Full recovery from malaria?

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QUESTION:

Does a person get over malaria?

ANSWER:

The majority of malaria cases are uncomplicated, and if diagnosed and treated early enough and correctly, the patient has every chance of making a full recovery from the infection. However, if treatment is delayed, or inappropriate treatment given, the infection can develop into more severe disease. Again, the chances of recovery are high given proper medical attention, but if not, malaria can certainly be fatal. Infection is usually most severe in children under 5 and pregnant women, meaning it is even more crucial for diagnosis and treatment to be made available for these high-risk groups. In many parts of the world, medical facilities are limited and treatment unavailable, which accounts for the high mortality caused by malaria, despite being easily treated in may circumstances.

Malaria Blood Work

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QUESTION:

What means smear for malaria – value 1?

ANSWER:

In most cases, I would suggest this means a positive result, though the exact meaning of that depends to some extent to the type of blood test it was. You mention a smear; to me, that implies that the test used traditional microscopy to look for red blood cells infected with malaria parasites. In this case, a result of 1 would indicate that one infected red blood cell was observed, meaning the patient is positive for malaria, although with a light infection (at least at that point in time – especially if the patient had falciparum malaria, the intensity of the infection can increase very rapidly). Otherwise, blood can be used in malaria rapid diagnostic tests (RDTs), which look for antibodies to malaria in the patient’s blood. In this case, the test result can sometimes be denoted by a binary value: in other words, 0 indicates negative and 1 indicates positive.

It is very important to find out from your doctor or clinic exactly what kind of test they ran and what the results mean, to ensure that correct and effective treatment is administered as quickly as possible.

Vomiting During Malaria

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QUESTION:

How can I reduce vomiting during malaria?

ANSWER:

The most important thing to do when suffering from malaria is to get diagnosed promptly by a doctor or clinic and then receive appropriate treatment. This is the quickest way to reduce symptoms of the disease, such as vomiting, as well as prevent progression of the disease. Once treatment has begun to be administered, your doctor or nurse may also be able to give you medication to reduce nausea and vomiting, but you should certainly consult with medical professionals before taking any other medication while being treated for malaria.

Illness from Uganda trip

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QUESTION:

I just came back from a visit to Uganda Africa. I was unable to take Malarone as I had bad side effects. Vomiting. I was only exposed once when we walked into a swampy rain forest. This of-course was the only day I did not have repellent. We were taking the kids on a nature walk and the German volunteer got a little lost. I ran as fast as could out of the area. Started to feel tired and weak 7 days later, getting severe headaches and going from hot to cold. 5 kids ended up with Malaria shortly after our walk. (I found this out after my return).

A missionary on the plain said I must likely had malaria and gave me Lumartem. By the time I got home I was having sever diarrhea and real bad body aches, low grade fever. The doctor here took my blood but reported my results would take 7 days. I started taking the Lumartem, & I felt better, the runs slowed down the boy aches lessened. Now I am finished with my 3 day prescription Feel pretty good compared to how I felt b4. Still have stomach cramps and small runs. What now? Should I go have a blood test to see if its gone or just wait and see???

ANSWER:

Considering you were in Uganda, it is not unlikely that you didn’t also pick up some sort of intestinal bug or parasite, which might be responsible for the residual runs and cramps. However, it is certainly important to take a blood test to ensure that you have completely cured the malaria infection; P. falciparum is common in Uganda, and causes a very severe form of malaria. While it can’t come back directly once it has been cured, if treatment is not entirely successful small numbers can remain in your blood stream and then start reproducing again once you have stopped taking medication, resulting in what is called “recrudescence” of the infection.

If possible, try to find out from the doctor that performs the blood test what type of malaria you had/have, as this will also determine whether you need additional medication (called primaquine) to prevent recurrence or relapse of the infection at a later date. Recurrence is due to a dormant phase of the malaria parasite hiding out in your liver; while P. falciparum cannot produce these dormant phases (and therefore can only relapse if the initial blood infection is not completely cured), two other malaria parasites, called P. vivax and P. ovale, can have liver stages, and so you may need to take primaquine if you are found to have been infected with either of these types.

Over-Treating Malaria in Africa

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Prescribing malaria medication to patients who don’t need it wastes precious resources in a country already dealing with drug shortages. It leaves patients untreated for the real cause of their sickness. And it can lead to drug resistance, making malaria parasites harder to eliminate when people really do contract the disease.

So why do health workers ignore negative test results?
[Read more…]

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.

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.