Bringing Malaria to the United States

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QUESTION

I was recently diagnosed with Malaria still waiting to find out what strand, but either got it in Uganda or Rwanda. I have recently came back to the states and have been bit by mosquito. I have already started to take some medication for it, but I am concerned about spreading the virus to others in the states including my family. Is it possible that if I still have the infection to spread it to others or in the states? If so what should I do.

ANSWER

There actually used to be malaria in the United States, particularly in the southern areas, but concerted mosquito control efforts as well as public health initiatives eradicated it in the 1950s. I don’t think you need to worry too much about transmitting malaria—once you are on treatment, the number of parasites in your blood drops dramatically and it becomes more difficult to transmit the parasite to a mosquito. Also, there are lots of types of mosquitoes in the US, and only those of the genus Anopheles can transmit malaria. As such, if you are concerned about spreading malaria, you should take precautions to protect yourself from mosquitoes especially at night and at dusk and dawn, as this is when Anopheles mosquitoes are most active. The type of mosquitoes which bite during the day usually belong to the genus Aedes, and cannot transmit malaria. During these high risk times of day, you should take care to wear long-sleeved clothing, and also wear insect repellent, preferably containing DEET.

Can Malaria Cause Blindness?

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QUESTION

Can you please help us? My husband got severe malaria and now he’s blind. He stayed 33 days in hospital.

We live in Portugal. My husband came back from Africa (Angola) on 2nd June 2012. On 3rd June he started feeling ill. He got worse next days. The symptoms were strong headache, high fever, chills, delirium, vomit, couldn’t breathe and weakness. He went to hospital on 7th June. On 8th June was diagnosed with Malaria (Plasmodium Falciparum). Doctors induced him in a coma (10 days) so he could breathe through a machine. He got kidney’s failure, cardiovascular collapse (he needed to be reanimated) and severe anemia. Doctors thought he would die… He woke up from coma on 18th June. On 19th June he couldn’t see anything, it was all dark… First Doctors told us it was due to the quinine treatment, that when quinine come out from the blood he would recover vision. Later exams revealed optic nerve damages. Sometimes he sees images only during few seconds… Can you help us? Do you think this blindness is reversible? Is there any treatment we can do? Are you aware of cases like this? He has 35 years old, we are in panic… Thank you in advance.

ANSWER

I think I have answered this question within one of the comments sections on the website, but will briefly address it here as well. Your doctors are right – the blindness is probably a side effect of the intravenous quinine treatment, which likely saved your husband’s life, but the high dosage is also somewhat toxic to the body. Most patients do recover their vision eventually; one report which I read said that in the short term, treatment with charcoal derivatives can help to lower quinine levels in the blood, thus encouraging faster recovery.

Mosquito Larvae Eradication

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QUESTION

What measures can be taken to eradicate mosquito larvae?

ANSWER

The main methods to control mosquito larval populations are by reducing areas available for adults to breed and also directly killing larvae. So, for example, adult mosquitoes need standing, stagnant water in order to lay their eggs. Getting rid of these sources of standing water, for example by filling in unwanted ditches and removing empty containers that can become filled with rainwater, therefore reduces the available breeding habitat for mosquitoes. Similarly, dripping a small amount of oil on top of standing water creates a thin film of oil over the surface of the water, preventing adults from laying eggs. In addition, the oil prevents the larvae from gaining access to air, suffocating them and killing them. There are other methods for killing larvae too. Directly spraying insecticides onto water is one method, but often not very specific, and can have a negative effect on other forms of aquatic life. One popular method for biocontrol is to introduce other animals which eat mosquito larvae, thus keeping numbers down. Examples include certain species of fish, as well as small crustaceans called copepods.

Recurrence of Malaria

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QUESTION

If a person treated for malaria after being infected from a malaria endemic country of West Africa and cured then he travel back to his country which does not known for malaria endemic region of the world. Question is: Is there any chance of re-occurrence even he is not being exposed to malaria spreading mosquito for some time may be year?
Is it true Malaria parasites stays in liver as hibernation for a long period and attack after many months or year?
If so what treatment can prevent it?

Please advise.

ANSWER

There are several different types of malaria which are found in West Africa, and the most common and deadly form, Plasmodium falciparum, is not able to hibernate in the liver. However, two other types of malaria are able to lay dormant in the liver – these two kinds are called Plasmodium vivax and P. ovale. Both are not nearly as common as P. falciparum in West Africa, though P. ovale has been reported at prevalences of over 10% in some areas, which is double its usual prevalence elsewhere in the world. Weeks, months or even years after an initial infection with P. vivax or P. ovale, the patient may experience what is known as a relapse, which is when the dormant liver forms become active again and re-invade the blood stream, causing a renewal of malaria symptoms. These relapses can be treated with normal anti-malarial drugs (even chloroquine, in many cases), but a different drug is required to kill the dormant liver forms and prevent future relapse. This drug is called primaquine, and may not be suitable for people with certain types of G6DP deficiencies, so you should talk to your doctor about having a test for this condition before taking primaquine.

