Severe Head Pain with Malaria

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QUESTION

Can severe head pain be a symptom of mistreated malaria? My son just returned from an 8 month trip to Ghana. He had malaria 3 times and typhoid 1 time. He is now dealing with a severe head pain in his frontal lobe.

He took doxycycline every day and when he got really sick, he took Coartem. He was finally sent home because they couldn’t figure out why he has such severe head pains. Where do we go from here? He has an MRI scheduled and an appointment with an Infectious Disease Doctor. I am afraid they will not know what to do to help him. I am seeking more advice. Hopeful…CT

ANSWER

Severe head pain is not associated with mistreated malaria, nor indeed is considered a possible lasting effect of malaria infection. You are doing the right thing by going to see a doctor, including one who is an infectious disease specialist—I hope they also have experience with tropical medicine, since in the US and Europe, many very well-trained doctors are still not very familiar with the types of infections which are more commonly observed in the tropics.

Your son was right to take Coartem when he had malaria, but do you know whether he went to a clinic for diagnosis first? The symptoms of malaria are very general, such as fever, chills, nausea and aches, and many people in malarial areas (particularly visitors) often assume they have malaria when in fact their symptoms could be caused by a number of other things.

Secondly, doxycycline is considered a very effective preventive medication against malaria, but only if taken properly. Since doxycycline can cause mild stomach upset, many people take it with milk, which can lessen these symptoms; however, the calcium in the milk can bind to the drug, preventing successful absorption and reducing its efficacy as a malaria preventive.

If your son had a diet high in diary products or took antacids while in Ghana, this could explain why he suffered several malarial episodes. Alternatively, if he took the drug regularly and correctly, and particularly if he did not seek diagnosis via blood test from a clinic, that may be an indication that he wasn’t suffering from malaria at all, and other causes should be explored.

Finally, one of the very well-described side effects of doxycycline is its tendency to cause people to become very sun sensitive. While this usually manifests itself in skin sensitivity, it could also be that your son has become more visually sensitive to light, which in itself could lead to severe headaches. I hope he feels better soon!

Other Causes of Malaria

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QUESTION

Apart from mosquitoe bites, is there any other thing that can cause malaria or if not from mosquitoes, is there any other way someone can get malaria?

ANSWER

Since the malaria parasites reside and reproduce in the blood, in some cases it is possible to transmit malaria from person to person through transfer of a large volume of blood, for example during a blood transfusion.

Some life stages of the parasite are also present in the liver, so cases of malaria transmission via organ donation (particularly of the liver) have also been noted. Finally, it is possible for a mother to transmit malaria to her unborn child via the placenta, or sometimes during childbirth, via the blood. The observation of malaria in newborn babies, who have not been bitten by mosquitoes, is known as congenital malaria. Despite the above possibilities, the vast majority of malaria transmission occurs via the bite of infected mosquitoes, so it is very important to protect yourself from these insects when in malarial areas.

Malaria Recurrence

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QUESTION

I had malaria 5 months back it has again reoccurred. this time there has been increase in the size of the spleen. As of now it is being treated but I fear of getting it again. Is it true the malaria which i am down with reoccurs every 6- 8 months ??? Local people call it as registered malaria.. .

ANSWER

There certainly are types of malaria that can reoccur relatively regularly, at various intervals. This malaria is caused by one of two species, either Plasmodium vivax or Plasmodium ovale.

With both, it is important to get it diagnosed via a blood test with a doctor before getting treated again, to make sure it is indeed a relapse of the same malaria, and not a new infection with a different kind, or indeed some other disease (the symptoms of malaria can often be confused with other infections).

There is also medication that can be taken to prevent future relapses and re-occurrences—it is called primaquine, so you should talk to your doctor about the possibility of taking this medication. Please note it is not suitable for people who have G6DP deficiency, so you should be tested for that before taking it.

Long and Short Term Effects of Malaria

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QUESTION

What are the long term and short term effects of malaria in brief please?

