Diagnosing Malaria

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QUESTION

My sister had fever before 2 weeks, she take tablets, and then she is fine. Then after three days she had a urine infection, take blood test and also urine test, the test result shows malaria is negative. Now she has fever. Take blood test, malaria is negative. Can she be affected by malaria or just urine infection?

ANSWER

Since your sister had two blood tests for malaria and they were both negative, it seems likely that her fever is from the urine infection. However, if she continues to have fever (after treatment for the urine infection), she needs to return to the clinic for further investigation to find the source of the problem.

Signs of Malaria

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QUESTION

I don’t like taking drugs, but since the past one month I’ve been very down with fever. My eyes have changed to yelllow, joint pain, I’ve severe pains in my ear, I have stomach and abdominal pain,  I have seizure undere my feet, sores on my tongue, throat pain, heart burn, and cough. Please are these malaria signs?

ANSWER

Thanks for your question. Malaria is often tricky because there are so many different symptoms. Here is a link to our webpage which lists some of the common symptoms of malaria. However, if you suspect you might have malaria, it is really important to get a proper diagnosis from a clinic or hospital, usually through a blood test. It is only with a proper medical diagnosis that you can be sure you are receiving the right medication for your illness, whether it is malaria or something else.

Anopheles Mosquitoes and Malaria Transmission

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QUESTION

How are the Anopheles mosquitoes able to transmit human Malaria and others are not? What makes them different from the other genus of mosquito?

ANSWER

This is a great question and in fact scientists are not really sure of the answer. The ability of female Anopheles to transmit malaria is a quirk of evolutionary history. Other species of Plasmodium (the Latin genus name of the group of parasites which cause malaria), for example those that infect birds and lizards, are transmitted by other mosquitoes, such as Culex. When the parasite switched hosts and started infecting mammals, this coincided with the parasite specializing in infecting Anopheles mosquitoes, and this relationship has remained ever since. It is a case of what scientists term “coevolution”, where a parasite and its vector have a tightly coupled and highly specialized relationship.

Can Malaria Penetrate the Brain

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QUESTION

Can malaria penetrate the brain?

 

ANSWER

Approximately 1% of people with malaria will develop a severe form, and in these cases the brain can be affected.  When the brain is affected, the condition is called cerebral malaria.  Functional changes to the blood-brain barrier occur in cerebral malaria, possibly as a result of the binding of parasitized red blood cells to cerebral endothelial cells,  although scientists do not really understand the mechanism.  However, people suffering from cerebral malaria can have seizures, fall into a coma, or show other neurological problems.

Without treatment, cerebral malaria generally leads to death.  Among children with cerebral malaria who received treatment and survived, it has been found that about a quarter (25%) have long-term problems with thought processes, motor function or have behavior impairments and  10% develop epilepsy.

How Long for Blood Count to Return to Normal

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QUESTION
I’m hoping to get some clarity on the following, as I’ve had a few rather large disparities in the information I’ve been given. My mother (66) recently had a very serious bout of Malaria and was hospitalised in Johannesburg for just over a week. (Both my Mom and Dad live in Tete, Mozambique) At one stage, she almost needed a blood transfusion as her parasite count was above 10% (12,5% to be precise). While Dr’s decided against the transfusion eventually, I would like to know how long it takes for her blood count to return to normal (she’s been out of hospital for almost 5 weeks now) as she would like to return to Mozambique. I’m grateful for any advice you can proffer.

ANSWER
A parasite count over 10% is indeed serious, but new findings suggest that if artesunate compounds are used for treatment, transfusions don’t add much, so if that is the case, the decision not to give a transfusion is probably a good one. Artesunate compounds are noted for reducing the parasite load quickly compared to other drugs (i.e.quinine), usually by 48 hours. Since your mother had severe malaria, she may also be suffering from anaemia which can make her feel very weak. She will need to rest and recuperate, take iron supplements and eat a nutritious diet with iron-rich foods (green vegetables, red meat etc). She must also take precautions to avoid getting malaria when back in Mozambique; use an insecticide treated bed net, avoid going out at dawn or dusk and/or wear long sleeves and long pants, use mosquito repellent, and seek treatment early if any signs of malaria (fever etc) appear.

Is it Malaria Relapse?

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QUESTION

WHILE IN VIETNAM, I HAD VIVAX AND FACIPRIUM MALARIA. THE OLDER I GET I COME DOWN WITH THE CHILLS, FEVER AND PROFUSE SWEATING. BLOOD TEST NEVER DOES SHOW ANY MALARIA BUT DOES SHOW THE VIVAX ANTIBODIES. DOES THIS MEAN I STILL HAVE MALARIA OR HOW LONG DO THE ANTIBODIES REMAIN IN MY BODY AND WHY NO MALARIA CELLS?

ANSWER

Antibodies to malaria can persist in the body for years after the malaria infection, so if blood tests are not showing up malaria parasites but do show you have antibodies, then you probably don’t have malaria now, and it is just showing that you once had malaria, but it could have been many years ago. You should talk to your doctor about other possible infections that might be causing your symptoms.

Can the PCR blood test identify hypnozoites?

