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Introduction: Co-infection with different agents such as bacterial, viral, and Rickettsia is being increasingly recognized due to greater availability and utilization of the diagnostic tests among malaria patients. Methods: Consecutive admitted malarial cases were included and were subjected to test for general investigations, bacteria, typhoid, dengue, chikungunya, and rest for specific diagnosis. All patients were followed up till discharge or death and appropriate statistical tests were performed. Results: A total of 152 malaria patients were recruited and 27 (18.8%) had concurrent infections. It included 40.7% dengue only, 18.7% pneumonia, 11.1% urinary tract infection (UTI), 7.4% enteric fever, 3.7% leptospirosis, chikungunya, and tuberculous meningitis each, and 3.7% each of dengue with pneumonia and UTI. The organisms isolated were Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Salmonella typhi, and Mycobacterium tuberculosis. The mean duration of fever was 6.33 ± 3.63 days with a range of 3–20 days. Blood culture grew in 2 cases S. typhi and K. pneumoniae. Dengue co-infections had significantly higher clinical and laboratory features of dengue and complications such as bleeding, jaundice, and cholecystitis, whereas rest concurrent infections had a significantly higher proportion of nausea and vomiting, convulsion, altered sensorium, productive cough, urinary symptoms, shock, acute kidney injury, anemia, and mean neutrophil count. There was significantly higher mortality among malaria–dengue concurrent infection group with 2 (15.4%) than malaria mono-infection group 3 (2.4%). Conclusion: Co-infections with malaria are not uncommon, especially dengue fever and other bacterial infections. The dominant clinical picture is of the superimposed infection. Decision should be clinically guided adjunct with specific diagnostic tests, and timely treatment has favorable outcome.

Hyperreactive malarial splenomegaly (HMS) is one of the important causes of massive splenomegaly in malaria endemic zones. It is thought to represent a dysfunctional immune response to recurrent malarial infection. It is usually reported due to physical symptoms of splenomegaly and hypersplenism and fever is classically absent. Concomitant malaria with HMS is a very rare finding in the Indian context. Here, we report a case of symptomatic falciparum malaria presented with fever, jaundice, massive splenomegaly and pancytopenia. Persistent massive splenomegaly led us to investigate thoroughly and finally diagnosed it as HMS with concomitant falciparum malaria. He received standard antimalarial treatment and 12 months of weekly chloroquine and completely recovered without any relapse or complications.