QUESTION

I am right now recuperating from a third attack in less than one year’s time. What could have gone wrong ?

I am awaiting to hear your advice.

ANSWER

There are a number of reasons for multiple malaria attacks. One is that although malaria can be easily treated, these treatments often don’t prevent re-infection. There are separate drugs which can be used to prevent malaria (known as malaria prophylactics), but these must be taken all the time to be effective (usually either once a week, once a day or twice a day, depending on the specific drug), and so usually aren’t appropriate (due to the unknown health risks of taking the drugs for that long, plus the prohibitive cost) for people living in areas where malaria occurs.

For people living in malarial areas, other means of prevention are required, of which avoiding being bitten by mosquitoes is paramount. For this, it is recommended to sleep under a long-lasting insecticide treated bednet at night, when many malarial mosquitoes are active. Similarly, wearing long sleeved clothing, especially if it is impregnated with an insecticide such as permethrin, can help avoid the bite of infected mosquitoes.

Second of all, there are some types of malaria which cause repeat episodes of illness, even after only a single infection. Specifically, Plasmodium vivax and Plasmodium ovale (the former is common in many parts of Asia in particular) can form life stages called hypnozoites which rest dormant in liver cells, even after the parasites in the blood have been cleared.

During this time, the patient will have no trace of malaria if they take a blood test, and they will feel fine. However, if these hypnozoites become active again, they will re-invade the blood, and the symptoms of disease will reoccur – at this stage, the parasite will once again be observable in the blood, and so the patient will be diagnosed as positive for malaria. As such, it is very important to find out what type of malaria you have, and if it is one of the above two species, then you can talk to your doctor about taking another type of medication, in addition to that which cures the blood infection, called primaquine—primaquine kills the hypnozoite liver stages of malaria and thus prevent recurrence of the disease.

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