Malaria vs COVID-19: Shared symptoms cause havoc

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The National Institute for Communicable Diseases (NICD) has raised a red flag that many malaria cases are being misdiagnosed as COVID-19. This is as South Africa enters its peak malaria season.

Both have non-specific early symptoms like fever, chills, headaches, fatigue, and muscle pain – but malaria poses a more immediate threat. People who have recently visited a malaria-endemic area and start to feel ill must seek medical attention immediately.

In 2020, an estimated 627 000 people died of malaria; most were young children in sub-Saharan Africa.

‘Misdiagnosis is common’

Dr. Jaishree Raman, Principal Medical Scientist at the Centre for Emerging Zoonotic and Parasitic Diseases, said misdiagnosis is common.

“Misdiagnosis is occurring at many levels.  Firstly, the patients think that they either have COVID-19 or the flu and are only going for COVID tests, often when they are rather ill. This complicates the picture, as respiratory difficulties are symptoms of both severe malaria and severe COVID-19,” said Raman.

Malaria is endemic in some areas of South Africa. The disease can be found in three of the provinces: north-eastern KwaZulu-Natal, parts of Mpumalanga, and Limpopo.

Travel history a major factor

If an individual resides in a malaria-risk area or has travelled to one recently, especially Mozambique, and is presenting with fever or flu-like illness, they must be tested. This involves a blood smear microscopy or a malaria rapid diagnostic test. If a patient tests positive for malaria, they must start malaria treatment immediately. Untreated or undiagnosed malaria will progress to severe illness and may become fatal.

Raman said that due to the pandemic, many healthcare facilities are testing for COVID-19 when individuals have flu-like symptoms and are not considering malaria in people who live in malaria-risk areas.

She added: “The COVID-19 and malaria tests look for very different molecular markers, so there is very little chance of someone testing positive for COVID-19 when they are actually malaria positive but COVID-19 negative. Some people have tested positive for both, but it appears to be rare in SA.”

Raman explained that Odyssean or “taxi malaria” needs to be considered in patients with unexplained fever who haven’t travelled to a malaria-risk area. They could deteriorate quickly and often have low platelet counts. – Health-e News 



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