Child Has Recurring Malaria

by

QUESTION

My two year old daughter was affected by malaria 9 months back we took proper course and also the follow up course of 6 weeks. After 2 months post 6 weeks she was infected again by malaria and now again she is getting fever and fear this could be malaria again.

ANSWER

If you suspect she might have malaria again it is important you go and get her tested immediately, as then the doctor can prescribe appropriate treatment. This is particularly important for young children, as they are most susceptible to severe malaria. You should also try to find out what type of malaria she had/has. Repeated attacks of malaria can occur three ways. The first is re-infection – the first infection was cured by the medication, but then your daughter was exposed to malaria again, through the bite of an infected mosquito. Preventative measures, such as making sure she sleeps under a long-lasting insecticide treated bednet, can help reduce the risk of re-infection. Secondly, it could be what is called “recrudescence” – this is when the treatment brings the number of parasites in the blood below detectable levels, and low enough so that symptoms subside.

However, once the treatment course stops, the parasite is able to replicate in the blood again, and symptoms return. This is rare if the full, proper course of medication is taken – in most circumstances, Coartem (artemether plus lumefantrine) should be the first line of treatment and it is very effective against preventing recrudescence. Finally, there is relapse. This only occurs with two species of malaria: Plasmodium vivax and Plasmodium ovale. In this case, the parasite is cleared from the blood by the treatment, but some parasites escape by laying dormant in the liver. These can then reactivate weeks, months or even years after the initial infection. Normal malaria medication can be given to treat relapses of infection, but an additional drug, called primaquine, should also be given, to kill the remaining dormant liver stages. Your doctor should be able to tell you whether he would recommend this drug for your child – they should also be tested for G6DP deficiency prior to taking the drug.

Malaria Recurrence

by

QUESTION

My friend suffers malaria due to plasmodium falsciparum at least every two weeks. It has been treated with coartem, artequine, artesunate+fansida, quinine/quinimax since 2004 without any relief at all. It returns a week or two later and lab tests attest to same. What else should be done?

ANSWER

It is rare for someone living in an endemic area to suffer so regularly from malaria—usually after repeated exposure the body builds up a certain level of immunity which prevents mild attacks developing into serious illness. Also, P. falciparum is not resistant to Coartem, so something else is probably going on. 

The first thing to make sure is that your friend complies fully with the medication they are given, and completes the full course of drugs. If they stop taking the pills before the full course is completed, the malaria parasite might be reduced enough for symptoms to subside and for the parasite to be undetectable in blood tests, but is still there in low numbers and so can bounce back after your friend stops taking the pills, resulting in a new bout of disease. This process is called recrudescence, and can be prevented by ensuring that the full course of medication is taken, so that ALL the malaria parasites in the blood are killed.

Otherwise, it is clear that your friend needs to take more preventative measures against contracting malaria. These include sleeping under a long-lasting insecticide-treated bednet, spraying the inside of the house with insecticides to prevent malaria mosquitoes from persisting inside and wearing long-sleeved clothing and insect repellent in the evenings and at night, when mosquitoes are biting most actively.

Your friend may also want to look into taking malaria prophylaxis (preventative medication) at times of the year when they are most at risk from infection, or if they know they will be undertaking activities that leave them vulnerable to mosquito bites (i.e. working outdoors at night for a period of time). Some anti-malarial prophylactic drugs, such as doxycycline, are readily available in most malarial countries at a very good price. However, they cannot be taken indefinitely, so for people living in endemic areas, other preventative measures should be considered first.

Malaria Cure

by

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 in Burkina Faso

by

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

by

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.

How soon can I take Coartem if I suspect Malaria?

by

QUESTION

Does one have to wait for the symptoms of Malaria to show before taking Coartem? Will the Coartem still be effective in killing the malaria before it has entered the red blood cells and the fever has broken?

ANSWER

I believe that Coartem is only effective against the blood form of the parasite, hence why it is not effective in treating the liver forms of Plasmodium vivax and Plasmodium ovale.

More to the point, if you don’t have symptoms of malaria you shouldn’t take any medication to treat it—improper use of treatment medication can lead to resistance to Coartem developing in the malaria parasite, which would be a tragedy as it is currently the front-line treatment for many millions of people affected by malaria around the world.

On a personal level, taking Coartem unnecessarily can also lead to unpleasant side effects. As such, you should always get tested and diagnosed as positive for malaria before taking treatment. As a rule of thumb, if you don’t have symptoms, you probably don’t have malaria (though if you live in a highly endemic area, you may be able to tolerate a certain burden of malaria without symptoms…but then you would also be very familiar with the symptoms). Generally speaking, testing asymptomatic people isn’t worthwhile.

Malaria Symptoms, Cures, and Prevention

by

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.

 

Recurrent Malaria

by

QUESTION

Malaria has been with me since the late 1980’s after 6 years in Malawi.
During the 90’s I had it twice per year in Feb and Sept. Blood tests always came up negative. Treatment was with Chloroquine, later Halafantrin and then Co Artem. 2 or 3 treatments were required as symptoms appeared 2 weeks after completion of initial treatment.

In 2004 I treated with a bodyweight specific dose of Arinate and did not have another bout until 1 week into a Southern Mozambique visit in Aug 2008. (I was on doxycycline as a prophylactic but discontinued due to it causing diarrhoea.) Treatment was with Artecospe (unsuccessful) and CoArtem (successful.) In Nov 2010 after a visit to N Botswana another bout – treated twice with CoArtem.
Sept 18 2011 it struck again. (I have not been near a malaria area since Nov 2010). CoArtem unsuccessful 3 times with Artecospe have not worked and now on Co Arinate.

Have I some resistant strain of Malaria? Does eating during a malaria bout reduce the efficacy of treatment?

ANSWER

So far, no strains of malaria have been discovered to be resistant to Coartem. Moreover, recurrent malaria is only caused by Plasmodium vivax and Plasmodium ovale—neither of these are nearly as common in Malawi as Plasmodium falciparum, which can recrudesce (parasites re-appear in the blood) if not treated appropriately but will not relapse or reoccur months or years after the initial infection—if you have tested positive for malaria in your more recent bouts of illness, you should ask your doctor whether it could be P. vivax or P. ovale.

If it is one of these two species of malaria, you should ask about the possibility of taking primaquine to kill the dormant liver stages of the parasites and prevent future recurrence. You will need to be tested for G6DP prior to being able to take primaquine.

However, since you tested negative in Malawi initially, I suspect you did not have malaria at all at that point, and should have been tested further to determine what was causing your symptoms. Moreover, chloroquine should not have been the first treatment of choice, as resistance is rife in sub-Saharan Africa.

The symptoms of malaria are notoriously non-specific and therefore diagnosis is crucial prior to treatment, as many other infections will present with similar clinical symptoms, such as fever and nausea. Therefore, if you have any further symptoms which you suspect might be malaria, please visit a doctor or travel medicine clinic straight away for a blood test. If it is not malaria, there is no point taking further doses of Coartem or other anti-malarials and further tests might reveal another diagnosis.

How is Malaria Treated

by

QUESTION

How is malaria treated?

ANSWER

This answer is copied from an earlier question about the various available cures for malaria.

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.

 

Chloroquine Resistant Malaria

by

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.