Discussion:
Here we report a case of malaria and RVF co-infection that was presented
with mild symptoms without involvement of the main characteristics of
RVFV infections, namely hemorrhage or neurological syndromes [28].
This none severe presentation of RVF infection has been observed during
a recent outbreak in the northern side of the country (Fig. 1) [1].
However, during another outbreak of RVF in the southeastern side of the
country during the same year, cases were presented with severe
manifestation (Fig. 1) [13]. This difference in the overall
manifestation of several patients could be attributed to the sensitivity
of the surveillance system and it is capacity to identify and detect
none severe cases during the outbreak [3,27]. Therefore, healthcare
providers in countries endemic with several causes of febrile illness
should pay extra attention during the differential diagnosis and the
possibility of co-infection should be high expected in such settings
[3,6,7, 29 -31]. Particularly, that recently there is a growing
evidence about diseases emergence and unusual presentation of endemic
diseases [24, 31 - 33]. Alternatively, this difference in the
clinical manifestation of RVF infection could be attributed to variation
in the virus strains some clads of viruses are more associated with
severe clinical presentations of the disease [34 - 36]. Similar
situation has been observed during the currently ongoing Mpox outbreak
of global concern [37]. Clade IIb of the Mpox virus that diverged
from the West African lineage is associated with globally expanded
transmission outside the endemic areas with none severe clinical
presentation. While on the other hand, the Democratic Republic of
Congo/Central African lineage (clade I) is associated with local
transmission in Africa and a higher Case Fatality Rate [37].
Interestingly, a substantial increase in outbreaks frequency of endemic
and emerging infectious diseases has been observed throughout the
country. Several outbreaks of vector-borne diseases including malaria
[17], CCHF [11], Chikungunya [10], dengue [29], RVF
[1], Leishmaniasis [16], and other zoonotic emerging infectious
diseases such as Cholera [38], COVID-19 [39], and hepatitis E
[40] were reported in Sudan. These outbreaks were associated with
climate change and sudden forcible displacement of human and animals
populations as well as international travel and unplanned urbanization
[25, 41].
Considering the lack of effective treatment and zoonotic nature of
arboviral diseases, their prevention and control rely on the
implementation of a transdisciplinary One Health strategy [13,42]
including the integration of diseases control programs [43],
enhanced surveillance and control of diseases vectors [18, 43,44],
improving the water sanitation and hygiene [45], and the use of
vaccines [38].
In conclusion, in areas endemic with several infectious diseases like
Sudan, co-infection should always be expected and investigated to
improve the case management and the clinical outcome. Therefore,
investment should be done on training clinical epidemiologists and
improving the diagnostic capacity and surveillance system. Additionally,
further studies are needed to investigate diseases progress and clinical
outcome in case of co-infection with two or more infectious diseases.