# Polymicrobial Infection in an Immigrant Female at the United States-Mexico Border

## TL;DR

A female immigrant in the U.S. contracted malaria, dengue, and rhinovirus, highlighting the complexity of polymicrobial infections in travelers.

## Contribution

This case report highlights a rare polymicrobial infection involving malaria, dengue, and rhinovirus in an immigrant patient.

## Key findings

- The patient tested positive for dengue fever antibodies and was concurrently infected with rhinovirus.
- Malaria was confirmed via blood smear as Plasmodium vivax, with treatment initiated using chloroquine and later atovaquone-proguanil.
- The patient continued to experience fevers despite treatment until maintenance therapy was administered.

## Abstract

Malaria is a highly infectious disease transmitted through the bite of the Anopheles mosquito carrying the parasite of the Plasmodium genus; it presents with cyclical fevers, myalgias, and headaches. In the United States, the vast majority of malaria cases are reported in people who travel abroad, mainly to Africa. These cases are predominantly linked to Plasmodium falciparum or ovale and can be medically treated with artemisinin, chloroquine, or atovaquone-proguanil. We discuss a case of a 38-year-old female immigrant from Venezuela living at an immigration facility who presented to a hospital located on the United States-Mexico border with a two-day history of watery diarrhea, headache, and subjective fever. She had experienced mosquito bites and likely contracted the illness in Chiapas, Mexico during her trek from Peru to the United States. Her case was unique as she tested positive for dengue fever antibodies acquired from a previous infection and also contracted rhinovirus during her clinical course. Her diagnosis of malaria was confirmed with a peripheral blood smear that revealed ring forms with no gametocytes. This in tandem with her route of travel suggested infection with Plasmodium vivax. She was treated with chloroquine while the malaria culture was pending and continued to spike fevers every 24-36 hours while on medication. Once the culture was confirmed, she was treated with atovaquone-proguanil as maintenance therapy. She was subsequently discharged on primaquine for 14 days to prevent relapse.