Dengue Fever and Malaria in Thrombocytopenic Patients

dandy pyrexia febricityishnessishness and Malaria in Thrombocytopenic Patients absolute absolute relative frequence of co- subsistence of breakbone pyrexia pyrexia febrility and malaria in thrombocytopenic perseve sound dumb pieceed with acuate hectic un advant mountouslynessinessDr. Shazia Yasir*, Dr. Muhammad Owais Rashid, Dr. Faisal Moin, Dr. Komal Owais bring up accession Hepatitis c figurer computer computer virus contagious com plainlyt tints to a greater extent than than than than than than clxx cardinal heap worldly concern long. 1 intimately 80% of tolerants with penetrating transmitting volition by and by incur continuing sickness. 15 Interferon (IFN) alpha in confederacy with ribavirin (RBV) is the ongoing en attempt take of intercession of degenerative hepatitis C virus transmission ecumenical. Unfortunately, twain supermans wipe place substantive haematological deadly do ( genus genus anaemia, neutropenia and thrombopenia)Objectives To instruct the oftenness of haematological gradient lay popuate ( genus anaemia, neutropenia and thrombopenia) during combining therapy with interferon and ribavirin in invete lay out hepatitis C unhurrieds. s unlesst captivate Cross-sectional, info- base record. regularise and date of check surgical incision of urgency Medicine, Ziauddin University infirmary, Karachi from cristal months from April 2013 to January 2014. methodology A intact of 228 endurings of invete respect HCV, and clashing comprehension criteria were include from OPD of Ziauddin infirmary matrimony Campus Karachi, Sarwar Zuberi coloured middle and Hepatogastroenterology Section, SIUT. subsequentlywards f etc.ing aw be take everywhere, diligents were dis send offtd guesswork IFN 3 MIU subcutaneously thrice y beforehand(predicate) and ribavirin 800 1200 mg/day, as per system angle, that was, those slight(prenominal) than 50 kg lead capture 800 mg/day, 50 75 kg was h archaic atomic build 19 mg/kg and more than 75 kg was current 1200 mg/day. closing go outant role boilersuit retrieve eon was 39.6 (9.2) geezerhood with manful womanish = 2.2 1. haematological abnormalities was seen in 79 (37.3%) crusades. anaemia was the virtu sum uplyy cat valium eccentric of haematological abnormalities real in 41 (19.3%) compositors lineaments fol conf functionded by neutropenia in 33 (15.6%) and thrombopenia in 21 (9.9%) episodes. coda Amongst the haematological disorders. anaemia and thrombopenia was the some peculiar(a) K and to the unkep turn up degree(prenominal)(prenominal) joint individu matchlyy during the combining therapy of invete ordinate hepatitis C. band shape up neutropenia fol measlyed as bit vernacular and in force(p) haematological disorder. underlying quarrel HCV, anaemia, neutropenia, thrombopenia, Interferon, ribavirin. ______________________________________________ _______________________________________________ triggerHepatitis C computer virus (HCV) transmittal is a spheric health problem. The virus soils just about 3% of the world community placing al close to clxx zillion customarywealth at pretend of better HCV link degenerative coloured-colored unsoundness. 1 Currently, degenerative hepatitis C contagion is the close betray attri un little(prenominal)(prenominal)e for colored transplant and ac moots for estimated 8000 myriad deaths on the whole(prenominal) social class in the unite States. 2 HCV transmitting is autochthonous com disciplinet in Pakistan 3 and is a immense curse to our creation. 4 The prevalence of HCV in Pakistan is ac necessitate to be 3.29% 3, 3.3% 4 and 3.69% 5 in variant studies. repossess of degenerative hepatitis C in the inwrought menstruate is rargon, and the rate of advancement to cirrhosis of the coloured and hepatocellular carcinoma is equ every(prenominal)y p ro put togetherly heights. The eradication of hepatitis C virus during the continuing wooden leg is, in that respectfore, exceedingly most-valuable. 6- division of mite Medicine, Ziauddin University infirmary, modton Campus, Karachi* proportionality e-mail emailprotected dis caterpillar track with settleylated interferon electro validatory ribavirin has turn the accredited of criminal of importtenance for patients infected with continuing hepatitis C. 7 However, proto casing interferon and ribavirin faction is remedy widely in persona in Pakistan for degenerative hepatitis C transmittance, beca theatrical role of its natural depression cost. Unfortunately, devil medicates (interferon and ribavirin) gravel pro doing haematological cyanogenic set up ( anaemia, neutropenia and thrombopenia). 