Curing Malaria

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QUESTION

What is needed to cure malaria?

ANSWER

Malaria is usually cured through treatment with an anti-malarial drug. The World Health Organization recommends use of an ACT (artemisinin-based combination therapy, such as Coartem) as first-line treatment for all non-complicated (i.e. not severe) malaria, and especially P. falciparum malaria (which in most places is resistance to chloroquine, and also to mefloquine in some locations). For complicated, severe malaria, or in cases where the patient is unable to take medication orally, the recommended treatment is intravenous quinine.

Herbal Treatment for Malaria

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QUESTION

Can any form of malaria be treated by herbs or plants, and how long does it take to recover from malaria?

ANSWER

Actually, two of the most important kinds of anti-malarial medication are derived by substances found naturally in plants, though they need to be processed in certain ways before the full pharmaceutical effect is felt.

Quinine, administered intravenously, is currently the first-line treatment for complicated malaria (i.e. when the patient has a history of high fever, plus additional severe symptoms such as impaired consciousness). It is derived from the bark of trees of the genus Cinchona, which are native to the tropical rainforests of western South America. Long known to native populations for its medicinal properties, it became known to Europeans in the early 17th century when the Countess of Chinchón, the wife of the viceroy of Peru at the time, was cured by it, having been suffering from what was likely malaria.

Similarly, artemisinin, currently used in combination with other anti-malarial compounds as the first-line treatment against non-complicated malaria (these combinations are known as artemisinin-based combination therapies, or ACTs), is derived from wormwood, a shrub native to Asia but now found throughout the world. As with the Cinchona trees, traditional healers in China had used wormwood to treat fever for thousands of years, but its use had been forgotten in modern times, until its rediscovery in the 1970s. Nowadays, artemisinin is not recommended for treatment alone, as it is feared this will lead to resistance developing, and so it is only used in the combination therapies described above.

If treated promptly, and with the correct form of medication, recovery from malaria can take only a few days. If not, recovery can take much longer (even up to weeks), and in the case of P. falciparum malaria, the most deadly kind, the infection can become life threatening in only a day or two. P. knowlesi (found in parts of south-east Asia), though less fatal than P. falciparum, can also become severe rapidly, and so prompt treatment is especially necessary for these two kinds of malaria.

Duo-Cotecxin and Fansidar as Treatment

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QUESTION

My husband weighs and has malaria. He was told by the pharmacist to take 2 tablets stat, then 1 daily for five days followed by 3 Fansidar tablets. We live in Papua New Guinea. I see on the Duo-Cotecxin web site the dose is three tabs daily. Which is correct?

ANSWER

Fansidar is a very different drug to Duo-Cotecxin—it is made of a combination of sulfadoxine and pyrimethamine, whereas Duo-Cotecxin is an artemisisin-based combination therapy (ACT), consisting of dihydroartemisinin together with piperaquine. As such, the dosages and time courses of therapy are likely to be different. However, Fansidar is not usually recommended as treatment anymore—it appears to have low efficacy against Plasmodium vivax and in the 1980s and 1990s, the World Health Organisation and Center for Disease Control (CDC in the US) only recommended it for use against chloroquine-resistant P. falciparum.

However, nowadays, both organisations recommend ACTs (like Duo-Cotexcin) to treat all uncomplicated P. falciparum infection as well. Therefore, unless your husband has been diagnosed with P. ovale or P. malariae malaria (both of which are sometimes found in PNG), Fansidar probably should not have been the first-line treatment given to him. Keep a close watch over his recovery, and if there is any sign of reccurrence of the symptoms, go back to the doctor for another malaria test.

Dangerous

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QUESTION

Why malaria so dangerous?

ANSWER

Malaria can be dangerous for a number of different reasons, some of which relate to each other. First of all, there are five different types of malaria that infect humans, and each varies in terms of its severity and potential for severe consequences. Even within these types, the severity of the disease caused (termed “virulence” by scientists and doctors), can even vary by strain or geography. Generally, the most dangerous form of malaria is caused by Plasmodium falciparum. One reason why this species of malaria is so dangerous is that is replicates very quickly in the blood. This means that infection levels can build up very quickly; if a person infected with P. falciparum does not get diagnosed and treated within a few days of feeling sick, the infection can progress to a point where the disease becomes very severe. This rapid accumulation of infection is also observed with P. knowlesi, a much rarer form of malaria found in south-east Asia. The parasites of P. knowlesi have a 24-hour reproductive cycle in the blood, the quickest for any type of malaria that infects humans. However, P. falciparum also has other characteristics which make it even more dangerous, and which do not occur with P. knowlesi. For example, when P. falciparum infects red blood cells, it causes their shape to change, and makes them “sticky”. This stickiness causes the red blood cells to become lodged in the blood vessels leading in to major organs, in a process known as sequestration. Sequestration creates blockages of these blood vessels, reducing blood flow and resulting in oxygen deprivation. When this process occurs in the blood vessels in the brain, the outcome is known as cerebral malaria, characterised by impaired consciousness, coma and even death. It is this pathology which is associated with most cases of severe malaria, and causes the most number of deaths.

