Diagnosing Malaria

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QUESTION

Where in Malaysia (Kuala Lumpur) can I diagnose malaria? Is it possible within 24 hours?

ANSWER

Given that malaria is endemic in Malaysia (though not usually found in Kuala Lumpar) you should be able to get a malaria test at most clinics or hospitals. The most common test is a thick and thin blood film, read under the microscope by a qualified technician—in some places, clinics are also using rapid diagnostic tests (RDTs). Both of these methods are rapid to prepare and analyse—microscopy may take a couple of hours, depending on the business of the medical staff, whereas an RDT should be ready in about half an hour. In some areas, you can also buy RDTs over the counter at a pharmacy for self-testing.

Malaria Transmission Through Sexual Contact

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QUESTION

Can i get malaria if i have sex with someone that has malaria?

ANSWER

No. Malaria cannot be sexually transmitted. In virtually all cases, malaria is transmitted through the bite of an infected mosquito, of the genus Anopheles. The mosquito passes the malaria parasite (there are several species which cause malaria in humans, all of the genus Plasmodium) through its saliva when it feeds on blood. Only female mosquitoes feed on blood, and so only females transmit malaria. The mosquito picks up malaria also by feeding on blood, this time from someone who already has the infection.

The only other ways to get infected with malaria are through blood transfusion, organ transplant and via the placenta during pregnancy (“congenital” malaria), and these are all very rare, particularly as blood and organ donors are now usually screened for malaria infection prior to transfusion or transplant.

If you have taken medications for malaria, please help Malaria.com by taking our Malaria Medication Side-effects Survey: Treatment and Prophylaxis. Thank you!

Mosquitoes and AIDS

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QUESTION

Can mosquito cause AIDS, and why?

ANSWER

No, HIV (the virus that causes AIDS) cannot be transmitted via mosquitoes. When the virus was first discovered, there was a fear that it could be transmitted via the blood ingested by mosquitoes as they feed between humans. However, it was shown very quickly that the virus was too unstable to survive within the mosquito, and so transmission of HIV is limited to direct transfer of blood, semen, vaginal fluid and breast milk, for example during sharing of intravenous needles, unprotected sexual activity and childbirth.

Post Malaria Auto-Immune Disease

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QUESTION

I contracted P. Malariae while on a Humanitarian trip in El Salvador in 1996, despite taking the Doxycycline prophylaxis. The diagnosis was difficult, as my fever never broke 100 deg F. A sample of my blood was eventually sent to the CDC to confirm the suspicions of my Dr, who just couldn’t prove the dx by smear. The titer came back positive 1. Now to my question. Have you come across any cases of post-malarial auto-immune disorders or cluster-type syndromes?

About a year and a half. After my initial infection, I developed severe hand joint pain that progressed to much of the rest of my body. At the time, RNP/anti-RNP tests were positive, with elevated sed rates, but negative ANA & RF tests. Now those tests are all “wnl,” but I have some form of “agressive osteoarthritis,” DDD, Spinal stenosis/osteophytes/spinalolisthesis w/nerve damage, and the catch all “Fibromyalgia” along with it’s cluster symptoms.

I would be so very, very grateful if you could point me in the right direction of a study, more information, a Dr who has experience with tropical diseases, or any other information that might net me some answers. I am so tired of being tired and in pain. I shouldn’t need knee replacements and 2 discectomies with a double lumbar fusion at 44. Sadly, I’ve already had one in my neck & may need more. I feel like my life was stolen by a mosquito—the deadliest creature on Earth.

ANSWER

I do not believe there is any relationship between the malaria and these symptoms or with any autoimmune diseases.  Although it sounds like your P. malariae infection was a bit difficult to diagnose it is very easy to treat.  There is no known drug resistance and so any of the recommended treatment courses should have cured you of the infection.  If you subsequently developed an autoimmune disease, it is most likely just a coincidence.  Untreated P. malariae infections can become chronic and result in late complications such as renal failure but that is not the case here.

