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Peer-reviewedCC BY-NC-ND 4.0Malaria Journal

First report of severe Plasmodium vivax malaria with sub-microscopic co-infection of Plasmodium vivax and Plasmodium falciparum and their clinicodemographic correlates: a study from hyperendemic areas of Tripura

  • Bidhan Goswami1
  • Ipsita Pal Bhowmick2
  • Shailja Singh3
  • Shauli Sengupta4
  • Ujjal Gogoi5
  • Saurav Biswas6
  • Savitha Chellappan5
  • Partha Saha4
  • Jadab Rajkonwar5
  • Himadri Sankar Bharali5
  • Samir Kumar Sil7
7 affiliations
  1. 1Department of Human Physiology, Tripura University & Department of Microbiology, Agartala Govt. Medical College and GBP Hospital, Tripura University and AGMC & GBPH, P. O. Kunjavan, Agartala, Tripura 799006 India
  2. 2ICMR-NIHR (previously known as ICMR-RMRCNE), Dibrugarh & MRHRU, Tripura, Dibrugarh, Tripura India
  3. 3Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, 110067 India
  4. 4Multidisciplinary Research Unit, Agartala Government Medical College, P. O. Kunjavan, Agartala, Tripura 799006 India
  5. 5ICMR-NIHR (ICMR-RMRCNE), Dibrugarh, India
  6. 6Malaria Project, MRU, Agartala Government Medical College, P.O. Kunjavan, Agartala, Tripura 799006 India
  7. 7Department of Human Physiology, Tripura University, Agartala, India
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Abstract

Malaria remains a major public health problem in Northeast India, particularly among the tribal population of Tripura, with increasing Plasmodium vivax (Pv) cases alongside predominant Plasmodium falciparum (Pf). This study assessed the demographic, clinical, haematological, and biochemical characteristics of severe malaria in hyperendemic areas of Tripura. A prospective hospital- and community-based study was conducted in three districts of Tripura from April 2023 to December 2024. Febrile individuals were screened through door-to-door village visits and primary health centres. Malaria was diagnosed using rapid diagnostic test, microscopy, and polymerase chain reaction, while severe malaria was classified according to World Health Organisation criteria. Among 1205 febrile tribal individuals screened, 465 malaria cases were identified. PCR detected the highest number of infections (422), including Pf (174), Pv (213), and mixed infections (35). Both RDT and microscopy showed high specificity (> 97%) but moderate sensitivity compared to PCR, missing many submicroscopic infections. Of 444 confirmed malaria cases (excluding 21 RDT positive but microscopy and PCR negative cases, which can be false positives due to persistence of antigens), 32 (7.2%) were severe, including Pf (17), Pv (11), and mixed infections (4). Severe malaria was associated with significantly lower haemoglobin, RBC count, haematocrit, platelet levels, and higher bilirubin. The high burden of submicroscopic malaria highlights limitations of conventional diagnostics. Pv emerged as an important cause of severe malaria in Northeast India, challenging its traditionally benign perception and emphasizing the need for integrated molecular surveillance and improved case management.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12936-026-06009-5.

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Cite

BibTeXRIS
BibTeX
@article{goswami2026first,
  title = {{First report of severe Plasmodium vivax malaria with sub-microscopic co-infection of Plasmodium vivax and Plasmodium falciparum and their clinicodemographic correlates: a study from hyperendemic areas of Tripura}},
  author = {Bidhan Goswami and Ipsita Pal Bhowmick and Shailja Singh and Shauli Sengupta and Ujjal Gogoi and Saurav Biswas and Savitha Chellappan and Partha Saha and Jadab Rajkonwar and Himadri Sankar Bharali and Samir Kumar Sil},
  journal = {Malaria Journal},
  year = {2026},
  month = aug,
  doi = {10.1186/s12936-026-06009-5},
  url = {https://doi.org/10.1186/s12936-026-06009-5},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - First report of severe Plasmodium vivax malaria with sub-microscopic co-infection of Plasmodium vivax and Plasmodium falciparum and their clinicodemographic correlates: a study from hyperendemic areas of Tripura
AU  - Bidhan Goswami
AU  - Ipsita Pal Bhowmick
AU  - Shailja Singh
AU  - Shauli Sengupta
AU  - Ujjal Gogoi
AU  - Saurav Biswas
AU  - Savitha Chellappan
AU  - Partha Saha
AU  - Jadab Rajkonwar
AU  - Himadri Sankar Bharali
AU  - Samir Kumar Sil
PY  - 2026
DA  - 2026/08/12
JO  - Malaria Journal
DO  - 10.1186/s12936-026-06009-5
UR  - https://doi.org/10.1186/s12936-026-06009-5
AB  - Malaria remains a major public health problem in Northeast India, particularly among the tribal population of Tripura, with increasing Plasmodium vivax (Pv) cases alongside predominant Plasmodium falciparum (Pf). This study assessed the demographic, clinical, haematological, and biochemical characteristics of severe malaria in hyperendemic areas of Tripura. A prospective hospital- and community-based study was conducted in three districts of Tripura from April 2023 to December 2024. Febrile individuals were screened through door-to-door village visits and primary health centres. Malaria was diagnosed using rapid diagnostic test, microscopy, and polymerase chain reaction, while severe malaria was classified according to World Health Organisation criteria. Among 1205 febrile tribal individuals screened, 465 malaria cases were identified. PCR detected the highest number of infections (422), including Pf (174), Pv (213), and mixed infections (35). Both RDT and microscopy showed high specificity (> 97%) but moderate sensitivity compared to PCR, missing many submicroscopic infections. Of 444 confirmed malaria cases (excluding 21 RDT positive but microscopy and PCR negative cases, which can be false positives due to persistence of antigens), 32 (7.2%) were severe, including Pf (17), Pv (11), and mixed infections (4). Severe malaria was associated with significantly lower haemoglobin, RBC count, haematocrit, platelet levels, and higher bilirubin. The high burden of submicroscopic malaria highlights limitations of conventional diagnostics. Pv emerged as an important cause of severe malaria in Northeast India, challenging its traditionally benign perception and emphasizing the need for integrated molecular surveillance and improved case management.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12936-026-06009-5.
SN  - 1475-2875
ER  -