The First Case Series of Malaria Overlapped with COVID-19 in Iran

Introduction: Although indigenous malaria cases have dramatically declined over the past decades, the COVID pandemic has continued to affect the programs designed to combat malaria, particularly in those countries where hydroxychloroquine and chloroquine have been used as medications for treating COVID. Two immigrants entered Iran illegally from neighboring countries (i.e., Afghanistan and Pakistan). This study mainly aimed to assess the effects of coronavirus disease (COVID-19) on these cases from all aspects (i.e., case-finding, diagnosis, and treatment). Case Presentation: Both cases presented with common symptoms such as fever and shaking chills. In addition, they had no sign of COVID-19, and their oxygen level and CT images were normal in some cases, but they were mistakenly treated as COVID-19 patients long after the onset of malaria symptoms. One of the suspected coronavirus cases was given chloroquine on a voluntary basis for one day, which may have been responsible for the possible relapse in vivax or resistance of plasmodium vivax to chloroquine and the recurrence of parasitemia in falciparum. Conclusions: The active case detection of malaria was affected by the COVID-19 pandemic. Case finding was dramatically decreased with the onset of coronavirus, thereby causing a spurt in malaria incidence. Moreover, the malaria treatment strategy was negatively affected by the misdiagnosis of COVID-19.