Malaria Cure

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QUESTION

What is the cure for malaria?

ANSWER

Malaria can be cured with a number of different medications, depending on then type of malaria and how far the disease has been progressed.

For standard, non-complicated Plasmodium falciparum malaria, the World Health Organisation recommends use of artemisinin-based combination therapies (ACTs), such as Coartem. This is due to increasing levels of resistance to chloroquine in many parts of the world. Indeed, even though chloroquine is still used in many places as first-line treatment against P. vivax, P. malariae, P. ovale and P. knowlesi uncomplicated malaria, there is some evidence that resistance to this treatment is also emerging, for example in P. vivax in parts of south-east Asia.

In cases where malaria infection has progressed to a stage where oral administration of medication is not possible, or where cerebral symptoms are suspected, the usual treatment option is intravenous quinine.

In addition, P. vivax and P. ovale malaria parasites are able to produce forms (called hypnozoites) which can become dormant in liver hepatocyte cells after the blood stages of the infection have been cleared. These dormant forms can become reactivated weeks or even months or years after the initial infection, which is called a “relapse” of the infection. One drug, called primaquine, is able to kill these liver stages, and so patients with either of these types of malaria should also discuss the possibility of taking primaquine.

Apart from these first-line treatments, there are other medications which are used against malaria, both prophylactically as well as for treatment. These include orally-administered quinine, pyrimethamine, mefloquine, proguanil, atovaquone and sulfonamides.

For more information, see the WHO recommendations for malaria treatment.


Slight Malaria

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QUESTION

Does “slight malaria”  mean you have malaria?

ANSWER

You have malaria if you are infected with the Plasmodium parasites that cause malaria. However, having a few of the parasites does not mean you experience symptoms of the disease.  Some forms of malaria, like P. malariae, can persist in a patient without causing any symptoms. However, in some cases, particularly P. falciparum and also P. knowlesi, a slight initial infection can rapidly increase in a severe, heavy infection, requiring immediate treatment. So it is important to to always consider a diagnosis alongside clinical symptoms as well as an appreciation of the different types of malaria and how they can progress.

Recovery Time

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QUESTION

My friend was diagnosed with P. Falciparum today. She was suffering from high fever, shivering and all the symptoms related to Malaria. She is now hospitalized after 1 week of these symptoms and her medication has started. I know this malaria is dangerous. Can you please tell me how much time it would take to be in the normal state and time to recover? Do reply, I’m waiting for your comments.

ANSWER

It is good to hear that your friend sought out diagnosis and is now being treated. Most people recover within a few days of starting treatment, so she should be feeling better very soon, although it is likely she may feel weak for up to a week or two after completing the treatment.

Can malaria affect one’s mental fitness?

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QUESTION

Can malaria affect ones mental fitness?

ANSWER

Given that malaria is often associated with severe fever and flu-like illness, I would say that is usually enough to prevent someone from feeling completely mentally fit! However, in addition to these general symptoms, there are other specific ways in which malaria can affect a patient’s mind.

With a particular type of malaria, called Plasmodium falciparum (the most common form in Africa and the most deadly worldwide), the disease can sometimes progress to what is called cerebral malaria, where the malaria parasite stick to red blood cells that clog up the tiny red blood cells in the brain. This condition is very serious, and can lead to impaired mental function, loss of consciousness, coma and even death.  Luckily, these effects are usually reversible and there are rarely permanent mental consequences of infection with malaria if treated promptly and effectively.

Symptoms of Malaria

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QUESTION

What are the symptoms of malaria?

ANSWER

Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.

 

Post Malaria Symptoms

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QUESTION

My girlfriend had malaria in Uganda. It was detected 2nd of October, it was mild form, she felt dizzy, temperature was little higher. She got Artefan, forth day she was in hospital for review, they told her from blood test that its not malaria anymore.

We came home (Slovakia) but week ago she had suddenly the same symptoms like she had had the first time—dizziness, pain in head, temperature. Rapid test showed her she has no malaria. But she is still feeling weak, once in five days she suddenly feels dizzy, sometimes temperature 37,3 Celsius (yesterday last time). Doctors found nothing. Could it be some post-malaria symptom or she might have some other infection? Is it normal?

