Malaria Recurrence

by

QUESTION

I had malaria 5 months back it has again reoccurred. this time there has been increase in the size of the spleen. As of now it is being treated but I fear of getting it again. Is it true the malaria which i am down with reoccurs every 6- 8 months ??? Local people call it as registered malaria.. .

ANSWER

There certainly are types of malaria that can reoccur relatively regularly, at various intervals. This malaria is caused by one of two species, either Plasmodium vivax or Plasmodium ovale.

With both, it is important to get it diagnosed via a blood test with a doctor before getting treated again, to make sure it is indeed a relapse of the same malaria, and not a new infection with a different kind, or indeed some other disease (the symptoms of malaria can often be confused with other infections).

There is also medication that can be taken to prevent future relapses and re-occurrences—it is called primaquine, so you should talk to your doctor about the possibility of taking this medication. Please note it is not suitable for people who have G6DP deficiency, so you should be tested for that before taking it.

Long and Short Term Effects of Malaria

by

QUESTION

What are the long term and short term effects of malaria in brief please?

ANSWER

The symptoms of malaria as an acute infection vary somewhat depending on the type of malaria, but usual signs include high fever (often in a cyclical pattern, with fever one day, then no fever for one or two days, then a recurrence of fever), chills, body aches and nausea.

For Plasmodium falciparum, the most deadly form of malaria, the infection can progress rapidly if left untreated, with organ failure, impaired consciousness, coma and even death occurring as quickly as a few days after the onset of symptoms.

If the patient is able to survive the infection, or gets treatment in time, there are usually no long term affects of malaria infection. Some people who have suffered severe cerebral malaria (from P. falciparum) may experience some longer term neurological effects. Other types of malaria, such as P. ovale and P. vivax, can form dormant life stages which hide in the liver for weeks, months or even years, leading to relapse at a later date. However, apart from these recurrences, there are also no long term effects of infection with these types of malaria.

P.vivax Malaria Treatment

by

QUESTION

Which drug should be given to a p.vivax malaria patient with deficient glucose 6-phosphate for prevention of relapse?

ANSWER

Unfortunately, primaquine is the only drug that is known to kill the latent liver stages of P. vivax and P. ovale. Since it can induce haemolysis in people with G6DP deficiency, this drug is usually not recommended for people with this deficiency. However, there are actually gradations of severity of G6DP deficiency, and so in some cases, primaquine at therapeutic doses may be tolerated by people with only mild G6DP deficiency, if they are carefully monitored for anaemia throughout the process. This may be preferable to no treatment, since no other known medication can prevent relapse.

Recurrent Malaria

by

QUESTION

can malaria represent itself after 50 years?

ANSWER

There are two types of malaria which can lay dormant for long periods of time, though I don’t personally know of more than a handful of cases where the relapse was a matter of decades after the initial infection. These two types are P. vivax and P. ovale, so if you know you were infected with one of these types a number of years ago, it is possible that you could experience a relapse many years later, though as mentioned above, it is rare for the time lapse to be as long as 50 years.

Malaria Effects on the Body

by

QUESTION

What are the effects of malaria on the body?

ANSWER

Malaria has a number of effects on the body. The parasite passes from the blood (where it enters via the bite of an infected mosquito) into the liver, where it reproduces and changes form. After a period of 1-4 weeks (usually – it can be longer) in the liver, the malaria parasite re-enters the blood and begins to infect red blood cells, undoing more reproduction inside the cells and then, in synchrony, bursting out once the cycle is complete. This process of reproduction and destroying red blood cells results in a build-up of toxins and debris in the blood; the resultant immune reaction produces side effects which are the common observable symptoms of malaria, such as fever, chills, nausea and aches.

One particular type of malaria, Plasmodium falciparum, is also able to modify the surface of red blood cells it infects. It causes these cells to become “sticky”, so they lodge in the small blood vessels leading up to major organs. This build-up is called sequestration, and results in reduced blood flow and oxygen deprivation in the organs. When sequestration occurs in the blood vessels in the brain, the patient may experience impaired consciousness, psychological disruption, coma and even death – this manifestation is called “cerebral malaria”.

If diagnosed and treated promptly, the malaria parasites in the blood can usually be killed rapidly and the patient will soon enjoy a complete recovery. With two forms of malaria, P. vivax and P. ovale, the parasite can remain dormant in the liver for months or even years, resulting in relapse of disease at a later date. To prevent this from occurring, patients with these types of malaria can sometimes take primaquine, a drug which kills the liver stages of the malaria parasite as well.

Reoccurring Malaria

by

QUESTION

Can malaria reoccur year after year from a single infection? I have been told that it comes back every year by many people. I have had malaria once and it never came back after successful treatment. My thinking is that once the parasite has been eliminated from the system it is gone unless you get bitten again.

ANSWER

There are several different types of malaria that infect humans, and two of these species (Plasmodium ovale and Plasmodium vivax) can recur from year to year after a single infection.

The way it happens is that these types of malaria are able to form dormant life stages which hide in the liver. Most malaria medication only targets the blood stage form of malaria, and so these liver stages escape being killed by the medication, and can survive for long periods of time without the patient knowing about them. Then, at some point later (no one knows exactly what triggers the relapse—there is evidence that infection with other forms of malaria can instigate relapse, or being bitten by mosquitoes, or even just the climate), the liver stages activate again and re-enter the blood stream, which causes a renewal of symptoms.

It is possible to prevent these relapses—there is one type of medication, called primaquine, which is able to kill the dormant liver stages and thus completely clear the patient of malaria. However, it is important to talk to your doctor before taking primaquine, as it is not suitable for some people (especially those with G6DP deficiency).

