Every patient with malaria should be examined for simultaneous infection with more than one species of Plasmodium. Infections with both P. falciparum and P. vivax are among the most commonly encountered mixed infections. In patients with falciparum malaria, attacks of P. vivax malaria may later develop; it is important not to misinterpret this delayed P. vivax form as a relapse of P. falciparum infection. If a mixed infection is identified, a combination of 4-aminoquinoline and primaquine should be administered, since the pri-maquine helps to eliminate any persisting tissue forms of P. vivax.
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