Diagnosing Malaria

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QUESTION

My sister had fever before 2 weeks, she take tablets, and then she is fine. Then after three days she had a urine infection, take blood test and also urine test, the test result shows malaria is negative. Now she has fever. Take blood test, malaria is negative. Can she be affected by malaria or just urine infection?

ANSWER

Since your sister had two blood tests for malaria and they were both negative, it seems likely that her fever is from the urine infection. However, if she continues to have fever (after treatment for the urine infection), she needs to return to the clinic for further investigation to find the source of the problem.

Signs of Malaria

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QUESTION

I don’t like taking drugs, but since the past one month I’ve been very down with fever. My eyes have changed to yelllow, joint pain, I’ve severe pains in my ear, I have stomach and abdominal pain,  I have seizure undere my feet, sores on my tongue, throat pain, heart burn, and cough. Please are these malaria signs?

ANSWER

Thanks for your question. Malaria is often tricky because there are so many different symptoms. Here is a link to our webpage which lists some of the common symptoms of malaria. However, if you suspect you might have malaria, it is really important to get a proper diagnosis from a clinic or hospital, usually through a blood test. It is only with a proper medical diagnosis that you can be sure you are receiving the right medication for your illness, whether it is malaria or something else.

Anopheles Mosquitoes and Malaria Transmission

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QUESTION

How are the Anopheles mosquitoes able to transmit human Malaria and others are not? What makes them different from the other genus of mosquito?

ANSWER

This is a great question and in fact scientists are not really sure of the answer. The ability of female Anopheles to transmit malaria is a quirk of evolutionary history. Other species of Plasmodium (the Latin genus name of the group of parasites which cause malaria), for example those that infect birds and lizards, are transmitted by other mosquitoes, such as Culex. When the parasite switched hosts and started infecting mammals, this coincided with the parasite specializing in infecting Anopheles mosquitoes, and this relationship has remained ever since. It is a case of what scientists term “coevolution”, where a parasite and its vector have a tightly coupled and highly specialized relationship.

Can Malaria Penetrate the Brain

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QUESTION

Can malaria penetrate the brain?

 

ANSWER

Approximately 1% of people with malaria will develop a severe form, and in these cases the brain can be affected.  When the brain is affected, the condition is called cerebral malaria.  Functional changes to the blood-brain barrier occur in cerebral malaria, possibly as a result of the binding of parasitized red blood cells to cerebral endothelial cells,  although scientists do not really understand the mechanism.  However, people suffering from cerebral malaria can have seizures, fall into a coma, or show other neurological problems.

Without treatment, cerebral malaria generally leads to death.  Among children with cerebral malaria who received treatment and survived, it has been found that about a quarter (25%) have long-term problems with thought processes, motor function or have behavior impairments and  10% develop epilepsy.

How Long for Blood Count to Return to Normal

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QUESTION
I’m hoping to get some clarity on the following, as I’ve had a few rather large disparities in the information I’ve been given. My mother (66) recently had a very serious bout of Malaria and was hospitalised in Johannesburg for just over a week. (Both my Mom and Dad live in Tete, Mozambique) At one stage, she almost needed a blood transfusion as her parasite count was above 10% (12,5% to be precise). While Dr’s decided against the transfusion eventually, I would like to know how long it takes for her blood count to return to normal (she’s been out of hospital for almost 5 weeks now) as she would like to return to Mozambique. I’m grateful for any advice you can proffer.

ANSWER
A parasite count over 10% is indeed serious, but new findings suggest that if artesunate compounds are used for treatment, transfusions don’t add much, so if that is the case, the decision not to give a transfusion is probably a good one. Artesunate compounds are noted for reducing the parasite load quickly compared to other drugs (i.e.quinine), usually by 48 hours. Since your mother had severe malaria, she may also be suffering from anaemia which can make her feel very weak. She will need to rest and recuperate, take iron supplements and eat a nutritious diet with iron-rich foods (green vegetables, red meat etc). She must also take precautions to avoid getting malaria when back in Mozambique; use an insecticide treated bed net, avoid going out at dawn or dusk and/or wear long sleeves and long pants, use mosquito repellent, and seek treatment early if any signs of malaria (fever etc) appear.