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QUESTION

I have never been diagnosed with malaria but returned from Turkey in 2007 (P. Vivax endemic area; Diarbykar & Mardin areas). My symptoms were consistent with malaria and I have now had 5 relapses since then, averaging one occurrence per year. I now have impaired kidney functioning and I am uncertain if this could be because of undiagnosed malaria? Would the PCR blood test at anytime be an option to conclusively rule out malaria or would blood need to be drawn during an actual relapsing event?

ANSWER

You have certainly done your research! It’s great to hear from someone who is so well informed about the risk areas they traveled too and the diagnostic options. You’re right in thinking that PCR is only appropriate during an active relapse; while the malaria parasites are dormant in the liver (called hypnozoites, in that form), they are extremely hard to detect. One option could be to investigate the possibility of taking a test to look for antibodies to the P. vivax parasite. These tests are often referred to as ELISAs (enzyme-linked immunosorbent assays) and they can sometimes be useful for testing for malaria in between relapses because the antibodies your body produces against the malaria parasite during the relapse phase can stick around in the blood for weeks, or even months or years. Therefore these tests are not very useful for people in endemic areas (who may always have these antibodies, regardless of their current infection status) but for travelers who have been exposed a limited number of times, this test may be able to say whether you have at some stage been infected with P. vivax; together with your clinical history, this will provide strong evidence to your doctor that you might need to discuss the possibility of taking primaquine, the drug which can kill the dormant hypnozoites and prevent further relapse.

What Cell count defines malaria?

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QUESTION

What Cell count defines malaria??

ANSWER

If you are referring to the cell count for diagnosis, then really the answer is that if ANY malaria parasites are observed in a blood film, then the slide should be considered positive for malaria. Of course, some people can have low levels of parasite in their blood, which are not easily detected under a microscope, using a blood slide. These people are also obviously positive for malaria, but have less severe symptoms or indeed may not have any symptoms at all. If they have symptoms, they may need to seek an alternative form of diagnosis, such as a rapid diagnostic test (RDT) or PCR (polymerase chain reaction).

Multiple Malaria Infections Each Year

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QUESTION

My name is Olumide and I live in Nigeria. I have had malaria too frequently and it’s giving me a lot of concern. I had one last August 2012 and am having another one this October as I am speaking with you. If I should count it, I’ll be having nothing less than 6 occurrences in a year. It’s always an headache induced malaria whereby after using the ACT combination recommended by WHO, two days after, am still having headache, am asthmatic though and can’t use more than Paracetamol. I am tired of all these and need your help.

ANSWER

One of the key things you should check is how you are being diagnosed with malaria—the symptoms of malaria are very general, such as headache, chills and fever. I have seen cases where people assume they have malaria and so take ACTs without getting properly diagnosed, and so they never actually go to the doctor to have their real illness diagnosed. Therefore, next time you feel sick, you should go to the doctor or to a clinic and make sure they do a proper malaria test. This will either be via taking your blood and looking at it on a slide under a microscope, or by using a drop of the blood in a rapid diagnostic test (RDT). I believe that in some parts of Nigeria, you can even buy the RDT in local pharmacies, and do the test yourself at home. Only if you test positive for malaria should you take ACTs; if the test is negative, you should go to a doctor and ask about other possible illnesses with similar symptoms (such as flu, pneumonia, etc).

At the same time, it could be that you are suffering from repeated malaria attacks, in which case you will need to improve your personal protection in order to prevent future attacks. Sleeping under a long-lasting insecticide treated bednet is crucial; you should also wear long-sleeved clothing at night and at the evening since this is when malarial mosquitoes in Africa are usually most active. You may also want to consider indoor residual spraying; this coats the inside walls of your house with insecticide, further reducing the number of mosquitoes that may bite you inside your home. For more information, please see our Malaria Prevention overview page: http://www.malaria.com/overview/malaria-prevention

Symptoms of Malaria but Tests Negative

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QUESTION

My sister has been suffering from fever from past 22 days temperature varying from 102-106 with chills shivering, headache, body pain,nausea and muscle ache but tested negative for malaria. She also tested negative for dengue, swine flu, hiv, and many others.  So out of frustration we gave her mefloc 250 and she seems to be responding. She is still having fever that is after 12 hrs of medication but the temprature is ranging between 98-100 and there is no headache and no chills and shivers.  Now we are confused how to confirm that it is really malaria and when will the fever stop completely. Should we shift her to a some other hospital at present she is in Pune.

ANSWER

The diagnosis of malaria is confirmed by observing parasites on a blood smear.  There are also Rapid Diagnostic Tests (RDT) that can be done with a pin prick of blood, but the blood smear is the definitive test. It is possible, that in your sister’s case,  a proper malaria test was not done or not interpreted correctly, and she does have malaria and it is responding to the medicine.   Alternatively it could be that your sister does not have malaria, but suffers from another problem that coincidentally is resolving itself at the same time the anti-malarial medicine is given.  It is hard to determine exactly what is wrong, but the good news is that she is getting better.

Sometimes medicine is given on presumption of illness which is what happened in your sister’s case. However, if someone has uncomplicated falciparum malaria, (most prevalent in India)  WHO recommends Artemisimin Combined Therapy (ACT), which uses an artemisinin compound with another anti malarial, such as mefloquine, not mefloquine alone.  If your sister’s fever returns, make sure to have a blood smear taken to see if it is malaria or not, and if so what kind of malaria it is, to better tailor her medicine.