After Malaria: Low Iron, Chest Pains

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QUESTION

I got malaria in Ghana in February 2012 and was treated for it and recovered within 10 days. I had no problem or illness after that. Returned to USA late May of 2012 healthy able to run 4 or 5 miles a day and be active. About 3 or 4 weeks later suddenly developed shortness of breath, chest pains with hunger and thirst. Have seen 5 different doctors and had extensive heart, lung, digestive, blood tests, thyroid, diabetis etc. All have come out okay except for recent blood test showing some very low iron levels (Iron always Ok previously). Still having chest pain, breathing problems, thirst and hunger. Can’t run more than a block now. Could this be related to malaria or similar illness from Ghana? Any suggestions on what it could be and what doctors should be looking for as the doctors seemed stumped? Has anyone else had similar problems after having malaria? I appreciate any assistance that you can provide.

ANSWER

Sorry to hear about your current situation.  My advice is to treat your low iron levels. There are cases where patients who have been cured of malaria still develop severe anemia, and it is conceivable that some of your symptoms such as shortness of breath, fatigue, and chest pain are caused by  severe anemia.  Treating anemia can often show dramatic results.  Oral iron tablets are effective as well as eating iron-rich foods (meat, greens such as spinach, dried apricots, beans etc).  If you don’t feel better in a couple of weeks, I suggest you go back to the clinic for further discussion with your health provider.

Can Malaria be Completely Cured?

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QUESTION

My 18 yo son in on a study abroad in Bangalore, India. He has been in India since July 1st and toured Northern India the first 6 days that he was there. He woke up yesterday with horrible chills/shakes, then transitioned into a fever for several hours, then fever broke and was sweating for another 3 hours, while having a migraine behind his eyes. He did you go to the doctor and was told he has Malaria. He has been on Doxycycline since 2 days before leaving to go to India. He is also taking Colloidal Silver everyday. The Dr gave him some medicine today (he has not told me the name yet) and told him to come back on Monday for a blood test. What I would like to know is—is it possible for this to be completely treated? Or will he always have some of the parasite left in his system?

ANSWER

A blood test can diagnose if malaria is present and which kind of malarial parasite is causing the illness. Usually it is done when the person first presents themselves at the clinic with malarial symptoms.   Sometimes, a health worker will treat the person based on symptoms alone, although having a blood test is recommended if available.

Malaria can come back in three ways: first of all, the person could have been successfully treated, but then re-infected again by being bitten by an infected mosquito. In these cases, the person should focus on improved malaria prevention, such as sleeping under a long-lasting insecticide treated bednet.

Secondly, the patient could have recrudescence: when the patient takes medication, the treatment kills most of the malaria parasites in the blood, and enough so the patient feels better again, but some parasites still remain. Then, after the treatment finished, the parasite is able to replicate again, they increase in number in the blood and the patient feels ill again. In this case, you would say the infection came back from the blood, and the patient should take another dose of anti-malarials, but of a different kind to that which they originally had, in order to kill all of the parasites.

Finally, there is what is called relapse, which only occurs with two types of malaria: Plasmodium vivax and Plasmodium ovale. These are able to form dormant stages in the liver, so even when all the parasites are killed in the blood by the malarial treatment, these dormant forms survive. Many weeks, months or even years later, these dormant liver stages can re-activate and enter the blood again, causing new malaria symptoms. In this case, the liver was the source of the parasites. Again, the active blood infection should be treated with anti-malarials, but the patient should also talk to their doctor about taking primaquine, a drug which can kill any remaining dormant liver forms and thus prevent future relapses.

I hope this answers your questions and that your son recovers soon.

Malaria: Should I See a Doctor?

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QUESTION

For the last couple of days I am suffering from all the symptoms that are mentioned on your website and I am taking tylenol for these symptoms thinking that it is flu but I am feeling better now. Should I still see a doctor or keep taking Tylenol?

ANSWER

Symptoms of malaria often include high fever, aches, chills, nausea, and headache.  When severe, malaria can lead to anemia, impaired consciousness and even coma or death.  The best course of action is to get a simple blood test to check if you have malaria, because if you do have it,  early treatment with the appropriate drug (for the type of malaria you have), is essential.

You should also know how to prevent getting malaria. The first thing to do is to make sure you are protecting yourself sufficiently from mosquito bites. You can’t get malaria if you aren’t bitten by mosquitoes, and the type of mosquitoes that transmit malaria usually bite at night. As such, it is crucial to sleep every night under a long-lasting insecticide treated bednet. If you have one, it might need to be re-dipped in insecticide to make sure it keeps working effectively. Also, you should make sure all your windows and doors are properly screened to prevent mosquitoes from coming in; many people also do something called “indoor residual spraying” where they spray insecticide on the walls inside their house to kill any mosquitoes which might come in. If you live in an urban area, this might not be necessary if you can get good screens, or indeed if you have air conditioning (mosquitoes do not like cooler environments). Finally, you should try to wear long-sleeved clothing in the evenings and at night, again to stop mosquitoes from biting.