Apart from these two types of malaria, the other three forms that infect people (P. falciparum, P. malariae and P. knowlesi) cannot reoccur in the same way as described above – if you have been infected with one of these, and then been successfully treated, you cannot get the disease again unless you are bitten by another infected mosquito.

Malaria Testing

by

QUESTION

My daughter is in Kigoma, Tanzania and has the symptoms of Malaria. She was given Duo Cotecxin and it seems to have started making her feel better. But after reading up on all the different types of Malaria parasites I am wondering if a blood test reading at a clinic would be recommended or is it too late for an accurate reading now that she is on meds?

ANSWER

I am always very nervous about people given malaria medication without a proper blood test-based diagnosis. The symptoms of malaria can sometimes be very general, and I have recently seen some data from elsewhere in Tanzania whereby clinics are giving virtually everyone who comes in with a fever malaria medication, even if the blood tests are negative! This is a sure way to develop resistance to malaria drugs, plus exposes people to the potential side effects of medication that they may not need, while also failing to diagnose or treat them for whatever other condition they may also have.

In your daughter’s case, since she is feeling better, it may be that she did indeed have malaria. Regardless, now that she is taking the treatment, she should make sure to finish the full dose of pills. It still could also be worth going in for a blood test. In any case it will put your mind at rest, and if there are still traces of the parasite in her blood, then you will know for sure that she had malaria. Moreover, it might tell you which type of malaria she had. While P. falciparum is the most common form of malaria in sub-Saharan Africa, cases of other types, such as P. vivax and P. ovale, are being reported more and more frequently.

These two types can form liver stages (called hypnozoites) which can stay dormant for weeks, months or even years after the initial infection. During this period, the patient will experience no symptoms; then, when the hypnozoites activate and re-enter the blood again, the patient will get a “relapse” of the malaria symptoms. The only drug available to kill these liver stages is primaquine; as such, if your daughter is positively diagnosed with P. vivax or P. ovale malaria, she should be aware of the possibility of a relapse, and perhaps discuss with a doctor the possibility of taking primaquine.

I hope she recovers fully and enjoys her stay in Kigoma—I spent almost a month out there last year!

Repeated Malaria

by

QUESTION

Since January 2011 I got three times malaria. Is it come regularly? Last week also I got maleria and I took medicine but still I have mild headache and sweating feeling tiredenes in between..

ANSWER

The timing of the repeated malaria episodes you have experienced means that it could be recrudescence (where treatment does not completely kill all the malaria parasites in your blood), relapse (where the malaria goes dormant in your liver, then comes back—this is only caused by Plasmodium vivax and Plasmodium ovale malaria) or even re-infection.

However, first of all, the most important thing is to make sure you are properly diagnosed with malaria and secondly, that you receive the right type of treatment for the kind of malaria that you have.

The symptoms of malaria are very general (fever, chills, nausea, tiredness, aches) and can also be caused by many other illnesses and diseases. As such, in order to confirm you actually have malaria, you should have a blood test (thick and thin blood smear, looked at under the microscope by a trained technician, or a rapid diagnostic test (RDT). In some places you can buy these RDTs from local pharmacies and do the test yourself at home).

Depending on where you live, there may be different types of malaria present; in this case, if you do have malaria, it is important to find out which one you have.

P. falciparum is the most common kind in sub-Saharan Africa and first-line treatment is an artemisinin-based combination therapy, such as Coartem – most areas have P. falciparum that is resistant to chloroquine, so this is not appropriate as treatment, nor are sulfadoxine and pyrimethamine combinations (such as Fansidar).

If you have P. vivax or P. ovale, chloroquine may be used, again depending on where you are and whether resistance is known from your area or not. In addition, you might also talk to your doctor about taking primaquine to prevent future relapse and recurrence of the infection.

Repeated re-infection can be prevented by protecting yourself more thoroughly against getting bitten by an infected mosquito. For example, you should sleep under a long-lasting insecticide treated bednet, screen your windows and doors and wear long-sleeved clothing at night and in the evenings. Indoor residual spraying, which coats your walls with insecticide, can also prevent mosquitoes from persisting inside your home.

Test for Malaria?

by

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 Recurrence and Treatment

by

QUESTION

Since September 2011 I had malaria falciparum. The first medication I took was Coartem, after 2 weeks  I had the same symptoms then the test was +1.5 ,i took Coartem again. 2 weeks after the doctor gave me Malarone ,then 19 days it come back . the doc. gave me Quinine -tablets without doxycycline. but no thing change.

Until now each 14-25 days the malaria comes back, I ask my doctor to do any extra test or to do any thing else, but he told me that “I don’t have severe malaria.”  So why all this medication but i still sick??

On 10 feb 2012 I took Artequin. I feel better but after 15 days it came back , then I take Artequin again. I`m confused what to do?
PLEASE HELP!!!

ANSWER

I think I replied to the comment you made on the “Diagnostic Advice” Q&A post – I will copy the response I wrote there below:

It is certainly unusual to have such persistent malaria; usually Coartem cures it very quickly. Where are you obtaining your medication? It could be that the drugs you took were out of date (expired) or counterfeit; this can decrease efficacy and lead to a reduction of symptoms but not a complete cure. Also, what kind of test is your doctor using? If it is a blood smear, you might want to ask if another technician could read the slides, to double-check the diagnosis. I have seen cases elsewhere in Africa where doctors diagnose malaria by default without really examining the blood slide closely. You could try to get a malaria rapid diagnostic test; this looks for specific proteins associated with malaria infection in your blood, and can be more sensitive than blood slides. You can even perform these tests at home, so double check what the doctor tells you.

Otherwise, if you are truly getting re-infected very rapidly, you should look into more effective preventive measures against getting bitten by mosquitoes. This includes sleeping under a long-lasting insecticide treated bednet, wearing long-sleeved clothing at night and in the evenings and applying insecticide to exposed skin.