Malaria Test for Infant

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QUESTION

What can I do if my infant (6-12 months) gets malaria and how can I tell if they have it?

ANSWER

Your infant can easily be diagnosed by a blood test, so visit a clinic, doctor or hospital immediately. The diagnosis will either be done by looking at a thick and thin blood film under a microscope, or by a rapid diagnostic test.

It is important that a blood test is done in addition to a clinical diagnosis—the symptoms of malaria are very similar to many other infections but the treatment may vary. If found to be positive for malaria, the doctor will recommend appropriate treatment and dosage for the type of malaria they have and their weight/age.

If you live in a malarial area, it is also important to take measures to prevent malaria, such as having your child sleep under a long-lasting insecticide treated bednet, and perhaps spraying your rooms in the evening with insecticides to reduce the number of mosquitoes.

Community Control of Malaria

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QUESTION

how can the community can control malaria through personal protection?

ANSWER

That’s a very good question. One of the most effective known ways for reducing infection with malaria is through the use of long-lastong insecticide treated bednets. Sleeping underneath one at night drastically reduces the chance of being bitten by the Anopheles mosquitoes that transmit malaria.

Other personal protection measures include indoor residual spraying (IRS) with insecticides, which reduces the number of mosquitoes inside houses and also prevents infection. These protection methods protect individuals and families from malaria, but they also can assist in interrupting transmission—that is, if enough families use bednets and do IRS, the whole community may benefit from reduced numbers of mosquitoes that are carrying malaria.

Estimates of the level of bednet or IRS coverage required for community benefits to occur vary based on the region and the local strength of transmission (Killeen et al. reported coverage ranging from 35%-65% as adequate for detecting community-level benefits. This was published in the journal PLoS Medicine in 2007). However, most organisations are advocating attempting 80% coverage of bednet use—therefore, large efforts are being made to increase current bednet coverage and IRS efforts, especially in sub-Saharan Africa where the highest number of cases and the highest mortality rates are observed.

Treating Headache Pain

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QUESTION

Is it ok to treat with NSAIDs or aspirin, or is paracetamol preferred?

ANSWER

If the question relates to headaches caused by malaria, then yes, most over the counter analgesics (pain relievers) can be used to treat the headaches and joint pain associated with malaria. Paracetamol may also assist in reducing fever.

Blood Test for Malaria

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QUESTION

I would like to know whether the malaria prevention medicine could impact the blood test result for malaria?
For example, if we did a blood test after taking the malaria prevention medicine, will the blood test result could be positive because of that and we are actually not having malaria parasite inside our body?

ANSWER

Malaria preventative medication should not give you a false positive test result – in other words, if you are on malaria medication and take a malaria blood test, if it says you are positive, then you probably have malaria! Anti-malaria medication prevents malaria from establishing in your blood, and it is very effective if taken correctly, but there are instances in which someone taking anti-malarials still gets malaria. In these cases, the anti-malarials will often ensure than the severity of the infection is greatly reduced – it can also delay the onset of symptoms.

If you have taken medications for malaria, please help Malaria.com by taking our Malaria Medication Side-effects Survey: Treatment and Prophylaxis. Thank you!

How Many People Have Died from Malaria?

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QUESTION

How many people have died from this disease today? (2011)

ANSWER

Estimates for the number of annual deaths from malaria vary, and are not very accurate since they depend heavily on the quality of reporting. Since the majority of people who die from malaria are in sub-Saharan Africa, and often far from decent health facilities, it can sometimes be difficult to determine whether someone died of malaria or some other cause. The latest data available are for 2010 (2011’s statistics will be published some time in 2012): World Health Organisation estimated that last year approximately 655,000 people died from malaria, which was a decrease of 39,000 from 2009 and a drop of 25% from 2000. It is expected that the number of deaths will continue to fall in 2011. Organisations such as Malaria No More are dedicated to ending all deaths from malaria by the year 2015.

If you have ever taken anti-malaria medication, please take Malaria.com’s brief Malaria Medication Side-effects Survey: Treatment and Prophylaxis.

