Malaria and Loss of Red Blood Cells

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QUESTION:

What is the percentage of red blood cell that is lost at the onset of malaria symptoms?

ANSWER:

This depends entirely on the severity of the malaria infection, and also the type of malaria. Malaria parasites, called Plasmodium, invade red blood cells and use them for rapid, asexual reproduction. After a certain number of multiplications, the parasites burst out from the red blood cell, destroying it. This process leads to the reduction in red blood cells, and causes anaemia in the patient. The most deadly type of malaria, Plasmodium falciparum, takes just 24 hours to complete its cycles of reproduction. Therefore it can very rapidly produce many more parasites, which spread quickly through the blood, reducing the number of red blood cells very quickly.

Malaria Cases in West Bengal

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QUESTION:

What is the number of Malaria patients in West Bengal?

ANSWER:

West Bengal is one of the states considered highly endemic for malaria in India. In 1998, cases in West Bengal comprised approximately 6% of the total number of cases of all malaria in India (corresponding to 129,000 of the total 2.15 million cases reported that year), and approximately 3% of the cases of Plasmodium falciparum malaria, the most acute and deadly form of the disease. However, more recently, there are encouraging signs of decreasing mortality from malaria in West Bengal; in 2007, the number of reported deaths from malaria was 100, down from 203 in 2006 (the total number of cases in 2007 was estimated at 86,132).

White Blood Cells and Malaria

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QUESTION

Does malaria cause loss of white blood cells / antibodies?

ANSWER

The parasites that cause malaria reproduce in the human host by infecting red blood cells, then multiplying asexually and bursting out into the bloodstream, ready to infect more red blood cells.

As such, malaria parasites do not destroy white blood cells. However, patients with malaria may display reduced white blood cell counts during blood tests; this is usually thought to be due to relocalization of the white blood cells from the limbs (where blood is usually taken from during these tests) to the spleen and other internal organs also affected by the malaria infection.

As for antibodies, the malaria parasites contain antigens, which are proteins that cause an antibody response in the patient, thus usually resulting in an increase in antibodies during infection, especially if the patient has been exposed to malaria previously.

Can malaria parasites pass to children through breast milk?

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QUESTION:

Can breast milk transfer malaria parasites from a mother to the child?

ANSWER:

No. Malaria parasites cannot be transferred via breast milk. However, there is evidence that some antimalarial drugs can pass through breast milk, with unknown effects on the infant; as such, it is not recommended that breast feeding mothers take certain antimalarial drugs.

Studies in rats have also shown that antibodies to malaria can pass from a mother to her infant via breast milk although it is unclear what level of protection this confers on the infant; children under five are generally much more susceptible to malaria infection than older children and adults, due to their lower levels of acquired immunity, and so young children should be protected from exposure as much as possible, for example by having them sleep under long-lasting insecticide treated bednets when in high-transmission zones for malaria.

How soon can malaria occur a second time?

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QUESTION:

My son is studying in Tanzania and was diagnosed June 28, 2011 with malaria while taking Malarone. He took Duo-Cotecxin as prescribed for treatment and was feeling much better. He was given a “clear” blood test result. He started taking Malarone July 16, 2011 and on June 18, 2011 was ill again and diagnosed with malaria a second time in less than 6 weeks. Can malaria occur in this way or is there a possibility that the first case of malaria was controlled but not cured with Dus-Cotecxin and then esculated when he started taking Malarone again?

ANSWER:

There are two possibilities in this case; first of all, your son could have had what is called a recrudescence. This is where levels of the parasite in the blood drop to below detectable limits, and the immune system is able to keep the infection at bay. It can occur due to a failure to complete the course of antimalarial drugs, or indeed also due to treatment failure of the medication itself. Although Duo-Cotecxin is one of the recommended artemisinin-based combination therapies (ACTs) on the market for treatment of uncomplicated Plasmodium falciparum malaria, its cure rate is still at 98.7%, meaning that there is still a possibility of the drug not being completely effective in every instance. Moreover, there is a worrying indication that some strains of malaria are actually managing to become resistant even to ACTs.

The other possibility is that your son became re-infected, and it was a separate case of malaria; he was just very unlucky! This is highly unusual while taking Malarone as a prophylaxis, but it is possible. Determining which of these two scenarios occurred is difficult, but some information may be had from the type of blood test he had; clinics in Tanzania regularly use either blood film microscopy or rapid diagnostic tests (RDTs). Microscopy is notoriously insensitive as a diagnostic, and cannot reliably detect malaria parasites below a certain threshold, which depends on the skill and experience of the technician reading the blood slide. Therefore, if your son was declared negative for malaria based on this diagnostic, after the initial treatment, I think there is a good chance he was suffering from a recrudescence or treatment failure. However, if he was diagnosed by RDT, which is very sensitive to even low levels of malaria parasite in the blood, then I would think it might have been re-infection. However, I have concerns about the accuracy of RDTs so soon after infections have been cleared; the tests usually work by binding to malaria antibodies in the blood, which can sometimes persist even after the parasites have all been cleared. As such, you should also check what the diagnostic was the third time he was tested, and if this differed from the other two times; another possibility is that his infection really was cleared through treatment, and then got sick with something other than malaria; if they used an RDT on him at this point to diagnose malaria, they might have got a positive result confounded by his earlier infection. In these cases, you must ensure that the clinician takes a full history and so knows that the patient recently suffered from malaria; it may not be appropriate to use an RDT in this instance.

