CRA18 A RARE OCCASION: MANAGING SUBMICROSCOPIC MALARIA IN A PULMONARY TUBERCULOSIS (PTB) PATIENT – A DISTRICT HOSPITAL EXPERIENCE

Syahrinnaquiah Samsuddin1, Syaza Naqibah Mohd Noor Rahim 1, Wan Jen Lye2.
1Medical department, Hospital Kuala Kubu Bharu, Selangor
2Respiratory unit, Hospital Selayang, Selangor

Introduction:

Managing co-infections of malaria and smear-positive PTB is challenging, especially in district hospitals. Submicroscopic malaria often goes undetected, leading to possible misdiagnosis and inadequate treatment. Timely diagnosis and treatment are further complicated by drug-to-drug interaction with anti-tuberculosis management. This case highlights the challenges faced when diagnosing and treating in a district hospital setting.

Case Report:

A 43-year-old Orang Asli gentleman was diagnosed with smear-positive TB and developed a persistent fever during treatment, Blood culture, sputum culture, and malaria blood film tests were negative, but due to high suspicion a, malaria PCR was sent and was positive for Plasmodium knowlesi. Due to drug interactions with Rifampicin, the patient was treated with intravenous Artesunate for one week instead of Artemether-lumefantrine (Riamet). His liver function test showed initial elevation before normalizing post-treatment.

Discussion:

Submicroscopic malaria requires a high index of suspicion and PCR testing for accurate diagnosis, crucial in co-infections with PTB due to higher mortality rates. Co-infection causes malaria parasites to decrease the host’s effective humoral and cellular immune responses to TB infection. There are no published guidelines for managing TB/Malaria co-infection. There is also no published data on the co-administration of Artesunate and Rifampicin, however, there is still a risk of reduced plasma DHA concentration and a possible reduction in efficacy which need to be closely monitored.

Conclusion:

Effective management of submicroscopic malaria in smear-positive TB patients requires a high index of suspicion, especially in resource-limited district hospitals. Treatment options are constrained by drug interactions with Rifampicin, necessitating careful consideration of alternative regimens, close monitoring, and multidisciplinary collaboration for optimal outcomes.

Keywords:

Tuberculosis, Malaria, Artemether-lumefantrine, Artesunate, Rifampicin