P. knowlesi versus P. falciparum: Treatment and Prevention

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QUESTION

I would like to know about the P. knowlesi – treatment compared to P. falciparum? preventive medicine?

ANSWER

At this point in time, P. knowlesi is completely susceptible to chloroquine, and so can be treated successfully using this drug. P. falciparum, on the other hand, is known to have widespread resistance to chloroquine, and so the World Health Organization recommends that chloroquine should not be used to treat P. falciparum malaria. Instead, for non-complicated malaria, the WHO recommends treatment with artemisinin-based combination therapies (ACTs). These drugs can also be used against other forms of malaria, including P. knowlesi, particularly if the hospital also treats cases of P. falciparum regularly and so has supplies of ACTs on hand. One study even showed that treatment with ACTs (specifically artemether-lumefantrine) was more effective than chloroquine in treating P. knowlesi. Severe cases of either infection should be treated with intravenous artesunate or quinine.

Prevention for both is roughly similar – chemoprophylaxis should be taken by people travelling to an area where transmission of these types of malaria occurs. However, given P. knowlesi‘s susceptibility to chloroquine, this drug is effective as a prophylactic for this malaria species, whereas it is not appropriate for P. falciparum, given high levels of resistance. In terms of prevention of mosquito bites, this differs due to the types of mosquito vectors each of these species of malaria uses. P. knowlesi is only found in south-east Asia, where the mosquitoes that transmit it tend to be forest dwelling. As such, people who spend time in the forest in the evening and at night are most at risk of contracting P. knowlesi. Wearing long-sleeved clothing and insecticide while in the forest may help prevention in this case. P. falciparum is found throughout the world, and uses many different species of mosquito vector. In Africa, the mosquitoes which transmit P. falciparum tend to rest indoors and thus bite people at night while they are sleeping. Therefore, in these settings, it is especially beneficial to sleep under a long-lasting insecticide treated bednet. Indoor residual spraying, which coats the inside walls of a house with insecticide to kill indoor-resting mosquitoes, can also be beneficial.

Is Malaria Related to Hemophilia or Nephrotic Syndrome?

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QUESTION

Is malaria related to hemophilia and nephrotic syndrome? If yes, how? Can anyone explain further?

ANSWER

Malaria is an infectious disease caused by the bite of an infected mosquito.  Hemophilia is a hereditary blood disease, and is not related to malaria.

However, there is a specific relationship between Plasmodium malariae and the nephrotic syndrome.  Along with bouts of fever and more general clinical symptoms such as chills and nausea, the presence of edema and the nephrotic syndrome has been documented with some P. malariae infections.  It has been suggested that immune complexes may cause structural glomerular damage and that renal disease may also occur. Although P. malariae alone has a low morbidity rate, it does contribute to the total morbidity caused by all Plasmodium species, as manifested in the incidences of anemia, low birth rate, nephrotic syndrome and reduced resistance to other infections.

Malaria Infection Even With Prevention

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QUESTION

Can you still get infected with Malaria even when taking a preventative such as doxycycline or Malarone?

ANSWER

Yes, no prophylactic medication is 100% effective though both Malarone and doxycycline are usually over 90% effective, when taken properly. It is important to make sure each tablet is taken approximately at the same time each day, and in the case of Malarone, it is important to take it with some fatty food as this assists in absorption. Conversely, doxycycline should not be taken within 6 hours of consuming dairy products, as the calcium present in milk can prevent uptake of doxycycline. For these reasons, it is important to also use other methods of preventing malaria, such as sleeping under a long-lasting insecticide treated bednet.

What Are the Symptoms of Malaria?

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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.

For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 7 days or as late as 1 year later. Two kinds of malaria, P. vivax and P. ovale, can occur again (relapsing malaria). In P. vivax and P. ovale infections, some parasites can remain dormant in the liver for several months up to about 4 years after a person is bitten by an infected mosquito. When these parasites come out of hibernation and begin invading red blood cells (“relapse”), the person will become sick.

Infection with malaria parasites may result in a wide variety of symptoms, ranging from absent or very mild symptoms to severe disease and even death. Malaria disease can be categorized as uncomplicated or severe/complicated. In general, malaria is a curable disease if diagnosed and treated promptly and correctly.