ANSWER

Rapid tests for malaria are usually quite accurate, especially if the patient is experiencing symptoms. Moreover, the cycles of malaria infection are usually shorter, with patients experiencing fever and dizziness every other day (for Plasmodium falciparum, which is the most common kind in Uganda). I would recommend trying a second rapid test, preferably of a different brand, just to check—make sure it detects ALL kinds of malaria and not just Plasmodium falciparum, as while it is the most common and dangerous kind, there are other types in Uganda, such as P. ovale, which might not show up on a P. falciparum-only test.

If you have access to a travel clinic or hospital that has experience in tropical diseases, you could also see if they could do a blood slide and check for the presence of malaria parasites in your girlfriend’s red blood cells.

If a second rapid diagnostic test is negative, or there is no sign of visible malaria parasites in her blood, then I suspect she has some other infection, as continued symptoms are not usually a side effect of successful malaria treatment.

Recurrent Malaria

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QUESTION

Malaria has been with me since the late 1980’s after 6 years in Malawi.
During the 90’s I had it twice per year in Feb and Sept. Blood tests always came up negative. Treatment was with Chloroquine, later Halafantrin and then Co Artem. 2 or 3 treatments were required as symptoms appeared 2 weeks after completion of initial treatment.

In 2004 I treated with a bodyweight specific dose of Arinate and did not have another bout until 1 week into a Southern Mozambique visit in Aug 2008. (I was on doxycycline as a prophylactic but discontinued due to it causing diarrhoea.) Treatment was with Artecospe (unsuccessful) and CoArtem (successful.) In Nov 2010 after a visit to N Botswana another bout – treated twice with CoArtem.
Sept 18 2011 it struck again. (I have not been near a malaria area since Nov 2010). CoArtem unsuccessful 3 times with Artecospe have not worked and now on Co Arinate.

Have I some resistant strain of Malaria? Does eating during a malaria bout reduce the efficacy of treatment?

ANSWER

So far, no strains of malaria have been discovered to be resistant to Coartem. Moreover, recurrent malaria is only caused by Plasmodium vivax and Plasmodium ovale—neither of these are nearly as common in Malawi as Plasmodium falciparum, which can recrudesce (parasites re-appear in the blood) if not treated appropriately but will not relapse or reoccur months or years after the initial infection—if you have tested positive for malaria in your more recent bouts of illness, you should ask your doctor whether it could be P. vivax or P. ovale.

If it is one of these two species of malaria, you should ask about the possibility of taking primaquine to kill the dormant liver stages of the parasites and prevent future recurrence. You will need to be tested for G6DP prior to being able to take primaquine.

However, since you tested negative in Malawi initially, I suspect you did not have malaria at all at that point, and should have been tested further to determine what was causing your symptoms. Moreover, chloroquine should not have been the first treatment of choice, as resistance is rife in sub-Saharan Africa.

The symptoms of malaria are notoriously non-specific and therefore diagnosis is crucial prior to treatment, as many other infections will present with similar clinical symptoms, such as fever and nausea. Therefore, if you have any further symptoms which you suspect might be malaria, please visit a doctor or travel medicine clinic straight away for a blood test. If it is not malaria, there is no point taking further doses of Coartem or other anti-malarials and further tests might reveal another diagnosis.

Injections for Malaria Treatment?

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QUESTION

I have a friend that just told me that she has Malaria. She said she has to go to the hospital every day for an injection for around the next 2 weeks. Is this a typical treatment. Why not just take pills? I`m just trying to wrap my head around this and understand the different treatments.

ANSWER

This is certainly not typical treatment for malaria. Uncomplicated malaria is usually treated with oral medication, and the type depends on the type of malaria you have. The most severe form of malaria, Plasmodium falciparum, is often resistant to chloroquine (still the first-line drug of choice for P. malariae, P. knowlesi and P. ovale infections, as well as for P. vivax in most parts of the world) and so first-line treatment is now usually an artemisinin-based combination therapy (ACT), such as Coartem.

As far as I am aware, it is only in cases of complicated, severe malaria that intravenous or intramuscular treatment is used (usually quinine), and in those cases, treatment would not be administered on an outpatient basis. It may be that your friend has a specific medical requirement for a non-oral form of medication, but it is definitely unusual!

