Test for Malaria?

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QUESTION

Is there a way to verify that someone has had malaria? I had symptoms that were treated with only 10 days of proper 14 days prescription and had a relapse a year later. Have felt weak and keep my drinking to a very light level as a result. Is there test that can be taken to verify having/had plasmodium vivax?

ANSWER

The best way to test for relapsing malaria (i.e. Plasmodium vivax or Plasmodium ovale) is via a blood test while you are experiencing a recurrence of symptoms. Symptoms are associated with the parasite re-entering the blood, and so at this point, they can be visualized on a blood film, or their proteins detecting using a rapid diagnostic test. Other than that, you could also investigate having a serological test done (some forms of these tests are called ELISAs, standing for enzyme-linked immunosorbent assay).

These test for antibodies to specific proteins associated with malaria, and so can be designed to test for a particular strain, such as P. vivax. As antibodies can persist in the blood for weeks or even months after the initial infection has cleared, this could be a way for you to determine whether you had P. vivax without waiting for another relapse. This paper describes the development of a P. vivax-specific serological assay, though I am not sure whether such a test is commercially available as of yet.

If you are diagnosed with Plasmodium vivax, you should ask your doctor about the possibility of taking primaquine to kill the dormant liver stages and prevent future relapse. Primaquine is not recommended for people with G6DP deficiency, so you should be tested for this before taking the medication.

Malaria Relapse

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QUESTION

Why do I suffer from constant malaria attack? The doctor has prescribed different prescriptions every time I get an attack but its still coming back. What could be the problem?

ANSWER

There are a number of possible answers to your question. First of all, your doctor might not be prescribing the right type of treatment for the type of malaria that you have. The World Health Organisation now recommends that all uncomplicated cases of malaria should be treated with artemisinin-based combination therapies (ACTs), such a Coartem. However, in some places, doctors still prescribe other drugs, such as Fansidar or chloroquine. This can be a problem, as in many areas, the local kinds of malaria have become resistant to these earlier drugs, and so you may not be cleared of the infection. This is called recrudescence—when a malaria infection is not cleared completely from the blood and so symptoms come back once the treatment has stopped.

Alternatively, if there is a longer time interval between your episodes of illness, you may be suffering from relapses. This occurs with two particular types of malaria: Plasmodium vivax and P. ovale. These types of malaria can form liver stages which remain dormant even after the treatment you take kills all the malaria in your blood. Therefore it will appear like you have been cured, but really you still have an infection in the liver.

These liver stages can re-activate and re-enter the blood, causing another episode of malaria symptoms months or even years after the initial infection. If your doctor finds that you are positive for one of these two types of malaria, you should talk to him/her about the possibility of taking primaquine. This drug kills the liver stages of the parasite, but is not appropriate for people with G6DP deficiency, so you should be tested for that first.

Finally, there is the possibility that you are continually being re-infected with malaria. In this case, you should take more preventative precautions. For example, sleep under a long-lasting insecticide-treated bednet, wear long-sleeved clothing (especially at night) and cover exposed skin with insect repellent. All of these measures will help prevent mosquito bites, which transmit malaria. In addition, you could consider indoor residual spraying, which coats the walls inside your house with insecticide to further eliminate the presence of mosquitoes.

Regular Fever after Malaria

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QUESTION

I am from Indore (India). I was affected by malaria positive vivax. My doctor give me some tablet but soon my fever is gone. After few months my fever is come back and fever is repeated every time but does not leave for long time. Fever will repeated after few hours. What can I do?

ANSWER

It sounds like you might have recurring P. vivax malaria. This is when the malaria is treated in the blood stage of infection, but some parasites are able to remain dormant in the liver, and come back and cause disease later on. You should talk to your doctor about taking primaquine—this is a drug that can kill the liver stages and thus prevent future relapses of infection. However, you should be tested for G6DP deficiency first. Also, when you experience a recurrence of the fever, you should still go to your doctor for diagnosis, to confirm that you do have malaria and not another disease. The symptoms of malaria are very generic and can be mistaken for many other things.

Malaria Relapse

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QUESTION

I had malaria in Papua New Guinea 40 years ago and had many relapses. I had one 11 years ago and was in hospital for 3 weeks. I have been to a massage therapist who used a hand machine giving out pulses rather strong a bit like tiny electric shots could this activate malaria?

ANSWER

The reasons why malaria relapses are not well known. Malaria acquired in different places tends to have different relapse times (faster in the tropics, less frequent in sub-tropical or temperate regions) and there is also some evidence that being bitten again by mosquitoes can trigger relapse. I am not aware of any evidence that electric pulses could trigger relapse, but likewise cannot discount the possibility! On another note, there is medicine that can be taken to prevent further relapse, by killing the dormant liver forms of the malaria parasite. It is called primaquine, and is only effective is taken exactly as prescribed for a 2 week period. Some people with G6DP deficiency may also not be recommended this medicine, so before prescribing it, your doctor should test you for this deficiency.

Long term health effects of malaria when young?

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QUESTION

I’m trying to find out if having malaria at a young age can have long term effects on health.

Around 25 years ago when I was 4 years old I contracted malaria when living in central Africa. Unfortunately I do not know the type of malaria, only that I received medication and recovered without complications.