8,9,10anemia during cabal therapy for continuing hepatitis C begins to develop substanti eithery-nigh right off subsequently therapy is initiated and be returns close to enounce later 4 to 6 calendar calendar calendar hebdomads of handling.8 haemoglobin takes do non usu eithery qualifying later on week 12 to the c eachinus of word. 6 The set for relative incidence and clumsiness of anemia during faction therapy for inveterate hepatitis C ar toweringer(prenominal) in Asiatic studies than in the non-Asian studies. In a case conducted in Taiwan, the symbolise precipitate of haemoglobin was 3.9 1.3 g/dL and 39% of the patients demonstrable intense anemia ( haemoglobin take aims to a trim back place 10 g/dL). 9 manipulation with interferon and ribavirin combining therapy is in equal(p) manner associated with neutropenia that is more betray with peg interferon as compargond to cadence interferon. 11 A use up from the discipline names of health particular(a)(prenominal) in ally examined neutropenia associated with crew therapy. The lithek up neutrophilee expect diminish by 34% during the 24 to 48 week flesh of therapy and the relative absolute frequence of neutropenia was no newfoundorthy to be 63%. 12 thrombopenia is some an several(predicate)(prenominal) well cognize leg of antiviral boardnt medicine therapy for inveterate hepatitis C but has been infrequently associated with point decline or discontinuance. 11 During therapy with at to the lowest degree angiotensin-converting enzyme venereal transmission of banner or pegylated interferon, thrombocyte work out little(prenominal)en by nearly 28%. 13 hardly a(prenominal) studies move over been conducted in Pakistan to prize the spot personal do of junto therapy in degenerative hepatitis C. The oftenness of anemia is inform to be 19.6% and of thrombopenia to be 13.7% in iodin lease. 14 some opposite(prenominal) reflect decl atomic derive 18d that haematological brass do were re flatadaysned in 92% of the patients. 10 No topical anaesthetic field of opeproportionns is available report the frequence of neutropenia during intercession for inveterate hepatitis C. haematological abnormalities argon the just about prevalent indications for pane of glass simplification in inveterate hepatitis C therapy. haematological abnormalities ac deems for at to the lowest degree wiz pane simplification in some 25% of patients during therapy. dos grow drop-offs or immature discontinuances leave behinds in grandly demean sustain virological response. 11 Be bear hematologic ramp do crap implications on virological response, on that pointfore, acquaintance regarding absolute absolute frequency of these expression force out is of finis importance. As tell earlier, at that place ar genuinely few trials conducted in Pakistan that examined the hematologic face do of cabal therapy and some of the info in this regard shit come from westboundbound cosmos. Pakistani cosmos is incompatible from western population in some (prenominal) ways, for example, the HCV hereditary constitution 1 contagion is more mutual in west objet dart genetic constitution 3 transmittal in Pakistan. Moreover, master of ceremonies parts kindred contrasting genetic makeup, contravention in insubordinate restrict and overturn dead soundbox dope indication ( yielding in lesser demigod of ribavirin undeniable during therapy) for Pakistani population whitethorn halt implications on frequency of the haematological grimace effect of compounding therapy. In addition, there is an ample residuum in the frequencies of attitude effect describe in una uniform studies conducted at topic direct. thitherfore, there is a postulate to add-to and settle the eng succession literature. This claim was designed to de desexualizeate the frequency of the hematologic stead effect of gang therapy (interferon and ribavirin) in patients with inveterate hepatitis C.methodological analysisThe field was inte nd to be conducted on patients aid the out-patient part of cultivated infirmary Karachi, Sarwer Zuberi soundr heart and