Testing for Dormant Malaria

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QUESTION

When malaria is dormant in the body can it be detected in a blood test?

ANSWER

Not directly, no. A normal malaria blood test consists of a thick or thin smear, which is often stained and then looked at under a microscope; with these tests, you would not be able to see any sign of the malaria which is lying dormant in the liver. However, there is another type of blood test, known as serology, which looks for the body’s antibodies against malaria. These are proteins produced by the immune system when the patient becomes infected with malaria. These antibodies are specific to the type of malaria the person was infected with, and can persist for many months and even years. As such, if a patient was infected with one of the types of malaria which can become dormant (i.e. P. vivax and P. ovale), a serology test might be able to tell whether the patient had ever been infected with one of these two types, and then suggest that they might continue to have a dormant infection.

Malaria Treatment Statistics

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QUESTION

Where can I find information on the ratio of malaria cases treated annually globally or per country?

ANSWER

A great resource for information on malaria is the World Health Organisation (WHO). They publish an annual malaria report which also includes lots of statistics about numbers of cases, numbers treated, and numbers of deaths from malaria. Some of the data is even available at the country level, I believe. You can download these reports, and also find out a lot more information about malaria, at the World Health Organisation malaria page.

Malaria or Kidney Infection?

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QUESTION

Two months ago my daughter was in Uganda working and when came back to the States she was hospitalized for 4 days with Malaria symptoms. Her tests came back negative they really didn’t act like they knew how to treat this. They kept telling her they didn’t know how to diagnosis Malaria. So they treated her for it. She now after 2 months is once again hospitalized with the same symptoms. They are telling her they think it is a kidney infection. Can malaria be misdiagnosed as a kidney infection. She once again has all the symptoms as malaria?

ANSWER

What tests did the doctors do to try to diagnose malaria in your daughter when she first got back to the States? Usually, malaria is diagnosed by a blood test, whereby a trained technician will look at the patient’s blood under a microscope. The technician looks for signs of the malaria parasite in the patient’s blood, and if seen, can determine the intensity of the infection as well as the species of malaria. This is important information for accurate treatment. Alternatively, rapid diagnostic tests, which utilize a droplet of blood in a device which looks similar to a pregnancy test, and can very quickly determine whether someone is infected with malaria. It is important to know that malaria cannot be diagnosed by looking at standard blood parameters. If you don’t think your doctors know what is afflicting your daughter, you should take her to a clinic which specializes in tropical or travel medicine. There, they will certainly know how to effectively diagnose your daughter.

Given that your daughter experienced a resurgence of symptoms two months after returning, if she did have malaria, then there are two kinds which she might have: Plasmodium ovale and Plasmodium vivax. The other types of malaria, including the most deadly kind, P. falciparum, are not able to come back and relapse once they are treated. However, in order to prevent future relapses, your daughter may also have to be treated with another form of medication called primaquine. I will emphasize again, however, that it is crucial to gain an accurate diagnosis before taking any form of treatment for malaria.

Medicine for Malaria

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QUESTION

is rotam and maladar malaria medicine?

ANSWER

I have never heard of Rotam, but Maladar is the brand name of a combination sulfadoxine-pyrimethamine, and is used to treat malaria. However, it should be noted that it is not recommended by the World Health Organization as a first-line treatment option, due to concerns about drug resistance, and also lack of efficacy against certain types of malaria.

Instead, first-line recommended treatment is of an artemisinin-based combination therapy, or ACTs, which combine an artemisinin derivative (such as artesunate, artemether or dihyrdoartemisinin) with another anti-malarial drug, such as lumefantrine, piperaquine or mefloquine. Common brand names include Coartem, Lonart and Duo-Cotecxin.

Effects of Malaria

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QUESTION

what are effects of malaria?

ANSWER

If a person becomes infected with malaria, they may start to experience the symptoms of the disease. These include high fever, aches, chills, nausea, headache, and sometimes more severe manifestations, such as severe anemia, impaired consciousness and even coma or death. These latter severe effects are more commonly associated with Plasmodium falciparum infection, the most deadly form of malaria.

Can malaria return?

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QUESTION

I got fever and weakness.  I went to the doctor and my malaria report is the ring stage of p.vivax. I take artemether and lumafetrime drug  but after ten days the fever  returns. What is this? Is this malaria or not?  Plz help. When my c.b.c was done before taking malaria drugs  my hemoglobin is 8.8 and leucocyte 6800 and sgpt is 52 but after treatment my sgpt is 45 and hemoglobin is 10.2 and leucocyte is 7800. Do I have malaria again?

ANSWER

The treatment for  uncomplicated P. vivax malaria as recommended by WHO (Guidelines for the Treatment of Malaria, 2nd edition 2010), includes a main malaria drug, i.e. choroquine in areas without choroquine resistance, and ACTs like artemeter and lumafetrine as in your case.  Along with this however, for cases of P. vivex, a course of primaquine should be given. The primaquine is effective in eliminating the form of vivax that can “hibernate” in the liver for months or years and resurface, causing relapse.  (Primaquine should not be taken if you have severe G6PD deficiency).  If your fever continues, however, you should return to the clinic so your doctor can examine you and take further tests to see if the malaria has been cured and if so, to determine what is now causing your fever.

