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.

My Malaria Refuses to Go Away

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QUESTION

The symptoms started about 2 months ago and I have used all kind of drugs. I have completed lumartem dose twice and I have used Coartem, I even took chloroquine injection and I am well for a few days and it comes back to the way it use to be, because of so many antibiotics I have taken I now have swellings in my body and in my leg and its making my leg ache and making walking difficult. What do I do?

ANSWER

Are you sure you have malaria? The most important thing is to get diagnosed accurately, either at a clinic or by a trained diagnostician. The most common form of diagnosis is a blood film on a slide, read under the microscope, but this can require expertise for accurate diagnosis. Another option is a rapid diagnostic test, now available in many places, which tests for the antibodies to malaria.

In my experience, in many places clinics will diagnose malaria purely on clinical symptoms, such as fever, which actually are very general to many diseases and so not necessarily mean malaria! So if you have been diagnosed without a blood test, go back to the clinic/doctor and demand a blood test.

There are no known strains of malaria that are resistant to Coartem which is why I suspect you may have something else, perhaps in addition to the initial malaria infection. Moreover, the drugs used to treat malaria are not antibiotics, and should not result in swollen legs; again, you should see a doctor or clinician before taking any further medication.

Chloroquine Resistant Malaria

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QUESTION

What is chloroquine resistant malaria?

ANSWER

Chloroquine-resistant malaria is exactly what it sounds like—particular types of malaria which are not cured by treatment with chloroquine.

Chloroquine was first discovered in the 1930s in Germany and began to be widely used as an anti-malaria post-World War II, in the late 1940s. However, resistance to the drug also rapidly emerged, with the first cases of Plasmodium falciparum not being cured by administration of chloroquine being reported in the 1950s.

Since then, resistance has spread rapidly (since obviously it is beneficial to the parasite to be resistant, so various mutations conferring this protection have arisen multiple times in different areas in the world and also been passed on preferentially to new generations of malaria parasites), and now chloroquine resistant P. falciparum can be found globally in malaria-endemic areas.

Chloroquine resistance in Plasmodium vivax has also now arisen, though more recently—the first reports came from 1989, in Australia, in travellers returning from Papua New Guinea. Now, chloroquine resistant forms of P. vivax are found in multiple locations in south-east Asia, such as Myanmar and India, as well as from Guyana in South America.

Nowadays, other drugs, and notably ones containing artemisinin-based compounds, are preferentially used to treat uncomplicated malaria and especially in areas where chloroquine resistance is known to occur. However, due to fears of resistance to these compounds also developing, the World Health Organisation recommends that artemisinin-based compounds only be administered in conjunction with other anti-malaria drugs, such as lumefantrine (which in combination with artemether forms the widely-used anti-malarial treatment Coartem). These combinations are known as artemisinin-based combination therapies, or ACTs for short.

Side Effects of Treatment

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QUESTION

What are the probable side effects / reaction of “Artemether with Lumefantrine” to a 4.5 years, 5ml syrup, 2 doses – 0 & 8 hours?

ANSWER

Artermeter with Lumefantrine is often sold under the brand name “Coartem” and is widely distributed in areas of high P. falciparum prevalence, and particularly where known resistance to chloroquine occurs.

Coartem is also the drug of choice for the Roll Back Malaria programme. A study of 1332 children, mainly in sub-Saharan Africa, revealed that few children experienced any side effects while taking Coartem, and of these, the vast majority of side effects were mild, did not prevent the child from continuing to take the medication, and were resolved.

The most common symptoms that were observed in children were pyrexia (fever), cough, vomiting, loss of appetite and headaches. Other, more clinically significant but also more rare, side effects which have been observed include tinnitus (ringing in the ears), blood disorders, problems sleeping, heart palpitations, mood swings, gastrointestinal upset, itchiness, back pain and vertigo.

ARCEVA for malaria

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QUESTION:

Is ARCEVA a good vaccine for malaria?

ANSWER:

ARCEVA isn’t a vaccine for malaria, but it is a brand name of one type of medication used to treat the disease. It belongs to the group of drugs called artemisinin-based combination therapies (ACTs), which are recommended by the World Health Organisation to treat uncomplicated malaria caused by Plasmodium falciparum, the most dangerous form of malaria. ARCEVA specifically contains artemether combined with lumefantrine. It is very important to know that there is no effective vaccine against malaria that is currently available; many scientists and researchers are vigorously hunting for such a vaccine, knowing that this would radically decrease the number of cases of malaria worldwide.