Child with Fever – Malaria Symptoms?

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QUESTION

Three yrs old boy having fever every 20 days for past 5 times. Remains for 2-3 days. Can it be malaria?
Never got blood tested.

ANSWER

Recurrence of malaria every 20 days is not that common, but could be caused by two different events: (1) true relapse, whereby the boy is infected with either Plasmosium vivax or Plasmodium ovale, and the parasite is disappearing from his blood but re-emerging from dormant forms in the liver (called hypnozoites), or (2) what is known as recrudescence, whereby the parasite never disappears fully from the blood, but reduced enough to stop symptoms from being felt, then flares up again.

Both options can be treated, but require a blood test, to ensure that malaria is the correct diagnosis and also to distinguish between options 1 and 2 above, and different treatment will be required.

A blood test should be performed during a period where the boy is experiencing symptoms, as with both options above, if the infection is not “active” (i.e. few or no parasites are visible in the blood) a blood test may prove negative. Rapid diagnostic tests which look for antibodies might be a good choice in this instance, as they may detect even a non-active infection.

My Malaria Refuses to Go Away

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QUESTION

The symptoms started about 2 months ago and I have used all kind of drugs. I have completed lumartem dose twice and I have used Coartem, I even took chloroquine injection and I am well for a few days and it comes back to the way it use to be, because of so many antibiotics I have taken I now have swellings in my body and in my leg and its making my leg ache and making walking difficult. What do I do?

ANSWER

Are you sure you have malaria? The most important thing is to get diagnosed accurately, either at a clinic or by a trained diagnostician. The most common form of diagnosis is a blood film on a slide, read under the microscope, but this can require expertise for accurate diagnosis. Another option is a rapid diagnostic test, now available in many places, which tests for the antibodies to malaria.

In my experience, in many places clinics will diagnose malaria purely on clinical symptoms, such as fever, which actually are very general to many diseases and so not necessarily mean malaria! So if you have been diagnosed without a blood test, go back to the clinic/doctor and demand a blood test.

There are no known strains of malaria that are resistant to Coartem which is why I suspect you may have something else, perhaps in addition to the initial malaria infection. Moreover, the drugs used to treat malaria are not antibiotics, and should not result in swollen legs; again, you should see a doctor or clinician before taking any further medication.

Malaria Medication Side Effects

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QUESTION

My mother is an old patient of arthritis. She has also had a long stint with asthma and tuberculosis. She has presently been diagnosed with urine infection but was treated with malaria medicines artesunate and primaquine phosphate.

What side effects could she possibly develop by wrong administration of malaria medicines?
ANSWER

Luckily there are few major side effects associated with either artesunate or primaquine. Mild side effects of the former include ones similar to malaria: nausea, headache, loss of appetite and vomiting. Side effects of primaquine are very similar to this, but can also include intense itching and anemia in some people (mainly of Mediterranean or African descent). The main thing to be aware of with primaquine is that it can be dangerous for people with G6DP deficiency, so patients should be tested for this before taking primaquine.

How soon can I take Coartem if I suspect Malaria?

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QUESTION

Does one have to wait for the symptoms of Malaria to show before taking Coartem? Will the Coartem still be effective in killing the malaria before it has entered the red blood cells and the fever has broken?

ANSWER

I believe that Coartem is only effective against the blood form of the parasite, hence why it is not effective in treating the liver forms of Plasmodium vivax and Plasmodium ovale.

More to the point, if you don’t have symptoms of malaria you shouldn’t take any medication to treat it—improper use of treatment medication can lead to resistance to Coartem developing in the malaria parasite, which would be a tragedy as it is currently the front-line treatment for many millions of people affected by malaria around the world.

On a personal level, taking Coartem unnecessarily can also lead to unpleasant side effects. As such, you should always get tested and diagnosed as positive for malaria before taking treatment. As a rule of thumb, if you don’t have symptoms, you probably don’t have malaria (though if you live in a highly endemic area, you may be able to tolerate a certain burden of malaria without symptoms…but then you would also be very familiar with the symptoms). Generally speaking, testing asymptomatic people isn’t worthwhile.

Can malaria affect one’s mental fitness?

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QUESTION

Can malaria affect ones mental fitness?

ANSWER

Given that malaria is often associated with severe fever and flu-like illness, I would say that is usually enough to prevent someone from feeling completely mentally fit! However, in addition to these general symptoms, there are other specific ways in which malaria can affect a patient’s mind.

With a particular type of malaria, called Plasmodium falciparum (the most common form in Africa and the most deadly worldwide), the disease can sometimes progress to what is called cerebral malaria, where the malaria parasite stick to red blood cells that clog up the tiny red blood cells in the brain. This condition is very serious, and can lead to impaired mental function, loss of consciousness, coma and even death.  Luckily, these effects are usually reversible and there are rarely permanent mental consequences of infection with malaria if treated promptly and effectively.