P.

After Malaria: Low Iron, Chest Pains

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QUESTION

I got malaria in Ghana in February 2012 and was treated for it and recovered within 10 days. I had no problem or illness after that. Returned to USA late May of 2012 healthy able to run 4 or 5 miles a day and be active. About 3 or 4 weeks later suddenly developed shortness of breath, chest pains with hunger and thirst. Have seen 5 different doctors and had extensive heart, lung, digestive, blood tests, thyroid, diabetis etc. All have come out okay except for recent blood test showing some very low iron levels (Iron always Ok previously). Still having chest pain, breathing problems, thirst and hunger. Can’t run more than a block now. Could this be related to malaria or similar illness from Ghana? Any suggestions on what it could be and what doctors should be looking for as the doctors seemed stumped? Has anyone else had similar problems after having malaria? I appreciate any assistance that you can provide.

ANSWER

Sorry to hear about your current situation.  My advice is to treat your low iron levels. There are cases where patients who have been cured of malaria still develop severe anemia, and it is conceivable that some of your symptoms such as shortness of breath, fatigue, and chest pain are caused by  severe anemia.  Treating anemia can often show dramatic results.  Oral iron tablets are effective as well as eating iron-rich foods (meat, greens such as spinach, dried apricots, beans etc).  If you don’t feel better in a couple of weeks, I suggest you go back to the clinic for further discussion with your health provider.

Can Malaria be Completely Cured?

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QUESTION

My 18 yo son in on a study abroad in Bangalore, India. He has been in India since July 1st and toured Northern India the first 6 days that he was there. He woke up yesterday with horrible chills/shakes, then transitioned into a fever for several hours, then fever broke and was sweating for another 3 hours, while having a migraine behind his eyes. He did you go to the doctor and was told he has Malaria. He has been on Doxycycline since 2 days before leaving to go to India. He is also taking Colloidal Silver everyday. The Dr gave him some medicine today (he has not told me the name yet) and told him to come back on Monday for a blood test. What I would like to know is—is it possible for this to be completely treated? Or will he always have some of the parasite left in his system?

ANSWER

A blood test can diagnose if malaria is present and which kind of malarial parasite is causing the illness. Usually it is done when the person first presents themselves at the clinic with malarial symptoms.   Sometimes, a health worker will treat the person based on symptoms alone, although having a blood test is recommended if available.

Malaria can come back in three ways: first of all, the person could have been successfully treated, but then re-infected again by being bitten by an infected mosquito. In these cases, the person should focus on improved malaria prevention, such as sleeping under a long-lasting insecticide treated bednet.

Secondly, the patient could have recrudescence: when the patient takes medication, the treatment kills most of the malaria parasites in the blood, and enough so the patient feels better again, but some parasites still remain. Then, after the treatment finished, the parasite is able to replicate again, they increase in number in the blood and the patient feels ill again. In this case, you would say the infection came back from the blood, and the patient should take another dose of anti-malarials, but of a different kind to that which they originally had, in order to kill all of the parasites.

Finally, there is what is called relapse, which only occurs with two types of malaria: Plasmodium vivax and Plasmodium ovale. These are able to form dormant stages in the liver, so even when all the parasites are killed in the blood by the malarial treatment, these dormant forms survive. Many weeks, months or even years later, these dormant liver stages can re-activate and enter the blood again, causing new malaria symptoms. In this case, the liver was the source of the parasites. Again, the active blood infection should be treated with anti-malarials, but the patient should also talk to their doctor about taking primaquine, a drug which can kill any remaining dormant liver forms and thus prevent future relapses.

I hope this answers your questions and that your son recovers soon.

Malaria: Should I See a Doctor?

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QUESTION

For the last couple of days I am suffering from all the symptoms that are mentioned on your website and I am taking tylenol for these symptoms thinking that it is flu but I am feeling better now. Should I still see a doctor or keep taking Tylenol?

ANSWER

Symptoms of malaria often include high fever, aches, chills, nausea, and headache.  When severe, malaria can lead to anemia, impaired consciousness and even coma or death.  The best course of action is to get a simple blood test to check if you have malaria, because if you do have it,  early treatment with the appropriate drug (for the type of malaria you have), is essential.

You should also know how to prevent getting malaria. The first thing to do is to make sure you are protecting yourself sufficiently from mosquito bites. You can’t get malaria if you aren’t bitten by mosquitoes, and the type of mosquitoes that transmit malaria usually bite at night. As such, it is crucial to sleep every night under a long-lasting insecticide treated bednet. If you have one, it might need to be re-dipped in insecticide to make sure it keeps working effectively. Also, you should make sure all your windows and doors are properly screened to prevent mosquitoes from coming in; many people also do something called “indoor residual spraying” where they spray insecticide on the walls inside their house to kill any mosquitoes which might come in. If you live in an urban area, this might not be necessary if you can get good screens, or indeed if you have air conditioning (mosquitoes do not like cooler environments). Finally, you should try to wear long-sleeved clothing in the evenings and at night, again to stop mosquitoes from biting.