Cyclical Fever

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QUESTION

My husband has been suffering from recurring fever every 3rd or 4th day for the past 7 months. All blood tests are normal, esr ,crp, cultures of urine and blood all normal, chest ct full body pet heart echo all normal. Tested positive for montoux and quantiferon gold, with no symptom other than fever, was put on ATT on 4th JULY 2011 fever persists with no other symptoms. Has been on ATT for more than 4 months with no respite and as per doctor TB is ruled out but 6 month course mandatory. Please help. Fever comes with mild chills and head ache at times.

ANSWER

Cyclical fever every few days is one of the characteristic signs of malaria, and the length of the cycles can help identify the type of malaria. Specifically a fever every three days is indicative of Plasmodium malariae infection, which also fits with the long, chronic persistence of the illness.

This parasite can be hard to diagnose as it is often present in low concentrations in the blood. If you haven’t had a blood film done already, ask your doctor to make a thin and thick blood film to look for the presence of Plasmodium malariae in your husband’s blood.

If the first films are negative, continue with daily films for a further 2 or 3 days. Another diagnostic option is a rapid diagnostic test, which can detect antibodies to the malaria parasites in the blood. P. malariae is easily treated with chloroquine.

Unfortunately, without further information and a more complete medical history it will be impossible to make a further diagnosis of your husband’s condition, but certainly checking for Plasmodium through a blood test would be a good first step.

Malaria Symptoms, Cures, and Prevention

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QUESTION

What is malaria cure, prevention, symptom and course?

ANSWER

I am not sure what you mean by “course” – however, links to information on malaria treatment, prevention and symptoms can be found on the main page of our website. For your convenience, I have provided them here:

As for malaria treatment, I have copied here an earlier answer in response to a question about malaria cures:

Malaria can be cured with a number of different medications, depending on then type of malaria and how far the disease has been progressed.

For standard, non-complicated Plasmodium falciparum malaria, the World Health Organisation recommends use of artemisinin-based combination therapies (ACTs), such as Coartem. This is due to increasing levels of resistance to chloroquine in many parts of the world. Indeed, even though chloroquine is still used in many places as first-line treatment against P. vivax, P. malariae, P. ovale and P. knowlesi uncomplicated malaria, there is some evidence that resistance to this treatment is also emerging, for example in P. vivax in parts of south-east Asia.

In cases where malaria infection has progressed to a stage where oral administration of medication is not possible, or where cerebral symptoms are suspected, the usual treatment option is intravenous quinine.

In addition, P. vivax and P. ovale malaria parasites are able to produce forms (called hypnozoites) which can become dormant in liver hepatocyte cells after the blood stages of the infection have been cleared. These dormant forms can become reactivated weeks or even months or years after the initial infection, which is called a “relapse” of the infection. One drug, called primaquine, is able to kill these liver stages, and so patients with either of these types of malaria should also discuss the possibility of taking primaquine.

Apart from these first-line treatments, there are other medications which are used against malaria, both prophylactically as well as for treatment. These include orally-administered quinine, pyrimethamine, mefloquine, proguanil, atovaquone and sulfonamides.

 

Malaria Symptoms When Underweight

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QUESTION

Can symptoms appear earlier when you are underweight?

ANSWER

The timing of the presentation of symptoms depend on the intensity of the infective dose, the type of malaria, your levels of natural immunity and whether you were taking anti-malarial medication. Your weight is unlikely to affect the timing of the disease, though other medical conditions, such as immune status, which can be  associated with low weight might impact your ability to fight the disease.

Artemether, Lumefantrine Given with Ceftriaxone

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QUESTION

Can ceftriaxone be given with artemether/lumefantrine for treatment of malaria?

ANSWER

As far as I know, there are no known interactions between cefriaxone and artemether/lumefantrine, and no specific contraindications. However, you should consult with a physician before taking both in combination.

Also, since ceftriaxone is usually used to treat bacterial infections, it may be that it is a better to treat the malarial infection and the concurrent bacterial infection one at a time, as heavy antibiotics in addition to the anti-malarials may stress the immune system and liver of the patient unnecessarily, particularly if the patient is already weakened.

Which Anti Malarial for South-East Asia?

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QUESTION

We are in our 70s and will be on a cruise from Siem Reap to Ho Chi Minh. Which anti malarial would be most effective for these areas?

ANSWER

The main thing to consider when travelling to south-east Asia is that there are areas where some of the malaria is resistant to mefloquine (commonly sold as Lariam), and therefore this drug is not appropriate as an anti-malarial in these regions.