Shelf Life of Malarone

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QUESTION

I’ve just finished reading several years’ worth of your responses to questions and I’m very impressed. Thank you for being surely one of the best sources on the web. My question pertains to the shelf life of Malarone tablets. My husband and I have been in Madagascar for three weeks now and will stay for another two and a half months. I am very preventive-oriented (long sleeves, pants and socks, mosquito tent at night) as mosquitos love me. I am not however taking a chemical prophylactic. I have brought with me 11 Malarone tablets (GlaxoKlineSmith) bought on prescription in France some years ago and whose expiration date is… 2010. If I do come down with the symptoms (likely falciparum) and test positive, would I not be better off taking these perimated pills than eventually buying counterfeit ones here, if you can get them, as I read on the internet that drug companies are very conservative re shelf life (the pills are in their original plastic/aluminum airtight wrappings)? I say I am preventive-oriented, though I admit that travelling with old Malarone (and not the 12 recommended but only 11) is not too wise.

ANSWER

Thanks so much for your question, and you certainly have done your research! I agree, often the expiry date of medications seems to be overly conservative, but unfortunately without testing the chemical properties of the tablets, you cannot know for sure whether the compounds in the drugs have begun to break down.

I understand your predicament that slightly weaker drugs might be better than counterfeit ones, but ultimately, both might not be completely effective and I would be very concerned about the possible contribution to drug resistance, if you try to treat malaria with a drug which is not fully operational. This is the same effect as taking only 11 out of the required 12 tablets for treatment; it’s like not completing a full course of antibiotics, and can assist the malaria parasite in developing drug resistance.

In your case, I have a couple of recommendations: First of all, you are unlikely to be able to find reliable Malarone, but doxycycline should be available and given how cheap it is as a generic, unlikely to be counterfeit. Given you will be in Madagascar for a reasonably long period of time, you probably should start chemical prophylaxis, and doxycycline could be a good option. The usual dose for prophylaxis is 100mg, taken orally, once a day. You will need to continue taking it every day for four weeks after you leave the malarial area. Most people tolerate doxycycline very well, but it can cause minor side effects such as stomach ache and sensitivity to the sun. You should also make sure to take it 2-3 hours before consuming any dairy products or other items containing calcium or magnesium (antacid tablets, etc), as doxycycline binds to calcium and magnesium, preventing it from being fully absorbed by the body.

Secondly, I would also investigate local pharmacies and clinics and find out which ones stock artemisinin-based combination therapies, such as Coartem, ASAQ, Pyramax or Duo-Cotecxin. Look for artemisinin-derivatives in the list of ingredients such as artesunate, dihydroartemisinin and artemether, together with a combination compound (having a second active ingredient is very important in terms of preventing development of drug resistance) such as lumefantrine, mefloquine, piperaquine and amodiaquine.

It is difficult to identify counterfeit drugs, but look for original packaging (including aluminum casings for the pills), manufacturer’s stamps and an expiry date (obviously you want to make sure the drugs have not expired!). Once you have sourced a suitable pharmacy, if you or your husband comes down with malaria (as you rightly say, once you have been positively tested for falciparum! I’m so happy you are aware of the importance of diagnosis), then you will have a sense of a pharmacy to turn to when you need treatment, though hopefully, if you start taking doxycycline, you will be completely protected!

Is it Malaria Relapse?

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QUESTION

WHILE IN VIETNAM, I HAD VIVAX AND FACIPRIUM MALARIA. THE OLDER I GET I COME DOWN WITH THE CHILLS, FEVER AND PROFUSE SWEATING. BLOOD TEST NEVER DOES SHOW ANY MALARIA BUT DOES SHOW THE VIVAX ANTIBODIES. DOES THIS MEAN I STILL HAVE MALARIA OR HOW LONG DO THE ANTIBODIES REMAIN IN MY BODY AND WHY NO MALARIA CELLS?

