ABSTRACT : Concurrent infection with more than one etiological agent can result in illness with overlapping symptoms. we present a case of successful management of mixed tropical infection of plasmodium falciparum malaria, dengue hemorrhagic fever andleptospirosis.

OBJECTIVE Concurrent infection with more than one etiological agent can result in illness with overlapping symptoms. we present a case of successful management of mixed tropical infection of plasmodium falciparum malaria, dengue hemorrhagic fever andleptospirosis.

CASE SUMMARY A 19 year patient was admitted in ICU with history of fever, jaundice, malenaof one week duration. On examination patient was pale,icteric,febrile, Sao2 89% room air, tenderness in right hypochondrium and hepatomegaly.Investigations revealed haemoglobin 4.3 g% and thrombocytopenia. LFT showed unconjugated hyperbilirubinemia.ABGmetabolic acidosis with respiratory compensation. Peripheral smear was positive for plasmodium falciparum , dengue IgM&leptoIgM. Ultrasound abdomen revealedsplenomegaly,ascites, bilateral pleural effusion.Patient treated with high flow oxygen at 15L/min using non rebreathing mask, started on inj. artesunate, penicillin, cap. doxycycline.Chest x ray showed diffuse bilateral infiltrates , ABG suggested poor oxygenation and started on BIPAPmask ventilation with PEEP 5, pressure support 10cms H2O, oxygenation improved withchestxray, laboratory values normal and was discharged.

DISCUSSION Coinfection with Malaria and leptospirosis are common in tropics. Our patient had dengue added to the spectrum which is very rare. Since the clinical manifestation of these three diseases overlapped Interpreting the multiple positive serological results in this setting may also be challenging. ARDS can be a presenting feature in all three conditions.

CONCLUSION Mixed infection with several pathogens is common in tropic.Careful examination and interpretation of laboratory results based on available evidence will help in management of patient.