Malaria.com

Malaria and Seizures

by

QUESTION

Is it possible to contract malaria early in life and have a seizure 20 years later?

ANSWER

I think it is highly unlikely. There are only two types of malaria that can reoccur long after the initial infection (Plasmodium vivax and Plasmodium ovale) and neither of these usually results in seizure or other cerebral effects. Looking through the literature, I can only find one case of P. vivax infection which had cerebral involvement (Beg et al., 2002, ‘Cerebral involvement in benign tertian malaria’, published in the American Journal of Tropical Medicine and Hygiene, volume 67, issue 3, pages 230-232).

Symptoms of Malaria

by

QUESTION

What are the symptoms of malaria?

ANSWER

Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.

 

Timing of Malaria Microscopy

by

QUESTION

Contrary to our past beliefs we came to know that malaria slides should be taken during afebrile periods when RBCs remain intact, enabling easier diagnosis of malarial parasites. Is this true?

ANSWER

That is a very interesting question, which I passed on to a diagnostic expert who serves as an advisor to Malaria.com. His response is as follows:

Blood films should be collected from someone who is sick with a febrile illness after they have been in an area where malaria transmission occurs.  That does not mean that the smears need to be collected during particular times during the fever cycle.  If the first set of films is negative they should be repeated every 12-24 hours for a total of 3 sets.  During that time period, in general, the parasitemia if present will be rising—increasing the likelihood of detection.

It is worth noting that blood films are of little to no value as a screening test of asymptomatic travelers.

Blood Test After Child’s Malaria Exposure

by

QUESTION

Our 2 year old son was exposed and bitten about 10 times on Friday, 21st of Ocober in Malindi, Kenya. This was our last day in Kenya after 3 days on the coast preceded by 4 in Masai Mara. On October 28, our son started vomiting. This lasted a day. He did not have a fever at the time. The doctor diagnosed him with rota virus. Our 2 year old took his last dose of Malarone on the same day the vomiting started.

We believe he did not keep it down. Since the doctor visit our son has developed a cough and has had a low constant 38 C fever for a day and a half. Given the risk of a small child to malaria, is there any reason we should not request a blood test for Malaria?

ANSWER

Generally speaking, coughing is not a common symptom of malaria, and fever more usually comes in cycles, so the clinical presentation suggests that your son may be suffering from another illness.

However, as you say, small children are particularly at risk from malaria, so I would say it is worth getting a blood test for malaria, to be on the safe side. It only requires fingerprick blood, and the results can be available very quickly.

It is also important to remember that Malarone (including Malarone Paediatric, the version marketing for children over 11kg in weight) should be taken for 7 days AFTER leaving a malarial area, to prevent latent stages of malaria developing into a full infection.

With small children, other preventative measures are also especially important, such as sleeping under an insecticide-treated bednet, wearing long sleeved clothing in the evenings and early mornings and using insect repellent on exposed skin.

Teen Has Anaemia, Mom Had Malaria

by

QUESTION

I am concerned that my 22 yr old daughter has anaemia (tired & sleepy), possibly caused by Malaria (Katima Mulilo, Namibia), which I contracted just before returning to Cape Town.

I fell pregnant at that time. I was treated at the local hospital before returning home. Could it have affected the unborn fetus? My daughter has a low red blood count.

ANSWER

Congenital malaria occurs when a foetus is infected with malaria from the mother, either through transmission across the placenta or during childbirth. It can cause serious complications for the foetus, including spontaneous abortion, low birth weight and anaemia.

However, I don’t think there is any evidence that anaemia persists later into life—usually congenital malaria only affects newborns a few weeks after birth.

One of our maternal/child health experts says that she knows of one study (mentioned in the Tanzania Journal of Health Research) which suggests that immune priming due to congenital malaria could result in longer term effects in infancy and childhood—however, anaemia is not mentioned specifically and the article emphasises that more study is required to confirm this hypothesis.

Our advisory expert also says that anaemia is common in teenage and pubescent girls, and it is important to confirm the anaemia with a haemaglobin blood test, and get advice regarding improving her diet and perhaps taking iron supplements if indeed she is anaemic.

Malaria with Eye Pain

by

QUESTION

I am having malaria with severe eye pains. What is this?

ANSWER

Have you actually been diagnosed with malaria, or do you just think you have malaria based on the symptoms? If the latter, I would suggest you visit the doctor immediately. Eye pain is not usually associated with malaria (beyond the fact that some headaches manifest behind the eyes), whereas eye pain is a common symptom of dengue fever, which is common in many of the same parts of the world as malaria.

The other symptoms of dengue include fever and nausea and are thus similar to the general symptoms of malaria, allowing them to be mistaken for each other in some cases. If the pain worsens with eye movement, this is also characteristic of dengue fever. A key symptom is the presence of a rash, similar to that of measles.

Diagnosis is usually made based on clinical presentation, so it is crucial you see a doctor or visit a clinic. Other tests, such as a tourniquet test or a white blood cell count, can also assist diagnosis. If necessary, there are also laboratory tests, such as cell culture or PCR, which can be used to confirm the infection.

