{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:57:27Z","timestamp":1791385047098,"version":"4.3.3"},"reference-count":18,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that may be triggered by infectious diseases, including malaria and viral infections. A case of mixed\n                    <jats:italic>Plasmodium vivax<\/jats:italic>\n                    and\n                    <jats:italic>Plasmodium falciparum<\/jats:italic>\n                    infection concomitant with severe acute respiratory syndrome coronavirus 2 in a patient who developed secondary HLH is described in the present study. Malaria was acquired in the endemic state of Mato Grosso, Brazil, but diagnosed in Maca\u00e9, Rio de Janeiro, a nonendemic region. The patient presented with high fever, pancytopenia, hypertriglyceridemia, and hyperferritinemia. Bone marrow aspirate revealed hemophagocytosis. The patient met six of the eight HLH-2004 criteria and had an HScore indicating a high probability of secondary HLH. Recovery was achieved after the initiation of antimalarial and corticosteroid therapies. This case suggests that parasitic and viral infections may synergistically trigger immunologic \u201csecond hits,\u201d promoting macrophage hyperactivation. Recognition of overlapping infections, particularly outside endemic areas, may facilitate earlier diagnosis and timely management of secondary HLH.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.26-0249","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T16:18:30Z","timestamp":1786033110000},"page":"807-810","source":"Crossref","is-referenced-by-count":0,"title":["Secondary Hemophagocytic Lymphohistiocytosis Triggered by Mixed Plasmodium spp. and SARS-CoV-2 Coinfection"],"prefix":"10.4269","volume":"115","author":[{"given":"Adelmo Henrique","family":"Daumas-Gabriel","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine, Federal Fluminense University, Niteroi, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara Leite","family":"Adami","sequence":"additional","affiliation":[{"name":"Department of Pathology, Federal Fluminense University, Niteroi, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Chung","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Federal Fluminense University, Niteroi, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Guia de Tratamento da Mal\u00e1ria no Brasil.","year":"2020"},{"issue":"2","key":"b2","series-title":"Rev Bras Anal Clin","first-page":"187","article-title":"The impact of COVID-19 on malaria","volume":"53","author":"Machado","year":"2021"},{"issue":"1","key":"b3","series-title":"PLoS Glob Public Health","first-page":"e0002845","article-title":"Is Brazil reaching malaria elimination? 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