Bringing Malaria to the United States

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QUESTION

I was recently diagnosed with Malaria still waiting to find out what strand, but either got it in Uganda or Rwanda. I have recently came back to the states and have been bit by mosquito. I have already started to take some medication for it, but I am concerned about spreading the virus to others in the states including my family. Is it possible that if I still have the infection to spread it to others or in the states? If so what should I do.

ANSWER

There actually used to be malaria in the United States, particularly in the southern areas, but concerted mosquito control efforts as well as public health initiatives eradicated it in the 1950s. I don’t think you need to worry too much about transmitting malaria—once you are on treatment, the number of parasites in your blood drops dramatically and it becomes more difficult to transmit the parasite to a mosquito. Also, there are lots of types of mosquitoes in the US, and only those of the genus Anopheles can transmit malaria. As such, if you are concerned about spreading malaria, you should take precautions to protect yourself from mosquitoes especially at night and at dusk and dawn, as this is when Anopheles mosquitoes are most active. The type of mosquitoes which bite during the day usually belong to the genus Aedes, and cannot transmit malaria. During these high risk times of day, you should take care to wear long-sleeved clothing, and also wear insect repellent, preferably containing DEET.

Can Malaria Cause Blindness?

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QUESTION

Can you please help us? My husband got severe malaria and now he’s blind. He stayed 33 days in hospital.

We live in Portugal. My husband came back from Africa (Angola) on 2nd June 2012. On 3rd June he started feeling ill. He got worse next days. The symptoms were strong headache, high fever, chills, delirium, vomit, couldn’t breathe and weakness. He went to hospital on 7th June. On 8th June was diagnosed with Malaria (Plasmodium Falciparum). Doctors induced him in a coma (10 days) so he could breathe through a machine. He got kidney’s failure, cardiovascular collapse (he needed to be reanimated) and severe anemia. Doctors thought he would die… He woke up from coma on 18th June. On 19th June he couldn’t see anything, it was all dark… First Doctors told us it was due to the quinine treatment, that when quinine come out from the blood he would recover vision. Later exams revealed optic nerve damages. Sometimes he sees images only during few seconds… Can you help us? Do you think this blindness is reversible? Is there any treatment we can do? Are you aware of cases like this? He has 35 years old, we are in panic… Thank you in advance.

ANSWER

I think I have answered this question within one of the comments sections on the website, but will briefly address it here as well. Your doctors are right – the blindness is probably a side effect of the intravenous quinine treatment, which likely saved your husband’s life, but the high dosage is also somewhat toxic to the body. Most patients do recover their vision eventually; one report which I read said that in the short term, treatment with charcoal derivatives can help to lower quinine levels in the blood, thus encouraging faster recovery.

Mosquito Larvae Eradication

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QUESTION

What measures can be taken to eradicate mosquito larvae?

ANSWER

The main methods to control mosquito larval populations are by reducing areas available for adults to breed and also directly killing larvae. So, for example, adult mosquitoes need standing, stagnant water in order to lay their eggs. Getting rid of these sources of standing water, for example by filling in unwanted ditches and removing empty containers that can become filled with rainwater, therefore reduces the available breeding habitat for mosquitoes. Similarly, dripping a small amount of oil on top of standing water creates a thin film of oil over the surface of the water, preventing adults from laying eggs. In addition, the oil prevents the larvae from gaining access to air, suffocating them and killing them. There are other methods for killing larvae too. Directly spraying insecticides onto water is one method, but often not very specific, and can have a negative effect on other forms of aquatic life. One popular method for biocontrol is to introduce other animals which eat mosquito larvae, thus keeping numbers down. Examples include certain species of fish, as well as small crustaceans called copepods.

Recurrence of Malaria

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QUESTION

If a person treated for malaria after being infected from a malaria endemic country of West Africa and cured then he travel back to his country which does not known for malaria endemic region of the world. Question is: Is there any chance of re-occurrence even he is not being exposed to malaria spreading mosquito for some time may be year?
Is it true Malaria parasites stays in liver as hibernation for a long period and attack after many months or year?
If so what treatment can prevent it?

Please advise.

