Multiple Malaria Infections Each Year

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QUESTION

My name is Olumide and I live in Nigeria. I have had malaria too frequently and it’s giving me a lot of concern. I had one last August 2012 and am having another one this October as I am speaking with you. If I should count it, I’ll be having nothing less than 6 occurrences in a year. It’s always an headache induced malaria whereby after using the ACT combination recommended by WHO, two days after, am still having headache, am asthmatic though and can’t use more than Paracetamol. I am tired of all these and need your help.

ANSWER

One of the key things you should check is how you are being diagnosed with malaria—the symptoms of malaria are very general, such as headache, chills and fever. I have seen cases where people assume they have malaria and so take ACTs without getting properly diagnosed, and so they never actually go to the doctor to have their real illness diagnosed. Therefore, next time you feel sick, you should go to the doctor or to a clinic and make sure they do a proper malaria test. This will either be via taking your blood and looking at it on a slide under a microscope, or by using a drop of the blood in a rapid diagnostic test (RDT). I believe that in some parts of Nigeria, you can even buy the RDT in local pharmacies, and do the test yourself at home. Only if you test positive for malaria should you take ACTs; if the test is negative, you should go to a doctor and ask about other possible illnesses with similar symptoms (such as flu, pneumonia, etc).

At the same time, it could be that you are suffering from repeated malaria attacks, in which case you will need to improve your personal protection in order to prevent future attacks. Sleeping under a long-lasting insecticide treated bednet is crucial; you should also wear long-sleeved clothing at night and at the evening since this is when malarial mosquitoes in Africa are usually most active. You may also want to consider indoor residual spraying; this coats the inside walls of your house with insecticide, further reducing the number of mosquitoes that may bite you inside your home. For more information, please see our Malaria Prevention overview page: http://www.malaria.com/overview/malaria-prevention

Symptoms of Malaria but Tests Negative

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QUESTION

My sister has been suffering from fever from past 22 days temperature varying from 102-106 with chills shivering, headache, body pain,nausea and muscle ache but tested negative for malaria. She also tested negative for dengue, swine flu, hiv, and many others.  So out of frustration we gave her mefloc 250 and she seems to be responding. She is still having fever that is after 12 hrs of medication but the temprature is ranging between 98-100 and there is no headache and no chills and shivers.  Now we are confused how to confirm that it is really malaria and when will the fever stop completely. Should we shift her to a some other hospital at present she is in Pune.

ANSWER

The diagnosis of malaria is confirmed by observing parasites on a blood smear.  There are also Rapid Diagnostic Tests (RDT) that can be done with a pin prick of blood, but the blood smear is the definitive test. It is possible, that in your sister’s case,  a proper malaria test was not done or not interpreted correctly, and she does have malaria and it is responding to the medicine.   Alternatively it could be that your sister does not have malaria, but suffers from another problem that coincidentally is resolving itself at the same time the anti-malarial medicine is given.  It is hard to determine exactly what is wrong, but the good news is that she is getting better.

Sometimes medicine is given on presumption of illness which is what happened in your sister’s case. However, if someone has uncomplicated falciparum malaria, (most prevalent in India)  WHO recommends Artemisimin Combined Therapy (ACT), which uses an artemisinin compound with another anti malarial, such as mefloquine, not mefloquine alone.  If your sister’s fever returns, make sure to have a blood smear taken to see if it is malaria or not, and if so what kind of malaria it is, to better tailor her medicine.

Abdominal Pain in Malaria

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QUESTION

What is the cause of abdominal pain in malaria?

ANSWER

Often, abdominal pain in malaria occurs in the early stages of malaria infection (first week or so) and can be caused by the rapid enlargement of the liver and spleen as they become inflamed. During malaria infection, and particularly that with Plasmodium falciparum, the most deadly and severe form of malaria, large numbers of red blood cell become sequestered in the liver and the spleen (as well as other major organs). A danger is that if the spleen becomes too enlarged, it may rupture, causing massive internal bleeding which can be incredibly dangerous to the patient, and  lethal without immediate medical attention.

Bio-larvicides

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QUESTION

Why is there no mention here of all the work being done on biolarvicides – the low cost solution for malaria control?

ANSWER

Actually, we had a question a while ago about the ECOWAS program in West Africa, which centers around the use of biolarvicides. A link to that question, and the answer, is provided here: http://www.malaria.com/questions/ecowas-malaria.

The most common form of biolarvicides are those using various microbes, notably Bacillus species, which target mosquito larvae but are harmless to other non-target organisms. A recent study in the Gambia showed very high success rates in killing Anopheles gambiae larvae, when a microbial larvicide using Bacillus thuringiensis var. israelensis strain AM65-52 was applied weekly. Some practitioners are concerned about the amount of effort and man-power a weekly application of larvicide might require, plus the training necessary for correct identification of habitat, but the study in the Gambia seemed to show good compliance once personnel were suitable trained. A link to the study, which is freely available via the Malaria Journal, is available here: http://www.malariajournal.com/content/6/1/76.