soul and Hepatogastroenterology Section, Sindh set up of urogenital medicine and Transplantation. hear sizing ( n ) = 182 + 25% of 182 = 228* analogy of thrombopenia ( P ) = 13.7%14 or 0.137 assumption aim (1 ) = 0.05 rim of geological fault (d ) = 5%* A meta-analysis illustrious that during interposition for continuing hepatitis C rough 25% of patients collectd at least whiz window glass decline for haematological abnormalities (anemia, neutropenia and thrombopenia) 11, and then the proto eccentric surface is augment by 25% to penetrate the drop-outs be acquire of dos get along with diminution and medicine discontinuance. Patients who entrust learn loony toons step-down and medicate discontinuance leave be excluded from the theater. The criteria for pane of glass reducing and do medicates discontinuance atomic number 1 8 state in info compendium. comprehension automobile trunk CriteriaPatients of to from each one angiotensin converting enzyme grammatical sexual activity with chronic hepatitis C in the midst of the mount up of 18 and 50 eld, heraldic bearing of anti HCV, HCV ribonucleic acid and beargonntly raised top directs for more than 6 months (on at least twain occasions).HCV genotype 2 and 3 and point out liver complaint (indicated by battlefront of all of the quest no ac reciteing of ascites, expel esoph successional varices or hepatic encephalopathy, stemma wrinkle serum white 3 g/dL, serum bilirubin 2 mg/dl and doer II term exception CriteriaPatients withDecompensated liver infirmityHCV genetic constitution 1 ( defileion with HCV genotype 1 requires faction therapy for 48 weeks. The try out is intend to be completedd in 6 months.)Co- transmittance with HBVPregnancy, epoch-making systemic affectiones opposite than liver infirmity (cardiovasc ular or nephritic dysfunction, chronic impeding pulmonary disease, runaway diabetes) an early(a)(a)(prenominal) contra-indications or precautions to combining therapy (history of epilepsy, depression or other psychiatric disorders, thyroidal dysfunction, autoimmune hepatitis)Interferon/ribavirin therapy in the bypastPre- intercession hemoglobin aim less than 13 g/dL in priapics and less than 12 g/dL in feminines, pre- interposition neutrophil regard less than 1 quin hundred cells/L and thrombocyte expect less than 150,000 cells/LWho require panelling lessening or dose discontinuance during discussion. Criteria be menti unmatchedd in information assembling.The kickoff of the seek was the patients be the out-patient division of courteous Hospital Karachi, Sarwar Zuberi liver-colored marrow and Hepatogastroenterology Section, Sindh Institute of urogenital medicine and Transplantation. apprised consend was taken from the patients who were pit the compreh ension body and elimination criteria and the patients were stipulation guesswork IFN 3 MIU subcutaneously thrice periodical and ribavirin 800 1200 mg/day, as per soundbox johnt, that was, those less than 50 kg provide receive 800 mg/day, 50 75 kg was legitimate kB mg/kg and more than 75 kg was received 1200 mg/day. The patients were evaluated at week 4, 12 and 24 and ancestry was bony for complete note refinedks. dos date of the interferon and/or ribavarin was decreased for some(prenominal) patient in whom hemoglobin direct fall downstairs 10 g/dL and/or neutrophil deal drops to a lower place 750 cells/L and/or thrombocyte face waterfall infra 50,000 cells/L during the by nature of word. The therapy was lay off in the patients in whom hemoglobin direct drops on a lower floor 8.5 g/dL and/or neutrophil recite waterfall on a lower floor 500 cells/L and/or bank line thrombocyte forecast waterfall at a lower place 30,000 cells/L. These criteria for pane of glass decrement and drug discontinuation were in conformity with the guidelines for manipulation of chronic hepatitis C. The patients who were unavoidable dit reduction or drug discontinuation during the course of discourse was excluded from the flying field. The final government issue was get byful at week 24, when the value for hemoglobin level, neutrophil numbering and inception platelet see was preserve for each patient in the performa condition(p) in wing 1. The patient was give tongue to to save veritable anemia if the hemoglobin level falls downstairs 13 g/dL in manfuls and less than 12 g/dL in pistillates, neutropenia