Diagnosed with Malaria in Nigeria

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QUESTION:

Hi my twin sister is in Nigeria on a 5 month missions trip. She has just been diagnosed with Malaria, they believe she got it a year ago in El Salvador and that it has been dormant in her system, she has week kidneys and has chronic high blood pressure due to childhood illnesses she has had her whole life. She is in the Northern part of Nigeria and the hospitals there are no real help, my questions is…. in your opinion should come home now to recover?? I am sure the type of Malaria she has, I have been doing lots of research and I am extremely concerned for her health. She has always had health issues and I am wondering if the malaria will be even worse for her given her pre-existing health conditions. It is very hard to reach her so I am not able to ask her many questions, I know she is in pain, can’t keep food down and currently is not being treated in a hospital. Any thoughts or recommendations would be appreciated!!! ASAP Please! Thank You! Tasha

ANSWER:

Hi Tasha, I answered your question directly in response to the comment you made on the Malaria Symptoms post, but here it is again:

Sorry for the slow reply, I’ve been travelling. It sounds like your sister really needs urgent medical attention, and is not receiving that where she is in northern Nigeria. If possible, I would try to encourage her to seek further medical help, either in the area she is in or, if she is able to travel, in one of the major cities. If they have accurately diagnosed the type of malaria she has (which is presumably how they suspected she was infected in El Salvador, since it is likely not a species of malaria that is commonly found in Africa), it will be straightforward to give her treatment, but any physicians she sees must be made aware of her existing health conditions. If she has Plasmodium vivax, which is often found in Central America, she should also look into taking a course of drugs (called primaquine) which will prevent further recurrence of the disease at a later date. Hope this has been of some help and that she is on the road to recovery already.

AND:

In addition to the above, I have just received some advice from a medical doctor who is involved with our website:

If she contracted it in El Salvador, then Plasmodium vivax most likely and not a particularly resistant strain (generally chloroquine sensitive west of Panama Canal). I think this could be easily treated in Nigeria so long as the diagnosis is clear and there are drugs available – almost any standard regimen would be effective. Did she have anything with her for prophylaxis or stand-by treatment? Chloroquine/mefloquine/Malarone shouldn’t need much adjustment for her kidneys, but it would help to know what her renal function is (GFR/Creatine). The pain and nausea/vomiting present a problem in keeping the medication down, however, even IV hydration is an option if she is becoming dehydrated from the illness. In general, more details are needed, as worsening kidney problems from hydration or gall bladder problems from not eating could complicate the picture, even if the malaria is treated. I don’t know where home is, but she should at least get to a town where basic blood work can be obtained, and anti-nausea medication/IV fluids are available.

 

Did I have malaria before?

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I am from East Africa. On July 3rd,2011 I had chills and I consulted a doctor, he did a blood test and told me I had malaria and gave me medication.

Then after 10 days I had neck pain and I went again to the doctor, who did another blood test, diagnosed malaria and gave medication. Then after 10 days it repeated.

It’s now the 22nd august,2011. I have pain in my neck and I went to another doctor he told to take blood test and he told for the last one month you didn’t get attacked by malaria. Can I know whether I suffered from malaria for the past 1 month? Also he has told me to take saline with some medicine to flush out that malaria medication. Is it correct? Please advise me.

ANSWER:

One of our collaborating medical doctors has kindly assisted in providing this answer. If recurrent symptoms of malaria were from one exposure to malaria earlier this year, then a drug-resistant strain of Plasmodium vivax is likely. OR, he/she simply needs to take primaquine for 4-6 weeks to eradicate the liver phase. The recurrent blood phase (symptomatic phase) may be due to smoldering infection in the liver. In order to confirm this hypothesis, you would need to know what drugs you were given on your earlier trips to the doctor, as well as the type of malaria the doctor diagnosed, if possible.

 

Dengue Fever

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QUESTION:

Hello, I work with an NGO . We work in the rural areas. Please give me idea about dengue. Thnx

ANSWER:

Hi there, I’m afraid that I can’t really help you without knowing where you are located! Also, this forum is generally dedicated to questions about malaria, and so maybe I could recommend you look at the World Health Organisation pages regarding dengue fever for more information.

