With the current trend of decrease in the number of malaria cases in Sri Lanka, multiple infections in the same family following a visit to a National Park situated in a previously malaria endemic area is unusual. With the sharp increase in the number of dengue cases and low malaria incidence, dengue infection is foremost in the differential diagnosis amongst clinicians when patients present with fever and thrombocytopenia in accordance with a famous quote in medicine: “If you hear hoof beats, think horse not zebra.”7 With this clinical scenario, which is the classical presentation of both

dengue fever and malaria, diagnosis of one of these infections should not rule out testing for the other infection. The importance of thoroughly investigating such patients for malaria, irrespective of blood smears being reported as negative for parasites (which may be due to submicroscopic learn more infection) needs to be stressed, especially if there is a history of a visit to a previously high buy Neratinib malaria endemic area within the past 2 weeks. In such an instance a RDT or polymerase chain reaction (PCR) can be carried out to confirm malaria. Investigations for dengue should commence simultaneously using virus isolation, serology, and/or molecular techniques such as reverse transcription-polymerase chain reaction (RT-PCR).8

The diagnosis of dengue infections using each of these methods depends on the time of illness, their availability and cost.9 Attention should also be given to the possibility of coinfection with malaria and dengue as early diagnosis and treatment is essential for prevention of complications of both diseases. Clinicians also need to consider other infective diseases such as leptospirosis, typhoid, and non-dengue viral fevers which may present with fever and thrombocytopenia. It is prudent to be mindful of clinical scenarios where a febrile patient’s thrombocytopenia 3-oxoacyl-(acyl-carrier-protein) reductase could be due to preexisting conditions such as idiopathic thrombocytopenic purpura, systemic lupus erythematosus, cirrhosis, and malignancies. As the automated analyzer may record a low platelet count with platelet aggregation or large platelets,10

clinicians are advised to look at a Leishmann- and/or Giemsa-stained blood film of all patients with thrombocytopenia. This practice will not only eliminate possible wrong information given by auto analyzers but will also enable to detect malaria parasites if present. Currently, the NMCP does not justify the use of chemoprophylaxis during visits to malaria endemic areas due to the low transmission of the disease. However, use of mosquito preventive measures is advised. The emphasis is placed on early identification and treatment of malaria which is imperative to decrease the morbidity associated with the disease and to prevent the occurrence and spread of a reservoir of infection in the phase of elimination of malaria from Sri Lanka.