Concurrent Dengue and Malaria

摘要

To the Editor: A 37-year-oldwoman, a logistics director for a non-government organization, returned toFrance in March 2004 from an 18-daytrip to Guinea, Senegal, and SierraLeone. Fever, chills, and myalgiadeveloped in the woman 3 days beforeshe returned to France, and she treat-ed herself with aspirin and paraceta-mol (acetaminophen). Malaria pro-phylaxis was taken neither during norafter the trip. The day after returning to France,the woman's condition progressivelyworsened; diarrhea and extremeweakness that led to the inability towalk developed. Ten days after herreturn, she was admitted to the localhospital and treated with intravenousquinine and oral doxycycline (2 g perday) after thick and thin blood filmsshowed 3% parasitemia withPlasmodium falciparum. Three dayslater, she was still febrile and had con-junctival jaundice, vomiting, insom-nia, and moderate hemorrhagic mani-festations (epistaxis, blood in urineand feces). Three days after initialhospitalization, the patient was trans-ferred to the Infectious Diseases Unitin Marseille; fever (39.5°C) contin-ued, and hepatosplenomegaly devel-oped. Biologic analyses showed dis-seminated intravascular coagulationwith platelet count of 22,000/μL, anelevated prothrombin time (54%higher than the control value), alonger activated clotting time (51 sec-onds versus a control value of 34 sec-onds), a fibrinogen level of 0.9 g/dL,exaggerated plasma fibrin formationand degradation, and hepatic cytolysiswith both aspartate aminotransferaseand alanine aminotransferase levels of80 U/L