ANSWER

The symptoms of malaria as an acute infection vary somewhat depending on the type of malaria, but usual signs include high fever (often in a cyclical pattern, with fever one day, then no fever for one or two days, then a recurrence of fever), chills, body aches and nausea.

For Plasmodium falciparum, the most deadly form of malaria, the infection can progress rapidly if left untreated, with organ failure, impaired consciousness, coma and even death occurring as quickly as a few days after the onset of symptoms.

If the patient is able to survive the infection, or gets treatment in time, there are usually no long term affects of malaria infection. Some people who have suffered severe cerebral malaria (from P. falciparum) may experience some longer term neurological effects. Other types of malaria, such as P. ovale and P. vivax, can form dormant life stages which hide in the liver for weeks, months or even years, leading to relapse at a later date. However, apart from these recurrences, there are also no long term effects of infection with these types of malaria.

Malaria Vaccine

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QUESTION

What is the shot you get to prevent malaria?

ANSWER

There is currently no shot available to prevent malaria. The most promising vaccine candidate, called RTS,S and being developed by GlaxoSmithKline, is currently undergoing Phase III trials in children in Africa.

Preliminary results have indicated it may prevent up to 50% of malaria cases, though this varies by age group and long term data are not yet available. The full results of the study will be published in 2014.

Malaria Parasites Classification

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QUESTION

Where are malaria parasites classified?

ANSWER

The parasite that causes malaria comes from the genus Plasmodium, which is part of a Phylum of single-celled protist organisms called Apicomplexa. The Apicomplexans mostly posses an organ called an apicoplast, which is part of an apical structure designed to aid entry into a host cell. The Apicomplexa is split into two Classes, of which Plasmodium belongs to the Aconoidasida (lacking a structure called a conoid, which is like a set of microtubules), and then to the Order Haemosporidia, which contains parasites which invade red blood cells. Within this Order, Plasmodium belongs to the Family Plasmodiidae, which all share numerous characteristics, including asexual reproduction in a vertebrate host and sexual reproduction in a definitive host (a mosquito, in the case of the Plasmodium species that infect all mammals, including humans).

In the case of human malarias, the definitive host is often referred to as the vector. The family contains about twelve genera, of which one is Plasmodium, which itself is now often divided up into numerous sub-genera, and then again into hundreds of different species, of which five infect humans (P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi).

Discovery of Malaria

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QUESTION

How was malaria discovered?

ANSWER

Malaria has long been known to human populations from across the world. In fact, the first mention of the symptoms of malaria comes from an ancient Chinese manuscript from 2700 BCE! However, the actual cause and mechanism of transmission of the disease was only discovered in the 19th century.

It was Charles Louis Alphonse Laveran, a French physician working in Algeria, who first observed the parasites that cause malaria in 1880, by looking at the blood of a patient that had recently died of malaria. However, at this point, it still wasn’t understood how malaria was transmitted. That was not discovered until 1897, when Ronald Ross, a British physician dedicated to curing malaria, observed malaria parasites in a mosquito that had been experimentally fed the blood of a patient infected with malaria. Working in India, Ross also later showed that mosquitoes could also transmit malaria to birds, if they had previously fed on the blood of birds which had malaria. In this way, he showed that mosquitoes of the genus Anopheles are responsible for transmitting malaria between hosts.

Vaccine for malaria? Differences with yellow fever?

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QUESTION

Is there a vaccine to prevent malaria?
What is the difference between yellow fever and malaria?

ANSWER

In answer to your first question, no, there is not currently a vaccine available to prevent malaria. The best current candidate, the RTS,S vaccine which was developed by GlaxoSmithKline, is currently undergoing Phase III clinical trials in Africa. Although preliminary results showed up to a 50% rate of protection against malaria in some age groups, the trials will not conclude until 2014 and so full results will not be known until after that date.

As for your second question, while yellow fever and malaria are both transmitted by mosquitoes, they share few other similarities. Yellow fever is caused by a virus, for example, whereas malaria is caused by a single-celled parasite of the genus Plasmodium. The group of organisms that Plasmodium belongs to is often called “Protista” (the exact grouping and classification constantly changes!), and they more generally belong, based on cell type, to the Eukaryotes, an enormous group of organisms which also includes all mammals and even humans! Viruses, on the other hand, are tiny pieces of genetic material wrapped in a protein coating, and can hardly be described as alive in a conventional sense.

