Plasmodium vivax and SARS-CoV-2 co-infection in Venezuela: A case series from the malaria hotspot in Latin America.

Background: Malaria-endemic areas are not spared from the impact of coronavirus disease 2019 (COVID-19), leading to co-infection scenarios where overlapping symptoms pose serious diagnostic challenges. Current knowledge on Plasmodium spp. and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection remains limited, especially in Latin America. Objective: Clinically and epidemiologically characterize patients with P. vivax and SARS-CoV-2 co-infection in Venezuela. Materials and methods: We present here a case series of 12 patients with P. vivax and SARS-CoV-2 co-infection seen at two main malaria referral centres of the Capital District and Bolivar state, Venezuela between March 13, 2020 and December 31, 2021. Results: Nine out of 12 patients had moderate to severe COVID-19 disease, and three patients had mild COVID-19 disease. Fever (12/12), chills (11/12), dry cough (9/12), headache (7/12), and diaphoresis (6/12) were the most frequent symptoms reported. Elevated AST/ALT levels, thrombocytopenia, severe anaemia, and thrombocytosis were the most relevant laboratory abnormalities documented. Mean time span between symptom onset and a positive test for SARS-CoV-2 infection based on RTPCR or a positive microscopy for Plasmodium spp. was 6.3 (SD 3.4; range: 3-15) days and 3.3 (SD 3.4; range: 1-13) days, respectively. Nine patients had previous P. vivax malaria episodes (range: 1-11), three of whom within the past six months (possible relapse cases). Conclusions: In malaria-endemic regions, suspected COVID-19 patients should also be monitored for malaria diagnosis without delays due to overlapping symptoms. P. vivax and SARS-CoV-2 co-infection could increase the severity of the disease rapidly. [ABSTRACT FROM AUTHOR]