If your son is still in Tanzania and would like more information on malaria, he can contact us.  I am currently also working in Tanzania and so can perhaps help more if I know the details of his case (where he is based, etc). I would be happy to answer any questions he has.

Primaquine for Malaria Treatment

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QUESTION:

In India what is the duration of primaquine therapy in confirmed Malaria infection?

ANSWER:

Primaquine is usually used to kill the hypnozoite stages of Plasmodium vivax or P. ovale. This life stage of the malaria parasite can reside, dormant in the liver’s hepatocyte cells, even after the patient has completed the normal course of treatment for the infection; at this stage, the patient might not have visible malaria parasites in the bloodstream, and thus be considered “cured”. Despite this, the patient is actually potentially at risk from recurrence of malaria if the dormant liver hepatocytes re-enter the blood stream.

For this reason, patients with P. vivax or P. ovale should complete a course of primaquine in addition to the standard malaria treatment offered. The usual adult dosage for primaquine is 15-30mg base, taken orally, once a day for 14 days.

What is the malaria antigen test?

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QUESTION:

How does the malaria antigen test work? After how many days presence of malaria can antigens be detected in the blood ? Is it posible to detect antigens on the first day of fever ?

ANSWER:

The malaria antigen test works by detecting antigens in the blood which are released by the parasite. The antigens are usually LDH (lactate dehydrogenase) or HRP2 (Histidine-rich protein 2). If the test is in RDT (rapid diagnostic test) format, there is an antibody against one of the parasite antigens stuck onto the test strip. A tiny drop of blood (usually from a fingerprick) is placed in a well at one end of the test, and covered with a test buffer solution; as the patient’s blood migrates up the test strip, the parasite antigen will be captured by this antibody. The parasite antigen is then bound by another antibody which is coupled to colloidal gold, which will show up as a positive band on the test.

Detection of the malaria antigen in the blood depends on the sensitivity of the test and the parasitaemia (number of parasites) in the blood. If the parasitaemia is high enough it should be possible to detect antigen on the first day of fever.

Malaria cure?

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QUESTION:

How do you cure malaria?

ANSWER:

There are a number of different types of treatment for malaria, depending on the kind you have and its severity. Most cases of malaria can be treated with orally administered medication; it is only in the most severe cases, for example if the patient is already in a coma or has had multiple convulsions, that intravenous medication is given. [Read more…]

What are the treatment options for malaria?

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QUESTION:

What is the treatment for Malaria?

ANSWER:

There are a number of different types of treatment for malaria, depending on the kind you have and its severity. Most cases of malaria can be treated with orally administered medication; it is only in the most severe cases, for example if the patient is already in a coma or has had multiple convulsions, that intravenous medication is given.

Chloroquine sulphate is the drug of choice for non-resistant strains of malaria; unfortunately, resistance has been detected in most of the main forms of malaria, in certain geographic regions of the world. In places known to suffer from chloroquine-resistant malaria, other options are available, such as quinine sulfate, doxycycline, tetracycline and atovaquone-proguanil (sold as Malarone, and also used to prevent malaria as a prophylaxis). More recently, treatment known as ACTs, or artemisinin-based combination therapies, have been introduced to treat cases of malaria which are known to be resistant to chloroquine. These ACTs combine various drugs in order to combat malaria effectively, though worryingly some cases of patient-level resistance to ACTs are also beginning to be reported. As such, there is a continual need for drug discovery research with regards to malaria, in order to control this global, deadly disease.

Is Malaria Deadly?

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QUESTION:

Can malaria come back, and is it deadly?
ANSWER:

In some cases, and if not treated properly, malaria can come back. One example of when malaria comes back is when the infection is not completely cleared from the blood, for example if the full course of treatment is not taken. This is more common with Plasmodium falciparum malaria, as it can multiply rapidly in the blood. This characteristic makes it the most dangerous form of malaria, and if left untreated, is can often be deadly.

Other forms of malaria come back through different methods; for example, Plasmodium falciparum and Plasmodium ovale, have forms of the parasite that can sequester in the liver and remain dormant for long periods of time, even years. Once these liver stages return to the blood and start multiplying again, the patient will get a recurrence of malaria symptoms. It is possible to treat these liver stages, through taking specific medication; for this reason, it is crucial that if you suspect you might have malaria, you are diagnosed accurately to ensure that you receive the correct forms of medication to prevent the malaria coming back in any way.