Malaria in Pakistan

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QUESTION

4 years ago I traveled to FATA Pakistan and in every year in the month of August I caught malaria. Last few days I feel much Headache and fever in the evening and go to doctor. He diagnosed malarial parasites in blood and has advised me take tab artem ds 2 BD for three days after complete the course I feel same headache fever with shivering. Please recommend something.

ANSWER

I am not sure which malaria treatment you have taken—was it just artemisinin, or a combination drug which also included another anti-malarial? The latter type is what is recommended by the World Health Organization (WHO); treatments only containing artemisinin are very effective short term, but can sometimes leave a few parasites alive at the end of the course, which not only may result in a recurrence of symptoms (known as recrudescence) but is very bad in terms of leading to drug resistance in the malaria parasite. However, it is also possible that you are merely experiencing some slight side effects to the medication you took; often these mild side effects are very similar to the symptoms of malaria! If you don’t feel better in a few days, it might be worth visiting the doctor again to check that you don’t still have malaria parasites in your blood.

Home Remedies for Malaria

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QUESTION

Are there any home remedies for symptoms of malaria?

ANSWER

Quinine is a natural chemical which has anti-malarial properties, and  tonic water is a good example of an everyday foodstuff which contains quinine.  For this reason, over the last hundred-odd years,  expatriates living in malarial countries have enjoyed drinking gin and tonic!  There are also reports that grapefruit contains a quinine-like substance, and so might help prevent malaria or indeed increase recovery from malarial episodes, but I am not sure if this has been scientifically established as fact. There are a number of other plants, herbs and fruits which advocates of traditional, home remedies suggest may help prevent or treat malaria, but I can’t find ANY solid scientific basis for these claims, nor any reports of trials where these remedies have been shown to be effective.

Overall, the best thing to do if you think you have malaria is to get diagnosed (either at the doctor, a hospital or using a self-diagnosis kit) and then seek medical treatment. Local clinics will be able to tell you what kind of malaria you have, and therefore what treatment is recommended.

Mosquito Life Cycle

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QUESTION

Please explain the life cycle of a mosquito.

ANSWER

Mosquitoes are insects which go through several life stages, starting out as eggs, then hatching into larvae before developing into adults. Mosquito eggs are laid in slow-moving or stagnant pools of freshwater, to provide suitable habitat for the larvae once they hatch. Different species of mosquito prefer different water conditions; some prefer shaded areas, whereas some prefer more direct sunlight, and some mosquitoes even lay their eggs in very specific habitats, such as brackish water in estuaries. The way the mosquitoes lay their eggs can aid in identifying the genus of mosquito; some genera, such as Culex, lay rafts of many eggs, whereas Anopheles mosquitoes (the ones which transmit malaria to humans) lay their eggs singly. Larvae usually hatch from the eggs after a couple of days. These larvae are predatory, feeding on other aquatic insects and organisms, but themselves can also be eaten by fish, copepods and other creatures. Most larvae lay at an angle to the water surface and breathe through a specialized tube-like organ, known as a siphon, but Anopheles larvae lack the siphon and so much lay parallel to the water’s surface in order to breathe. Each larva must shed its skin (molt) four times, before reaching the stage where it forms a pupa. These four molts take anywhere from 7 to 14 days, depending on the water temperature. The pupa is just like a butterfly pupa – the mosquito does not feed and lays still in a cocoon as it develops into a adult. This process usually takes 2 days, after which the pupa splits and the adult emerges. The length of the full cycle is dependent on whether the conditions were optimal for that species of mosquito, and specifically based on temperature. Male adult mosquitoes usually live for about a week, feeding on nectar – they also possess very bushy antennae for seeking out females to mate with. Female mosquitoes have specialized mouthparts that allow them to feed on blood; they require the extra nutrients that blood provides in order to lay their eggs. The lifespan of a female adult depends on a number of environmental factors, but also her ability to get sufficient blood meals; in nature, they usually live 1-2 weeks.

A schematic of the life cycle is provided below:

Mosquito lifecycle schematic

Schematic of the mosquito lifecycle. Courtesy of Purdue University (Scott Charlesworth): http://extension.entm.purdue.edu/publichealth/insects/mosquito.html

How easily is malaria passed between humans?

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QUESTION

Can malaria be passed between humans if one has a bloody nose or if sex tears the vagina and a small bleed occurs?

ANSWER

It is extremely unlikely malaria would be transmitted via transfer of small amounts of blood. The only documented examples of direct transmission of malaria between humans is during blood transfusion, organ donation and from a mother to her unborn child, all of which require transfer of very large volumes of blood or the transfer of a specific organ containing malaria parasites. In the case of a mother transmitting malaria to her child, it either occurs across the placenta (again, via blood) or via the large amounts of blood which can be exposed during childbirth.

Malaria Statistics in Limpopo in Malamulele Town, South Africa

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QUESTION

What is the statistics of malaria from 2008 to 2011 in limpopo im malamulele town?

ANSWER

I think your best bet to get access to specific statistics for a particular town is to contact the local district health office directly, or contact an organization that works in the area on health issues. As far as I know, there are no publicly available malaria statistics for Malamulele town on the Internet. One organization I have found which works in the region is Sakhiwo Health Solutions, a company which appears to be involved in a malaria mitigation project in Malamulele. Their website is sakhiwo.com.