Malaria Prevention

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QUESTION

what is the prevention of malaria?

ANSWER

There are many ways in which to prevent malaria. I’ll break them down into three categories: 1) medical prevention, 2) protection from getting mosquito bites and 3) vector control.

1) Medical prevention

Malaria can be prevented using certain medications. Taking drugs to prevent a disease is known as “chemoprophylaxis”, and so these drugs are often referred to as “malaria prophylactics”. There are several different types of malaria prophylactic: the most common ones are chloroquine, a mix of atovaquone and proguanil (marketed as Malarone), mefloquine (marketed as Lariam) and doxycycline. The mode of taking these medications vary (Lariam is taken once a week, for example, whereas the others are usually taken once every day), and they also have different restrictions and side effects. Chloroquine is not effective in areas where local forms of malaria have become resistant, for example, and Lariam is not recommended for people with a history of mental instability, as it is known to cause hallucinations and otherwise impair consciousness. Here on Malaria.com, we are actually currently running a survey on side effects of malaria prophylactic drugs, so if you have ever taken medication to prevent malaria, please take the survey: Malaria Medication Side-effects Survey: Treatment and Prophylaxis

It is worth noting that these drugs have not been tested for long term use, plus they can be expensive if taken for an extended period of time. As such, they may not be appropriate for people living in endemic areas for malaria. However, medication can be useful for preventing malaria in high risk groups, even when they are living in a malaria endemic area. One example is the use of intermittent preventive treatment (IPT) for preventing malaria infection in pregnant women, infants and young children. For more information on this, please see the review article written by Dr Felicia Lester for this website: http://www.malaria.com/research/malaria-pregnancy-preventive-treatment

2) Protection from getting mosquito bites

This section links in with the more general vector control strategies, which will be discussed below. Since malaria is transmitted through the bite of infected mosquitoes, preventing mosquito bites is a very effective way of reducing malaria incidence. One of the most popular methods for personal protection, especially in areas where malaria is endemic, is through sleeping under a mosquito bednet. The mesh prevents mosquitoes from being able to fly close to the person sleeping; however, if there are holes in the net, or the person skin is pressed directly against the mesh, the mosquito may still be able to bite them. This is where insecticide-treated bednets come in – they are impregnated with mosquito repellents to stop mosquitoes from biting through the mesh or passing through holes. Newly developed long-lasting insecticide treated bednets (LLINs) are even more effective, in that they don’t require “re-dipping” to maintain the level of repellent in the fibres, and so can protect a person for several years without losing efficacy. These LLINs have been instrumental in reducing cases of severe and fatal malaria, especially among pregnant women and young children, who are often targeted by bednet distributors.

Other methods for preventing mosquito bites include wearing long-sleeved clothing and personal application of mosquito repellent, particular those containing a percentage of DEET, which is a very effective insecticide. These measures should be especially taken in the evening, early morning and at night, which is when the Anopheles mosquitoes that carry malaria are most active.

3) Vector control

Finally, malaria can be prevented from reducing numbers of mosquitoes directly. Some methods target the adult mosquitoes; one such initiative is indoor residual spraying (IRS), whereby the inside of a house is sprayed with an insecticide to kill mosquitoes. Twelve different insecticides are approved by the World Health Organisation for this purpose, though pyrethroids are among the most popular, as they can be used on a variety of surfaces, do not leave a visible stain and can also protect against other insect pests, such as bedbugs.

Other methods for vector control focus on other parts of the mosquito lifecycle. Mosquito larvae require stagnant freshwater for their development, so some projects have worked to eliminate standing water sources, such as unnecessary ditches and puddles, which reduces the amount of habitat available for mosquitoes to lay their eggs and sustain larvae. Other programmes have spread insecticides directly in stagnant water to kill the larvae, or sought to introduce fish or other aquatic organisms, such as copepods, which consume mosquito eggs and larvae. This latter biological control approach is popular because it can also supply an area with fish for local consumption, and doesn’t contaminate water sources with chemicals.