QUESTION:
I live in Pucallpa, Peru. I recently went on a trip to a remote jungle location in amazon jungle of Peru, and now I have malaria, but I’m not sure if it’s Vivax or falciparum. How could I know the difference? It seems like vivax is more common here in the jungle region of Peru, or am I wrong? Also, if it is Vivax, is Chloroquine with primaquine the best thing to take? I heard vivax is starting to develop a resistance to Chloroquine, but is there any evidence of a resistance to chloroquine + primaquine? Thanks.

ANSWER:
The symptoms of malaria infection with P. vivax vesus P. falciparum are similar. P. vivax has fewer severe complications and is almost never fatal. The two strains can be distinguished in the laboratory where the diagnosis of malaria is confirmed, either by their appearance under a microscope or by more sophisticated molecular approaches. In your region of South America, P. vivax is far more common that P. falciparum. Yes, there is a small risk of chloroquine resistance, but it is low in this region and the combination of chloroquine and primaquine remains a standard treatment. The combination of chloroquine plus primaquine helps overcome chloroquine resistance in P. vivax and P. falciparum. The primaquine is also effective in eliminating the form of vivax that can “hibernate” in the liver for months or years and resurface, causing relapse. Despite this, there are rare cases of relapse after a full course of standard chloroquine and primaquine and close medical follow up during and after treatment will be important.