Over the last few years I’ve had a general feeling of poor health and fatigue. Blood tests indicate I have some level of liver damage but I’m at a loss for the cause.

Is there any chance of having picked up liver damage (or other long term effects) from contracting malaria at a young age?

ANSWER

There is little evidence for any long term complications associated with uncomplicated malaria infection. One thing to investigate might be the type of malaria you had as a child; Plasmodium vivax and Plasmodium ovale, while not as common as Plasmodium falciparum in Central Africa, both occur in this region, and differ from P. falciparum in that they can have a dormant liver stage.

While I still have not heard of liver problems being associated with dormant malaria parasites, it is conceivable that if you had one of these two types of malaria and did not have the liver stages treated, you might later feel some ill effects; relapse from P. vivax has been known to occur decades after the initial infection. The good news is that there is a drug available, called primaquine, which can kill these liver stages (known as hypnozoites). So, if you know you had P. vivax or P. ovale, you could mention this possibility to your doctor—prior to taking primaquine you should have a test for G6DP deficiency, as such as deficiency makes it dangerous to take this medication.

If you have ever taken anti-malaria medication, please take Malaria.com’s brief Malaria Medication Side-effects Survey: Treatment and Prophylaxis.

Malaria in Burkina Faso

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QUESTION

(1)What drug is administered in the first 24 hours after malaria symptoms onset. What side effects have this/these drugs.

(2) I it is not possible to reach a treatment facility etc until 7 days after initial chills, fever etc and there are no symptoms remaining other than tiredness what is the drug of choice?. Local people say it is malaria but there is no diagnostic facility near the location until a week has passed.

The person in question is visiting in Burkina Faso where malaria is endemic. Standard anti malaria treatment was taken, but we are told that this is not always effective.

ANSWER

1) In most parts of sub-Saharan Africa, due to the spread of chloroquine-resistant strains of Plasmodium falciparum (the most widespread and deadly form of malaria), the first-line treatment for uncomplicated malaria infection are artemisinin-based combination therapy (ACTs) drugs, which combine artemisinin or a derivative (such as artemether) with another anti-malarial drug.

One very common combination is artemether with lumefantrine, which is often marketed as Coartem. ACTs have few common side effects, and very few severe ones, but mild side effects which are reported include nausea, dizziness, loss of appetite and vomiting. One severe side effect that has been reported is allergic reaction.

2) If a patient has had suspected malaria but seems to have recovered, they should probably present themselves to a clinic or physician for a blood test. This will determine whether the patient is still currently suffering from malaria; if so, they will probably still be treated with Coartem or another ACT as above. If there is no trace of the malaria parasites in the blood, the patient might want to try a rapid diagnostic test which looks for antibodies to the malaria parasite; this will tell them if they did in fact have malaria before. Some tests can also differentiate between Plasmodium falciparum and other forms of malaria.

This is important because if they test positive for P. vivax or P. ovale, there is a possibility that the malaria parasites are still present in the liver, in a dormant form, even once all the parasites are gone from the blood stream. In this case, the patient may want to consider talking to their doctor about taking primaquine, which kills the dormant liver stages of the parasites.

People with G6PD deficiency cannot take primaquine so in some cases a G6PD deficiency test may be required first. If the patient is found to have had Plasmodium falciparum, but no active infection appears in the blood, they should still monitor their health carefully for several weeks, and perhaps take malaria preventative medication such as doxycycline or Malarone; even after symptoms cease, in some cases a small number of P. falciparum parasites can remain in the blood, at concentrations too low to be seen under the microscope, but which can then flare up at a later date and cause symptoms to reappear. This is called recrudescence; once symptoms reappear, the patient should immediately seek a diagnosis from the doctor to confirm it is malaria, and then take treatment.

Drugs for Malaria

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QUESTION

What drugs are used in the treatment of malaria?

ANSWER

There are a number of medicines used to treat malaria. Traditionally, chloroquine has been the first line drug of choice for uncomplicated, non-resistant malaria. However, several types of malaria, and most notably Plasmodium falciparum, the most severe and deadly kind, has become resistant to chloroquine in many places. In some parts of south-east Asia, Plasmodium vivax has also begun to show worrying signs of chloroquine resistance. In such settings, where resistance to chloroquine is suspected, the first line medications for uncomplicated cases are artemisinin-based combination therapies (ACTs), such as Coartem.

The World Health Organization has recommended that artemisinin only be given in combination with another drug to prevent malaria also becoming resistant to this therapy as well. Cases of malaria which have progressed beyond the grasp of that treatable with oral medication as described above (so-called “complicated” cases, most common with P. falciparum infection) are usually given intravenous quinine as a first-line response.

All of these treatments have been rigorously tested in strictly controlled clinical and field trials, and while they may have side effects, they are generally mild and in most cases, the patient will be given the dose without prior testing for reaction to the drug. One exception is with primaquine, which is sometimes used as a preventative medication against malaria and can also be used to treat the liver stages of P. vivax and P. ovale. Primaquine is known to cause severe haemolysis in people with G6DP deficiency, and so people with a high statistical probability of having this condition (for example due to family history or ethnicity) should be tested prior to being given primaquine.