Malaria in Borneo, Indonesia

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QUESTION

We fly to Borneo tomorrow and have been very stupid not thinking about Malaria medication. Can someone quickly tell if I should take medication when there and also what type would be best to take?

Thank you for your help.

ANSWER

Yes! Malaria prophylaxis is recommended for trips to Indonesian Borneo, particularly rural areas. Recommended forms of prophylaxis are Malarone (atovaquone-proguanil), doxycycline and Lariam (mefloquine). The first is the most expensive, but has the fewest side effects, the second is the cheapest but can induce sun sensitivity and needs to be taken for 4 weeks after returning home and the third only requires one pill a week (the others are taken daily) but side effects can be severe and disturbing, including vivid dreams, impaired consciousness and hallucinations.

I am less familiar with south-east Asia, but I know in Africa doxycycline is readily available, for very little money, at local pharmacies. Therefore if you don’t have time to get the necessary anti-malarials before you leave, don’t panic! You may well be able to buy them in-country, particularly if you stop in Jakarta or another major city on your way. Check expiry dates and make sure the drugs are in the original packaging before you purchase though, as counterfeit drugs are distressingly prevalent. Also, do not buy chloroquine (or indeed any anti-malarial not listed above)—malaria in Borneo has been reported to be resistant to chloroquine and so this is not an appropriate anti-malarial for this area.

Please consider sharing your experiences with whichever prophylactic you choose when you return from your trip. We at MALARIA.com are trying to compile data on people’s experiences with malaria prophylactics and treatment medication, and we would be very grateful if you would take our malaria survey. Thank you!

Please also use other preventative measures against malaria while you are in Borneo—sleeping underneath an insecticide-treated bednet and wearing long-sleeved clothing in the evenings and at night, plus applying insect-repellent to exposed skin, can all help to reduce the incidence of mosquito bites and thus the risk of contracting malaria. Plus, avoiding insect bites will probably improve your enjoyment of the trip as a whole!

Malaria After Doxycycline?

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QUESTION

I recently spent a month in Asia. I took doxycycline tablets for malaria. I took them for the month I was away and when I returned. I took the full course and had been fine. Within two days of completing the course I became ill. This has be going on for about a month now with severe headaches, nausea, dizziness, very tired all the time and feeling like I’m going to faint. I have been to the doctor five times, they think this is a virus, I have been tested for malaria and dengue fever. I am only just now starting to feel better. What could this be?

ANSWER

Since you are beginning to feel better, I would go with your doctors’ diagnosis of a viral infection of some kind. It is also possible that you were infected with intestinal amoebas or even worms. A more accurate diagnosis would require faecal sample and possibly blood tests. You did the right thing by getting tested for malaria and making sure you didn’t have dengue.

US Army Doctor William Crawford Gorgas: Sent to Panama to fight Malaria

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QUESTION

What was the doctor’s name who was sent to Panama to fight Malaria when Panama Canal was being built?

ANSWER

I believe the person you are referring to is Dr. William Crawford Gorgas. Dr Gorgas was the chief sanitary officer for the Panama Canal project and had gained experience in controlling vector borne diseases while working in Havana, Cuba, where yellow fever was a problem.

It had also been shown a few years earlier, in 1898, that mosquitoes carried malaria as well. In Panama, Dr Gorgas focused his efforts on controlling mosquitoes, through drainage of standing water, adding larvicide and oil to remaining water and hand-collection of adult mosquitoes. In addition, Dr Gorgas screened all government buildings and workers’ quarters to prevent mosquitoes from entering, and gave workers prophylactic quinine. He was assisted in these endeavours by Dr Joseph Augustin LePrince and Dr Samuel Taylor Darling; together, their efforts led to the elimination of yellow fever from the canal zone and a great decrease in the number of malaria cases, though malaria continued to be a problem throughout the construction of the Panama Canal.

Malaria Causes

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QUESTION

What are the causes of malaria?

ANSWER

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery (“congenital” malaria).

How to Protect from Malaria

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QUESTION

How can I protect my body from malaria?

ANSWER

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 someone is 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.

The problem is that these drugs have not been tested for long-term use, can be expensive and may have side-effects. Therefore they are of limited use for people who live in areas where malaria is endemic, and are more appropriate for travelers who are in malarial areas for short amounts of time. However, anti-malarial medication may be used in a very specific way for people at particularly high-risk for malaria, such as pregnant women and young children. In these cases, the high-risk individuals receive a dose or series of doses of malaria medication in order to prevent malaria. This form of prevention is known as intermittent preventive therapy (IPT).

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.

Recurring Malaria

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QUESTION

I had malaria twice when I was 4 and 8 years old. I am 50 years old now but I have severe chills at least once or twice a month, muscle aches, fatigue severe head aches for the past 10-15 years with no apparent cause and my I take head ache medication for migraine (maxalt and excedrim) and my chills and fatigue is getting more frequent. I had no other history of any diseases. Is this symptoms a possible recurrent malaria.

ANSWER

Thanks for your question. One of the most common symptoms of malaria is high fever, which comes in cycles with chills in between. Without fever, it is unlikely that you are suffering from malaria.

