Need for vigilance as dengue, malaria symptoms similar to Covid-19 in pregnant women: study

As many as 2,500 cases have been documented in the network of National Registry of Pregnant Women with Covid-19 in India to better understand how pregnant women are affected by the infection.

Researchers have cautioned physicians and obstetricians that malaria and dengue symptoms are similar to Covid-19 in pregnant women and if misdiagnosed, could be life-threatening to both the patient and the foetus.

Citing the case of a woman who had both SARS-CoV-2 and malaria, researchers said the patient experienced foetal demise and had to undergo abortion, adding that if the malaria had been diagnosed earlier, the pregnancy might have been saved.

“Our observations reveal that pregnant women with suspected Covid-19 infection can show the same clinical symptoms associated with dengue or malaria,” Dr Rahul Gajbhiye, scientist at ICMR-NIRRH who was part of the study, told The Indian Express.

The study, ‘Co-infection of malaria and dengue in pregnant women with SARS-CoV-2’, was conducted by researchers at the Indian Council of Medical Research-National Institute of Research in Reproductive Health (ICMR-NIRRH), along with BYL Nair Hospital, and published in International Journal of Gynaecology and Obstetrics.

As many as 2,500 cases have been documented in the network of National Registry of Pregnant Women with Covid-19 in India to better understand how pregnant women are affected by the infection. As part of this ongoing effort, researchers studied three cases where the clinical presentations of malaria and dengue strongly overlap with that of Covid-19, posing an additional challenge for differential diagnosis.

Dr Smita Mahale, director of ICMR-NIRRH, said this was an important observation as dengue and malaria are endemic in several parts of India.

Researchers Dr Niraj Mahajan from the department of obstetrics and gynaecology, BYL Nair Hospital and Rahul Gajbhiye, scientist at ICMR-NIRRH, among others, have described the symptoms, treatment and outcomes of three pregnant women with SARS-COV-2 infection who also had co-infection of malaria, and one patient with dengue.

Some of these women may remain asymptomatic throughout their pregnancy, while others might show mild to moderate symptoms at some point of their pregnancy, researchers said. The present case series shows that patients with mild to moderate symptoms of Covid-19 are problematic because co-infections can be misdiagnosed easily as late-onset Covid-19 presentation, whereas they may be presentations of dengue or malaria, which require a completely different clinical management protocol to that of Covid-19. Misdiagnosis could have life-threatening consequences for the patient and the foetus, researchers said.

Considering that the pandemic has spread to the tribal and rural parts of India, the healthcare system should be strengthened for diagnosis and appropriate management of co-infections, Dr Mahale said. All symptomatic Covid-19 cases with fever must be investigated for other common infections in endemic regions, both in the general population as well as in vulnerable populations, including pregnant women, to reduce mortality, researchers have urged.

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