Malaria Diagnosis

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QUESTION

How to identify malaria? My son has fever and headache for the past three days and also vomiting. Is treatment is necessary and what type of treatment he needs?

ANSWER

You need to take your son to the doctor or to a clinic where they can do a blood test to look for malaria. They will either look at his blood under a microscope or use his blood in a “rapid diagnostic test” (RDT), both of which can identify the presence of the malaria parasites in his blood. If he is positively diagnosed with malaria, then your son should receive treatment, probably a type of artemisinin-based combination therapy (ACT) – common brands include Coartem, Lonart and Alu (though there are many others). These are what the World Health Organisation recommends as first line treatment against non-severe malaria.

Given your son’s symptoms, you should certainly go for a malaria test, just in case. However, vomiting is not usually a symptoms associated with malaria, so it is also possible he has another infection, such as an intestinal parasite, or even a bacterial or viral infection. Unfortunately, the symptoms of malaria are very general, so you really need to have one of the blood tests I mention above in order to be sure that your son has malaria.

Which Medication to Take for Malaria Treatment

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QUESTION

Which medicion should we take during malaria?

ANSWER

Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

  • chloroquine
  • atovaquone-proguanil (Malarone®)
  • artemether-lumefantrine (Coartem®)
  • mefloquine (Lariam®)
  • quinine
  • quinidine
  • doxycycline (used in combination with quinine)
  • clindamycin (used in combination with quinine)
  • artesunate (not licensed for use in the United States, but available through the CDC malaria hotline)

In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How to treat a patient with malaria depends on:

  • The type (species) of the infecting parasite
  • The area where the infection was acquired and its drug-resistance status
  • The clinical status of the patient
  • Any accompanying illness or condition
  • Pregnancy
  • Drug allergies, or other medications taken by the patient

If you have or suspect you have malaria, you should contact your doctor immediately.

Malaria Prevention During Pregnancy

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QUESTION

I am emigrating (moving permanently) to Mozambique – Vilanculos in October after my marriage, I want to fall pregnant.

What medicine can I take to prevent malaria during my pregnancy in Mozambique? I am afraid of getting malaria while I am pregnant. I am from South Africa, will the doctors here have a remedy for me to take before I am moving to Vilanculos? Do you know of any malaria prevention during pregnancy medicine?

ANSWER

Certain drugs commonly used to prevent malaria are not appropriate for
pregnant women. Those which can be taken by pregnant women are
chloroquine and mefloquine (the latter is commonly sold as Lariam).
Unfortunately, the type of malaria found in Mozambique is resistant to
chloroquine, and so this drug is not recommended for people living in
this area. As such, mefloquine remains as the likely first choice
preventive drug for you when you get pregnant. Some studies suggest
mefloquine should not be taken in the first trimester of pregnancy,
but in high malaria transmission zones, the dangers of malaria may
outweigh these early risks. You can talk to your doctor about the pros
and cons of this. There are also no problems with taking it long term
(i.e. for the 9 months of pregnancy), and the Centers of Disease
Control in the US also state it is safe for infants to consume small
amounts of mefloquine, so it can be taken during breast feeding as
well. It is important to note that mefloquine is not recommended for
people with a history of certain psychiatric disorders, so you should
consult with your doctor before taking it if you have a history of
mental illness.

Throughout your pregnancy, you should also be aware of other methods
for preventing malaria, such as sleeping under a long-lasting
insecticide treated bednet, and making sure your house is fully
screened to prevent mosquitoes from entering. Wearing long sleeved
clothing in the evening and at night when you’re outside, and insect
repellent on exposed skin, can also help prevent mosquito bites.

Malaria Test – Can Malaria Return?

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QUESTION

I am working in Tanzania. I felt sick about 10 days ago and I went for a test for malaria and the test was positive. The doctor gave me some pills and said I must come back in one week for a test again. I went back and it was negative but now I don’t feel too good. Is it possible for the malaria to come back after 10 days?

ANSWER

It is unlikely that the malaria has come back, and if your malaria test is negative, then you probably don’t have malaria any more, and you can be confident the treatment worked. It sometimes takes a few days or even a couple of weeks to fully recover from the infection, since it takes quite a toll on the body’s immune system. Also, the medication you take to treat malaria can also have side effects, such as nausea and headaches, which actually seem similar to the symptoms of malaria itself.

Paracetamol to Control Fever

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QUESTION

If I take paracetamol to help control my temperature will it affect my blood test results— can they fail to detect the plasmodium?

ANSWER

No—taking paracetamol (also called acetaminophen, and sold variously as Tylenol, Panadol and other brand names) is a good way to control your temperature during malaria infection, and it won’t affect your blood test results. If you haven’t done this already, if you think you have malaria you should go to a doctor or clinic to get a blood test for diagnosis. Once you have been positively diagnosed, you can be given appropriate treatment, probably one of a number of available artemisinin-based combination therapies (such as Coartem, Alu, Lonart, etc).

Long Term Health Effects of Malaria

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QUESTION

Ten years ago, at the age of 21, I contracted both forms of malaria. I was severely unwell with falciparum, losing around 15kgs over the course of a week, and I suffered one relapse. I had ongoing vivax for 2 and a half years. I would like to know if there are any known long term complications, or possible health problems I may encounter in the future as a result of having had malaria.

ANSWER

There is a discussion going on about the question of possible long-term consequences of malaria infection based on an earlier question in this forum. You can follow the discussion here: Long Term Health Effects of Malaria When Young.