Malaria Prophylaxis – Delaware

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QUESTION

Where can I get vaccinated for malaria in Wilmington, DE?

ANSWER

Currently there is no vaccine for preventing malaria.  However, there are a number of ways to prevent malaria. These can be placed into two categories: medication and vector protection.

For medication, there are drugs you can take to prevent the malaria parasite from developing after being bitten by an infected mosquito. These drugs are known as “chemoprophylaxis.” There are several different kinds, such as doxycycline, mefloquine (marketed as Lariam), atovaquone-proguanil (marketed as Malarone) and chloroquine—the type you use depends on the type of malaria present in the area. For example, in much of Africa and India, malaria is resistant to chloroquine, so this cannot be used as a prophylactic. In parts of Thailand, resistance to mefloquine has emerged. However, if the appropriate type of prophylaxis is used, it is very effective against malaria.

Vector prevention involves protecting oneself against getting bitten by mosquitoes. This can involve wearing long-sleeved clothing in the evenings and at night, when malaria mosquitoes are most active, or wearing insect repellent on exposed skin. Indoor residual spraying, whereby repellent and insecticides are sprayed inside the house, can also be used to bring down the number of mosquitoes.  Another very effective technique for preventing malaria is to sleep under a long-lasting insecticide-treated bednet. The mesh acts as a barrier against the mosquitoes, and the insecticide impregnated in the mesh further repels the mosquitoes and prevents them from biting through the mesh.

Check the “Malaria Overview” section of malaria.com for a map showing where malaria is found, and for appropriate  preventive treatment. You can also look at the CDC website and consult your physician before traveling.

First in Malaria: U.S. or China?

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QUESTION

Who discovered the world’s first malaria vaccine? Is it the US marines in Washington DC or the People’s Republic of China?

ANSWER

Unfortunately there is still no effective malaria vaccine.  You might be referring to the race between the US and China to find an effective malarial treatment during the Vietnam War years.  Currently, artemisinins, from the wormwood plant, discovered in China is the recommended treatment for malaria caused by Plasmodium falciparam.

Malaria Cure

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QUESTION

What medicine is good for curing malaria?

ANSWER

There are lots of different types of medication which are effective against malaria. However, for uncomplicated, unsevere cases, the World Health Organization (WHO) recommends using a type of medication called artemisinin-based combination therapy, or ACT. Again, there are many types of ACTs, so the name may vary depending on what is most common in your area, but some widespread brands include Coartem, Lonart, Duo-Cotecxin, etc. In some countries, they are known by an abbreviation of the drug name – for example, in Tanzania, the most common ACT is a combination of artemether and lumefantrine, and the different brands are collectively known as Alu.

For severe or complicated malaria (there is no hard and fast definition, but the clinical diagnosis may include cerebral involvement, seizure, coma, inability to take oral medication, severe anaemia, etc), the WHO recommends intravenous  (IV) artesunate, with quinine as a second choice.

There are also additional forms of treatment which may be used in certain settings, depending on the geographical region and the type of malaria, or if one of the above treatments is not successful. Likewise, pregnant women should not take ACTs, so they need to seek alternative forms of treatment, such as chloroquine (if the local malaria is known to be sensitive), mefloquine or sulfadoxine-pyremethamine.

What is Acute Malaria?

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QUESTION

What does acute malaria mean?

ANSWER

Acute malaria is severe malaria, with major signs of organ dysfunction and/or high level of malarial parasites on blood tests. In endemic areas, young children and pregnant women are at high risk for severe malaria. Older children and adults develop partial immunity after repeated infections; these groups are thus at relatively low risk for severe disease. Travelers to areas where malaria is endemic generally have no previous exposure to malaria parasites and so are at high risk for severe disease.

Malaria Treatment Options

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QUESTION

What can be used or eaten to treat malaria?

ANSWER

There are many drugs which can be used to treat malaria. Of these, the World Health Organization recommends artemisinin-based combination therapies (ACTs) to be used as first-line treatment against uncomplicated, non-severe malaria, and intravenous artesunate as the first-line therapy against severe or complicated malaria. More detailed information about the range of medications which can be used, some against specific kinds of malaria and some in specific areas of the world, can be found on our page relating to malaria treatment, which can be accessed via this link:Malaria Treatments. Also see  Guidelines for the Treatment of Malaria 2010, on the WHO website.