Triple malaria infection in twin sisters from the Democratic Republic of Congo

Infections with 3 species of malaria parasites are rarely encountered and observed in less than 0.05% of cases. We came across such an infection in four year-old, monozygote twin sisters, coming from Kinshasa (Democratic Republic of Congo). In both of them, parasitemia was low or very low for P. falciparum and P. ovale and of 0.1-0.2% for P. malariae. The twin sisters presented with an iron deficiency anaemia, associated with an heterozygous sickle-cell anaemia and a moderate splenomegaly. The biological tests results were similar. They responded well to treatment. We point out the difficulty in recognizing the concomitant presence of several species of hematozoaire on blood smear.