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CO-INFECTION WITH MALARIA AND LEPTOSPIROSIS

Malaria and leptospirosis are both common in the tropics. Simultaneous infections are possible, although not previously reported. We report two cases of malaria from an area of Thailand on the Thailand-Myanmar border with compelling serologic evidence of simultaneous acute leptospirosis. One was a case of infection with Plasmodium falciparum with acute and convalescent microscopic agglutination test (MAT) titers for Leptospira serovar icterohaemorrhagiae of 1:200 and 1:1,600, respectively. The other was a case of infection with P. vivax that seroconverted to a titer of 1:3,200 for Leptospira serovar bataviae. Additionally, there were five probable cases of leptospirosis with patent malaria parasitemia (three P. falciparum and two P. vivax) detected. Management of dual infections is complicated by their similar clinical presentations, and because the confirmatory diagnosis of malaria is readily available as opposed to that of leptospirosis. Treatment focusing on malaria mono-infections instead of dual infections could result in a delay of specific therapy for leptospirosis and possible consequences of serious complications.

Received October 24, 2002. Accepted for publication January 3, 2003.

Acknowledgments: We are grateful to the Fever Study Team of the Armed Forces Research Institute of Medical Sciences and the staffs of the Kwai River Christian Hospital and the Vector Borne Diseases Control Unit No. 9 (Sangkhlaburi) for their support.

Financial support: This study was supported by the U.S. Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS).

Disclaimer: The opinions or assertions contained herein are those of the authors and should not be construed as reflecting the official positions of the U.S. Army or U.S. Department of Defense.

Authors’ addresses: Chansuda Wongsrichanalai, R. Scott Miller, Wilson J. Liao, and Amy L. Pickard, Department of Immunology and Medicine, Armed Forces Research Institute of Medical Sciences, 315/6 Rajvithi Road, Bangkok 10400, Thailand. Clinton K. Murray, Infectious Disease Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234-6200. Michael Gray, Veterinary Command Food Analysis and Diagnostic Laboratory, Fort Sam Houston, TX 75234-6232. Philip McDaniel, Kwai River Christian Hospital, Sangkhlaburi, Kanchanaburi 71240, Thailand. Alan J. Magill, Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500.

Reprint requests: Chansuda Wongsrichanalai, Parasitic Diseases Program, U.S. Naval Medical Research Unit No. 2, Kompleks P2M/PLP-LITBANGKES, Jalan Percetakan Negara No. 29, Jakarta 10560, Indonesia, Telephone: 62-21-421-4458 extension 1230, Fax: 62-21-424-4507, E-mail: chansuda{at}namru2.med.navy.mil

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