Abstract

Neeraj Varyani*, Sunny Garg, Kamlakar Tripathi, Lalit Prashant Meena, Uma Shankar Rath, Sourav Mishra and Garima Gupta

Two brothers aged 14 and 17 years presented in our emergency department with complaints of fever and yellowish discoloration of eyes and urine for 6 and 10 days, respectively. They had similar clinical presentation, examination findings, laboratory biochemical derangements and positive results for rapid tests of Plasmodium falciparum and vivax species along with IgM Enzyme-linked immunosorbent assay (ELISA) test for hepatitis A virus. They also showed similar response to therapy and improved simultaneously within two to three days. This suggests the role of immunogenetics in modifying the natural course of disease. Moreover, triple infection by these hepatotropic pathogens lead to a presentation that is much more severe than that caused by either of them alone. This could only be explained by a synergistic interaction between these pathogens. This case foretells that co-infections with two or more hepatotropic pathogens require immediate attention with an aggressive management and role of immunogenetics along with co-infections in altering the phenotypic expression of a disease.