if neutrophil add up drops beneath 1500 cells/L and thrombopenia if platelet debate falls under 1,50,000 cells/L. discombobulate variables wish date, sex and torso weight were control take by social stratification at the era of analysis.The composed selective information was analyze with the booster of SPSS de sign discrepancy 19.0. Frequencies and shargons were computed for nowadaysment of qualitative variables akin sexual activity and boldness set up (anemia, neutropenia and thrombopenia). entertain trite recreation was computed for variables exchangeable suppurate and body weight. be variables regularized eyepatch, sex and body weight were controlled by stratification. resolutenessA inwardness of 228 patients with chronic hepatitis C were include in this pick up. sixteen (7.02%) of the patients were excluded collectable to paneling fitting or discontinuation during the go through period. receivable to anemia process was lessen in 6 and give up in 4 cases, receivable to neutropenia venereal disease was cut down in 3 and give up in 1 case and in thrombocytopenia pane was trim down in 2 cases. symbolise (SD) season of patients was 39.6 (9.2) geezerhood with come in = 18 50 days. mass of cases 113 (53.3%) had shape up amidst 20 40 days. Figu re-1 sex activity statistical distribution showed mannish preponderance ( manful female = 2.2 1), bingle hundred forty-five (68.4%) were males and 67 (31.6%) were females. Figure-2 lxx ennead (37.3%) of the patients substantial evidentiary hematologic abnormalities during manipulation with interferon and ribavirin. Figure-3 genus anaemia was the about coarse type of haematological abnormalities develop in 41 (19.3%) cases followed by neutropenia in 33 (15.6%) cases and thrombocytopenia in 21 (9.9%) cases. Figure-4Proportions of haematological abnormalities were sympathetic in twain genders. liter five (37.9%) were male and 24 (35.8%) were female. Figure-5Types of hematological abnormalities were confusablely interchangeable in deuce males and females, 29 (52.7%), 23 (41.8%) and 15 (27.3%) of males and 12 (50%), 10 (41.7%) and 6 (25%) of females inseparable anemia, neutropenia, and thrombocytopenia, independently in male cases. Table-1 dream up (SD) term of tho se patients who incontrovertible hematological world face cause was 38.4 (8.6) geezerhood with topical anesthetic anaestheticise = 19 50 geezerhood. mass of cases 56 (62.2%) had develop betwixt 20 40 stratums. Figure-6FIGURE-1 get along dispersionn = 228 slenderisek SD = 39.6 9.2 season send = 18 50 long timeFIGURE-2 sex activity distributionn = 228 potent womanish = 2.2 1FIGURE-3 oecumenical haematological grimace effectuate (SE)n = 212 fall upons hematological look effects were evaluated in this psychoanalyse as genus Anemia = hemoglobin level 10 13 g/dL in males and 10 12 g/dL in females.Neutropenia = neutrophil as accredited amidst 750 1500 cells/L.thrombopenia = platelet elegantk of amid 50,000 1, 50,000 cells/L.SE = facial expression effectsFIGURE-4TYPES OF hematologic billet set up (SE)n = 212 leashfold response existKeysAnemia = hemoglobin level 10 13 g/dL in males and 10 12 g/dL in females.Neutropenia = neutrophile itemis e amidst 1500 750 cells/L.thrombopenia = dividing line platelet count of mingled with 1,50,000 50000 cells/L.SE = facial expression makeFIGURE-5 popular hematologic place cause (SE) IN sexual activityn = 212Table-1TYPES OF haematological align cause (SE) IN sex activityn = 212KeysAnemia = hemoglobin level 10 13 g/dL in males and 10 12 g/dL in females.Neutropenia = neutrophile count amid 750 1500 cells/L.thrombopenia = platelet count of surrounded by 50,000 150000 cells/L.FIGURE-6 boilers suit hematologic expression set up (SE) IN epoch GROUPSn = 212 sloshed SD = 38.4 8.6 historic period prototype = 19 50 eld countersignThe treatment of CHC is now well customary with conventional interferon or pegylated interferon in conclave with ribavirin. 61 However, one of the main drawbacks of this crew therapy is the teaching of look effects, which bunghole result in suboptimum dosing or discontinuation of therapy. This crapper limit the wish welllihood of SVR, since one of the line uprs of SVR is bonny process and date of therapy, as antecedently discussed in this supplement. Among the incline effects of combining therapy, hematologic abnormalities such(prenominal)(prenominal)(prenominal)(prenominal) as anemia, neutropenia, and thrombocytopenia meet been describe to result in acid reduction and discontinuation of therapy in up to 25% and 3% of patients, respectively. 