Managing Dual Malaria Infections in Sickle Cell Anemia in Nigeria: A Case Report of Plasmodium falciparum and Plasmodium vivax Co-infection

Introduction: Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) are the two primary species of parasites that significantly contribute to the global malaria burden. In Nigeria, P. falciparum is predominant, whereas P. vivax is rare due to the protection conferred by the Duffy-negative red blood cell trait. As a result, co-infection of P. falciparum with P. vivax is uncommon. The patterns of malaria prevalence are similar to those of sickle cell anaemia (SCA). And in these malaria-endemic areas, infection with the parasite is the most common trigger for sickle cell crises. Therefore, all suspected cases of malaria in SCA should be confirmed through parasite-based diagnostic testing to ensure accurate diagnosis and initiate appropriate treatment.

Presentation of Case: An 18-year-old Nigerian male, with SCA presented with fever and mild generalized body pains. Nil history of travel. A positive microscopy and rapid diagnostic test (RDT) for both P. vivax and P. falciparum malaria necessitated the use of artemisinin-based combination therapy. Oral primaquine was used for radical clearance of the remaining dormant forms of P. vivax in the liver, thus preventing recurrent infections. Treatment was tailored for both malaria and SCA-related complications. He responded to treatment with no significant adverse effects.

Discussion: The accurate and rapid identification of P. vivax in a P. falciparum-endemic region, facilitated the radical clearance of P. vivax. This is particularly important in SCA, as malaria significantly increases morbidity and mortality.

Conclusion: There is need for increased awareness among clinicians regarding the possible diagnosis of mixed Plasmodium spp. infections in SCA.