Can Child Be Affected by Mother’s Malaria

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QUESTION
If the baby’s mother has malaria, can it affect the child?

ANSWER

If the mother is pregnant when she gets malaria, particularly if it is her first pregnancy and particularly if she has never had malaria before, the effects on both the mother and child can be very serious. For the mother, this is because her immune system changes when she gets pregnant. This leaves her more vulnerable to the effects of malaria, including anaemia.

The most dangerous type of malaria, P. falciparum, also seems very able to infect cells in the placenta, leading to a higher intensity infection, and also reducing oxygen delivery to the baby. This, combined with the mother’s illness and anaemia, can lead to low birth weight, anaemia and other complications in the child once it is born. Malaria can also pass through the placenta, or be transferred to the baby through blood during childbirth, resulting in “congenital malaria”; that is, malaria which has been passed from mother to infant. Since newborns have inexperienced immune systems, malaria in the first days or weeks of life, and especially if the child is already low birth weight, can be very dangerous.

As such, a lot of effort has gone to finding ways to prevent malaria in pregnancy and to treat women who do get malaria while pregnant to prevent negative effects both to her and her unborn child. These efforts mainly involve the distribution of long-lasting insecticide treated bednets, and in some places also include the administration of intermittent preventive therapy, where women are given periodic doses of anti-malarials during pregnancy to protect against the disease.

First Malaria Outbreak

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QUESTION

When was the first ever outbreak of malaria?

ANSWER

Malaria has actually been known in human populations for thousands of years, so the first ever outbreak occurred long before any records were kept. The ancient Chinese recorded the symptoms of malaria in a medical manuscript which dates back to 2700 BCE, so almost 5000 years ago!

The symptoms of malaria were also known to the ancient Romans, Greeks, Egyptians and native peoples of the Americas, though none of them fully understood the cause of the disease or how it was transmitted. That information was discovered in the late 19th century, by Charles Louis Alphonse Laveran, who first observed malaria parasites in the blood of a patient and attributed them to the disease, and by Ronald Ross, who demonstrated that the malaria parasite was transmitted by mosquitoes.

Swelling of Lymph Nodes and Malaria

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QUESTION

I would like to know if swelling of lymph nodes in neck is any way connect to malaria?

ANSWER

Swollen lymph nodes are often a sign that the body is trying to fight off an infection, and so swollen lymph nodes are certainly sometimes observed in malaria patients. However, most malaria infections would also be associated with other symptoms, such as fever, chills, nausea and aches.

In some cases (but not all), malaria patients experience cyclical fever, whereby they have a high fever one day and no fever the next, but the fever returns on the third day, and the cycle continues. One type of malaria exhibits a cycle of fever one day, then no fever for two days, then fever returns on the fourth day. However, many patients do not experience these cycles, which means their symptoms are very similar to those for many other illnesses, which is why if you are in or have been visiting an area where malaria is transmitted and you have some of the above symptoms, it is very important to visit a doctor or clinic to get diagnosed for malaria. This can be done with a simple blood test, and the results are usually available very quickly. Then, if you are diagnosed as positive for malaria, the doctor can recommend appropriate treatment and instruct you in the proper way of taking it.

Pathophysiology of Malaria

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QUESTION

What is the pathophysiology of malaria?

ANSWER

Malaria causes disease through a number of pathways, which depend to a certain extent on the species. Malaria is caused by a single-celled parasite of the genus Plasmodium; there are five species which infect humans, beingPlasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi.

All these species are introduced into the human blood stream through the bite of an infected mosquito; the life stage of malaria at this point is called a “sporozoite”, and they pass first to the liver, where they undergo an initial stage of replication (called “exo-erythrocytic replication”), before passing back into the blood and invading red blood cells (called “erythrocytes”, hence this is the “erythrocytic” part of the cycle). The malaria parasites that invade red blood cells are known as merozoites, and within the cell they replicate again, bursting out once they have completed a set number of divisions. It is this periodic rupturing of the red blood cells that causes most of the symptoms associated with malaria, as the host’s immune system responds to the waste products produced by the malaria parasites and the debris from the destroyed red blood cells. Different species of malaria rupture the red blood cells at different intervals, which leads to the diagnostic cycles of fever which characterise malaria; P. vivax, for example, tends to produce cycles of fever every two days, whereas P. malaria produces fever every three.

In addition, Plasmodium falciparum produces unique pathological effects, due to its manipulation of the host’s physiology. When it infects red blood cells, it makes them stick to the walls of tiny blood vessels deep within major organs, such as the kidneys, lungs, heart and brain. This is called “sequestration”, and results in reduced blood flow to these organs, causing the severe clinical symptoms associated with this infection, such as cerebral malaria.