Chloroquine resistance is also rife throughout the region, although this drug is rarely used as a malaria prophylactic drug. However, apart from this, the choice of anti-malarial depends to a large extent on personal preferences.

The two main types recommended by the CDC for travel to south-east Asia are atovaquone-proguanil (marketed commonly as Malarone) and doxycycline. The former is associated with very few side effects, is taken once a day, and needs to be taken for a week after returning from the malarial area. However it is also very pricey! Doxycycline, on the other hand, is very cheap, but many people experience high sun sensitivity which can lead to severe sun burn if sufficient care is not taken. It also has to be taken for a full four weeks after returning from the malarial area.

Malaria Deaths in the Tropics

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QUESTION

What’s the difference of malaria deaths between the subtropical and tropical regions and all the other regions?

ANSWER

I am assuming you are asking about the distribution of deaths caused by malaria between the tropics/sub-tropics and the rest of the world.

95% percent of all fatal malaria cases occur in sub-Saharan Africa, which lies entirely in the sub-tropics and tropics. Additionally, most of the deaths occur in Central, West and Eastern Africa (North Africa and South Africa have more advanced malaria prevention and control initiatives to the rest of the continent, and transmission is also less severe), and the other 5% of malaria deaths are mostly found in India and south-east Asia, so you could say that virtually all deaths due to malaria occur in tropical regions alone.

Indeed, there is almost no malaria in non-tropical or sub-tropical regions; the few cases each year in North America and Europe are usually due to imported cases from people who have traveled to tropical or sub-tropical regions.

What happens after you get malaria?

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QUESTION

What are the after effects of malaria?

ANSWER

In almost all cases, if malaria is diagnosed accurately and treated promptly, patients make a full recovery with no after effects. In some cases of severe malaria, the disease can develop into cerebral malaria, which can result in impaired mental function, loss of consciousness and coma (and, if untreated, even death). Again, if treated promptly, these effects should reverse, but in some cases, some neurological damage remains.

Similarly, children who are affected by malaria while still in the womb or during birth (“congenital” malaria) may experience low birth weight or retarded growth, which can have health implications later in life.

How to get malaria?

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QUESTION

How do we get 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.

Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery (“congenital” malaria).

Lariam Side Effects

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QUESTION

How long does it take for the side effects of Lariam to disappear?

ANSWER

The manufacturers of Lariam report that it can take a “long” time for side effects to disappear, though they don’t specify an exact time frame.

While most people cease to experience side effects within a few days or weeks of stopping taking the drug (the half-life of the medication in the body is about 2-4 weeks), some people report side effects continuing for a period of months, and in a few rare cases, even years.

In order to minimise the occurrence of disturbing or even dangerous side effects, Lariam is not recommended for people with a history of depression or mental illness, or with heart or liver troubles. The physical side effects of Lariam can be just as dangerous and long-lasting as the more famous psychiatric side effects; in particular, long-term balance problems have been reported.

Is it Malaria?

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QUESTION

I was in Zambia 3-4 weeks ago and had yellow fever shot and malaria pills. A week ago I got a severe headache. I suffer from migraines now and then but it wasn’t one. The headache has not passed. 4 days ago I was feeling really ill. I was extremely tired and disorientated. I am nauseated, but not all the time. Have no appetite. I generally feel ill, like something isn’t right. Exhausted and almost confused. I just don’t have a fever and haven’t had the entire time—that’s why I haven’t been to doc for tests. Is having a fever the main symptom for Malaria? I am not pregnant and am generally a very healthy person.

Not sure if I should go for tests or just wait a few more days?

ANSWER

Fever is certainly a key symptom associated with malaria, due to the way the disease progresses through the human body. However, if you were taking malaria pills, it might be that they suppressed the infection sufficiently to reduce your symptoms. I would certainly recommend having a malaria test, if just for peace of mind. If you test positive you can immediately be treated, and if you are negative and still feeling unwell, you can discuss other possibilities with your doctor. One thought might be worm infections – helminths such as hookworm, roundworm (Ascaris or Strongyloides) or whipworm are very common in Zambia and are associated with symptoms of tiredness, listlessness, headache and nausea. The tests for these diseases are usually easy to perform from either a stool sample or blood test, and treatment is likewise very straightforward, with a single dose of albendazole or mebendazole for Ascaris, whipworm and hookworm, and a series of doses for Strogyloidiasis (this parasite can be harder to get rid of, though it is still very treatable. Ivermectin is another possible drug for this helminth).