Started Late on Anti-malaria Medication

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QUESTION:

I’m in a malarious country and I had no idea about anti-malarials until I got here, so I started taking anti-malaria(doxycicline) two weeks late. It has been three weeks since I started taking the medicine. Do you think it would work or should I stop taking it?

ANSWER:

It depends a bit on where you are, and what types of malaria are in your region. Plasmodium falciparum usually takes between 7 and 14 days for symptoms to develop after exposure; P. vivax and P. ovale take between 9 and 14 days. P. malariae, on the other hand, sometimes doesn’t show symptoms until 30 days after infection. However, the most acute and dangerous form of malaria is that caused by P. falciparum; as such, if you haven’t had any symptoms since you started taking anti-malarials three weeks ago, you should be ok, and it certainly would be advisable that you continue with the preventative medicine while you remain in the malarial area.

It’s also worth mentioning that because of the lag between infection and symptoms, in many cases you need to continue taking antimalarials for some period of time after you leave the malaria zone. Of course, if at any point you start to develop symptoms, such as fever or chills, go to a hospital or see a doctor for prompt diagnosis.

How serious is malaria as a disease?

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QUESTION:

(In conclusion to an earlier question regarding the seriousness of the disease and the way it is likely to affect population vigour if not controlled) –  What can the community, the government, individuals (school children, parent, and teachers) do to improve the situation?

ANSWER:

The best way to improve the impact that malaria has upon populations afflicted by malaria is to prevent the disease in the first place.

At a community level, this can be done through the use of long-lasting insecticide treated bednets, which have been shown to be extremely effective in preventing exposure to malaria-carrying mosquitoes. The nets are furthermore cheap and easy to use; the problem is distributing them, and ensuring that the highest-risk groups of people (pregnant women and children under 5 years old) have priority access to the bednets.

In some places, bednets are given out for free at antenatal clinics to target pregnant women; in other places, bednets have been sold at subsidised prices as a way of maintaining the sustainability of the delivery program.

For more information about bednet distribution and the debate surrounding whether they should be free or paid for, please see the post “Malaria – Free Bednets?”

These high risk groups may also benefit from intermittent preventive therapy (IPT) whereby individuals are given treatment for malaria at set intervals, to reduce the risk of suffering from a full-on malaria infection. More information on IPT can be seen in the comments to the question “Reduce risk of P. falciparum.”

If bednet coverage is not thorough an thus prevention not complete, the next stage in reducing the burden of the disease on endemic communities is through accurate, effective diagnosis followed by appropriate treatment. This requires a functional and efficient health services system as well as a well developed transportation network, to ensure that people are encouraged to seek assistance at a clinic or hospital if they develop malaria symptoms, and that they can easily and quickly reach these facilities.

Advanced health systems and transportation networks are the goal of many developing countries, and many regions in the world have made huge amounts of progress in these areas recently. However, momentum must be maintained, and governments throughout the regions of the world where malaria continues to be a huge public health burden need to continue their efforts to strengthen the availability of malaria diagnostics and treatment, in order to remove malaria as an obstacle to people’s well-being and development.

Introduction of malaria

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QUESTION:

What is the introduction of malaria?

ANSWER:

Malaria is introduced into the human host via mosquitoes, who pass the parasite into the human blood stream through their mouthparts as they take a blood meal. Since the development of both the mosquito and the parasite are temperature-dependent, and tend to favour warm, humid conditions (mosquito larvae require pools of still water to develop into adults), the distribution of malaria is limited to parts of the world where these temperature and humidity conditions are met.

However, cases of malaria can also be introduced into other parts of the world by travellers coming from malarial regions or by mosquitoes, already infected with malaria, being accidentally transported into non-malarial countries in aeroplanes or in ships. These kinds of introductions resulted in about 1500 cases of malaria reported in the United States in 2007, a country which is usually free of malarial transmission. These introductions are rare, and also short lived, as the conditions do not favour the continued survival of the transmission cycle. However, this is one of the worries regarding climate change; it may make some areas of the world, which currently do not have malaria, more climatically suited to transmission of the disease, thus allowing for introductions of the mosquitoes and the parasite in the future.

Treatment for malaria in Africa

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QUESTION:

What is the treatment for malaria in Africa?

ANSWER:

The appropriate form of treatment for malaria, regardless of where you are, depends on the type of malaria you have. This can be determined through diagnosis; each of the main malaria parasites that ordinarily infect humans (P. falciparum, P. vivax, P. malariae and P. ovale) looks slightly different under the microscope, although you have to be well trained to tell them apart! Rapid diagnostic tests (RDTs) can also sometimes distinguish between malaria species, although many RDTs only test for P. falciparum, he most acute, severe and deadly of the species.

