Author reply.

Dear Sir,

We appreciate the interest shown in our case report[1] and the opportunity to clarify the queries raised by the authors.[2]

While writing case report, one has to follow the journal's guidelines and it becomes difficult to provide very minute details such as date of admission and discharge of the patient. This patient was admitted to our hospital in July 2007[3] and rapid test for malaria was done on the 2nd day of admission (G0161 CareStart Malaria HRP2/PLDH (Pf/Pv) COMBO). We completely agree that the ‘gold standard’ is microscopy with a thin and thick smear for which National Vector Control Programme would have been more suitable.

P. vivax and falciparum are the most prevalent species that cause malaria, and mixed infection of the two species are common and frequently recorded in the field survey,[4] but are underreported. A study revealed that 10.5% of the patients diagnosed with P. vivax alone actually harbored P. facliparum as well.[5] Indeed, the danger of misdiagnosing mixed infection as a single infection has been noticed by Knowles and White[6] who described the ‘flexible stopping rule’, the tendency of the worker to stop examining a blood film once parasite have been found.

P. falciparum disease severity ranges from severe and complicated malaria to mild and uncomplicated, to asymptomatic.[7] In our case, we speculated Japanese Encephalitis Virus (JEV) as a cause of acute encephalitic syndrome (AES) as suggested by the clinical course of the disease. However, at times it becomes very difficult to clinically differentiate between the two due to overlapping clinical presentations.