Cyclical Fever

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QUESTION

My husband has been suffering from recurring fever every 3rd or 4th day for the past 7 months. All blood tests are normal, esr ,crp, cultures of urine and blood all normal, chest ct full body pet heart echo all normal. Tested positive for montoux and quantiferon gold, with no symptom other than fever, was put on ATT on 4th JULY 2011 fever persists with no other symptoms. Has been on ATT for more than 4 months with no respite and as per doctor TB is ruled out but 6 month course mandatory. Please help. Fever comes with mild chills and head ache at times.

ANSWER

Cyclical fever every few days is one of the characteristic signs of malaria, and the length of the cycles can help identify the type of malaria. Specifically a fever every three days is indicative of Plasmodium malariae infection, which also fits with the long, chronic persistence of the illness.

This parasite can be hard to diagnose as it is often present in low concentrations in the blood. If you haven’t had a blood film done already, ask your doctor to make a thin and thick blood film to look for the presence of Plasmodium malariae in your husband’s blood.

If the first films are negative, continue with daily films for a further 2 or 3 days. Another diagnostic option is a rapid diagnostic test, which can detect antibodies to the malaria parasites in the blood. P. malariae is easily treated with chloroquine.

Unfortunately, without further information and a more complete medical history it will be impossible to make a further diagnosis of your husband’s condition, but certainly checking for Plasmodium through a blood test would be a good first step.

Malaria Symptoms, Cures, and Prevention

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QUESTION

What is malaria cure, prevention, symptom and course?

ANSWER

I am not sure what you mean by “course” – however, links to information on malaria treatment, prevention and symptoms can be found on the main page of our website. For your convenience, I have provided them here:

As for malaria treatment, I have copied here an earlier answer in response to a question about malaria cures:

Malaria can be cured with a number of different medications, depending on then type of malaria and how far the disease has been progressed.

For standard, non-complicated Plasmodium falciparum malaria, the World Health Organisation recommends use of artemisinin-based combination therapies (ACTs), such as Coartem. This is due to increasing levels of resistance to chloroquine in many parts of the world. Indeed, even though chloroquine is still used in many places as first-line treatment against P. vivax, P. malariae, P. ovale and P. knowlesi uncomplicated malaria, there is some evidence that resistance to this treatment is also emerging, for example in P. vivax in parts of south-east Asia.

In cases where malaria infection has progressed to a stage where oral administration of medication is not possible, or where cerebral symptoms are suspected, the usual treatment option is intravenous quinine.

In addition, P. vivax and P. ovale malaria parasites are able to produce forms (called hypnozoites) which can become dormant in liver hepatocyte cells after the blood stages of the infection have been cleared. These dormant forms can become reactivated weeks or even months or years after the initial infection, which is called a “relapse” of the infection. One drug, called primaquine, is able to kill these liver stages, and so patients with either of these types of malaria should also discuss the possibility of taking primaquine.

Apart from these first-line treatments, there are other medications which are used against malaria, both prophylactically as well as for treatment. These include orally-administered quinine, pyrimethamine, mefloquine, proguanil, atovaquone and sulfonamides.

 

Malaria Symptoms When Underweight

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QUESTION

Can symptoms appear earlier when you are underweight?

ANSWER

The timing of the presentation of symptoms depend on the intensity of the infective dose, the type of malaria, your levels of natural immunity and whether you were taking anti-malarial medication. Your weight is unlikely to affect the timing of the disease, though other medical conditions, such as immune status, which can be  associated with low weight might impact your ability to fight the disease.

Artemether, Lumefantrine Given with Ceftriaxone

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QUESTION

Can ceftriaxone be given with artemether/lumefantrine for treatment of malaria?

ANSWER

As far as I know, there are no known interactions between cefriaxone and artemether/lumefantrine, and no specific contraindications. However, you should consult with a physician before taking both in combination.

Also, since ceftriaxone is usually used to treat bacterial infections, it may be that it is a better to treat the malarial infection and the concurrent bacterial infection one at a time, as heavy antibiotics in addition to the anti-malarials may stress the immune system and liver of the patient unnecessarily, particularly if the patient is already weakened.

Which Anti Malarial for South-East Asia?

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QUESTION

We are in our 70s and will be on a cruise from Siem Reap to Ho Chi Minh. Which anti malarial would be most effective for these areas?

ANSWER

The main thing to consider when travelling to south-east Asia is that there are areas where some of the malaria is resistant to mefloquine (commonly sold as Lariam), and therefore this drug is not appropriate as an anti-malarial in these regions.

Chloroquine resistance is also rife throughout the region, although this drug is rarely used as a malaria prophylactic drug. However, apart from this, the choice of anti-malarial depends to a large extent on personal preferences.

The two main types recommended by the CDC for travel to south-east Asia are atovaquone-proguanil (marketed commonly as Malarone) and doxycycline. The former is associated with very few side effects, is taken once a day, and needs to be taken for a week after returning from the malarial area. However it is also very pricey! Doxycycline, on the other hand, is very cheap, but many people experience high sun sensitivity which can lead to severe sun burn if sufficient care is not taken. It also has to be taken for a full four weeks after returning from the malarial area.