Contrasting Patterns of Malaria Drug Resistance Found Between Humans and Mosquitoes

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A recent study has detected contrasting patterns of drug resistance in malaria-causing parasites taken from both humans and mosquitoes in rural Zambia.

Parasites found in human blood samples showed a high prevalence for pyrimethamine-resistance, which was consistent with the class of drugs widely used to treat malaria in the region. However, parasites taken from mosquitoes themselves had very low prevalence of pyrimethamine-resistance and a high prevalence of cycloguanil-resistant mutants indicating resistance to a newer class of antimalaria drug not widely used in Zambia.

The study was conducted by researchers at the Johns Hopkins Malaria Research Institute and their Zambian colleagues and the findings were published November 7, 2011 in the online edition of the journal PNAS.

Surveillance for drug-resistant parasites in human blood is a major effort in malaria control. Malaria in humans is caused by the parasite Plasmodium falciparum, which is spread from person to person through the feeding of the Anopheles mosquito. Over time, through repeated exposure to medications, the parasites can become less susceptible to drugs used to treat malaria infection, limiting their effectiveness.

“This contrast in resistance factors was a big surprise to us,” said Peter Agre, MD, an author of the study and director of the Johns Hopkins Malaria Institute. “The contrast raises many questions, but we suspect that the malaria parasite can bear highly host-specific drug-resistant polymorphisms, most likely reflecting very different selection preferences between humans and mosquitos.”

For the study, Sungano Mharakurwa, PhD, lead author and senior research associate with the Johns Hopkins Malaria Research Institute in Macha, Zambia, conducted a DNA analysis of P. falciparum found in human blood samples to those found in mosquitoes collected inside homes in rural Zambia. In samples taken from human blood, pyrimethamine-resistant mutations were greater than 90 percent and between 30 percent to 80 percent for other polymorphisms. Mutations of cycloguanil-resistance were 13 percent.

For parasites found in the mosquito midgut, cycloguanil-resistant mutants were at 90 percent while pyrimethamine-resistant mutants were detected between 2 percent and 12 percent.

“Our study indicates that mosquitoes exert an independent selection on drug resistant parasites—a finding that has not previously been noticed. If confirmed in other malaria endemic regions, it suggests an explanation for why drug resistance may appear so rapidly,” said Mharakurwa.

Worldwide, malaria afflicts more than 225 million people. Each year, the disease kills approximately 800,000, many of whom are children living in Africa.

Authors of “Malaria antifolate resistance with contrasting Plasmodium falciparum dihydrofolate reductase (DHFR) polymorphisms in humans and Anopheles mosquitoes” are Sungano Mharakurwa, Taida Kumwenda, Mtawa A. P. Mkulama, Mulenga Musapa, Sandra Chishimba, Clive J. Shiff, David J. Sullivan, Philip E. Thuma, Kun Liu and Peter Agre.

The Johns Hopkins Malaria Research Institute is a state-of-the-art research facility at the Johns Hopkins Bloomberg School of Public Health. It focuses on a broad program of basic science research to treat and control malaria, develop a vaccine and find new drug targets to prevent and cure this deadly disease.

Funding was provided by the Johns Hopkins Malaria Research Institute, the Bill & Melinda Gates Foundation and the National Institutes of Health.

Source: Johns Hopkins University

Is Malaria Fatal?

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QUESTION

Can you die from malaria?

ANSWER

Yes. If left untreated, certain types of malaria in particular can cause severe complications, and can even lead to death. Plasmodium falciparum is the most dangerous form of malaria and is responsible for 90% of the approximately 700,000 annual deaths caused by malaria.

However, P. vivax infections can also be very serious, and more recently, cases of P. knowlesi in south-east Asia have been shown to develop into severe disease very rapidly, thus making it dangerous for people who are not close to health care services and thus delay getting treatment.

The people most at risk from severe malaria are children under the age of five and pregnant women, as well as travellers to malarial areas who are not taking adequate preventative measures (such as not taking anti-malaria medication or not sleeping under a long-lasting insecticide treated bednet).

However, malaria is still dangerous to all people, so if you think you might be infected, it is crucial to seek out diagnosis immediately, so that you can be quickly given appropriate treatment. If diagnosed early, malaria is usually very easily treated and full recovery occurs quickly.