Co-infection of Dengue and Malaria Complicated With Acute Respiratory Distress Syndrome (ARDS) in a Critically Ill Patient: A Case Report From a Tertiary Care Center in Jharkhand, India.

Co-infections of dengue and malaria are uncommon but clinically significant due to overlapping presentations and divergent management strategies. This article presents a case report of a 25-year-old adult female patient admitted to the critical care unit (CCU) of a tertiary care center in Jharkhand, India, with co-infection of Plasmodium falciparum malaria and dengue virus. The patient exhibited varying degrees of multiorgan failure, including severe respiratory failure necessitating mechanical ventilation, hepatic dysfunction, and hematological abnormalities. The diagnosis of dengue was established by a positive dengue nonstructural protein 1 (NS1) antigen and immunoglobulin M (IgM) antibody by enzyme-linked immunosorbent assay (ELISA), in addition to the confirmed malaria diagnosis by peripheral blood smear. The patient subsequently developed acute respiratory distress syndrome (ARDS), requiring intubation, lung-protective mechanical ventilation, and prone positioning. Management required a multidisciplinary approach involving fluid balance guided by dynamic parameters, including the inferior vena cava (IVC) distensibility index (dIVC) and serial lactate measurements, pharmacotherapy of malaria, and ventilatory support. Despite the critical nature of illness, the patient recovered with aggressive supportive care, emphasizing the importance of early recognition and individualized management in co-infection scenarios.