Malaria Locations in Africa

September 16, 2011 by Malaria Q&A

QUESTION:

Where in Africa is malaria mainly found?

ANSWER:

The distribution of malaria is constrained by two main factors: temperature and the presence of suitable mosquito hosts. These mosquitoes also depend on certain climatic conditions for their development, namely warm temperatures and sufficient rainfall to produce stagnant water, required by mosquito larvae. As such, although most of Africa lies within latitudes that would normally produce warm enough temperatures for at least seasonal transmission of malaria, in fact the disease is not found everywhere.

: Spatial distribution of Plasmodium falciparum malaria in Africa. From Hay et al., 2009, “A world malaria map: Plasmodium falciparum endemicity in 2007”, PLoS Medicine 6(3)

Winters in the Mediterranean region and most of the Cape are too cold for malaria, and in these areas, control interventions have largely eliminated the risk of summer sporadic transmission. Similarly, at high elevations, temperatures are too low for the development of the parasite and/or the mosquito vector. For this reason, places such as central Zimbabwe, the high plateau of Ethiopia and even large cities like Nairobi are relatively malaria-free. Finally, the Sahara and Kalahari desert regions are too dry – there is insufficient moisture for the survival of the mosquito vectors.

Based on these factors, the hotspots for malaria transmission in Africa lie in lowland areas with moderate to high rainfall. The map above shows the distribution of Plasmodium falciparum, the most severe and deadly form of the disease.

How quickly should patient take medicine for malaria?

September 15, 2011 by Malaria Q&A

QUESTION:

My sister has been suffering from malaria for three months. She consulted with doctor in the first symptom of malaria but doctor gave only fever medicine at that time. Blood test was not done at that time. So my question is: “within how many days or months malaria patient has to immediately take medicine?”

ANSWER:

One of our collaborating medical doctors has assisting in providing this answer:

It depends on the type of malaria….with Plasmodium vivax infection she could have a low burden due to concurrent treatment or recent prophylaxis which is breaking through because of low grade resistance. Alternatively, it could be P. malariae or P. ovale, both of which sometimes cause only mild disease that may or may not progress. P. falciparum shouldn’t act this way; it is usually a much more severe, aggressive infection. Another option is that she might not have malaria at all. She needs qualitative and quantitative smears to confirm the diagnosis, together with a comprehensive travel/exposure history to support any clinical suspicions.

Why are platelets low in malaria infections?

September 14, 2011 by Malaria Q&A

QUESTION:

Why are platelets low in malaria infections? Why is there no internal bleeding in malaria?

ANSWER:

Platelets are low especially with P. falciparum infections, but also potentially with high-burden P. vivax infections. This is probably from sequestration in blood vessels and spleen. Actually, there is life threatening bleeding associated with severe cerebral malaria from this stasis and sequestration in the brain. Similarly, enlargement of the spleen leaves it susceptible to rupture, which would lead to critical internal bleeding.

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.