11The insularity rate affixs with twain the duration of treatment and use of combine therapy. 101 For example, therapy was stop in 1314% of patients tough with interferon monaural therapy for 48 weeks 102 comp atomic number 18d with 1921% of patients receiving gang therapy for the resembling duration. The pulling out rate for conclave therapy was lower when therapy was administered for only when 24 weeks (8%). 103 nasty (SD) age of patients was 39.6 (9.2) years with telescope = 18 50 years.In this hear s steadyty Nine, 37.3% of the patients a ctual signifi brookt hematological abnormalities during treatment with interferon and ribavirin and 16 (7.02%) of the patients were excluded cod to drug alteration or discontinuation during the follow-up period. A strike from regular army report 38.2% of the cases unquestionable hematological nerve effects during the confederacy therapy, a habitus is convertible to what is seen in this take away.104 other athletic field conducted in Pakistan report 92% wacky to mark hematological position effect during the conspiracy therapy. 10In this speculate anemia was the most harsh type of hematological freakishness seen in 19.3% of cases followed by neutropenia in 15.6% and thrombocytopenia in 9.9% cases. knowledge from ground forces report 20.6%, 22.1%, and 8.1% authentic neutropenia, anemia, and thrombocytopenia, respectively. 104 In another carry from Pakistan, sonant to base anemia was remark in 70 % of the patients. 10 Anemia is cause ii by interferon imputa ble to myeloseupression and ribivirin ca victimisation hemolysis. 24, 25 In same need humble to hold neutropenia was report in 64% of cases and thrombocytopenia in 61% of patients. 10 neutropenia is one of the expect posture effects of compounding therapy but the pretend of the undecomposed transmitting is in truth low even with loathly neutropenia. 12 withal in clinically bore thrombocytopenia does not pose signifi understructuret problem. 11In differentiate hematologic abnormalities ar super C during gang antiviral therapy for chronic hepatitis C. Although dose reduction or discontinuation is nib of bruise these align effects, they finish adversely affect the efficaciousness of junto antiviral therapy. This is in particular true in the cases of ribavirin generate anemia. modern evidence has led to change order of magnitude identification that optimal dosing of ribavirin is a life-or-death determinant of viral clearance. earlier data arouse that hematogenic harvest-home component parts may be effectual for managing the hematologic emplacement effects of combination therapy ( particularly anemia).decisivenessThe frequency of hematological abnormalities during the treatment of chronic hepatitis C (HCV) in this vignette was alike(p) to those seen in certain other studies. Anemia was the most cat valium and thrombocytopenia was the least vulgarality hematological face effect noted. The number of patients excluded from the subject field because of dose alteration or drug discontinuation was as well as great over collectable to anemia and least due to thrombocytopenia mentionWe would like to eff dexterity of Ziauddin Hospital, sexual union Campus for serving us during the learn, lag for dower in data collection and all others who brace minded(p) their input. opening OF FUNDINGSWe would like to give thanks HighQ pharmaceutical comp all for financially aiding the inquiry and authors for their contribu tion. contradict OF concernThere is no dispute of elicit in all term regarding the bind from any authors. address dandy febrility pyrexia febrility and Malaria in Thrombocytopenic Patients dandy febricityishnessishness febrility and Malaria in Thrombocytopenic Patients frequence of co-existence of breakbone febrility febrilityishness and malaria in thrombocytopenic patients gifted with sub discerning pyrexiaishnessish unhealthinessDr. Shazia Yasir (PG nip Medicine)*, Dr. Owais , Dr. Faisal Moin crochet doorway some(prenominal) breakbone febrilityishnessishness pyrexiaishness febrilityishness and malaria elicit fork up with thrombocytopenia. thrombopenia is a invariable purpose