More details on the exact biochemical mechanisms for sequestration and its effect on the pathology of the infection can be found on the Tulane University website.

Malarone and Mefloquine for Malaria

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QUESTION

Which drug is better for kids for anti-malaria – Malarone or Mefloquine. I have heard about lot of side-effects of Mefloquine. So, which is a safer drug out of these two or is there any other drug with no side-effects? Is it important to take anti-malaria pills keeping in mind the side-effects?

ANSWER

Both drugs are considered safe for children, though Malarone (atovaquone-proguanil) should not be given to pregnant women or those nursing a child under 5kg. Malarone is also available in a pediatric form in some places, where the dose is reduced specifically for prescription to children under 40kg in weight. Personally, I took both Malarone and mefloquine (as Lariam) when I was a child, and experienced no side effects from either, though certainly many more people do report side effects from mefloquine, including disturbed sleep and hallucinations, or increased anxiety, and it is therefore not recommended for people with a history of psychiatric illness or disorders.

If this does not apply to you or your children, then it really is a matter of preference, cost and practicality. Malarone is generally more expensive than Lariam, needs to be taken every day, but only needs to be taken a few days before departing for the malarial area and for only one week after you return. Lariam, on the other hand, is only taken weekly (which can be an advantage with small children), but needs to be started 2 weeks before travel and for 4 weeks afterwards, which can make it less convenient for short trips.

The other thing to consider, finally, is where you are going—some forms of malaria found in south-east Asia are resistant to mefloquine, meaning it is not a suitable anti-malarial for travel in those areas, so Malarone would be a better choice in that circumstance. Both mefloquine and Malarone are suitable for travel in all other malarial areas.

What Causes Malaria

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QUESTION

What are the causes of malaria?

ANSWER

Malaria is caused  by infection with certain single-celled parasites of the genus Plasmodium. Specifically, there are five species which infect humans: P. falciparum (the most severe and dangerous form of malaria), P. vivax, P. ovale, P. malariae and P. knowlesi.

The symptoms of the disease occur when the parasite enters the blood stream (after a brief 1-3 week period of development in the liver) and begins to enter red blood cells, reproduce inside them, and then burst out, destroying the cell. The debris caused by this bursting, as well as various other aspects of the process, cause the body to mount an intense immune reaction which results in high fever, chills, aches and nausea. For P. falciparum infection, the infection is particularly severe because the parasite causes red blood cells it infects to stick inside the small blood vessels that lead to major organs, reducing blood flow and causing oxygen deprivation. When this occurs in the blood vessels in the brain, the result is impaired consciousness, unconsciousness, coma and even death – hallmarks of what is known as “cerebral malaria,” which is implicated in many of the deaths related to malaria each year.

Number of Species of Malaria

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QUESTION

I recently read an ISOS world malaria day poster saying 5 species of plasmodium cause malaria. I think that is confusing as we always talked about 4, ovale, vivax, falciparum and malaria….are they referring to the way we now split ovale into 2 sub species? or is this a typo on their part?

ANSWER

That is a really interesting question, and a good observation on your part! I imagine the fifth species they are referring to is Plasmodium knowlesi, which is found in parts of south-east Asia, with the majority of cases being reported from Borneo. Originally known only from macaque monkeys, it appears to be occurring more frequently in humans. However, it is not known whether this is a new host switch, or whether it is simply a matter of better detection methods—the morphology of P. knowlesi closely resembles that of P. falciparum in its early trophozoite stages, and P. malariae in later trophozoite and other life stage forms. Moreover, some molecular-based tests for P. knowlesi cross-react with other forms of malaria, such as P. vivax, leading to greater diagnostic confusion.

There is also a hypothesis that changes in land use in tropical forests may be resulting in greater human exposure to the vectors which carry P. knowlesi, which accounts for its increased recent prevalence in humans. P. knowlesi is the only known malaria in humans (and indeed, in all primates) with a 24-hour reproductive cycle, which means that without treatment, high levels of parasitaemia can accumulate rapidly in the blood, and lead to severe clinical symptoms. This makes its apparent emergence of great public health concern in south-east Asia. Luckily, at this point, P. knowlesi is completely susceptible to chloroquine treatment and other medications, and so is easily controlled once diagnosed.

One of our contributors, Christina Faust, wrote a blog post last year on P. knowlesi entitled Of Macaques and Men. More information on recent research about P. knowlesi can be found in the article, Monkeys Provide Malaria Reservoir for Human Disease in South-East Asia.