However, if treated promptly with the correct drugs, even P. falciparum malaria is usually easily controlled. Therefore, one of the additional reasons why malaria is so dangerous is that in many places, and particularly sub-Saharan Africa, people do not have access to medication, or not the right types of medication. Many strains of P. falciparum have become resistant to chloroquine, once the first line treatment for malaria, and so this drugs is now ineffective in many cases. Instead, the World Health Organisation recommends now that artemisinin-based combination therapies (ACTs, such as Coartem) should be given as first-line treatment against all uncomplicated malaria, to prevent additional resistance from developing.

Malaria Medicine for Pregnant Women

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QUESTION

What medicine can be given to a pregnant woman who has malaria?

ANSWER

The type of anti-malarial that should be given to a pregnant women depends on the type of malaria they have, its severity and how long she has been pregnant. Chloroquine, quinine and artemisinin-derivatives can be given during all trimesters, but in many places malaria is resistant to chloroquine.

In general, the World Health Organisation recommends ACTs (artemisinin-based combination therapies) as the first line treatment against uncomplicated malaria. Mefloquine and pyrimethamine/sulfadoxine are able to be given the second and third trimesters; again, in some areas, resistance to mefloquine has been detected. Moreover, some people are allergic to sulfas, and so pyrimethamine/sulfadoxine would not be appropriate for these patients. Primaquine, doxycycline and halofantrine are contraindicated during pregnancy.

Do malarial drugs engender joint pains?

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QUESTION

I am now over 50 and I lived all my life in Africa during which time I have had a considerable incidences of malarial attacks. Each time I took any anti-malarial drug I experienced some side-effects including blurred vision, fatigue and joint pains. The pains especially have since become a permanent part of me and even severe enough to hamper my mobility. Does my condition sound to have any relationship with the several quantity and varieties of anti malarial drugs that I took almost all my life?

ANSWER

There are no known long-term side effects to taking modern anti-malarial drugs. However it could be that you have had a reaction or allergy to the specific kind of anti-malarials you have used in the past. For example, quinine sulphate is associated with joint pain in rare cases. However, in Africa these days, the World Health Organisation recommends only the use of artemisinin-based combination therapies (ACTs, such as Coartem) as the first-line treatment for malaria. The side effects of ACTs tend to be mild, and limited to nausea, dizziness and vomiting. As far as I am aware, joint pain and blurred vision have not been reported as side effects.

We at Malaria.com are very interested in hearing people’s experiences with antimalarial medication, so we would be very grateful if you would take the time to complete a survey on malaria treatment which we are running on the website. Thank you!

Lasting Headaches and Malaria

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QUESTION

I had malaria in July of 2011, returned to the U.S. in August, and had an occurrence of P. falciparum a little more than a month later. It was quickly treated, but I continue to get headaches. They occur about daily, and exercise induces a very severe headache. Is this a common lasting symptom of malaria?

ANSWER

Once successfully treated, malaria almost never has recurring or lasting side effects, nor are lasting headaches a known side effect of treatment with ACTs (artemisinin-based combination therapies, which is the recommended first-line treatment against P. falciparum). If your headaches are made worse through exertion, you should talk to your doctor about making sure they are not a symptom of a more serious condition.

Treatment of Malaria in India

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QUESTION

In India how to treat a child and adult suffering from malaria?

ANSWER

Chloroquine-resistant malaria has been observed in India and so the first line drug of choice should be an artemisinin-derivative in combination with another drug (this group of medications are more generally known as “artemisinin-based combination therapies” or ACTs). A common example of this is artemether in combination with lumefantrine, which is marketed as Coartem. Coartem is also used to treat malaria in children over 11 pounds (5 kg) in weight.

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.


Malaria Symptoms, Cures, and Prevention

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QUESTION

What is malaria cure, prevention, symptom and course?

ANSWER

I am not sure what you mean by “course” – however, links to information on malaria treatment, prevention and symptoms can be found on the main page of our website. For your convenience, I have provided them here:

As for malaria treatment, I have copied here an earlier answer in response to a question about malaria cures:

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.