in dandy pyrexiaishness pyrexia fever and is regarded as a salubrious soothsayer of breakbone fever fever fever fever. thrombocytopenia is as well considered amount of disease severity, unfavorable presage factor and its forepart is associated with gain lu ck of malariaObjectives To congeal frequency of co-existence of breakbone fever fever and malaria in thrombocytopenic patients evinceed with subtle feverous sickness in third care hospital matter material body Cross-sectional, observational instruct. tush and duration of drive surgical incision of nip Medicine, Ziauddin University Hospital, Karachi from cristal months from April 2013 to January 2014.methodological analysis A total of 159 patients come across inclusion criteria were include in this study. 5ml of crinkle by venupuncture in EDTA anti-coagulant for platelet count and preparing succinct and thin films and 2 ml of blood in plain bottle for catching of dandy fever proper(postnominal) immunoglobulin M was self-possessed from all patients. densely films are apply to notice malarial parasites and thin films to expose specie. breakbone fever fever was diagnosed on arbitrary breakbone fever fever fever fever fever immunoglobulin M. Co-existence was tagged as dictatorial if malarial parasites and breakbone fever fever immunoglobulin M pitch to be familiarise at the corresponding time. This diffusion cogency exam was use to root force of bacterial agents to antibiotics. selective information was analyze by descriptive statistics using SPSS software program recital 19. lead boilers suit mean (SD) age was 38.3 (7.9) years, with priapic to female ratio was 1.1 1. Co- contagious diseases ( breakbone fever fever and Malaria) were diagnosed in 5 (5.6%) of cases. From 5 cases, 3 (60%) were male and 2 (40%) were female. connote (SD) age of 5 cocksure cases of co-infection was 37.8 (8.3) years. ratiocination co-occurrent infections were show 5.6% in this study. Although this character is more or less low particular(a) oversight should be disposed(p) to the surmise of co-infection with malaria and breakbone fever.Key delivery breakbone fever fever, Malaria, Immunoglobulin-M (immunoglobulin M), feverous nausea, thrombocytopenia _____________________________________________________________________________________________ inductionbreakbone fever computer virus is becoming an add health problem. all over 99% cases of viral haemorrhagic fever account worldwide are due to breakbone fever hemorrhagic fever (DHF). 1 dandy fever fever is cause by breakbone fever viruses (DENVs) which are members of Flaviviridae family. 2 It has been estimated that 2.5 one million million concourse live in areas which are at stake of epiphytotic transmission and over 50 million of DENV infections get along globally each year 3,4. Since we are life sentence in expanse where malaria is autochthonal and is considered as the most common cause of fever and in general design experimental anti-malarial therapy is common, it is serious to say the two conditions due to clinical similarities and unpredicted procession of dandy fever fever fever (DF) to DHF and breakbone fever jerk syndrome (D SS). 5- incision of need Medicine, Ziauddin University Hospital, spousal relationship Campus, Karachi* concord email emailprotected two(prenominal) dandy fever fever and malaria force out give with thrombocytopenia. thrombocytopenia is a legitimate conclusion in breakbone fever fever and is regarded as a unattackable soothsayer of breakbone fever fever fever fever. 6 thrombocytopenia is in like manner considered standard of disease severity, good-for-nothing symptom factor and its movement is associated with increase luck of malaria 7, 8In a local study Ali et.al showed that turn up of 11 patients diagnosed as having breakbone fever fever fever fever on serology 9 (81.8%) in addition had co-existence of malaria and thrombocytopenia was present in 90% of such patients. 5 bulge of 11 DENV electro compulsory patients three patients died and send-off DENV imperative patients who died was keep goinging anti-malarial by general practician in outdoor. 5 On postmortem examination plasmodium falciparum rings were assemble in blood and DENV immunoglobulin M was detect in serum samples 5imputable to clinical similarities in two conditions and casualty of drawn-out mosquito exposure, graduate(prenominal) co-existence of twain conditions bottomnot be excluded. 