While both yellow fever and malaria are transmitted by mosquitoes, yellow fever is transmitted by the genus Aedes, whereas malaria is exclusively transmitted by the genus Anopheles (at least in humans, and all other mammals for that matter).While spraying inside households may reduce the prevalence of  both types of mosquitoes, Aedes mosquitoes tend to feed during the day, so sleeping under an insecticide-treated bednet is less protective against yellow fever than it is against malaria. Also, a vaccine is available for yellow fever (and has been available for over 50 years), whereas as I describe above, no such vaccine yet exists for malaria.

Finally, while superficially the symptoms of yellow fever and malaria may seem similar (fever, nausea, aches), other manifestations of the disease can be very different. Yellow fever is technically considered a hemorrhagic disease, since it can cause increased tendency to bleed in patients. Also, in some patients, the initial symptoms are followed by an acute liver phase, causing jaundice which can turn the patient yellow (and hence the name). Malaria can also affect the liver, and cause ild jaundice, but usually not to the extent of yellow fever.  Once a patient has been diagnosed with yellow fever, there is no specific treatment, and the patient is merely treated based on symptoms, to ease their discomfort. Vaccination is the mainstay of control of this disease, and has been very successful in many places; the total number of worldwide cases is estimated by the World Health Organization to be around 300,000, with 20,000 deaths, mainly in Africa.

The burden of malaria is also mainly felt in Africa, though the number of cases and deaths is vastly higher – globally, there are approximately 200 million cases of malaria in 2010, with almost 700,000 deaths. Along with the general symptoms of fever and nausea, the most dangerous manifestation of malaria is when it causes cerebral symptoms; this is usually only caused by Plasmodium falciparum malaria, and can lead to impaired consciousness, coma and even death. Also in contrast to yellow fever,  the mainstay of control is a combination of prevention (mostly with vector control, i.e. using bednets, indoor residual spraying and destruction of breeding habitats and larvae) and treatment (using a variety of medications).

Treatment of Malaria

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QUESTION

How is malaria treated?

ANSWER

Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

  • chloroquine
  • atovaquone-proguanil (Malarone®)
  • artemether-lumefantrine (Coartem®)
  • mefloquine (Lariam®)
  • quinine
  • quinidine
  • doxycycline (used in combination with quinine)
  • clindamycin (used in combination with quinine)
  • artesunate (not licensed for use in the United States, but available through the CDC malaria hotline)

In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How to treat a patient with malaria depends on:

  • The type (species) of the infecting parasite
  • The area where the infection was acquired and its drug-resistance status
  • The clinical status of the patient
  • Any accompanying illness or condition
  • Pregnancy
  • Drug allergies, or other medications taken by the patient

If you have or suspect you have malaria, you should contact your doctor immediately.

Injections to Get Malaria

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QUESTION

I was wondering at one time did they give people shots to get malaria and then give them like I.V.S with some kind of medicine it the i.v. to counteract it, I know that some one that had ulcers of the eye and the eye specialist sent her home to her home hospital for i.v.s as he had given her a shot so she would get MALARIA, THIS would have been years ago, I don’t understnd the concept of giving her a shot for malaria and then give orders for her to have i.v.s.

ANSWER

The only reason I can think of for someone to be given an injection which might give them malaria, and then medication (perhaps in the form of an IV) in order to cure it is if they had volunteered to participate in a clinical trial, for example to test new malaria medications.

All clinical trials have to be approved by the medical research board of the country in which they are taking place, in order to ensure they comply with ethical considerations regarding patient rights, safety, etc. Many countries have an online database where clinical trials must be posted, so the public can be kept aware of what is going on. If you have such a registry in your country, you could look up whether a malaria treatment trial was conducted around the time that your friend received the injections. Otherwise, you could contact the hospital directly and ask if they participated in any trials.