Malaria Treatment Time and Hiccups

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QUESTION

I am suffering from pf malaria with enlarged liver and spleen under the treatment from last one week and the abdominal pain has subsided. But I am experiencing hiccups. How long it will take for complete recovery?

ANSWER

It is a good sign that you are already feeling better following your treatment for malaria. Interestingly, hiccups have been linked to infections with parasites, including malaria; in one case, it was discovered that the treatment the patient was taking (doxycycline) had actually caused some secondary problems of the esophagus which was causing the hiccups. The patient was given medicine which treated these secondary problems and cured the hiccups. So if you continue to experience hiccups after you have completed the treatment for malaria, you should ask your doctor if it is possible to arrange for an endoscopy, to check for any secondary problems caused by the medication.

As for recovery time otherwise, you will probably feel much better as soon as the course of medication is completed. However, many malaria patients still feel fatigued for weeks or even months after they have had the disease, so full recovery can take some time.

It is important, however, to visit your doctor again if you have any recurring symptoms of malaria after you have finished the medication (such as fever or nausea) since this could indicate that the infection was not completely cured the first time; another blood test may then be required, with another course of treatment if you test positive again for malaria.

Typhoid and Malaria

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QUESTION:

Since i was suffering with fever for 5 days I consulted a doctor, have undergone blood test, and got typhoid as positive, but the treatment didn’t work. I was tested for malaria and result was positive. Ii’ve been given chloroquine for three days and primaquine for 28 days. After chloroquine was completed I started using primaquine. During this time I got fever and I got typhoid positive. My question is though iI’ve been treated for typhoid before malaria is conformed why it has come again?

ANSWER:

Typhoid and malaria are very different illnesses, caused by different disease organisms. Typhoid is caused by a Salmonella bacterium, whereas malaria is caused by single-celled animals, called protozoa, of the genus Plasmodium.

Typhoid is usually transmitted by eating food or drinking water which has been contaminated by sewage or handled by someone else with typhoid fever. It is usually treated with antibiotics; however, these antibiotics do not prevent re-infection with the disease. The best way to prevent re-infection is through washing food thoroughly in clean (boiled) water and by washing hands regularly, especially after going to the bathroom. There is also a vaccine against typhoid which you can get which will prevent further re-infection. As such, if you think you have typhoid again, you will need to visit your doctor again for more treatment, as it is unrelated to your malaria infection (apart that you might have been weakened by one infection, leaving you more susceptible to a second disease). While at the doctor, you should also have another test for malaria to ensure that the treatment was successful.

Malaria and Sexual Contact

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QUESTION

Is a person with malaria allowed sexual contact or not?

ANSWER

Malaria cannot be transmitted between people through sexual contact (or indeed, between people at all—it must go through a mosquito before it can pass into another human host), so from the point of view of spreading the disease, sexual activity is not disallowed. However, people with malaria often feel very sick, and moreover, will need their full strength to ensure recovery, so it might not be a bad idea to refrain until the patient is fully recovered!

Pathophysiology of Malaria

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QUESTION

What is the pathophysiology of malaria?

ANSWER

Malaria causes disease through a number of pathways, which depend to a certain extent on the species. Malaria is caused by a single-celled parasite of the genus Plasmodium; there are five species which infect humans, being Plasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi.

All these species are introduced into the human blood stream through the bite of an infected mosquito; the life stage of malaria at this point is called a “sporozoite”, and they pass first to the liver, where they undergo an initial stage of replication (called “exo-erythrocytic replication”), before passing back into the blood and invading red blood cells (called “erythrocytes”, hence this is the “erythrocytic” part of the cycle). The malaria parasites that invade red blood cells are known as merozoites, and within the cell they replicate again, bursting out once they have completed a set number of divisions. It is this periodic rupturing of the red blood cells that causes most of the symptoms associated with malaria, as the host’s immune system responds to the waste products produced by the malaria parasites and the debris from the destroyed red blood cells. Different species of malaria rupture the red blood cells at different intervals, which leads to the diagnostic cycles of fever which characterise malaria; P. vivax, for example, tends to produce cycles of fever every two days, whereas P. malaria produces fever every three.

In addition, Plasmodium falciparum produces unique pathological effects, due to its manipulation of the host’s physiology. When it infects red blood cells, it makes them stick to the walls of tiny blood vessels deep within major organs, such as the kidneys, lungs, heart and brain. This is called “sequestration”, and results in reduced blood flow to these organs, causing the severe clinical symptoms associated with this infection, such as cerebral malaria.

