Differentiating Between Malaria and Dengue Fever Using Hematological Parameters in an Endemic Area

  • J Stephanie Lilia Pushpam Department of Pathology, Father Muller Medical College, Mangalore
  • Preethi Rai Department of Pathology, Father Muller Medical College, Mangalore
  • Umashankar T Department of Pathology, Father Muller Medical College, Mangalore
  • Dotton Denis Noronha Department of Critical Care & Internal Medicine, A.J. Hospital & Research Centre, Kuntikana, Mangalore
Keywords: Malarial parasite fluorescence test, Dengue non-structural protein antigen


Background Malaria and Dengue fever are the two most common arthropod-borne diseases in tropical countries like India, and endemic areas like Mangalore. Since they share a similar clinical presentation, identifying the hematological parameters, can help differentiate between patients of malaria and dengue fever and can help with its prognosis and early treatment. This study aims to find a link between diagnostic markers that are used to discriminate between the infections, occuring in malaria-endemic areas, such as Mangalore, Karnataka. Methods Retrospective study was carried out at department of Pathology, Father muller medical college, Mangalore for the duration of 2 years, January 2019 to January 2021. The hematological parameters for the diagnosed cases were collected from hospital database, were analyzed and evaluated. Results White blood cells, neutrophils, monocytes were significantly lower in patients with DF compared to patients with malaria (P < 0.005). In contrast, lymphocytes, red blood cells, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were significantly higher in patients with DF as compared to patients with malaria (P < 0.005). Conclusion This study concludes that hematological parameters differ  in Dengue Fever and Malaria,and using these parameters- haemoglobin, PCV, RBC, total count, neutrophils, lymphocytes, monocytes, eosinophils, platelets, MCV, MCH, MCHC, age and gender, we can discriminate patients with dengue and malaria infection. In addition, using these parameters, will lead to early detection, diagnosis, and managementt of these tropical diseases.


World Health Organization. World Malaria Report. Geneva: WHO Press; 2015.

Bureau of Epidemiology. Malaria. Department of Disease Control Ministry of Public Health, Nonthaburi. 2015. Available from: http://www.boe.moph.go.th/boedb/surdata/annualdata/d3052.pdf. Accessed 22 Feb 2016.

Anderson CR, Downs WG, Hill AE. Isolation of dengue virus from a human being in Trinidad. Science. 1956;124(3214):224–5.

World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva: WHO Press; 2009.

Potts JA, Rothman AL. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health. 2008;13(11):1328–40.

World Health Organization. Dengue haemorrhagic fever: diagnosis, treatment, prevention, and control. Geneva: World Health Organization; 1997.

Price RN, Simpson JA, Nosten F, Luxemburger C, Hkirjaroen L, ter Kuile F, et al. Factors contributing to anemia after uncomplicated falciparum malaria. Am J Trop Med Hyg. 2001;65(5):614–22.

Epelboin L, Boulle C, Ouar-Epelboin S, Hanf M, Dussart P, Djossou F, et al. Discriminating malaria from dengue fever in endemic areas: clinical and biological criteria, prognostic score and utility of the C-reactive protein: a retrospective matched-pair study in French Guiana. PLoS Negl Trop Dis. 2013;7(9):e2420.

Malik AM, Zaffar N, Ali N, Khan R. Haematological findings and endemicity of malaria in Gadap region. J Coll Physicians Surg Pak. 2010;20(2):112–6.

Baird JK. Host age as a determinant of naturally acquired immunity to Plasmodium falciparum. Parasitol Today. 1995;11(3):105–11.

Carlos CC, Oishi K, Cinco MT, Mapua CA, Inoue S, Cruz DJ, et al. Comparison of clinical features and hematologic abnormalities between dengue fever and dengue hemorrhagic fever among children in the Philippines. Am J Trop Med Hyg. 2005;73(2):435–40.

Guzman MG, Kouri G, Bravo J, Valdes L, Vazquez S, Halstead SB. Effect of age on outcome of secondary dengue 2 infections. Int J Infect Dis. 2002;6(2):118–24.

Price RN, Simpson JA, Nosten F, Luxemburger C, Hkirjaroen L, ter Kuile F, et al. Factors contributing to anemia after uncomplicated falciparum malaria. Am J Trop Med Hyg. 2001;65(5):614–22.

Kitua AY, Smith TA, Alonso PL, Urassa H, Masanja H, Kimario J, et al. The role of low-level Plasmodium falciparum parasitemia in anemia among infants living in an area of intense and perennial transmission. Trop Med Int Health. 1997;2(4):325–33.

Kotepui M, Piwkham D, PhunPhuech B, Phiwklam N, Chupeerach C, Duangmano S. Effects of malaria parasite density on blood cell parameters. PLoS One. 2015;10(3):e0121057.

Kotepui M, Phunphuech B, Phiwklam N, Chupeerach C, Duangmano S. Effect of malarial infection on haematological parameters in a population near the Thailand-Myanmar border. Malar J. 2014;13:218.

Itoda I, Masuda G, Suganuma A, Imamura A, Ajisawa A, Yamada K, et al. Clinical features of 62 imported cases of dengue fever in Japan. Am J Trop Med Hyg. 2006;75(3):470–4.

World Health Organization, No.22,. Monograph on Dengue/Dengue Hemorrhagic Fever. 1993.

Kalayanarooj S, Vaughn DW, Nimmannitya S, Green S, Suntayakorn S, Kunentrasai N, et al. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis. 1997;176(2):313–21.

Ali N, Usman M, Syed N, Khurshid M. Haemorrhagic manifestations and utility of haematological parameters in dengue fever: a tertiary care centre experience in Karachi. Scand J Infect Dis. 2007;39(11–12):1025–8.

Chadwick D, Arch B, Wilder-Smith A, Paton N. Distinguishing dengue fever from other infections based on simple clinical and laboratory features: application of logistic regression analysis. J Clin Virol. 2006;35(2):147–53.

Thein TL, Lye DC, Leo YS, Wong JG, Hao Y, Wilder-Smith A. Severe neutropenia in dengue patients: prevalence and significance. Am J Trop Med Hyg. 2014;90(6):984–7.

Durbin AP, Vargas MJ, Wanionek K, Hammond SN, Gordon A, Rocha C, et al. Phenotyping of peripheral blood mononuclear cells during acute dengue illness demonstrates infection and increased activation of monocytes in severe cases compared to classic dengue fever. Virology. 2008;376(2):429–35.

La Russa VF, Innis BL. Mechanisms of dengue virus-induced bone marrow suppression. Baillieres Clin Haematol. 1995;8(1):249–70.

Beeson PB. The eosinophils. Major problems in internal medicine. Philadelphia: WB Saunders Co; 1977.

Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, Thomas EM, et al. Acute undifferentiated febrile illness in adult hospitalized patients: the disease spectrum and diagnostic predictors - an experience from a tertiary care hospital in South India. Trop Doct. 2010;40(4):230–4.

Shah I, Katira B. Clinical and laboratory profile of dengue, leptospirosis, and malaria in children: a study from Mumbai. Arch Dis Child. 2007;92(6):561.

Original Article