhya Pradesh, India.

Material and Methods

The present prospective study was conducted for a period of two years from January 2019 to December 2020 in the Serology section of the Department of Microbiology of a teaching tertiary care hospital located in central India. All the blood samples received in the serology laboratory for the investigation of dengue and malaria parasite, during the period of two years were considered for study. The study was orally approved by the Institutional Ethical Committee (IEC).

Inclusion criteria: All the blood samples that were tested for both malaria parasite and dengue were considered for the study.

Exclusion criteria: The lipemic, haemolysed and icteric samples were rejected and excluded from the study.

Study Procedure

A 3-5 mL of venous blood was collected from 1519 patients in each of the two tubes (Ethylenediaminetetraacetic acid i.e EDTA tube and a plane tube). The patients were, clinically suspected cases of febrile illness compatible with dengue and/or malaria. The blood in the plane tube was further subjected to centrifugation at 1000 rpm (rotation per minute) for five minutes. The serum obtained was then used to identify Dengue NS1 antigen (Qualisa NS1 Antigen, Tulip Diagnostics, Goa, India) and Dengue IgM and IgG antibodies (Qualisa Dengue IgM & IgG, Tulip Diagnostics, Goa, India) by solid phase ELISA. Optical Density was measured at 450 nm by automated ELISA machine, Erba Manheim Elan 30 (Transasia Bio-Medicals ltd., Mumbai, MS, India). The test was done according to the manufacturer’s instructions.

Also, the whole blood from the same patient was used to perform Malaria antigen test (BeneSphera Malaria PAN/Pf kit, Avantor Performance Materials India Ltd., Gurgaon, Haryana, India) by using rapid diagnostic immunochromatographic test kit, following the prescribed protocol. Also, Field stained thick and thin Peripheral Smears (PS) were simultaneously prepared to identify the malaria parasites (4),(5) (Table/Fig 1). All demographic parameters were simultaneously analysed.

Statistical Analysis

The collected data was transferred to the computer and Microsoft Excel 2000 (version 9). Analysis Tool Pack was used for analysis of data. Chi-square test was performed and p≤0.05 was considered statistically significant.

Results

A total of 1519 blood samples were tested for both Dengue (NS 1 antigen and IgM and IgG antibodies) and Malaria PS and antigen. Among them, 718 samples were from male patients and 801 were from females. Out of 1519 samples, 267 (17.5%) samples were found to be positive for dengue (any one or multiple parameters) and 6 (0.39%) samples were positive for malaria. Out of 267 dengue positive samples, 169 (63.3%) were from male patients while 98 (36.7%) were from females. The difference was not found to be statistically significant (p=1.8291). Similarly, out of six malaria positive samples, 4 (66.7%) were from males and 2 (33.3%) were from females (Table/Fig 2). Among these, five samples had P. vivax and one sample had P. falciparum as the malaria parasite. Highest number of patients suffering from dengue belonged to the age group of 11-20 years followed by 21-30 years of age. While those suffering from malaria belonged to the age groups 21-30 and 31-40 years of age with more patients in the age group of 21-30 years. Whereas, more male patients suffering from dengue belonged to the age group of 11-20 years while more females belonged to the age group of 21-30 years. The difference was not found to be statistically significant (p=1.83289) (Table/Fig 3).

Highest numbers of dengue positive cases were detected during post monsoon period (October-November). Positive malaria cases were also detected during monsoon and post monsoon period (Table/Fig 4). Among the various dengue positive cases, 185 (69.2%) patients were diagnosed with recent primary infection while 20 (7.49%) patients had primary infection. A total of 185 (69.2%) patients tested positive for NS1 antigen, 53 (19.8%) tested positive for IgM while 76 (28.4%) tested positive for IgG immunoglobulins (Table/Fig 5).

Discussion

The present prospective study was conducted with an aim to determine the seroprevalence of dengue and malaria among the patients visiting the hospital with febrile illness along with the complains of myalgia, headache and nausea. Each of the patients was tested for both malaria and dengue apart from other haematological and clinical parameters. Initially, the study was set up for 12 months period. But later on, in order to confirm the observations of last one year, the study period we extended for one more year.

During the study period of 24 months, authors observed that only dengue was prevalent in the area. Less than one percent (0.39%) cases of malaria was detected. It was surprising because during early years of this decade, there were enormous number of cases of malaria. Dengue used to be detected sporadically among very few numbers of patients before and after a dengue outbreak in 2009 (8).

When dengue and malaria coexists in the same patient then it is called as a concurrent infection of dengue and malaria. Due to similarities in the clinical characteristics exhibited by the two infections, it is often misinterpreted or misdiagnosed as a mono infection. However, the biological picture and treatment protocols of both the infections may vary greatly. Dual infection sometimes drastically changes the spectrum of clinical manifestations by posing a diagnostic challenge. However, the cases of dual infection have been rarely documented across the globe (1),(2),(3),(4),(5),(9),(12).

In the present study, no case of co-infection in the period of 24 months was found. However, it was astounding to observe that 17.5% cases of dengue were observed over a period of 24 months while there were only 0.39% cases of malaria. On collecting the travel history of patients who were detected as malaria positive, it was observed that all of the six patients had travelled to malaria endemic areas like Zabua, Jabalpur and Ratlam districts of Madhya Pradesh, India, a few days prior to the appearance of symptoms. Therefore, to confirm the endemicity of dengue and total absence of malaria parasite in our area, literature search was done (1),(2),(3),(4),(5),(7),(9). Basically, it is all about the availability of mosquito vectors in the geographical region (7).