Repeated Malaria Cases, New Guinea

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QUESTION

Hello, I live in Papua New Guinea. Myself, my wife and my 2 kids (both under 4 years old), get diagnosed with malaria approximately 3-4 times a year, usually vivax or falciparum. Our GP uses a prick of blood and examines under a microscope. Is it that easy/obvious to diagnose under this method and is it common to get this many attacks in a year? I also fear the affects of taking malaria tabs (eg Fansidar, Primaquin, Artemeter, Amodiaquine) this many times, especially for my young kids. Please help!

ANSWER

In high transmission areas, particularly in rural areas in sub-Saharan Africa, it certainly isn’t unusual for children to get as many a 5 or 6 malaria attacks in a year; adults tend to present with fewer clinical episodes, usually because they were heavily exposed as children and thus developed a significant level of immunity against malaria.

If you and your wife didn’t grow up in a malarial area, then you would not have that acquired immunity, and so you would be expected to get sick almost as often as your young children. Papua New Guinea certainly is a high transmission zone, and I think one thing which might help your family is to focus more on malaria prevention. Since malaria is transmitted by mosquitoes, the best way to avoid getting malaria is to avoid getting bitten by mosquitoes. You should all be sleeping under log-lasting insecticide-treated bednets, which kill and/or repel mosquitoes that try to bite you while you sleep (the mosquitoes that transmit malaria, of the genus Anopheles, are most active at dusk, at night, and at dawn—during the heat of the day they usually don’t feed, but may be found in cooler, heavily shaded areas).

You could also try spraying the walls of your house with a long-lasting insecticide like permethrin, which will also kill adult mosquitoes. Making sure your house is well-screened will also prevent mosquitoes from getting in and biting you at night and in the evenings, and if you are going out during these times, you and your family should wear long-sleeved clothing, and exposed skin should be covered with insect repellent. A DEET-based insect repellent is best, but you may not be comfortable using these regularly on young children, since it can have some potentially dangerous long-term effects, particularly on the liver.

In terms of your other questions, looking at your blood under the microscope is the normal way to diagnose malaria in many places, so it sounds like your GP is doing a good job. There is no indication of adverse effects from taking multiple, repeated doses of anti-malarials, but as I mention above, taking additional preventive measures may further help in reducing your family’s malaria incidence.

One thing you might want to talk to your doctor about is the fact that in some cases, Plasmodium vivax can cause relapses of infection weeks or even months after the initial infection. The reason is that P. vivax can form dormant life stages, which can hide out in the liver, and cannot be killed by the normal anti-malarial treatment. However, there is a medication, called primaquine, which can kill these liver forms, and prevent future relapse. People with a deficiency in a particular enzyme, called G6DP, may not be able to take this medication, as it may cause severe anaemia, so prior to taking the drug you might have to be tested for this deficiency. However, it is definitely something you should talk to your GP about.

Please take a moment to complete our Malaria Survey, as it will help us better understand the effects of malaria medications.

Coartem Treatment

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QUESTION

my husband has been taking coartem for 3 days now. He was fine yesterday and then last night the symptoms re-appeared like it was day one. Can I carry on with coartem and start another course? Or shall I switch to something else ? If so, what? We live in zambia by the way.

Thank you for your help.

ANSWER

If your husband still has strong symptoms after taking all doses of the Coartem, go back to see your doctor  or to the clinic for another blood test. If it is positive, then your doctor may recommend trying a different form of anti-malarial medication—artemisinin-based combination therapy (a group of medications that includes Coartem) is recommended as the first-line treatment against malaria, but a second line option could be atovaquone-proguanil (Malarone) or another medication. Please note that Fansidar (sulfadoxine and pyrimethamine) and chloroquine are not recommended for use in Africa as levels of resistance are high. 

It could be that the medication hasn’t had time to fully act, which is why it is important to wait until the full dose has been taken, and then to confirm that malaria is still present. Sometimes the side effects of anti-malarials can appear similar to malaria itself, such as nausea, chills, body aches, etc, so it is important not to start another course of treatment without further diagnosis.

We are actually very interested in learning about our readers’ experiences with anti-malarial medications, and so we would be very grateful if you might be able to take a few minutes to complete our malaria survey we are running on Malaria.com. We will post any findings that may be of interest to our readership on Malaria.com later this year—all submissions are completely anonymous. Many thanks for your time and help, and I hope your husband recovers fully soon.

World Malaria Day Date

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QUESTION

What is the background of 25 April to be celebrated as World Malaria Day? Why just 25 April?

ANSWER

World Malaria Day was instituted by the World Health Assembly at its 60th meeting in May 2007. As far as I know, the choice of April 25th was arbitrary – it was almost a full year after the instituting assembly meeting, perhaps intending to give the organizers plenty of time to make preparations for the first observance of the day. In any case, World Malaria Day is now a symbolic date and a rallying time point for malaria advocacy and control efforts.