Malaria Symptoms

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QUESTION

How does the virus cause the symptoms?

ANSWER

Malaria is actually not caused by a virus—it is caused by a microscopic single-celled parasite called Plasmodium. Several different species cause malaria in humans, the most common of which are P. vivax and P. falciparum.

To describe the process in a very oversimplified way, the malaria parasites cause disease by infecting red blood cells, multiplying inside them, then simultaneously bursting out again, destroying then red blood cell in the process. The sudden destruction of lots of red blood cells, plus the debris and waste products left behind by the malaria parasites, stimulate a rapid immune reaction, which itself causes the rapid spike of fever. The characteristic cycles of fever sometimes seen with malaria sufferers occurs because the malaria parasites synchronise their emergence from the red blood cells. The destruction of red blood cells, together with concurrent physiological changes associated with immune response and inflammation, can also lead to decreased haemoglobin levels and anaemia.

More severe clinical symptoms are often seen with P. falciparum malaria infection, particularly if not promptly diagnosed and treated. This is because the P. falciparum parasite infects a red blood cell, it changes the surface of the cell and makes it “sticky”; when the red blood cell then tries to pass through the small blood vessels that lead into the body’s organs, it becomes stuck. This process is known as “sequestration”. If enough red blood cells become sequestered in the organs, it can reduce blood flow to the organ, resulting in oxygen deprivation. When this happens in the blood vessels in the brain, the patient may experience impaired consciousness, confusion and even coma and death—this manifestation is known as “cerebral malaria.”

Malaria Testing

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QUESTION

My daughter is in Kigoma, Tanzania and has the symptoms of Malaria. She was given Duo Cotecxin and it seems to have started making her feel better. But after reading up on all the different types of Malaria parasites I am wondering if a blood test reading at a clinic would be recommended or is it too late for an accurate reading now that she is on meds?

ANSWER

I am always very nervous about people given malaria medication without a proper blood test-based diagnosis. The symptoms of malaria can sometimes be very general, and I have recently seen some data from elsewhere in Tanzania whereby clinics are giving virtually everyone who comes in with a fever malaria medication, even if the blood tests are negative! This is a sure way to develop resistance to malaria drugs, plus exposes people to the potential side effects of medication that they may not need, while also failing to diagnose or treat them for whatever other condition they may also have.

In your daughter’s case, since she is feeling better, it may be that she did indeed have malaria. Regardless, now that she is taking the treatment, she should make sure to finish the full dose of pills. It still could also be worth going in for a blood test. In any case it will put your mind at rest, and if there are still traces of the parasite in her blood, then you will know for sure that she had malaria. Moreover, it might tell you which type of malaria she had. While P. falciparum is the most common form of malaria in sub-Saharan Africa, cases of other types, such as P. vivax and P. ovale, are being reported more and more frequently.

These two types can form liver stages (called hypnozoites) which can stay dormant for weeks, months or even years after the initial infection. During this period, the patient will experience no symptoms; then, when the hypnozoites activate and re-enter the blood again, the patient will get a “relapse” of the malaria symptoms. The only drug available to kill these liver stages is primaquine; as such, if your daughter is positively diagnosed with P. vivax or P. ovale malaria, she should be aware of the possibility of a relapse, and perhaps discuss with a doctor the possibility of taking primaquine.

I hope she recovers fully and enjoys her stay in Kigoma—I spent almost a month out there last year!

What is the Meaning of the Word “Malaria”?

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QUESTION

The word malaria comes from two medievial Italian words meaning?

ANSWER

Malaria comes from “mal” and “aria,” which means “bad air.” Before the parasite that caused malaria was discovered, people thought the disease was caused by foul air, and associated it with marshes and low-lying swamps. They were not 100% wrong—those areas are perfect breeding grounds for the mosquitoes which transmit malaria, and so infection often occurs in and around these areas.

Duo-Cotecxin and Fansidar as Treatment

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QUESTION

My husband weighs and has malaria. He was told by the pharmacist to take 2 tablets stat, then 1 daily for five days followed by 3 Fansidar tablets. We live in Papua New Guinea. I see on the Duo-Cotecxin web site the dose is three tabs daily. Which is correct?

ANSWER

Fansidar is a very different drug to Duo-Cotecxin—it is made of a combination of sulfadoxine and pyrimethamine, whereas Duo-Cotecxin is an artemisisin-based combination therapy (ACT), consisting of dihydroartemisinin together with piperaquine. As such, the dosages and time courses of therapy are likely to be different. However, Fansidar is not usually recommended as treatment anymore—it appears to have low efficacy against Plasmodium vivax and in the 1980s and 1990s, the World Health Organisation and Center for Disease Control (CDC in the US) only recommended it for use against chloroquine-resistant P. falciparum.

However, nowadays, both organisations recommend ACTs (like Duo-Cotexcin) to treat all uncomplicated P. falciparum infection as well. Therefore, unless your husband has been diagnosed with P. ovale or P. malariae malaria (both of which are sometimes found in PNG), Fansidar probably should not have been the first-line treatment given to him. Keep a close watch over his recovery, and if there is any sign of reccurrence of the symptoms, go back to the doctor for another malaria test.

How can I get malaria pills?

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QUESTION

I do have symptoms of severe malaria. How can I get malarial pills in Holland? I went to the hospital the doctors said nothing is wrong with me which is not true.

ANSWER

If you have the symptoms of severe malaria (high fever, chills, nausea, body aches) then you should go to an emergency room at a hospital immediately.

