Plasmodium and Borrelia Co-infection

test was negative. Liver enzymes, creatinine, urea blood levels, glucose-6-phosphate dehydrogenase activity and urinalysis were normal. Examination of blood thick smear revealed Borrelia sp. and Plasmodium vivax parasites (fig.). Therapy was started with doxycycline 200 mg/day and chloroquine base 1,000 mg, followed by 500 mg at 12,24 and 36 h.Subsequent treatment with primaquine (15mg base) continued daily for 14 days, and doxycycline treatment was continued for 7 days.During hospitalization, the patient’s temperature returned to normal; however,pancytopenia and hemolytic anemia continued for a few days and gradually improved. No blood transfusion was necessary. Repeat examination of blood thick smear on day 7 of the admission revealed no malarial parasites or Borrelia spp. The patient was discharged on day 9 after admission and has been well since.