In much of Africa, P. falciparum is the most common and dangerous form of the disease. In some places, it can be treated with chloroquine, though in many places the parasite has developed resistance to this drug, so other treatment is necessary.

The most common drugs given in areas with known chloroquine-resistant strains of P. falciparum are ACTs (artemisinin-based combined therapies). There are some parts of Africa where other forms of malaria, such as P. ovale and P. vivax, can also occur – it is important to know whether a patient is infected with these species as they require an additional form of treatment, the drug primequine, in order to kill dormant liver stages that characterise these species and can lead to a relapse of infection months or even years after the initial exposure.

How does malaria spread?

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QUESTION:

How does malaria spread?

ANSWER:

Malaria is a vector-borne disease; this means that it has to be spread through a “vector” species, which in this case are female mosquitoes of the genus Anopheles. The female mosquito needs to feed on blood in order to produce eggs; most species lay eggs every 2-3 days, which means each female mosquito needs to take very regular blood meals.

Around 20 species of Anopheles mosquito have been implicated in the transmission of malaria; some species are better than others at acting as a vector. The most important group in Africa is the Anopheles gambiae complex; these mosquitoes are also relatively long-lived, which is important for transmission since it means that whole portions of the malaria parasite’s life cycle can be completed inside the vector mosquito.

When the female mosquito takes a blood meal, she inserts her slender mouth part (called a ‘proboscis’) into a tiny cut she makes uses specialized slicing parts of her mouth. She probes until she finds a small surface blood vessel, from which she feeds. The proboscis contains two narrow tubes – one delivers her own saliva into the wound (containing chemicals to stop the blood coagulating as well as a slight pain-killer, to stop you feeling the bite) while the other sucks up blood.

The mosquito’s saliva also contains the malaria parasite; this is how the parasite is delivered into the human body. Similarly, the parasite passes back into the mosquito through the blood she ingests, once the human portion of the life cycle has been completed. As mosquitoes pass between human to human, and indeed also between other animals, they spread the malaria parasite through the delivery of saliva and the uptake of blood.

What is malaria? What Causes Malaria?

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QUESTIONS:

What is malaria?
What causes malaria?

ANSWER:

I have copied below the text from an earlier question, also asking about the causes of malaria and explaining what it is:

Malaria is a disease caused by a parasitic single-celled animal known as Plasmodium. There are different species of Plasmodium, which cause different kinds of malaria. The main types which infect humans are P. falciparum, P. vivax, P. ovale and P. malariae. The parasite is transmitted by certain species of mosquito; the parasite lives in the human blood stream and so goes in to the mosquito when the insect feeds. When the same individual mosquito then feeds on another person, it transmits parasites into a new host.

The symptoms of malaria are caused by the actions that the parasite undertakes while in the human host. For example, part of its reproductive cycle involves invading and then multiplying inside red blood cells. Once several cycles of reproduction have occurred, the new parasites burst out of the red blood cell, destroying it. The cycles are times so that all the new parasites burst out of the red blood cells at the same time; this coordinated destruction of the red blood cells, either every 24, 48 or 72 hours, depending on the malaria species, causes the one day, two day or three day cycles of fevers and chills that characterize malaria infection episodes.


Incidence of malaria in Quito, Ecuador

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QUESTION:

What is the number of cases of malaria reported in Quito, Ecuador? In 1940 was it a common problem?

ANSWER:

There is no transmission of malaria in Quito – it is at too high an altitude! Transmission of malaria in Ecuador is estimated to stop at around 1500m of altitude, and the central plaza of Quito, Plaza Grande, sits at almost 3000m! As such, even in 1940 malaria in Quito would not have been a problem. However, there may still be a small number of reported cases even at such altitudes each year – this is due to people who get infected with malaria from mosquito bites at lower altitudes, such as in much of the rainforest and coastal regions of Ecuador, and then travel back up to the highlands before the first symptoms appear, which can be as long as two weeks after exposure to the parasite.

As mentioned briefly above, although Quito, Guayaquil, the central highlands and the Galapagos Islands are considered areas with low to no malaria transmission, travellers to or residents in other parts of Ecuador should take precautions against getting bitten by mosquitoes, such as long-sleeved clothing in the evenings and sleeping under an insecticide-treated bednet at night. They might also consider taking preventative medication, also known as prophylaxis, against malaria. As this can be expensive long-term, this is usually only used by travellers rather than residents in malarial regions. There are several different types of medication that can be taken; since chloroquine resistant types of malaria are known to occur in Ecuador, Lariam, doxycyline and Malarone are the main types of prophylaxis recommended for this country.