Post Malaria Symptoms

by

QUESTION

My girlfriend had malaria in Uganda. It was detected 2nd of October, it was mild form, she felt dizzy, temperature was little higher. She got Artefan, forth day she was in hospital for review, they told her from blood test that its not malaria anymore.

We came home (Slovakia) but week ago she had suddenly the same symptoms like she had had the first time—dizziness, pain in head, temperature. Rapid test showed her she has no malaria. But she is still feeling weak, once in five days she suddenly feels dizzy, sometimes temperature 37,3 Celsius (yesterday last time). Doctors found nothing. Could it be some post-malaria symptom or she might have some other infection? Is it normal?

ANSWER

Rapid tests for malaria are usually quite accurate, especially if the patient is experiencing symptoms. Moreover, the cycles of malaria infection are usually shorter, with patients experiencing fever and dizziness every other day (for Plasmodium falciparum, which is the most common kind in Uganda). I would recommend trying a second rapid test, preferably of a different brand, just to check—make sure it detects ALL kinds of malaria and not just Plasmodium falciparum, as while it is the most common and dangerous kind, there are other types in Uganda, such as P. ovale, which might not show up on a P. falciparum-only test.

If you have access to a travel clinic or hospital that has experience in tropical diseases, you could also see if they could do a blood slide and check for the presence of malaria parasites in your girlfriend’s red blood cells.

If a second rapid diagnostic test is negative, or there is no sign of visible malaria parasites in her blood, then I suspect she has some other infection, as continued symptoms are not usually a side effect of successful malaria treatment.

Meaning of DDR

by

QUESTION

what’s the meaning of DDR?

ANSWER

Within the context of malaria and health more generally, “DDR” often refers to “Drug Development Research,” meaning investigation of new anti-malarial compounds, both for malaria prevention (prophylaxis) and treatment.

However, in some health contexts (for example recreational drugs) it can also mean “Drug Demand Reduction,” which is very different. Therefore the specific program in question may determine the meaning of the acronym.

Recurrent Malaria

by

QUESTION

Malaria has been with me since the late 1980’s after 6 years in Malawi.
During the 90’s I had it twice per year in Feb and Sept. Blood tests always came up negative. Treatment was with Chloroquine, later Halafantrin and then Co Artem. 2 or 3 treatments were required as symptoms appeared 2 weeks after completion of initial treatment.

In 2004 I treated with a bodyweight specific dose of Arinate and did not have another bout until 1 week into a Southern Mozambique visit in Aug 2008. (I was on doxycycline as a prophylactic but discontinued due to it causing diarrhoea.) Treatment was with Artecospe (unsuccessful) and CoArtem (successful.) In Nov 2010 after a visit to N Botswana another bout – treated twice with CoArtem.
Sept 18 2011 it struck again. (I have not been near a malaria area since Nov 2010). CoArtem unsuccessful 3 times with Artecospe have not worked and now on Co Arinate.

Have I some resistant strain of Malaria? Does eating during a malaria bout reduce the efficacy of treatment?

ANSWER

So far, no strains of malaria have been discovered to be resistant to Coartem. Moreover, recurrent malaria is only caused by Plasmodium vivax and Plasmodium ovale—neither of these are nearly as common in Malawi as Plasmodium falciparum, which can recrudesce (parasites re-appear in the blood) if not treated appropriately but will not relapse or reoccur months or years after the initial infection—if you have tested positive for malaria in your more recent bouts of illness, you should ask your doctor whether it could be P. vivax or P. ovale.

If it is one of these two species of malaria, you should ask about the possibility of taking primaquine to kill the dormant liver stages of the parasites and prevent future recurrence. You will need to be tested for G6DP prior to being able to take primaquine.

However, since you tested negative in Malawi initially, I suspect you did not have malaria at all at that point, and should have been tested further to determine what was causing your symptoms. Moreover, chloroquine should not have been the first treatment of choice, as resistance is rife in sub-Saharan Africa.

The symptoms of malaria are notoriously non-specific and therefore diagnosis is crucial prior to treatment, as many other infections will present with similar clinical symptoms, such as fever and nausea. Therefore, if you have any further symptoms which you suspect might be malaria, please visit a doctor or travel medicine clinic straight away for a blood test. If it is not malaria, there is no point taking further doses of Coartem or other anti-malarials and further tests might reveal another diagnosis.

Injections for Malaria Treatment?

by

QUESTION

I have a friend that just told me that she has Malaria. She said she has to go to the hospital every day for an injection for around the next 2 weeks. Is this a typical treatment. Why not just take pills? I`m just trying to wrap my head around this and understand the different treatments.

ANSWER

This is certainly not typical treatment for malaria. Uncomplicated malaria is usually treated with oral medication, and the type depends on the type of malaria you have. The most severe form of malaria, Plasmodium falciparum, is often resistant to chloroquine (still the first-line drug of choice for P. malariae, P. knowlesi and P. ovale infections, as well as for P. vivax in most parts of the world) and so first-line treatment is now usually an artemisinin-based combination therapy (ACT), such as Coartem.

As far as I am aware, it is only in cases of complicated, severe malaria that intravenous or intramuscular treatment is used (usually quinine), and in those cases, treatment would not be administered on an outpatient basis. It may be that your friend has a specific medical requirement for a non-oral form of medication, but it is definitely unusual!