ANSWER

There are several different types of malaria which are found in West Africa, and the most common and deadly form, Plasmodium falciparum, is not able to hibernate in the liver. However, two other types of malaria are able to lay dormant in the liver – these two kinds are called Plasmodium vivax and P. ovale. Both are not nearly as common as P. falciparum in West Africa, though P. ovale has been reported at prevalences of over 10% in some areas, which is double its usual prevalence elsewhere in the world. Weeks, months or even years after an initial infection with P. vivax or P. ovale, the patient may experience what is known as a relapse, which is when the dormant liver forms become active again and re-invade the blood stream, causing a renewal of malaria symptoms. These relapses can be treated with normal anti-malarial drugs (even chloroquine, in many cases), but a different drug is required to kill the dormant liver forms and prevent future relapse. This drug is called primaquine, and may not be suitable for people with certain types of G6DP deficiencies, so you should talk to your doctor about having a test for this condition before taking primaquine.

Malaria in Pakistan

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QUESTION

4 years ago I traveled to FATA Pakistan and in every year in the month of August I caught malaria. Last few days I feel much Headache and fever in the evening and go to doctor. He diagnosed malarial parasites in blood and has advised me take tab artem ds 2 BD for three days after complete the course I feel same headache fever with shivering. Please recommend something.

ANSWER

I am not sure which malaria treatment you have taken—was it just artemisinin, or a combination drug which also included another anti-malarial? The latter type is what is recommended by the World Health Organization (WHO); treatments only containing artemisinin are very effective short term, but can sometimes leave a few parasites alive at the end of the course, which not only may result in a recurrence of symptoms (known as recrudescence) but is very bad in terms of leading to drug resistance in the malaria parasite. However, it is also possible that you are merely experiencing some slight side effects to the medication you took; often these mild side effects are very similar to the symptoms of malaria! If you don’t feel better in a few days, it might be worth visiting the doctor again to check that you don’t still have malaria parasites in your blood.

Home Remedies for Malaria

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QUESTION

Are there any home remedies for symptoms of malaria?

ANSWER

Quinine is a natural chemical which has anti-malarial properties, and  tonic water is a good example of an everyday foodstuff which contains quinine.  For this reason, over the last hundred-odd years,  expatriates living in malarial countries have enjoyed drinking gin and tonic!  There are also reports that grapefruit contains a quinine-like substance, and so might help prevent malaria or indeed increase recovery from malarial episodes, but I am not sure if this has been scientifically established as fact. There are a number of other plants, herbs and fruits which advocates of traditional, home remedies suggest may help prevent or treat malaria, but I can’t find ANY solid scientific basis for these claims, nor any reports of trials where these remedies have been shown to be effective.

Overall, the best thing to do if you think you have malaria is to get diagnosed (either at the doctor, a hospital or using a self-diagnosis kit) and then seek medical treatment. Local clinics will be able to tell you what kind of malaria you have, and therefore what treatment is recommended.

Mosquito Life Cycle

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QUESTION

Please explain the life cycle of a mosquito.

ANSWER

Mosquitoes are insects which go through several life stages, starting out as eggs, then hatching into larvae before developing into adults. Mosquito eggs are laid in slow-moving or stagnant pools of freshwater, to provide suitable habitat for the larvae once they hatch. Different species of mosquito prefer different water conditions; some prefer shaded areas, whereas some prefer more direct sunlight, and some mosquitoes even lay their eggs in very specific habitats, such as brackish water in estuaries. The way the mosquitoes lay their eggs can aid in identifying the genus of mosquito; some genera, such as Culex, lay rafts of many eggs, whereas Anopheles mosquitoes (the ones which transmit malaria to humans) lay their eggs singly. Larvae usually hatch from the eggs after a couple of days. These larvae are predatory, feeding on other aquatic insects and organisms, but themselves can also be eaten by fish, copepods and other creatures. Most larvae lay at an angle to the water surface and breathe through a specialized tube-like organ, known as a siphon, but Anopheles larvae lack the siphon and so much lay parallel to the water’s surface in order to breathe. Each larva must shed its skin (molt) four times, before reaching the stage where it forms a pupa. These four molts take anywhere from 7 to 14 days, depending on the water temperature. The pupa is just like a butterfly pupa – the mosquito does not feed and lays still in a cocoon as it develops into a adult. This process usually takes 2 days, after which the pupa splits and the adult emerges. The length of the full cycle is dependent on whether the conditions were optimal for that species of mosquito, and specifically based on temperature. Male adult mosquitoes usually live for about a week, feeding on nectar – they also possess very bushy antennae for seeking out females to mate with. Female mosquitoes have specialized mouthparts that allow them to feed on blood; they require the extra nutrients that blood provides in order to lay their eggs. The lifespan of a female adult depends on a number of environmental factors, but also her ability to get sufficient blood meals; in nature, they usually live 1-2 weeks.

A schematic of the life cycle is provided below:

Mosquito lifecycle schematic

Schematic of the mosquito lifecycle. Courtesy of Purdue University (Scott Charlesworth): http://extension.entm.purdue.edu/publichealth/insects/mosquito.html