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.

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.

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.

Is malaria possible years after bite?

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QUESTION

My child had a fever for 40 days after returning from a cruise 3 years ago. I begged the pediatrician to test for malaria because she got bit by something in Mexico but they laughed at me. She has had swollen lymph nodes on both sides of her neck for 3 years and all the docs tell me you can have swollen lymph nodes forever but now she has them in her groin and under arm on left side. She is pale and tired all the time. I took her back to the pediatrician and her cbc was normal so the dr is blowing it off. Malaria and Lymphoma are on my mind. My question is, Can malaria live in the body that long without it killing you?

ANSWER

Malaria can certainly survive in the body for a long time, but usually would present as recurring episodes of fever rather than enlarged lymph nodes (the malaria parasites reside dormant in the liver). There are two types of malaria that can reside in the body for extended periods: Plasmodium vivax and P. ovale. The former is found in parts Mexico, but cases of malaria are rare, especially in coastal areas. Unfortunately, malaria can only be detected when it enters the blood again – this occurs during the fever episodes. So, if your daughter does have a fever again, it might be worth asking for a malaria test, and specifically to look for P. vivax. If positive, there is a drug, primaquine, which can be taken to kill the remaining liver stages of malaria and prevent further relapses. However, overall, your daughter’s case doesn’t sound like malaria. What was your daughter’s Hb level? Anemia could explain the pallor and lethargy, though your pediatrician should have spotted that on the blood tests.

How long do I need to carry a Malaria Risk Card

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QUESTION

Hello, 13 months ago I worked in Nigeria, Africa for a period of 6 weeks. During which time I took Malarone tables daily. I think I was only bitten once or twice when there – but have never had Malaria. I currently carry a Malaria Risk Card in my wallet. At the time I was told I could potentially contract Malaria up to a period of 2 years after exposure – is this correct, or can I now remove the Risk Cards from my wallet?

ANSWER

If you never had malaria while you were in Nigeria, then you certainly would not still be at risk from it now. The only case in which you might still be at risk is if you had been diagnosed with either Plasmdodium ovale or P. vivax (two of the five forms of malaria that infect humans) – these can cause relapses months or even years after initial infection.

However, as I said above, since you did not have malaria at all, this does not apply to you. It is true that malaria has a latent phase, and so can sometimes only start to cause symptoms after someone returns home from a malarial area, but this period is usually one or two weeks, and certainly not months or years!

Child Has Recurring Malaria

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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.

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 Relapse Again and Again

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QUESTION

Hi, I have malaria, after every 2 to 3 months.  I had malaria positive when I was pregnant at 3 mnths I was hospitalized, it was P.vivax, it aggravated my pregnancy symptoms even, I had blood transfusion as Hb was 7, then aftr completion of 10 tab chloroquin course on discharge doctr advice me to take 2 tab chloroquin once a week for my whole pregnancy, I stopd taking drug at my 7 mnth as I got fed up of treatment, n hyperemesis whenevr I took chloroquin, then I had malaria in last days of my pregnancy again, it was vivax again then I had premature delivery with antepartum hemorage following c.section, after one month I had p.vivax malaria again, I am breast feeding mother, doctor again after completion of 10 tabs chloroquin advice 2 tabs chloroquin a week til I breast feed, I am fed up of taking chloroquin, its effects and malaria again and again, pls help me to ERADICATE from my blood, can I take Primaquine to help myself even I am breast feeding? And is it sure primaquine stop relapsing malaria?
I dont know why but I also had chest pain these days, I have enlarged spleen tip, Hb. 9, trophozites again in blood.
how to completely get rid of it? pls help me!

ANSWER

Thanks for your question – it sounds like you have had a very grueling time getting through these malaria episodes! I have forwarded your question to the medical experts who advise us here on malaria.com, but in the meantime I will try to at least partially answer your question.

As far as I am aware, there is not a lot of safety testing of primaquine in breast-feeding mothers. The main concern is with hemolysis, if either the mother or baby is G6PD deficient. However, I have heard of breast-feeding mothers being given primaquine in some cases, if the G6PD status of her and her baby has been determined to be normal. Primaquine, when taken for the full dosage period, is very effective at killing hypnozoites, which are the latent form of malaria that cause relapses. If you are interested in taking primaquine, you should talk to your doctor about the risks associated with taking the drug, and certainly have yourself and your infant tested for G6PD deficiency before starting treatment.

If you have taken medications for malaria, please help Malaria.com by taking our Malaria Medication Side-effects Survey: Treatment and Prophylaxis. Thank you!

What are the Symptoms of Malaria?

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QUESTION

What are malaria symptoms?

ANSWER

Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells.

Symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.

For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 7 days or as late as 1 year later. Two kinds of malaria, P. vivax and P. ovale, can occur again (relapsing malaria). In P. vivax and P. ovale infections, some parasites can remain dormant in the liver for several months up to about 4 years after a person is bitten by an infected mosquito. When these parasites come out of hibernation and begin invading red blood cells (“relapse”), the person will become sick.

Infection with malaria parasites may result in a wide variety of symptoms, ranging from absent or very mild symptoms to severe disease and even death. Malaria disease can be categorized as uncomplicated or severe (complicated) . In general, malaria is a curable disease if diagnosed and treated promptly and correctly.

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.