Malaria Relapse

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QUESTION

Why do I suffer from constant malaria attack? The doctor has prescribed different prescriptions every time I get an attack but its still coming back. What could be the problem?

ANSWER

There are a number of possible answers to your question. First of all, your doctor might not be prescribing the right type of treatment for the type of malaria that you have. The World Health Organisation now recommends that all uncomplicated cases of malaria should be treated with artemisinin-based combination therapies (ACTs), such a Coartem. However, in some places, doctors still prescribe other drugs, such as Fansidar or chloroquine. This can be a problem, as in many areas, the local kinds of malaria have become resistant to these earlier drugs, and so you may not be cleared of the infection. This is called recrudescence—when a malaria infection is not cleared completely from the blood and so symptoms come back once the treatment has stopped.

Alternatively, if there is a longer time interval between your episodes of illness, you may be suffering from relapses. This occurs with two particular types of malaria: Plasmodium vivax and P. ovale. These types of malaria can form liver stages which remain dormant even after the treatment you take kills all the malaria in your blood. Therefore it will appear like you have been cured, but really you still have an infection in the liver.

These liver stages can re-activate and re-enter the blood, causing another episode of malaria symptoms months or even years after the initial infection. If your doctor finds that you are positive for one of these two types of malaria, you should talk to him/her about the possibility of taking primaquine. This drug kills the liver stages of the parasite, but is not appropriate for people with G6DP deficiency, so you should be tested for that first.

Finally, there is the possibility that you are continually being re-infected with malaria. In this case, you should take more preventative precautions. For example, sleep under a long-lasting insecticide-treated bednet, wear long-sleeved clothing (especially at night) and cover exposed skin with insect repellent. All of these measures will help prevent mosquito bites, which transmit malaria. In addition, you could consider indoor residual spraying, which coats the walls inside your house with insecticide to further eliminate the presence of mosquitoes.

When to Seek Malaria Treatment

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QUESTION

I have been in New Guinea recently and 2 weeks on am exhibiting all the signs and symptoms of malaria. What is best course of action, considering I do not know what sort of mosquito was hovering about?

ANSWER

You should visit your physician or a clinic immediately. Depending on where you are, you may have to visit a specialist travel medicine clinic, to be sure that you will be seen by someone who understands how best to diagnose malaria. They should take blood and examine it under a microscope (using thick and thin blood films), or they may utilise a rapid diagnostic test. Either way, they will be able to determine whether you have malaria and if so, which type of malaria you have. 

This is important because some types of malaria, such as Plasmodium vivax (which is very common in PNG) can remain dormant in the liver after the initial infection has been treated, which leads to relapses months or years later. In order to prevent relapses, if you find you are infected with P. vivax you should inquire about the possibility of also being given primaquine, which is a drug that can kill these liver stages.

Frequent Urination and Malaria

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QUESTION

Can malaria result in frequent urination, especially during night?

ANSWER

Malaria can affect the kidneys, especially malaria caused by P. falciparum. This could result in changes to urination patterns. However, at this stage in the infection, the patient would also be experiencing severe fever, chills and other symptoms associated with malaria. The fever would also likely be causing dehydration if the patient was not taking on sufficient fluids, which would result in less frequent urination.

Can malaria be dormant for years?

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QUESTION

My child (age 5 at time) was bitten by something in Mexico that looked like a mosquito bite. About 7 days later we were home in the US and she developed high fever, headache, chills,sweating at night, extreme fatigue,abdominal pain, and swollen lymph nodes in neck. She had a fever for 40 days! I took her to the pediatrician almost every other day and had immediately informed them of the bite in Mexico and asked if they could test her for malaria. They laughed at me and said that is not high malaria area.

Her wbc was 30,000ish and liver enzymes 1000–tons of other blood work got lost. I had researched and agreed but told them it still exits there even if it is low. So 3 years later she still has swollen lymph nodes in neck that are bigger and now in the axillary and groin area, always sweats in the middle of the night, pale, and very tired. Dr. tells me not to worry about the lymph nodes but it is hard not to. I have bypassed her finally and talked with an infectious disease doctor that suggested we get a lymphnode biopsy. We have an appt w/an hem/onc Dr in 5 days. If they were to biopsy a lymph node could it show Malaria this late or would it have to be the liver or could they do a blood smear this late? She also has had low amounts of myoglobin in her urine for about a year.

