QUESTION

I got fever and weakness.  I went to the doctor and my malaria report is the ring stage of p.vivax. I take artemether and lumafetrime drug  but after ten days the fever  returns. What is this? Is this malaria or not?  Plz help. When my c.b.c was done before taking malaria drugs  my hemoglobin is 8.8 and leucocyte 6800 and sgpt is 52 but after treatment my sgpt is 45 and hemoglobin is 10.2 and leucocyte is 7800. Do I have malaria again?

ANSWER

The treatment for  uncomplicated P. vivax malaria as recommended by WHO (Guidelines for the Treatment of Malaria, 2nd edition 2010), includes a main malaria drug, i.e. choroquine in areas without choroquine resistance, and ACTs like artemeter and lumafetrine as in your case.  Along with this however, for cases of P. vivex, a course of primaquine should be given. The primaquine is effective in eliminating the form of vivax that can “hibernate” in the liver for months or years and resurface, causing relapse.  (Primaquine should not be taken if you have severe G6PD deficiency).  If your fever continues, however, you should return to the clinic so your doctor can examine you and take further tests to see if the malaria has been cured and if so, to determine what is now causing your fever.

P.