Feeling Ill After Malaria Infection

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QUESTION

How soon after infection, will a person usually begin to feel ill?

ANSWER

There is a latent period, during which time the malaria parasites (which had entered the bloodstream via the bite of an infected Anopheles mosquito) migrate to the liver and undergo replication. The sporozoites (the life stage that enters the blood from the mosquito) differentiate in many merozoites, which are contained within a schizont in the liver cells. When the schizont ruptures, the merozoites are released and re-enter the blood, where they set about infecting red blood cells. Once in the red blood cells, the infected person will begin to experience symptoms—this is usually between 6-16 days after the initial infection, during which time the parasite is reproducing in the liver.

What Food Should I Eat for Malaria

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QUESTION

What food I eat in malaria?

ANSWER

If you mean what foods should you eat while you are suffering from malaria, then there are no specific diet specifications. Since many people feel nauseous and sick to their stomach while they are suffering from the disease, it may be hard to get people to eat anything at all – however, it is very important that the patient takes in a lot of fluids (water, diluted juice, herbal tea) in order to keep from getting dehydrated. If they are able to eat small amounts of food, that will also help to keep their strength up. Plain foods such as rice or dry toast may be the easiest for the person to digest, without feeling more nauseous.

Curing Malaria

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QUESTION

What is needed to cure malaria?

ANSWER

Malaria is usually cured through treatment with an anti-malarial drug. The World Health Organization recommends use of an ACT (artemisinin-based combination therapy, such as Coartem) as first-line treatment for all non-complicated (i.e. not severe) malaria, and especially P. falciparum malaria (which in most places is resistance to chloroquine, and also to mefloquine in some locations). For complicated, severe malaria, or in cases where the patient is unable to take medication orally, the recommended treatment is intravenous quinine.

Malaria in Southern Africa

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QUESTION

Which areas in southern africa harbour malaria?

ANSWER

Most of Namibia, Botswana and South Africa does not harbor malaria, either because it is too cold, too dry, or control measures have successfully eliminated transmission. However, malaria transmission is found in virtually all parts of Zimbabwe and southern Mozambique.

In addition, pockets of malaria transmission can be found in parts of the other countries of southern Africa, namely in northern Namibia (provinces of Kunene, Ohangwena, Okavango, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa and in the Caprivi Strip), in northern Botswana (Central, Chobe, Ghanzi, Northeast, and Northwest provinces) and also in the north-eastern corner of South Africa (north-eastern KwaZulu-Natal, with the southern-most limit of transmission corresponding with the Tugela River, Limpopo (Northern) Province, and Mpumalanga Province). Malaria is also transmitted in Kruger National Park.

Vaccine for Malaria

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QUESTION

Is there a vaccine to prevent malaria?

ANSWER

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.

Can Child Be Affected by Mother’s Malaria

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QUESTION
If the baby’s mother has malaria, can it affect the child?

ANSWER

If the mother is pregnant when she gets malaria, particularly if it is her first pregnancy and particularly if she has never had malaria before, the effects on both the mother and child can be very serious. For the mother, this is because her immune system changes when she gets pregnant. This leaves her more vulnerable to the effects of malaria, including anaemia.

The most dangerous type of malaria, P. falciparum, also seems very able to infect cells in the placenta, leading to a higher intensity infection, and also reducing oxygen delivery to the baby. This, combined with the mother’s illness and anaemia, can lead to low birth weight, anaemia and other complications in the child once it is born. Malaria can also pass through the placenta, or be transferred to the baby through blood during childbirth, resulting in “congenital malaria”; that is, malaria which has been passed from mother to infant. Since newborns have inexperienced immune systems, malaria in the first days or weeks of life, and especially if the child is already low birth weight, can be very dangerous.

As such, a lot of effort has gone to finding ways to prevent malaria in pregnancy and to treat women who do get malaria while pregnant to prevent negative effects both to her and her unborn child. These efforts mainly involve the distribution of long-lasting insecticide treated bednets, and in some places also include the administration of intermittent preventive therapy, where women are given periodic doses of anti-malarials during pregnancy to protect against the disease.

First Malaria Outbreak

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QUESTION

When was the first ever outbreak of malaria?

ANSWER

Malaria has actually been known in human populations for thousands of years, so the first ever outbreak occurred long before any records were kept. The ancient Chinese recorded the symptoms of malaria in a medical manuscript which dates back to 2700 BCE, so almost 5000 years ago!

The symptoms of malaria were also known to the ancient Romans, Greeks, Egyptians and native peoples of the Americas, though none of them fully understood the cause of the disease or how it was transmitted. That information was discovered in the late 19th century, by Charles Louis Alphonse Laveran, who first observed malaria parasites in the blood of a patient and attributed them to the disease, and by Ronald Ross, who demonstrated that the malaria parasite was transmitted by mosquitoes.

Swelling of Lymph Nodes and Malaria

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QUESTION

I would like to know if swelling of lymph nodes in neck is any way connect to malaria?

ANSWER

Swollen lymph nodes are often a sign that the body is trying to fight off an infection, and so swollen lymph nodes are certainly sometimes observed in malaria patients. However, most malaria infections would also be associated with other symptoms, such as fever, chills, nausea and aches.

In some cases (but not all), malaria patients experience cyclical fever, whereby they have a high fever one day and no fever the next, but the fever returns on the third day, and the cycle continues. One type of malaria exhibits a cycle of fever one day, then no fever for two days, then fever returns on the fourth day. However, many patients do not experience these cycles, which means their symptoms are very similar to those for many other illnesses, which is why if you are in or have been visiting an area where malaria is transmitted and you have some of the above symptoms, it is very important to visit a doctor or clinic to get diagnosed for malaria. This can be done with a simple blood test, and the results are usually available very quickly. Then, if you are diagnosed as positive for malaria, the doctor can recommend appropriate treatment and instruct you in the proper way of taking it.

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, beingPlasmodium 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.

Malarone and Mefloquine for Malaria

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QUESTION

Which drug is better for kids for anti-malaria – Malarone or Mefloquine. I have heard about lot of side-effects of Mefloquine. So, which is a safer drug out of these two or is there any other drug with no side-effects? Is it important to take anti-malaria pills keeping in mind the side-effects?

ANSWER

Both drugs are considered safe for children, though Malarone (atovaquone-proguanil) should not be given to pregnant women or those nursing a child under 5kg. Malarone is also available in a pediatric form in some places, where the dose is reduced specifically for prescription to children under 40kg in weight. Personally, I took both Malarone and mefloquine (as Lariam) when I was a child, and experienced no side effects from either, though certainly many more people do report side effects from mefloquine, including disturbed sleep and hallucinations, or increased anxiety, and it is therefore not recommended for people with a history of psychiatric illness or disorders.

If this does not apply to you or your children, then it really is a matter of preference, cost and practicality. Malarone is generally more expensive than Lariam, needs to be taken every day, but only needs to be taken a few days before departing for the malarial area and for only one week after you return. Lariam, on the other hand, is only taken weekly (which can be an advantage with small children), but needs to be started 2 weeks before travel and for 4 weeks afterwards, which can make it less convenient for short trips.

The other thing to consider, finally, is where you are going—some forms of malaria found in south-east Asia are resistant to mefloquine, meaning it is not a suitable anti-malarial for travel in those areas, so Malarone would be a better choice in that circumstance. Both mefloquine and Malarone are suitable for travel in all other malarial areas.