ANSWER

Antibodies to malaria can persist in the body for years after the malaria infection, so if blood tests are not showing up malaria parasites but do show you have antibodies, then you probably don’t have malaria now, and it is just showing that you once had malaria, but it could have been many years ago. You should talk to your doctor about other possible infections that might be causing your symptoms.

Malaria IgG Test

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QUESTION
My uncle has been ill since returning from Belize, where he was bitten by multiple mosquitoes. He has every symptom of malaria, and did a malaria antibody IgG test, which came back high at 1.49 that was ordered by his primary care physician.

He has now been to a hematologist/oncologist and even an infections disease doctor who have both ignored the lab result. He has since done multiple biopsies and lab tests that reveal nothing. He continues to worsen, but they refuse to even consider malaria as an option of disease process. Please advise on steps that we can take to help get him well. We live in Oklahoma City, Oklahoma.

ANSWER
Transmission of malaria in Belize usually only occurs in mainland areas away from Belize City; as such, if your uncle was only there visiting the islands, for example, then while he may still have been bitten frequently by mosquitoes, it is unlikely he was infected with malaria.

Has your uncle ever traveled to other malarial areas of the world? I ask because one of the problems with the IgG test is that it looks for antibodies to malaria – as these can persist for a long time (weeks, months or even years) after the malaria infection has cleared, a positive IgG test just means that the patient was infected by malaria at some point, and doesn’t necessarily mean they have an active infection.

To check this, your uncle should ask his doctor (or better yet, an infectious disease or travel medicine specialist) to
check for an active malaria infection. This can be done two ways: either by looking at your uncle’s blood under a microscope (usually via thick and thin blood smears, the latter of which may be Giemsa stained) or by putting a drop of his blood into a malaria rapid diagnostic test (RDT). Both of these methods test for active infection, and depending on the type of RDT, both methods can also usually show which type of malaria has caused the infection. This is important in terms of ensuring the patient receives appropriate treatment.

I don’t know how you can convince your uncle’s medical team to give him a blood test, but that is the only definitive way to show he has malaria, if indeed that is what is causing his symptoms.

Can the PCR blood test identify hypnozoites?

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QUESTION

I have never been diagnosed with malaria but returned from Turkey in 2007 (P. Vivax endemic area; Diarbykar & Mardin areas). My symptoms were consistent with malaria and I have now had 5 relapses since then, averaging one occurrence per year. I now have impaired kidney functioning and I am uncertain if this could be because of undiagnosed malaria? Would the PCR blood test at anytime be an option to conclusively rule out malaria or would blood need to be drawn during an actual relapsing event?

ANSWER

You have certainly done your research! It’s great to hear from someone who is so well informed about the risk areas they traveled too and the diagnostic options. You’re right in thinking that PCR is only appropriate during an active relapse; while the malaria parasites are dormant in the liver (called hypnozoites, in that form), they are extremely hard to detect. One option could be to investigate the possibility of taking a test to look for antibodies to the P. vivax parasite. These tests are often referred to as ELISAs (enzyme-linked immunosorbent assays) and they can sometimes be useful for testing for malaria in between relapses because the antibodies your body produces against the malaria parasite during the relapse phase can stick around in the blood for weeks, or even months or years. Therefore these tests are not very useful for people in endemic areas (who may always have these antibodies, regardless of their current infection status) but for travelers who have been exposed a limited number of times, this test may be able to say whether you have at some stage been infected with P. vivax; together with your clinical history, this will provide strong evidence to your doctor that you might need to discuss the possibility of taking primaquine, the drug which can kill the dormant hypnozoites and prevent further relapse.

What Cell count defines malaria?

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QUESTION

What Cell count defines malaria??

ANSWER

If you are referring to the cell count for diagnosis, then really the answer is that if ANY malaria parasites are observed in a blood film, then the slide should be considered positive for malaria. Of course, some people can have low levels of parasite in their blood, which are not easily detected under a microscope, using a blood slide. These people are also obviously positive for malaria, but have less severe symptoms or indeed may not have any symptoms at all. If they have symptoms, they may need to seek an alternative form of diagnosis, such as a rapid diagnostic test (RDT) or PCR (polymerase chain reaction).