Key Malaria Scientists

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QUESTION:

I would like to know what key scientists are involved with the cure of Malaria.
Thanks

ANSWER:

There are literally hundreds of scientists around the world who are all working on different aspects of curing malaria. The complexity of the life cycle of the parasite means that there are lots of different areas of potential research, and some scientists specialise very precisely on one tiny aspect of the life cycle, hoping to find a way in which it can be exploited as a vulnerability, and used to develop new medications. I will resist naming any particular names, as that would be unfair to all the other scientists, whose work is equally important, that I don’t have space to list!

For example, some scientists devote their attention to the reproduction of the parasite inside human red blood cells or the process of infection; a paper came out very recently which looked at ways in which the malaria parasite uses host proteins to fulfill its own reproductive processes, and how that cycle can be disrupted as a way of treating malaria. A review of that paper will be appearing on this website in the very near future. Other scientists focus on the life cycle of the parasite inside the mosquito, or indeed even just the mosquito itself; some very cool research came out last year, for example, by scientists at Cornell University on how manipulating proteins in the mosquitoes’ kidneys can prevent them from successfully flying off after drinking human blood, thus killing them. Other scientists focus on treatment; for example, the quest for a vaccine against malaria has been a lifelong devotion for many teams of scientists around the world. Other cutting edge research involves looking at whether existing drugs can be used to tackle malaria; recently, it was discovered that a common drug used for treating cancer also has anti-malarial effects.

Finally, there are a whole army of scientists who work away from the lab at ways of curing malaria; this includes, for example, epidemiologists who look at disease distribution and burden at different scales, and geospatial statisticians who apply their research to informing health professionals where the highest risk locations for malaria are, and so treatment and resources can be targeted effectively and efficiently. Many of these control interventions also involved scientists, whose job is to evaluate the success of such operations, and design strategies that can even more rapidly deliver malaria diagnosis, treatment and prevention information to the people who need it most.

Hopefully by now you will see why it is impossible to give you a list of the most important malaria scientists in the world; there are so many people working on so many different facets of treating the disease that I would never be able to include them all! However, we are encouraging many of the scientists who work on malaria to join this website; as such, keep an eye on the membership and feel free to contact any members who are engaged directly in research; I am sure they would be happy to give you more information as to the research groups working on specific areas of malaria control.

Are these malaria symptoms?

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QUESTION:

My daughter (10yrs) had high fever with chills till 4 days back but now she has low or no fever but feels cold at intervals & for that duration she is feeling giddy & vomittish. A little cough is also their . During this duration she is very uncomfortable & feels she has very high fever. Does all this reflect as malaria symptoms or it is some other problem. Please respond immediately with your suggestions.

ANSWER:

The best thing to do would be to take your daughter IMMEDIATELY to a hospital or to see a doctor. Her symptoms are consistent with malaria, but likewise could be caused by a number of other diseases. The only way to know for sure whether she has malaria is through diagnosis via a blood film or blood test – such diagnosis is crucial to ensure that she is treated promptly and accurately.

Malaria Treatment

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QUESTION:

What is the proper treatment for people with malaria symptoms?

ANSWER:

The proper treatment for malaria depends on the type of malaria parasite that the patient is infected with. Therefore, before treatment begins, the patient should be accurately diagnosed.

In most cases of non-Plasmodium falciparum malaria (the most deadly form of malaria, found throughout the world but most prevalent in sub-Saharan Africa), and even in some places where P. falciparum has not yet developed resistance, treatment with chloroquine is sufficient.

The dosage will depend on body weight (usually approximated by age). Where there is a risk of chloroquine-resistant malaria occurring, treatment of non-complicated cases will usually consist of orally-administered artemisinin-based combination therapy (or ACT) – again, the dosage will depend on age/weight.

For severe malaria, parenteral ingestion of drugs is required. For the treatment of cerebral malaria, caused by P. falciparum, quinine is the traditional drug of choice, though artemisinin has also been shown to be effective. Anti-convulsants and anti-pyretics (to reduce fever) should also be administered.

In cases of infection with P. vivax or P. ovale, the parasite can become dormant in the liver and result in a relapse of the disease if not treated properly. As such, patients with either of these forms of malaria should also be treated with primaquine.

If you have, or suspect you have a health problem, you should visit a physician for a medical diagnosis and treatment.