Commentary: Navigating symptom and diagnostic overlap in pneumonia and malaria: insights from the field from the PERCH Study

Abstract

Every year, severe pneumonia and malaria still cause an unacceptably high burden of disease and mortality globally. These illnesses predominantly affect children <5 years of age in low- and middle-income countries (LMICs), particularly in Southeast Asia and sub-Saharan Africa. In malaria-endemic regions, distinguishing severe pneumonia from malaria with respiratory symptoms is an almost impossible task for clinicians in the absence of accurate diagnostic tools, which are often scarcely available in these settings. The symptom overlap is frequent; in hospital-admitted paediatric patients, >40% of malaria cases have severe respiratory findings and 24% of paediatric patients fulfil World Health Organization (WHO) criteria for both diseases]. The true coinfection (or dual diagnosis) proportion of severe pneumonia among paediatric patients with malaria is estimated at about one-fifth of patients [1]. Understanding this overlapping clinical epidemiology and performing a reliable differential diagnosis between the two entities has arisen as a public health priority.