|Year : 2005 | Volume
| Issue : 4 | Page : 132
Tuberculosis and malaria - an unusual combination
Department of Tuberculosis and Respiratory Diseases, Fr. Muller Medical College, Mangalore-575002, Karnataka, India
"Hemadri" IInd Cross, Behind SDM Law College, Kodialbail, Mangalore - 575 003.
Source of Support: None, Conflict of Interest: None
| Abstract|| |
An unusual combination of tuberculosis and malaria which can pose clinical problems is reported and its implications discussed.
|How to cite this article:|
Sukesh R. Tuberculosis and malaria - an unusual combination. Lung India 2005;22:132
| Introduction|| |
Incidence of tuberculosis and malaria is relatively high in developing countries, more so in rural areas because of various factors like poor health, poor literacy status, bad hygienic conditions etc. An unusual and uncommon combination of tuberculosis and malaria was encountered which prompted us to report this case.
| Case Report|| |
Mr. S., a 48yr old male, clerk by occupation presented with fever and generalized weakness of two weeks duration. Past history revealed that he was treated for tuberculosis 6 months back which the patient stopped on his own 2 weeks back.
Examination revealed left sided fibrocavitory lesions. Chest skiagram confirmed and he was found to be suffering from far advanced tuberculosis  . Sutum examination was positive for acid fast bacilli by smear microscopy. Other haematological and biochemical parameters were within normal limits. Subsequently he was put on antitubercular treatment comprising of Ethambutol, Isoniazid, Rifampicin and Pyrazinamide. During hospital stay his fever persited and after 4 days of persistent fever in spite of staring antitubercular treatment he was investigated for other causes of pyrexia and during this course, blood examination by fluorescent microscopy revealed ring form and gametocytes of Plasmodium falciparum. He was promptly put on anti-malaria treatment and his fever subsided within 72 hours and he was asymptomatic at the time of discharge after 1 week.
| Discussion|| |
Pyrexia is one of the presenting features of both tuberculosis and malaria. Usually clinical presentation, pattern of fever and associated symptoms-eg. chills, rigor loss of appetite and weight are helful in establishing the etiology. Also, fever in tuberculosis usually resolves completely within 2-4 weeks of starting treatment  . But prompt and adequate antitubercular treatment usually decreases the bacterial load within 48hrs  and hence a clinical improvement is expected. But, as in this patient, who had a dual infection, this may not be the case always. We feel that it is important for physicians to be aware of this possibility and use a high degree of suspicion on clinical ground in such cases. This becomes all the more important in specific clinical settings e.g. the developing countries, bad hygiene and sanitary conditions, malnourishment/immunosuppression where typical clinical features of either infection might be masked.
| References|| |
|1.||National Tuberculosis Association U.S.A. - Diagnostic standards and classification of tuberculosis, New York, 1961. |
|2.||Barues PF, Chan LS, Wong SF, The course of fever during treatment of pulmonary tuberculosis, Tubercle, 1987; 68: 255-260. |
|3.||Toman K. Tuberculosis - Case finding and chemotherapy World Health Organization, Geneva 1979; 206-207. |