Sepsis secondary to co-infection with malaria, dengue and COVID-19: a case report

The co-infection of malaria, dengue fever, and COVID-19 is rarely described in Sub-Saharan Africa, yet the overlapping clinical and biological features of these diseases pose a significant diagnostic challenge in endemic areas. We report the case of a 36-year-old woman requiring admission to the intensive care unit in Burkina Faso with acute respiratory distress. She presented with a triple co-infection of Plasmodium falciparum malaria, dengue fever (DEN3 serotype), and COVID-19, complicated by sepsis and multiple organ dysfunction. The patient exhibited severe hypoxemia, hepatic dysfunction (cytolysis and cholestasis), and a SOFA score of 7. Initial diagnosis focused on malaria and dengue, leading to a 10-day delay in the diagnosis of COVID-19. This case underscores the diagnostic complexity of triple co-infection in Sub-Saharan Africa. The diagnosis of COVID-19 was delayed due to the overlapping signs of malaria and dengue fever. Each disease should be assessed systematically in the context of any infectious presentation in this region, especially during the rainy season, as symptoms and biological parameters are not discriminatory. We advocate for the systematic use of multiplex PCR testing to ensure early and accurate diagnosis.