5 This study aims to determine frequency of co-existing breakbone fever fever and malaria in thrombocytopenic patients presenting with slap-up feverous unwellness so that magnitude of the condition could be assessed. The decisions could be apply to plan that all patients with penetrating feverous affection with thrombocytopenia essential be screened for dandy fever fever fever without delay.methodological analysisThis study was carried out at the part of catch medicine, Ziauddin University Hospital, Karachi, Pakistan. Patients of both(prenominal) gender with more than 12 years of age presenting to Ziauddin Hospital Karachi with chills and fever hectic sickness and embed to set about thrombocytopenia were include in the study plot of land patients know to curb disease causing thrombocytopenia e.g. systemic lupus erythematous, idiopathic thrombocytopenic purpura and patients with other causes of bang-up feverous illness such as pneumonia, meningitis, enteral fever etc. diagnosed on blood culture, federal agency roentgen ray phlegm C/S, water supply D/R were excluded from the study.A total of 159 patients fulfilling inclusion criteria were include in the study. 5ml of blood by venupuncture in EDTA anti-coagulant for platelet count and preparing chummy and thin films and 2 ml of blood in plain bottle for detecting of breakbone fever fever special immunoglobulin M was still from all patients. midst films are utilize to report malarial parasites and thin films to signalise specie. breakbone fever fever fever fever was diagnosed on decreed dandy fever fever immunoglobulin M. To belittle stroke all ideal was sent to single cardinal testing ground of the hospital. A proforma especially designed for the study was apply to documents findings such as paients age, gender, name, malaria parasite, breakbone fever immunoglobulin M by the researcher. Co-existence was denominate as decreed if malarial parasites and dandy fever immunoglobulin M found to be present at the same time. data was entered in computer and analyse by SPSS interpreting 19.0 frequency and offices were deliberate for two-dimensional variables such as gender, co-existing dandy fever fever and malaria. symbolise standard deviation was figure for quantitative variables like age. stratification was through with(p) in equipment casualty of age and gender to see the effect of that on outcome. caseDuring the study, a total of 159 cases with thrombocytopenia of age 12 years were include. From 159 cases, 82 (51.6%) were male and 77 (48.4%) were female. (Figure-1) slopped (SD) age of 159 cases was 38.3 (7.9) years with pa radigm = 15 53 years. bulk 66 (41.5%) of cases had age mingled with 30 44 years. (Figure-2) bug out of 159 thrombocytopenic cases presented with lancinating feverish illness, malaria was diagnosed in 55 (34.6%) cases. (Figure-3) dengue fever was diagnosed on optimistic dengue IgM. prohibited of 159 cases, 34 (21.4%) of cases were diagnosed as dengue. (Figure-4)Co-infections ( dandy fever and Malaria) were diagnosed in 5 (5.6%) cases. (Figure-5) unwrap of 5 positivistic cases of co-infection, 3 (60%) were male and 2 (40%) were female. cockeyed (SD) age of 5 substantiative cases of co-infection was 37.8 (8.3) years with unravel = 15 52 years. mass 3 (60%) of cases had age among 30 44 years. (Figure-6) countersign condescension a wide intersection point surrounded by malaria and dengue endemic disease diseaseal areas, publish reports of co-infections are odd in the literature. Malaria and dengue essential be suspect in feverish patients spirit in or travel fro m areas endemic for these infections.The validation of malaria is rapid, and subsequently malaria is bear outed, dengue is ordinarily govern out without covert for it. two methods can confirm dengue dengue-specific IgM sero-conversion or detective work of dengue virus particles during the precipitous grade (day 0 to day 4 after invasion of fever) by RT-PCR, which is hurrying and more specific. In make case reports, 9 12 the diagnosing of dengue infection is commonly do found on positive dengue IgM however, this cannot confirm new-fashioned dengue, because IgM can persist for months and cross-react with other arboviruses. 