However, there are some forms of malaria which can cause relapses. Specifically, Plasmodium vivax and P. ovale can form dormant liver stages which can then re-enter the blood causing a relapse of malaria infection and a recurrence of symptoms. To diagnose malaria in your case, next time you have an episode of chills, go to your doctor and ask for a blood test to check for malaria. S/he will either look at your blood under the microscope or perform a rapid diagnostic test, which tests for malaria-specific proteins, called antigens, in your blood.

In either case, it will tell you whether you have malaria, and which kind. If you have one of the relapsing kinds (P. vivax  or P. ovale) then you may be able to take a course of a drug called primaquine which kills the dormant liver forms of the malaria parasite and thus prevents future relapses. However, people with G6DP deficiency should not take primaquine, so you should be tested for this deficiency prior to taking the drug.

Paludrine/Avloclor Anti Malaria Travel Pack

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QUESTION

Is this anti malaria travel pack suitable for Borneo?

ANSWER

This kit is NOT appropriate for preventing malaria in Borneo. Avloclor contain chloroquine phosphate, and some types of malaria present in Borneo are resistant to chloroquine.

The CDC recommends that travelers to Malaysian or Indonesian Borneo should use atovaquone-proguanil (Paludrine contains proguanil, but the drug Malarone contains the combination of proguanil and atovaquone in one pill), mefloquine (sold under the brand name Lariam) or doxycycline.

Each of these different types of prophylaxis (preventative medication) has its advantages and disadvantages: Malarone is very expensive but many people consider it to have the fewest side effects; Lariam has been associated with severe side effects and is not recommended for people with a history of mental illness, but only needs to be taken once a week (the others require a daily pill); and doxycycline is cheap but may produce sun sensitivity.

When you return from your trip, please take a moment to share your experiences with anti-malarial medication by taking our malaria survey. We will compile all the results and post them on MALARIA.com, so visitors to the site can be informed about the preferences and side effects experienced by other members of the public who have used different forms of prophylaxis.

Evolution of Malaria

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QUESTION

how did malaria evolve?

ANSWER

Malaria in humans probably evolved independently several times, and both times likely due to a cross-over event from a closely related primate malaria. For example, Plasmodium vivax is evolutionarily closely related to several species of malaria found in macaque monkeys in south-east Asia, and so a cross-over of one of those species into human, with subsequent adaptation and speciation, is one hypothesis as to the origin of P. vivax. Conversely, some people argue that P. vivax emerged in Africa, due to the high prevalence of certain genetic traits in African populations (such as the Duffy negative antigen), which protect against P. vivax.

In contrast, P. falciparum is agreed to have emerged in sub-Saharan Africa, and likely in the Congo basin, though the exact source of its origin has been under recent scientific dispute. Until 2010, it was thought that P. falciparum had crossed over to humans from chimpanzees, as chimps are known to be infected with P. reichenowi, a species very closely related to P. falciparum. However, a paper was published in 2010 which had sampled Plasmodium parasites of gorillas and revealed new species of Plasmodium which are even more closely related to P. falciparum, suggesting that the cross-over occurred from gorillas to humans.

As you can see, humans are not the only primates to get malaria; many species of monkey and ape are also susceptible to Plasmodium species, and even lemurs have their own suite of Plasmodium parasites. Among the mammals, rodents also can get malaria, and bats are infected with Hepatocystis, a malaria-like parasite which also infects hippos, primates and rodents. However, no other species of mammal appears to be susceptible to Plasmodium/Hepatocystis, and the reasons for this are not entirely clear.

Plasmodium probably crossed over to mammals from birds or lizards, both of which are infected with a vast number of species of Plasmodium. It is unclear in which of these groups Plasmodium first emerged, though it likely evolved originally from another type of blood-borne parasite called Leucocytozoon, which infects birds and uses blackflies (genus Simulium) as vectors.

A sister group to Plasmodium, called Haemoproteus, also evolved from Leucocytozoon but utilises a variety of different vectors, including mosquitoes, biting midges (Culicoides), louse flies (Hippoboscidae) and tabanids (Tabanidae). Plasmodium, by contrast, exclusively uses mosquitoes as its vectors (apart from one species of lizard Plasmodium, P. mexicanum, which uses sandflies), but while mammalian Plasmodium is only transmitted by Anopheles mosquitoes, bird and lizard Plasmodium can be transmitted by Culex, Aedes, Culiseta, Anopheles, Mansonia and Psorophora. As such, understanding the patterns of vector and host switches within Plasmodium and related taxa can actually provide interesting insights into the genus’ evolutionary history.

Plasmodium

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QUESTION

Is Plasmodium a bacteria. Why?

ANSWER

No, Plasmodium is actually a protozoan—that is, a single-celled organism that is usually microscopic and belongs to the Domain Eukaryota (which also includes all plants and animals, but excludes bacteria and archaea). More specifically, Plasmodium belongs to the Apicomplexa group of protozoans, which are characterised as being parasites of animals, and possessing several unique characteristics, such as an apical complex structure used for invading host cells, and from which the group derives its name.

Protozoans differ from bacteria in terms of evolutionary history as well as a number of key characteristics. For example, protozoans, like all eukaryotes, possess a membrane-bound nucleus and organelles, neither of which are seen in bacteria. Bacteria, moreover, can produce their own food (they are autotrophic), whereas protozoans tend to be heterotrophic and rely on other organisms for food.

How does one catch malaria?

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QUESTION

How do you get malaria?

ANSWER

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery (“congenital” malaria).