Malaria Deaths in the Tropics

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QUESTION

What’s the difference of malaria deaths between the subtropical and tropical regions and all the other regions?

ANSWER

I am assuming you are asking about the distribution of deaths caused by malaria between the tropics/sub-tropics and the rest of the world.

95% percent of all fatal malaria cases occur in sub-Saharan Africa, which lies entirely in the sub-tropics and tropics. Additionally, most of the deaths occur in Central, West and Eastern Africa (North Africa and South Africa have more advanced malaria prevention and control initiatives to the rest of the continent, and transmission is also less severe), and the other 5% of malaria deaths are mostly found in India and south-east Asia, so you could say that virtually all deaths due to malaria occur in tropical regions alone.

Indeed, there is almost no malaria in non-tropical or sub-tropical regions; the few cases each year in North America and Europe are usually due to imported cases from people who have traveled to tropical or sub-tropical regions.

What happens after you get malaria?

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QUESTION

What are the after effects of malaria?

ANSWER

In almost all cases, if malaria is diagnosed accurately and treated promptly, patients make a full recovery with no after effects. In some cases of severe malaria, the disease can develop into cerebral malaria, which can result in impaired mental function, loss of consciousness and coma (and, if untreated, even death). Again, if treated promptly, these effects should reverse, but in some cases, some neurological damage remains.

Similarly, children who are affected by malaria while still in the womb or during birth (“congenital” malaria) may experience low birth weight or retarded growth, which can have health implications later in life.

How to get malaria?

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QUESTION

How do we 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).

Lariam Side Effects

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QUESTION

How long does it take for the side effects of Lariam to disappear?

ANSWER

The manufacturers of Lariam report that it can take a “long” time for side effects to disappear, though they don’t specify an exact time frame.

While most people cease to experience side effects within a few days or weeks of stopping taking the drug (the half-life of the medication in the body is about 2-4 weeks), some people report side effects continuing for a period of months, and in a few rare cases, even years.

In order to minimise the occurrence of disturbing or even dangerous side effects, Lariam is not recommended for people with a history of depression or mental illness, or with heart or liver troubles. The physical side effects of Lariam can be just as dangerous and long-lasting as the more famous psychiatric side effects; in particular, long-term balance problems have been reported.

Is it Malaria?

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QUESTION

I was in Zambia 3-4 weeks ago and had yellow fever shot and malaria pills. A week ago I got a severe headache. I suffer from migraines now and then but it wasn’t one. The headache has not passed. 4 days ago I was feeling really ill. I was extremely tired and disorientated. I am nauseated, but not all the time. Have no appetite. I generally feel ill, like something isn’t right. Exhausted and almost confused. I just don’t have a fever and haven’t had the entire time—that’s why I haven’t been to doc for tests. Is having a fever the main symptom for Malaria? I am not pregnant and am generally a very healthy person.

Not sure if I should go for tests or just wait a few more days?

ANSWER

Fever is certainly a key symptom associated with malaria, due to the way the disease progresses through the human body. However, if you were taking malaria pills, it might be that they suppressed the infection sufficiently to reduce your symptoms. I would certainly recommend having a malaria test, if just for peace of mind. If you test positive you can immediately be treated, and if you are negative and still feeling unwell, you can discuss other possibilities with your doctor. One thought might be worm infections – helminths such as hookworm, roundworm (Ascaris or Strongyloides) or whipworm are very common in Zambia and are associated with symptoms of tiredness, listlessness, headache and nausea. The tests for these diseases are usually easy to perform from either a stool sample or blood test, and treatment is likewise very straightforward, with a single dose of albendazole or mebendazole for Ascaris, whipworm and hookworm, and a series of doses for Strogyloidiasis (this parasite can be harder to get rid of, though it is still very treatable. Ivermectin is another possible drug for this helminth).

Malaria and Seizures

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QUESTION

Is it possible to contract malaria early in life and have a seizure 20 years later?

ANSWER

I think it is highly unlikely. There are only two types of malaria that can reoccur long after the initial infection (Plasmodium vivax and Plasmodium ovale) and neither of these usually results in seizure or other cerebral effects. Looking through the literature, I can only find one case of P. vivax infection which had cerebral involvement (Beg et al., 2002, ‘Cerebral involvement in benign tertian malaria’, published in the American Journal of Tropical Medicine and Hygiene, volume 67, issue 3, pages 230-232).

Symptoms of Malaria

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QUESTION

What are the symptoms of malaria?

ANSWER

Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.

 

Timing of Malaria Microscopy

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QUESTION

Contrary to our past beliefs we came to know that malaria slides should be taken during afebrile periods when RBCs remain intact, enabling easier diagnosis of malarial parasites. Is this true?

ANSWER

That is a very interesting question, which I passed on to a diagnostic expert who serves as an advisor to Malaria.com. His response is as follows:

Blood films should be collected from someone who is sick with a febrile illness after they have been in an area where malaria transmission occurs.  That does not mean that the smears need to be collected during particular times during the fever cycle.  If the first set of films is negative they should be repeated every 12-24 hours for a total of 3 sets.  During that time period, in general, the parasitemia if present will be rising—increasing the likelihood of detection.

It is worth noting that blood films are of little to no value as a screening test of asymptomatic travelers.

Blood Test After Child’s Malaria Exposure

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QUESTION

Our 2 year old son was exposed and bitten about 10 times on Friday, 21st of Ocober in Malindi, Kenya. This was our last day in Kenya after 3 days on the coast preceded by 4 in Masai Mara. On October 28, our son started vomiting. This lasted a day. He did not have a fever at the time. The doctor diagnosed him with rota virus. Our 2 year old took his last dose of Malarone on the same day the vomiting started.

We believe he did not keep it down. Since the doctor visit our son has developed a cough and has had a low constant 38 C fever for a day and a half. Given the risk of a small child to malaria, is there any reason we should not request a blood test for Malaria?

ANSWER

Generally speaking, coughing is not a common symptom of malaria, and fever more usually comes in cycles, so the clinical presentation suggests that your son may be suffering from another illness.

However, as you say, small children are particularly at risk from malaria, so I would say it is worth getting a blood test for malaria, to be on the safe side. It only requires fingerprick blood, and the results can be available very quickly.

It is also important to remember that Malarone (including Malarone Paediatric, the version marketing for children over 11kg in weight) should be taken for 7 days AFTER leaving a malarial area, to prevent latent stages of malaria developing into a full infection.

With small children, other preventative measures are also especially important, such as sleeping under an insecticide-treated bednet, wearing long sleeved clothing in the evenings and early mornings and using insect repellent on exposed skin.