As it is well known that each infection has specific mosquito vector and each of these vectors have a different habitat. Malaria mosquito vector i.e Anopheles prefers forest, while dengue mosquito vector i.e Aedes prefers urban areas. Therefore, overlapping of habitats is not easily available (4),(13),(14). The typical, human-vector-human transmission cycle is commonly exhibited in both malaria and dengue. However, there is a great potentiality of dengue virus to shift from animal transmission cycle (sylvictic jungle cycle in monkeys) to human transmission cycle (4). Dengue is assumed to be an urban disease but the Aedes mosquito has been located in forested areas when it is not circulating in humans. It is known to spread in cities especially where there are abundant stocks of fresh water available along with an unplanned urbanisation that creates an environment that support the breeding of vectors (1),(5),(15),(16),(17),(18).

Since, long time malaria had been endemic in our area and hence population must have developed immunity against malaria parasite (19). Even interspecies cross protection can be one of the possible reasons for elimination of one and emergence of other mono infection in a certain geographical area (11). So, co-infection in most of the geographical areas would have been occurring by chance and that is why there are scarce published cases as far as concurrent infections are concerned with respect to malaria and dengue (2),(3),(4),(5),(7). Whenever, there are cases of co-infection, there might be history of travel to a certain vector endemic regions. The reasons for disappearance of malaria vector in our region can also be attributed to establishment of ‘cleanest city’ since last four years. Vectors might not be getting enough establishing sites for propagation. Instead, the day biting dengue vectors prefer to reproduce in sites where fresh water is stored in flower vase and planters inside residential areas. Also, the primary vectors for dengue are diurnal and therefore renders the use of insecticide treated mosquito nets useless in dengue control (11). Thus, it can be said that the same individual might carry the two organisms but the two vectors may not coexist in the same geographical sites there by reducing the chances of co infection. The chances of an individual carrying a co-infection may be imputed to their travel history in malaria/dengue endemic region (7). However, in geographical areas where both the vectors-we cannot rule out the simultaneous occurrence of both the diseases in a single individual. Since both the diseases share some clinically indistinguishable characteristics it become very essential to differentiate the two on the basis of laboratory diagnosis in order to rule out poor patient outcomes.

Though, it was an incidental finding in present study, it was quite sure that there might be a wide overlap between the endemic areas of both these vectors in some parts of the world. The worldwide documentation of co-infection are scarce, either both the cases are not being laboratory confirmed simultaneously or the reason of under diagnosis of one of the infection may be because of self limitation turning into recovery in case of dengue or carrier status in case of malaria when patients do not visit clinicians during acute febrile illness (7). Even sometimes if one underlying disease is laboratory diagnosed in a patient with acute febrile illness, there is always a very low index and suspicion for co-infection. However, severity could prompt the testing for dual infections (4),(11). Sometimes, co-infection in an individual is missed during cases when laboratory detection of one of them in an acute febrile patient masks the diagnosis of another (3).

Still, worldwide studies have detected co-infection in the range of 1-27% thereby challenging the classical concept that dengue occur in urban and malaria in rural areas (1),(3),(5). Authors feel that collection of travel history would help in understanding the vector spread and overlapping of mosquito biotypes.

In this study, maximum number of cases was diagnosed in the post monsoon period and present study results resembled those published by other authors in the previous studies. Just like present study, different authors have also noticed a gradual increase in cases following August with a peak reaching in November (post monsoon period) and soon tapering down to zero after the month of December (20),(21),(22),(23). This may be because the post monsoon cooler months favor the breeding of vectors thereby extending the risks of viral transmission.

Even if the study did not come across any cases of concurrent infection of dengue and malaria, it was suggested the laboratory confirmation of both the vector borne diseases in patients visiting a hospital with febrile illness because even if the vector may not be prevalent in the patients’ residential locality there may be chances that the individual would have travelled in the areas endemic for either of these infections.

Initially, ‘Anopheles’ was the ‘domestic’ vector. Urbanisation and globalised travel was responsible for proliferation of ‘Aedes aegyptii’ and establishment of dengue virus in the city. Now, ‘Aedes’ has become endemic in our region and sporadic cases of malaria in our city are attributed to the travel history of patients in malaria endemic zones.

Limitation(s)

Though, this study covered most of the aspects related to both the diseases, there were few limitations. Firstly, the study only referred haematological and clinical parameters for the purpose of correlation. However, those parameters in the manuscript was not tabulated. Secondly, since authors did not mark the day when the particular patient’s sample was tested after the onset of illness, hence the data would have underestimated the overall prevalence. Thirdly, because antibodies to other pathogens including SARS-CoV-2 virus (as the study was being conducted during the COVID-19 pandemic months) is known to cross react with dengue ELISA, there might be possibilities of false positivity in dengue IgM antibody results.

Conclusion

The present prospective study incidentally detected that only dengue cases prevailed in the past two years with the cases of malaria in a very insignificant number. No case of co-infection was detected. Therefore, it can be concluded that though the two diseases may coexist in an individual, but they may rarely co-exist in the same geographical area. Co-existence in an individual may be ascribed to his travel history in the dengue/malaria endemic area. However, the threat of dengue is prevailing in our region.

Acknowledgement

The authors wish to thank the Chairperson and Dean of the institute for providing laboratory facilities and healthy working atmosphere during the study period. The authors are also thankful to the technical staff of the institute for providing necessary helping hand during the endeavor.

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DOI and Others

10.7860/JCDR/2021/49909.15085

Date of Submission: Apr 15, 2021
Date of Peer Review: May 15, 2021
Date of Acceptance: June 04, 2021
Date of Publishing: Jul 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No (only orally approved)
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 16, 2021
• Manual Googling: June 04, 2021
• iThenticate Software: Jun 05, 2021 (7%)

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