ANSWER

I replied to an earlier version of this post—reading your subsequent details, I think it is unlikely that the cause is malaria, but rather an infection or indeed another disorder which would result in elevated WBC and enlarged lymph nodes. A biopsy at this stage would not be able to diagnose malaria—a blood test would only reveal an active, blood-borne infection, which would be associated with high fever and other “typical” malaria symptoms. If your daughter is experiencing these (though fever/sweats at night are not particularly associated with malaria), a blood test could put your mind at rest by eliminating malaria as a cause. However your pediatrician will be better placed to discuss other possible diagnoses which correspond to the symptoms.

Is malaria infectious?

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QUESTION

Is malaria infectious or noninfectious?

ANSWER

Malaria is considered an infectious disease because it can be transmitted from one person to another, via the bite of an infected mosquito. Since the parasite that causes malaria is passed through the blood, it can also be transmitted via organ transplant, blood transfusion, or via pregnancy (so-called “congenital” malaria).

Malaria Medicine for Pregnant Women

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QUESTION

What medicine can be given to a pregnant woman who has malaria?

ANSWER

The type of anti-malarial that should be given to a pregnant women depends on the type of malaria they have, its severity and how long she has been pregnant. Chloroquine, quinine and artemisinin-derivatives can be given during all trimesters, but in many places malaria is resistant to chloroquine.

In general, the World Health Organisation recommends ACTs (artemisinin-based combination therapies) as the first line treatment against uncomplicated malaria. Mefloquine and pyrimethamine/sulfadoxine are able to be given the second and third trimesters; again, in some areas, resistance to mefloquine has been detected. Moreover, some people are allergic to sulfas, and so pyrimethamine/sulfadoxine would not be appropriate for these patients. Primaquine, doxycycline and halofantrine are contraindicated during pregnancy.

Do malarial drugs engender joint pains?

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QUESTION

I am now over 50 and I lived all my life in Africa during which time I have had a considerable incidences of malarial attacks. Each time I took any anti-malarial drug I experienced some side-effects including blurred vision, fatigue and joint pains. The pains especially have since become a permanent part of me and even severe enough to hamper my mobility. Does my condition sound to have any relationship with the several quantity and varieties of anti malarial drugs that I took almost all my life?

ANSWER

There are no known long-term side effects to taking modern anti-malarial drugs. However it could be that you have had a reaction or allergy to the specific kind of anti-malarials you have used in the past. For example, quinine sulphate is associated with joint pain in rare cases. However, in Africa these days, the World Health Organisation recommends only the use of artemisinin-based combination therapies (ACTs, such as Coartem) as the first-line treatment for malaria. The side effects of ACTs tend to be mild, and limited to nausea, dizziness and vomiting. As far as I am aware, joint pain and blurred vision have not been reported as side effects.

We at Malaria.com are very interested in hearing people’s experiences with antimalarial medication, so we would be very grateful if you would take the time to complete a survey on malaria treatment which we are running on the website. Thank you!

Malaria’s Impact on Tourism

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QUESTION

How is malaria’s impact on tourism?

ANSWER

These days, with effective preventative measures such as prophylactic medication and long-lasting insecticide treated bednets, the risk of contracting malaria as a tourist is greatly reduced. However, there is some evidence that the risk of contracting malaria is a deterrent for some tourists, particularly during high transmission periods of the year, in certain places.

For example, in South Africa, a group of researchers surveyed tourist facilities in KwaZulu-Natal and found that risk of contracting malaria was the major cause behind lack of bed occupancy. Improving tourists’ awareness of how the disease is transmitted and ways of preventing infection will go a long way to reducing the negative impact of the disease on the tourism industry in malarial countries.

Malaria Recovery Time

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QUESTION

How long does it take to recover from malaria?

ANSWER

A number of different factors affect recovery time from malaria. These include the type of malaria, how quickly treatment is administered and the immune status of the patient. For example, children and pregnant women tend to get much more severe cases of malaria, due to their reduced natural immunity. 

The type of malaria will impact on the severity and length of the infection as well—P. falciparum is the most severe kind, and can result quickly in death if not treated promptly, whereas less rapidly progressing forms of malaria, such as P. malariae, may persist for longer but not cause severe disease. For most cases of uncomplicated malaria, once the appropriate form of treatment is started, the patient will start to recover within a couple of days.