More details on the exact biochemical mechanisms for sequestration and its effect on the pathology of the infection can be found on the Tulane University website.

 

Malaria and Anemia

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QUESTION

How does malaria cause anemia?

ANSWER

Anemia is the result of a decrease in the number of red blood cells in the blood. Malaria specifically attacks red blood cells, invading them and then undergoing multiple cycles of reproduction inside them. Once replication has been completed, the malaria parasites burst out of the red blood cell, destroying it in the process. Over the course of an infection, this can destroy many red blood cells, resulting in anemia in the patient.

Does all malaria kill without treatment?

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QUESTION:

Does all malaria kill without treatment?

ANSWER:

No. There are five main species of malaria which infect humans: Plasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi. Of these, P. falciparum is the most deadly, and can often cause death if left untreated.

The other four may also result in death, but more rarely, and usually only in high risk individuals, such as young children, pregnant women and people with weakened immune systems. Given the seriousness of the symptoms and the possibility of death in all cases, it is very important to seek medical advice if you suspect you have malaria. Once given accurate diagnosis of which type of malaria you have, you can be given appropriate treatment.

Side Effects of Treatment

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QUESTION

What are the probable side effects / reaction of “Artemether with Lumefantrine” to a 4.5 years, 5ml syrup, 2 doses – 0 & 8 hours?

ANSWER

Artermeter with Lumefantrine is often sold under the brand name “Coartem” and is widely distributed in areas of high P. falciparum prevalence, and particularly where known resistance to chloroquine occurs.

Coartem is also the drug of choice for the Roll Back Malaria programme. A study of 1332 children, mainly in sub-Saharan Africa, revealed that few children experienced any side effects while taking Coartem, and of these, the vast majority of side effects were mild, did not prevent the child from continuing to take the medication, and were resolved.

The most common symptoms that were observed in children were pyrexia (fever), cough, vomiting, loss of appetite and headaches. Other, more clinically significant but also more rare, side effects which have been observed include tinnitus (ringing in the ears), blood disorders, problems sleeping, heart palpitations, mood swings, gastrointestinal upset, itchiness, back pain and vertigo.

Malaria Month

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QUESTION

What is the national month for malaria?

ANSWER

I’m not exactly sure I understand your question. If you are asking if there is a specific month when malaria is the worst, that depends on where you are. Malaria transmission is highly seasonal, because the mosquitoes that transmit the disease require pools of standing water in order to reproduce. Therefore in many places, transmission is highest during the rainy or wet season.

However, if you mean if there is a specific month dedicated to raising awareness about malaria and control, then the answer is yes, at least for certain countries. India, for example, has declared each June between 2005 and 2012 to be “Anti-malaria Month,” when a big push is made nation-wide to educate people about preventing malaria, implement early diagnosis and treatment and organise vector control efforts. June was selected as it is the month before the start of the monsoon season, when malaria transmission increases due to the heavy rains.

Malaria and Blood Cells

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QUESTION

What effect does malaria have on blood cells?

ANSWER

Malaria survives by invading red blood cells (erythrocytes), then replicating within them several times (the exact number and timing of replication depends on the species of malaria), then, once done with replication, bursts from inside the red blood cells, destroying it in the process. As such, malaria infection decreases the number of red blood cells in a patient’s blood, which can lead to anaemia. Moreover, the most severe species of malaria, Plasmodium falciparum, forces red blood cells to stick to the insides of tiny blood vessels deep within major organs such as the kidneys and even brain. This process is called sequestration.

Infection with malaria is also often associated with a decrease in the overall number of white blood cells, but elevated numbers of monocytes can sometimes be observed.

Reports of community mobilisation on prevention and treatment of malaria

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QUESTION:

Do you have any reports on community mobilisation on malaria prevention?

ANSWER:

There are a lot of organisations that utilise community involvement and mobilisation in their strategies to prevent and control malaria. One example of such an organisation is UNICEF; they work closely with governments to develop initiatives that allow for scaling up of community and health facility integrated packages for the control of malaria. Such packages might include distribution of bednets alongside messages about education to prevent malaria, plus diagnosis and treatment of infections. More information can be found on the UNICEF website.