A 34-year-old man from India presented with a 1-month history of intermittent high-grade fevers, generalized weakness, and cough. The patient had a history of being treated for malaria. He was lethargic but vitally stable. Complete blood count showed thrombocytopenia with a platelet count of 71 × 109/L, a hemoglobin level of 12.3 g/dL, mild neutrophilia at 7.3 × 109/L, but no eosinophilia. Liver function tests showed mild hyperbilirubinemia with total bilirubin of 55 μmol/L. Malaria screening by the immune-chromatographic test (OptiMAL-IT; BIO-RAD, Marnes la Coquette, France) was positive for non–falciparum Plasmodium species, and thin smear demonstrated Plasmodium vivax species with a parasitemia level of 2.5%. In addition, Wuchereria bancrofti microfilariae were present (panel A). Both ring forms of P vivax and W bancrofti microfilariae are shown (panel B) (original magnification ×50). Microfilariae antigen testing was not available. The patient was treated with chloroquine followed by primaquine for 2 weeks for the malaria, and ivermectin and doxycycline for W bancrofti.
Combined malaria and filariasis should not be overlooked in patients from endemic areas, including the Indian subcontinent and central Africa. Both parasites affect the same human hosts and share common mosquito vectors. Careful evaluation of concomitant filariasis should be pursued prior to treatment. Although this can be done by antigen testing, examination of blood smears is an acceptable alternative in settings where antigen testing is not available.