Certainly there are some very interesting data regarding the possible relationship between chloroquine resistance in malaria (and thus the reduction in prescribing it for malaria treatment) and the increase in incidence of dengue in many areas, but that’s a whole different story!

NRHM payment

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QUESTION:

NRHM Payment by malaria in Jharkhand

ANSWER:

I’m afraid I don’t fully understand the question. Perhaps you could rephrase it, and then I will try to answer you as fully as possible. Thank you!

Incubation Period for Malaria

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QUESTION:

What is the incubation period of malaria?

ANSWER:

That depends on the species of malaria. Plasmodium falciparum has the shortest incubation time, typically 10 to 14 days. For P. vivax, incubation is usually between 10 to 17 days, but can be much longer (up to a year; the longest incubation time recorded for this species was 30 years!). P. ovale has an incubation period similar to that of P. vivax, and can also be dormant for many months or even years. P. malariae is thought to have an incubatiom time of between 16-59 days.

Malaria prophylaxis

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QUESTION:

What name brand medicine should you take if you are traveling to area where malaria is present?

ANSWER:

That depends on a few factors, such as where exactly you are going, whether you have had bad experiences with any malaria preventative drugs (prophylactics) in the past, and how much money you want to spend! Common brand names of malaria prophylactic drugs include Lariam (generic name mefloquine) and Malarone (a combination of atovaquone and proguanil). Doxycycline is also a popular antimalarial, which is often sold under its generic name.

Malaria Eradication and Water Quality

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QUESTION:

How will the eradication process of the mosquito larva influence the quality of the water?

ANSWER:

That’s a very interesting question. The answer is that it depends a lot on the way in which the mosquito larva are controlled. The usual, traditional method is through the application of insecticides. Many of these are known to have severe negative effects on water quality, particularly through being non-selectively toxic and therefore killing lots of other aquatic life as well as the mosquitoes. Moreover, some are known for their effects on animals further up the foodchain; the most famous example of this being DDT, which was used to kill adult mosquitoes. It was discovered that this pesticide resulted in birds laying eggs that had very thin shells, preventing the chicks from hatching successfully. As such, it was banned in most developed countries. Modern insecticides used for mosquito larva reduction have been developed to target mosquitoes specifically; a popular one in the USA is methoprene, which interferes with the mosquitoes’ growth hormones, preventing development into adults. Microbial compounds, which are not dangerous to other organisms, are also sometimes used.

Another approach is through the use of natural enemies of the mosquito larvae, notably certain species of fish and dragonflies. These will eat mosquito larvae and pupae, thus naturally reducing numbers, and with little undue effect on water quality (although in some contexts, such as reservoir water, there may be concerns with stocking the water source with large numbers of fish).

G6PD and Malaria

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QUESTION:

Does one need to have a normal result in G6PD screening before he can take Malarial pills?

ANSWER:

In some cases, yes. When a patient has been diagnosed with Plasmodium ovale or Plasmodium vivax infection, in addition to medication such as chloroquine to target the blood stages of the parasite, an additional drug, called primaquine, may also be required. Primaquine kills the liver stages, known as hypnozoites, of these forms of malaria, preventing relapse of infection later on.

However, primaquine is known to cause severe haemolytic anaemia in people who are G6PD deficient. G6PD deficiency is restricted to certain populations or segments of populations; therefore it may be that not every person requiring primaquine will be tested for their G6PD status, only those considered high risk for potential deficiency. Patients with severe G6PD deficiency should not take primaquine; unfortunately at this stage there are no alternative drug regimens available. Patients with mild forms of G6PD deficiency should take primaquine at an alternative dose to G6PD-normal patients, usually 0.75mg/kg bodyweight once a week for 8 weeks (as opposed to 0.25mg/kg bodyweight once a day for 5 or 14 days, depending on the case history of the patient and the physician’s recommendation).

