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Malaria co-infection

Visceral leishmaniasis and malaria have overlapping geographic distribution. Up to 20% co-infection rate is observed in leishmania treatment centers. The occurrence of the two infections together can cause severe anemia due to the non-functional spleen.

The diagnosis of malaria in a patient with prolonged fever and from visceral leishmania endemic area should not make the physician rely only with the malaria diagnosis.

During treatment, overlapping toxicities of the drugs should be taken into account. Antimonials and quinine have cardiotoxicity. So these two drug should not be given together. Uncomplicated malaria in VL patients should better be treated with Coartem; and artesunate and artemether can be used for severe form of malaria. Liposomal amphotericin B is preferred to treat VL in a malaria co-infected patient as such a patient will be severely sick.

If the only available drugs are quinine and SSG, malaria treatment should precede first and SSG should be started only after 24 hours of last quinine dose.