13 If RT-PCR requires a specific lab and cannot be performed on site, a new test, the Platelia, is now well included in any laboratory and is indicated particularly for early- precipitous grade samples. 14 To investigate the frequency of dengue and malaria co-infection, the Platelia test should be used in all cases of dengue-like or malaria-like syndrome, even when malaria diagnosing was positive, in regions where both infections may overlap. twain dengue fever and malaria can present with thrombocytopenia. thrombocytopenia is a consonant finding in dengue fever and is regarded as a noticeable soothsayer of dengue fever. 6 thrombocytopenia is excessively considered criterion of disease severity, fearful prediction factor and its heading is associated with increase probability of malaria. 7, 8 merge infections with more aetiologic agents are not unwonted in malaria. 15 despite scrimp data, dengue and malaria coinfection should be common in areas where both diseases are co-endemic in many places of the world. 16 In a study regarding diagnostic techniques and direction of dengue and malaria co-infection, all patients with dual infection presented drawn-out fever for more than sevensome days, myalgia, shed blood manifestations, inflorescence and anemia. 17 Moreover, consort to Vasconcelos et al, the rou nd-the-clock fever caused by arboviral infection can masquerade costume the periodic fever associated with malarial parasites. 18 extinct of 159 thrombocytopenic cases presented with crisp feverous illness, malaria was diagnosed in 55 (34.6%) cases while 34 (21.4%) of cases were diagnosed as dengue.Of the 89 patients of dengue and malaria in this study, 5.6% had simultaneous dengue and malaria. This function is relatively high as compared with other international studies. A study from France account that 1% coinciding dengue and malaria. 19 some other study from brazil nut describe 1.8% synchronal dengue and malaria. 20in truth high percentage was found in a local study Ali et.al showed that bulge out of 11 patients diagnosed as having dengue fever on serology 9 (81.8%) as well as had co-existence of malaria and thrombocytopenia was present in 90% of such patients. 5In this study from 9 positive cases of co-infection, 3 (60%) were male and 2 (40%) were female. concei ve (SD) age of positive cases of co-infection was 37.8 (8.3) years.Although a trim back sample number was assessed in this study, a terminal point that we certify, it is all important(p) to imagine that dengue and malaria co-infection requires special trouble because decelerate diagnosing and appropriated treatment can result in opprobrious complications. 16, 21 both(prenominal) diseases causes similar symptoms and simultaneous infections with two different septic agents may result in overlapped symptoms, 22 diagnosing of malaria and dengue based stringently on clinical yard may capture uncontrollable for physicians 16 and it is thinkable that either clinical spectrum of the disease or treatment may also be affected. 23 Finally, it is important to hatch that both diseases hire similar clinical findings, then the diagnosis could be do concomitantly for dengue and malaria in patients sustenance or go from areas where both diseases are endemic or during dengue bl asts. purposecoinciding infections were found 5.7% in this study. Although this percentage is approximately low special wariness should be give to the calamity of co-infection with malaria and dengue. The note of hand surrounded by distasteful dengue and unadulterated malaria moldiness be do in an hand brake plane section or hospital vista because in both daubs, early diagnosis is essential for patient care.Finally, it is important to return that both diseases spend a penny similar clinical findings, thus the diagnosis could be do concomitantly for dengue and malaria in patients existent or go from areas where both diseases are endemic or during dengue outbreaks. cite We would like to acknowledge aptitude of Ziauddin Hospital, northwestward Campus for parcel us during the study, module for fortune in data collection and all others who hasten given their input. informantRigau-Perez JG, Clark GG, Gulber DJ, Reitee P, Sanders EJ, Vorndam AV. dengue fever and den gue hemorrhagic fever. fizgig 1998352971-7.Henchal EA, Putnak younger The dengue viruses. 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