Malaria infection can be very serious if not treated promptly and with appropriate medicine. You must inform the doctors of your travel and medical history. Malaria is not transmitted in Holland so you must have been infected elsewhere.

Tell the doctors in particular if you have recently (in the past month) travelled to an area where malaria is transmitted (sub-Saharan Africa, South America, some parts of Central America, Haiti, Central Asia, South-East Asia, many of the Pacific Islands). I am certain that if you truly have the symptoms of severe malaria they will not turn you away from the hospital, and especially not if you make it clear that you may have been at risk for malaria.

However, if you have not travelled to malarial areas recently, then it is much less likely you have malaria. However, some forms of malaria can “relapse” after a long dormant period. If you have had malaria previously, and have suffered these relapses, then this is also very important information to tell your doctors.

It is important to take anti-malarial medication only if you have had a blood test to confirm that you have malaria. The symptoms are general enough that they are often mistaken for malaria when they are in fact caused by another disease. Moreover, in most parts of Europe, it is difficult to get malaria medication without a prescription.

It is very important that you visit an emergency room, hospital or your doctor as soon as possible to get tested for malaria and given the appropriate treatment if indeed you test positive for malaria.

Sexual Transmission of Malaria

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QUESTION

Can malaria be transmitted by having sex with an infected person?

ANSWER

No. Malaria cannot be transmitted sexually. It is only present in the blood and in certain organs such as the liver and spleen. As such, it is usually only transmitted via the bite of an infected mosquito, though in rare cases, it can be transmitted directly via blood transfusion, organ transplant or via the placenta during pregnancy (called congenital malaria).

Malaria Causes

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QUESTION

What are the causes of malaria?

ANSWER

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Please see “Malaria Symptoms and Causes” for more.

Repeated Malaria

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QUESTION

Since January 2011 I got three times malaria. Is it come regularly? Last week also I got maleria and I took medicine but still I have mild headache and sweating feeling tiredenes in between..

ANSWER

The timing of the repeated malaria episodes you have experienced means that it could be recrudescence (where treatment does not completely kill all the malaria parasites in your blood), relapse (where the malaria goes dormant in your liver, then comes back—this is only caused by Plasmodium vivax and Plasmodium ovale malaria) or even re-infection.

However, first of all, the most important thing is to make sure you are properly diagnosed with malaria and secondly, that you receive the right type of treatment for the kind of malaria that you have.

The symptoms of malaria are very general (fever, chills, nausea, tiredness, aches) and can also be caused by many other illnesses and diseases. As such, in order to confirm you actually have malaria, you should have a blood test (thick and thin blood smear, looked at under the microscope by a trained technician, or a rapid diagnostic test (RDT). In some places you can buy these RDTs from local pharmacies and do the test yourself at home).

Depending on where you live, there may be different types of malaria present; in this case, if you do have malaria, it is important to find out which one you have.

P. falciparum is the most common kind in sub-Saharan Africa and first-line treatment is an artemisinin-based combination therapy, such as Coartem – most areas have P. falciparum that is resistant to chloroquine, so this is not appropriate as treatment, nor are sulfadoxine and pyrimethamine combinations (such as Fansidar).

If you have P. vivax or P. ovale, chloroquine may be used, again depending on where you are and whether resistance is known from your area or not. In addition, you might also talk to your doctor about taking primaquine to prevent future relapse and recurrence of the infection.

Repeated re-infection can be prevented by protecting yourself more thoroughly against getting bitten by an infected mosquito. For example, you should sleep under a long-lasting insecticide treated bednet, screen your windows and doors and wear long-sleeved clothing at night and in the evenings. Indoor residual spraying, which coats your walls with insecticide, can also prevent mosquitoes from persisting inside your home.

Information About Malaria

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QUESTION

What is malaria?

ANSWER

Malaria is a serious and sometimes fatal disease caused by a tiny parasite that commonly infects a certain type of mosquito (of the genus Anopheles) which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness. Four kinds of malaria parasites can infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. Infection with P. falciparum, if not promptly treated, may lead to death. Although malaria can be a deadly disease, illness and death from malaria can usually be prevented.

Test for Malaria?

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QUESTION

Is there a way to verify that someone has had malaria? I had symptoms that were treated with only 10 days of proper 14 days prescription and had a relapse a year later. Have felt weak and keep my drinking to a very light level as a result. Is there test that can be taken to verify having/had plasmodium vivax?

ANSWER

The best way to test for relapsing malaria (i.e. Plasmodium vivax or Plasmodium ovale) is via a blood test while you are experiencing a recurrence of symptoms. Symptoms are associated with the parasite re-entering the blood, and so at this point, they can be visualized on a blood film, or their proteins detecting using a rapid diagnostic test. Other than that, you could also investigate having a serological test done (some forms of these tests are called ELISAs, standing for enzyme-linked immunosorbent assay).

These test for antibodies to specific proteins associated with malaria, and so can be designed to test for a particular strain, such as P. vivax. As antibodies can persist in the blood for weeks or even months after the initial infection has cleared, this could be a way for you to determine whether you had P. vivax without waiting for another relapse. This paper describes the development of a P. vivax-specific serological assay, though I am not sure whether such a test is commercially available as of yet.

If you are diagnosed with Plasmodium vivax, you should ask your doctor about the possibility of taking primaquine to kill the dormant liver stages and prevent future relapse. Primaquine is not recommended for people with G6DP deficiency, so you should be tested for this before taking the medication.