In summary, there is little evidence of any long term effects on health from having single or relatively few malaria infections; however, this may partly be through lack of concerted research on this topic. Most research looks at the impact of chronic or very frequent malaria infections, such as that experienced by young children living in holo-endemic areas (i.e. sub-Saharan Africa).

Death from Malaria: Humans and Other Primates

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QUESTION

If not treated in some form, do most who acquire malaria die? What about primates, such as orangutans that live in the wild and would not be treated as such. Do they die or do they become chronically ill within period of remission?

ANSWER

That’s a really good question, and the answer is: it depends! In humans, the most deadly form of malaria is Plasmodium falciparum—when infected for the first time, if not given prompt treatment, many people will die from this infection. However, after repeated infections, people develop acquired immunity to the P. falciparum parasite which means they are increasingly able to survive subsequent infections without treatment. This reason of acquired immunity is why young children, who do not yet have immunity, and visitors to malarial areas tend to have the most severe infections and most require treatment in order to survive.

The other three major forms of human malaria, P. vivax, P. malariae and P. ovale, are generally less deadly, though they can also result in death in some circumstances if the person does not have immunity and is not treated. Although much less common than P. falciparum, P. knowlesi is the fifth type of malaria to infect humans (it is more commonly an infection of macaque monkeys in south-east Asia), and because it replicates in a 24-hour cycle (the other types of human malaria have either a 48 or 72 hour cycle), high parasite loads can establish very quickly, leading to severe disease. As such, P. knowlesi is also quite dangerous and a high proportion of untreated cases result in death.

It is great that you ask about malaria in other primate species—as with humans, some forms of malaria are tolerated reasonably well while others are more deadly. It varies depending on the type of malaria as well as the species of primate. So, for example, P. knowlesi in long-tailed macaques is rarely observed to cause severe disease. In fact, infected macaques sometimes don’t even appear to have any symptoms. In contrast, if rhesus macaques are experimentally infected with P. knowlesi (the transmission range of this type of malaria does not overlap with the natural range of rhesus macaques), almost 100% of them will die without treatment.

You ask specifically about orangutans: one problem is that it is unclear which, and how many, species of malaria infect these apes. Past research has uncovered two species which are thought to be unique to orangutans (namely P. silvaticum and P. pitheci) while molecular studies have also shown non-specific species, namely human P. vivax and macaque P. cynomolgi and P. inui. As such, while originally orangutan malaria was thought to be not very dangerous to these apes, more recently there have been reports of orangutans showing very human-like symptoms suggestive of more advanced disease. However, rarely do studies link symptoms and observations of parasites in the blood, so it is unclear which parasites are causing these symptoms, if indeed it is malaria at all (in some sanctuary/rehabilitation center settings, orangutans exhibiting malaria symptoms have responded positively to treatment with anti-malarials, though this is not definitive evidence that their symptoms were caused by malaria).

So, in short, more research should be done on wild primates, particularly using molecular tools, to ascertain accurately what species of malaria they are infected with, and whether they are associated with symptoms and/or severe disease.

Do Male Mosquitoes Bite?

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QUESTION

Why do male mosquitoes not bites humans?

ANSWER

Male mosquitoes do not possess the right kind of feeding apparatus to feed on humans—they only feed on nectar. This is because they do not need to produce eggs, which require lots of energy and protein to make, and so the female mosquitoes need a more comprehensive food source than just nectar when they are egg-laying, such as blood. This is why they feed on humans and other animals when egg-laying.

Socio economic conditions surrounding malaria

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QUESTION

What are the socio economic conditions surrounding malaria?

ANSWER

Malaria transmission requires the presence of Anopheles mosquitoes; as such, conditions which favor the growth and persistence of these mosquitoes will also be hotspots for malaria transmission, provided the climate is also sufficiently warm for the development of the parasite within the mosquito.

Rural areas without sophisticated water and sanitation systems often utilize streams or ponds for everyday water needs; if these produce stagnant patches of water, they can be an ideal location for the development of mosquito larvae.

Similarly, if rural farmers dig canals or ditches to irrigate their fields, these can become breeding areas. Urban areas tend to have less standing water, apart from cisterns, so in many cases transmission is less prevalent in urbanized locations.

As a further socio-economic factor, preventing mosquitoes from entering the house and biting people is  key way to prevent infection. Rich people in malarial areas may be more able to have fully screened houses, possibly even with air-conditioning, which will prevent mosquitoes from establishing in the house. They may also be more likely to have access to a long-lasting insecticide treated bednet, which further reduces mosquito bites, and also access to accurate diagnostic screening and treatment, if they do happen to get infected.

All of these factors contribute to making malaria burden highest in some of the world’s poorest areas, with the highest levels of mortality in sub-Saharan Africa.

Malaria: Mode of Transmission

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QUESTION

What is the mode of transmission of Malaria?

ANSWER

Malaria is transmitted normally via the bite of an infected mosquito. These mosquitoes, always female and of the genus Anopheles, carry malaria parasites in their salivary glands. The parasites, at this part of their life cycle known as sporozoites, are introduced into the host’s blood when the mosquito takes a blood meal. From there, the sporozoites travel to the liver, reproduce (this process may take several weeks), then finally re-enter the blood stream. At this point, the patient will begin to experience symptoms. Eventually, the malaria parasites change again, into gametocytes, which are picked up by another mosquito, again when it bites the infected person. In this way, the life cycle of the malaria parasite continues.

Because malaria reproduces in the blood and in the liver, in some cases malaria can be transferred via organ transplant or blood transfusion. In addition, malaria parasites can cross the placenta, and so can be transmitted from a mother to her unborn child, either in the womb or during childbirth. This is known as congenital malaria.