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.

Cyclical Fever and Malaria Symptoms

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QUESTION

My dad is not well from last one month. In the evening time he feels headache, neck pain and 102 Temp.

Can you please tell me can it be Malaria.

ANSWER

Those symptoms can be characteristic of malaria—cyclical fever is a key symptom, though usually the cycles are every other day or even every third day (depending on the type of malaria). However, in some cases the cycles are more frequent or the patient may even have constant fever.

One of the difficulties with diagnosing malaria is that its symptoms are very general and can therefore be mistaken for many other illnesses. Likewise, in areas of high malaria transmission, doctors may assume a feverish illness is malaria without thinking about other possible diseases. As such, it is crucial that you take your father for a blood test, which is the only accurate way to diagnose malaria.

The doctor or clinician will either make a blood film and look at it under the microscope, or use a tiny drop of blood in a rapid diagnostic test. Either way, it is important for them to see evidence of a malaria infection before they give your father treatment. The diagnostic test should also show which type of malaria your father has (if indeed he has malaria), and this will also help to determine which is the most appropriate type of medication.

When to Seek Malaria Treatment

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QUESTION

I have been in New Guinea recently and 2 weeks on am exhibiting all the signs and symptoms of malaria. What is best course of action, considering I do not know what sort of mosquito was hovering about?

ANSWER

You should visit your physician or a clinic immediately. Depending on where you are, you may have to visit a specialist travel medicine clinic, to be sure that you will be seen by someone who understands how best to diagnose malaria. They should take blood and examine it under a microscope (using thick and thin blood films), or they may utilise a rapid diagnostic test. Either way, they will be able to determine whether you have malaria and if so, which type of malaria you have. 

This is important because some types of malaria, such as Plasmodium vivax (which is very common in PNG) can remain dormant in the liver after the initial infection has been treated, which leads to relapses months or years later. In order to prevent relapses, if you find you are infected with P. vivax you should inquire about the possibility of also being given primaquine, which is a drug that can kill these liver stages.

Malaria Detection

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QUESTION

what’s the newest form of malaria detection?

ANSWER

While the traditional form of malaria detection has been through microscopy of a blood film slide, two new technologies have recently emerged. The first is the use of reagent strips, which are impregnated with molecules that bind to various other proteins present in the blood during a malaria infection. These reagent strips are usually manufactured as part of a rapid diagnostic test (RDT) kit, whereby a patient only has to provide a single drop of blood, and the result can be read within minutes, a bit like a pregnancy test. The other new method which has emerged is based on PCR (polymerase chain reaction) technology. This method looks for malaria DNA directly in the patient’s blood, using specific sequences of DNA that are unique to the malaria parasite. This method is expensive and takes several hours at minimum, but is very sensitive, and even very low levels of malaria can be detected.

Diagnosing Malaria

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QUESTION

Where in Malaysia (Kuala Lumpur) can I diagnose malaria? Is it possible within 24 hours?

ANSWER

Given that malaria is endemic in Malaysia (though not usually found in Kuala Lumpar) you should be able to get a malaria test at most clinics or hospitals. The most common test is a thick and thin blood film, read under the microscope by a qualified technician—in some places, clinics are also using rapid diagnostic tests (RDTs). Both of these methods are rapid to prepare and analyse—microscopy may take a couple of hours, depending on the business of the medical staff, whereas an RDT should be ready in about half an hour. In some areas, you can also buy RDTs over the counter at a pharmacy for self-testing.

Child with Fever – Malaria Symptoms?

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QUESTION

Three yrs old boy having fever every 20 days for past 5 times. Remains for 2-3 days. Can it be malaria?
Never got blood tested.

ANSWER

Recurrence of malaria every 20 days is not that common, but could be caused by two different events: (1) true relapse, whereby the boy is infected with either Plasmosium vivax or Plasmodium ovale, and the parasite is disappearing from his blood but re-emerging from dormant forms in the liver (called hypnozoites), or (2) what is known as recrudescence, whereby the parasite never disappears fully from the blood, but reduced enough to stop symptoms from being felt, then flares up again.

Both options can be treated, but require a blood test, to ensure that malaria is the correct diagnosis and also to distinguish between options 1 and 2 above, and different treatment will be required.

A blood test should be performed during a period where the boy is experiencing symptoms, as with both options above, if the infection is not “active” (i.e. few or no parasites are visible in the blood) a blood test may prove negative. Rapid diagnostic tests which look for antibodies might be a good choice in this instance, as they may detect even a non-active infection.

Cyclical Fever

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QUESTION

My husband has been suffering from recurring fever every 3rd or 4th day for the past 7 months. All blood tests are normal, esr ,crp, cultures of urine and blood all normal, chest ct full body pet heart echo all normal. Tested positive for montoux and quantiferon gold, with no symptom other than fever, was put on ATT on 4th JULY 2011 fever persists with no other symptoms. Has been on ATT for more than 4 months with no respite and as per doctor TB is ruled out but 6 month course mandatory. Please help. Fever comes with mild chills and head ache at times.

ANSWER

Cyclical fever every few days is one of the characteristic signs of malaria, and the length of the cycles can help identify the type of malaria. Specifically a fever every three days is indicative of Plasmodium malariae infection, which also fits with the long, chronic persistence of the illness.

This parasite can be hard to diagnose as it is often present in low concentrations in the blood. If you haven’t had a blood film done already, ask your doctor to make a thin and thick blood film to look for the presence of Plasmodium malariae in your husband’s blood.

If the first films are negative, continue with daily films for a further 2 or 3 days. Another diagnostic option is a rapid diagnostic test, which can detect antibodies to the malaria parasites in the blood. P. malariae is easily treated with chloroquine.

Unfortunately, without further information and a more complete medical history it will be impossible to make a further diagnosis of your husband’s condition, but certainly checking for Plasmodium through a blood test would be a good first step.

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.