 

Female Mosquitos and Malaria

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QUESTION

How come only the female mosquitoes can pass malaria?

ANSWER

Malaria is transmitted among humans by female mosquitoes of the genus Anopheles. Female mosquitoes need to bite people to get blood, in order  to carry out egg production.  These blood meals are the link between the human and the mosquito hosts in the parasite life cycle. Only female mosquitoes feed on blood, thus males do not transmit the disease.

Side Effects of Chloroquine

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QUESTION

After taking chloroquine injection ( which works for me) I am  having occassional bitter taste and severe nasal congestion, please what would you advise I take?

ANSWER

I am not sure why you are taking chloroquine injections. Chloroquine,  taken orally,  can be used as a preventive drug (except in Asia where there is  choroquine resistance to plasmodium falciparum)  and also for treatment (along with primaquine) for malaria caused by plasmodium vivex.  Chloroquine is only given by injection if the person cannot take medicine by mouth because of vomiting.    Side effects of oral chloroquine include a “bitter taste in the mouth” and rarely nasal congestion.  For the nasal congestion, you could try breathing steam to open the nasal passages. Unfortunately I have no suggestion for the bitter taste.

Falciparum Long-term Outcomes

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QUESTION

My husband was admitted to ICU for 22% falciparum parasite load (with some mild kidney and liver failure, as well as low blood pressure) after being overseas two weeks earlier.

They treated him with IV artesunate and oral Malarone and an exchange transfusion, and discharged him after a week, as his kidneys had improved and so had his blood pressure, and he wasn’t yellow anymore. He never went unconscious.

He’s still quite short of breath and having a challenging time climbing stairs which hasn’t really improved over the past week. It’s not outright respiratory distress, as he was having this in the hospital as well and never actually needed oxygen. He’s also still feeling warm (though no documented fevers).

I am wondering about: a) Whether testing for recrudescence is useful almost two weeks after symptoms started b) how long this shortness of breath is anticipated to last (and is it secondary to a mild transfusion reaction, as his chest Xrays were always normal in the hospital) and c) will there be long-term sequelae I should be aware of (as I can’t find anything except for “falciparum infection has poor prognosis if not treated promptly’) and d) what are his risks of becoming this sick again?

ANSWER

It sounds as if your husband received good care and that you are very well informed which is excellent.  Recrudescence can occur up to 28 days after initial infection but it isn’t common if the above treatment was given.  One of the side effects of malaria is anemia, and this can cause fatigue and breathlessness.  My hunch is that he probably is anemic and should be eating iron rich foods (meats, greens) and taking an iron supplement. It is best to check with your primary care physician who can order a simple blood test to check for anemia and advise you on supplements and nutrition.  There shouldn’t be a poor prognosis in the long term for people treated and recovered from falciparum malaria. I hope this helps.

Favism (G6PD Deficiency) and Malaria

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QUESTION

My son has Favism (G6PD deficient). He is going to stay for 2 years in Chad (malaria-endemic country). It is contraindicated for him to take antimalarial drugs. What can we do if he gets a malaria infection? One physician said that he can use Artelum (Artemether + Lumefantrine) for protection. Is it a right prescription?

ANSWER

Yes, you are correct that Primaquine (which along with chloroquine is used to treat people diagnosed with Plasmodium ovale or Plasmodium vivax infection) generally should not be given for people with G6PD deficiency. However, other malaria drugs are okay. The most common type of malaria in Chad is Plasmodium falciparum, and your doctor is correct is saying that  Artemether + Lumetantrine is the drug of choice to treat falciparum malaria and can be used by your son.   It is best however to take precautions against mosquito bites.  Please see more information: Malaria Prevention.

After Effects of Malaria

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QUESTION

If I had malaria about a month ago is it normal to still get nauseous on a daily basis and often even vomit?

ANSWER

It sometimes takes a few days or even a couple of weeks to fully recover from the infection, since it takes quite a toll on the body’s immune system. Also, the medication you take to treat malaria can also have side effects, such as nausea and headaches, which actually seem similar to the symptoms of malaria itself.

However since you have not been feeling well for a month after treatment, you should consider that something else may be going on (gastro-intestinal problem? pregnancy if you are female?)  It is best to check with your health care provider.

Precautions to Prevent Malaria

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QUESTION

What precautions can be taken to prevent malaria?

ANSWER

This is a common question.  Communities can try to control or eliminate mosquitoes (who when infected with the malaria parasite can bite humans and transmit the disease) by spraying with insecticide, using biological agents, or draining mosquito breeding areas.  These methods are called vector control. On a personal level, people can prevent being bitten by infected mosquitoes by screening their rooms, sleeping under long acting insecticide bednets, wearing protective clothing and using insect repellent. See: Malaria Prevention and Control for more information.