Integrated diagnostic approach for mixed Plasmodium infection among acute febrile patients: rare incidence from Eastern Uttar Pradesh.

Acute febrile illness (AFI) is a leading cause of hospital admissions in rural areas and can progress to acute encephalitis syndrome (AES) if untreated, with significant morbidity and mortality. Malaria incidence from eastern Uttar Pradesh (E-UP) has not been documented in the past few years. This study investigates malaria prevalence among AFI patients in E-UP, India, using multi-faceted diagnostic methods to support malaria elimination programs in India. We found four Plasmodium positive cases confirmed by RDT and three by microscopy with mono-infection. Upon PCR, three of four samples had mixed infections of P. falciparum (Pf) and P. vivax (Pv), while one was infected with Pf only. Additionally, one malaria-positive case had varicella-zoster virus infection. Another case had Japanese encephalitis and scrub typhus infection along with malaria, and passed away during hospitalization. Mixed Pf and Pv infections can be associated with a life-threatening complication, a rare occurrence in the past decade in the Gorakhpur division. In endemic regions, the possibility of cerebral malaria should be considered even in cases of Pv and Pf co-infection. The Government should closely monitor the malaria cases to ensure the success of the National Malaria Elimination Program.