There is also some evidence that quinine can cause haemolysis in patients with G6PD deficiency; such patients may also have increased blood concentrations of mefloquine when taken concurrently with primaquine. As such, combinations of quinine or mefloquine with primaquine in G6PD-deficient patients is not recommended.

Will malaria come back?

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QUESTION:

As a result of a blood test I have just been informed that at some time I have had malaria. Though I have no idea when this was. I once was ill for 4 days with what I thought was flu and that is the only occasion I can remember. Therefore I have never been treated for malaria. Could you please tell me if there is any chance the disease will come back.

ANSWER:

That will depend on the type of malaria you had. I presume you found out you were infected through a blood test – it is likely a test that looked for antibodies to malaria in your blood. These tests can sometimes differentiate between the different species of malaria, and so it is definitely worth asking the clinic or doctor that performed the test if they can give you this information. Your location, or places where you have travelled in the last 4 years, may also assist in determining which type of malaria you had. Given that you barely registered being sick, I would suspect that you probably didn’t have Plasmodium falciparum, which is usually the most severe kind; it also cannot survive dormant in your system for long periods of time, so if you happened to have this kind, you wouldn’t need to worry about it coming back (though of course you can still be re-infected by all types of malaria, so prevention is still important!).

However, the other three main types of malaria can linger in a patient’s body. P. malariae is the least acute of all the malaria species, and can survive for a long time in the bloodstream, meaning that some people can have the infection for long periods of time without really feeling sick. If the blood test you took looked directly for parasites in your blood, and you tested positive, it is likely you have this kind. Like all uncomplicated cases of malaria, it is easily treatable, and once cured, you won’t have worry about it coming back (again, you do still need to watch out for being bitten by mosquitoes and getting re-infected though!).

The final two types of malaria are P. vivax and P. ovale. These persist in the body in a slightly different way than P. malariae – these have a special life stage which can lie dormant in the liver. Months or even years later, these dormant stages can re-activate and enter the blood stream, causing the patient to feel symptoms again, such as fever and nausea. Therefore, if you find you tested positive for one of these two forms, it is very important to ask your doctor about receiving medication (called primaquine) that will specifically target the liver stages of the parasites, to ensure you don’t get a recurrence of the infection later on.

As I’ve mentioned a couple of times earlier in this response, a key thing to be aware of is that even if you don’t have a recurring form of malaria, or treat it successfully, you will still be susceptible to re-infection if you are bitten by an infected mosquito. As such, if you live in or travel to a region known to have malaria transmission, it is crucial to take steps to prevent infection. For example, sleeping under a long-lasting insecticide treated bednet greatly reduces your risk of being bitten by the mosquitoes that carry malaria; similarly, wearing long-sleeved clothing and insect repellent, especially at night when malaria mosquitoes are most active, is recommended. Finally, medication is available that can be taken to prevent malaria (these are called prophylactics). As they can be expensive and are not recommended to be taken over long periods of time, these tend to be used primarily by people travelling to malarial areas rather than residents. There are several different forms of these prophylactics available commercially; the one to use will depend on several factors, including where you are travelling to.

Drugs to Treat Pregnant Woman with Malaria

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QUESTION:

What are the drugs for a pregnant woman who has malaria for the first to third trimester?

ANSWER:

The treatment of malaria in pregnant women has become more challenging in recent years, as many types of malaria are developing resistance to the standard arsenal of drugs. In locations where the dominant form of malaria is still chloroquine-sensitive, chloroquine can be used safely throughout pregnancy.

However, given the high levels of chloroquine-resistance, other drug regimens may be required. Currently, first-line treatment options for uncomplicated malaria caused by Plasmodium falciparum (many strains of which are resistant to chloroquine), is quinine plus clindamycin (doxycycline is contraindicated in pregnant women). In the second and third trimesters, artesunate plus clindamycin can be administered, or the artemisinin-based combination therapy (ACT) commonly used in that region, although some of these combinations, particularly those containing artemether, have limited safety testing in pregnant women. In general, the paucity of controlled, randomized trials has posed a problem to creating safe and effective recommendations for the treatment of malaria in pregnant women.