Malaria After Doxycycline?

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QUESTION

I recently spent a month in Asia. I took doxycycline tablets for malaria. I took them for the month I was away and when I returned. I took the full course and had been fine. Within two days of completing the course I became ill. This has be going on for about a month now with severe headaches, nausea, dizziness, very tired all the time and feeling like I’m going to faint. I have been to the doctor five times, they think this is a virus, I have been tested for malaria and dengue fever. I am only just now starting to feel better. What could this be?

ANSWER

Since you are beginning to feel better, I would go with your doctors’ diagnosis of a viral infection of some kind. It is also possible that you were infected with intestinal amoebas or even worms. A more accurate diagnosis would require faecal sample and possibly blood tests. You did the right thing by getting tested for malaria and making sure you didn’t have dengue.

Recurring Malaria

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QUESTION

I had malaria twice when I was 4 and 8 years old. I am 50 years old now but I have severe chills at least once or twice a month, muscle aches, fatigue severe head aches for the past 10-15 years with no apparent cause and my I take head ache medication for migraine (maxalt and excedrim) and my chills and fatigue is getting more frequent. I had no other history of any diseases. Is this symptoms a possible recurrent malaria.

ANSWER

Thanks for your question. One of the most common symptoms of malaria is high fever, which comes in cycles with chills in between. Without fever, it is unlikely that you are suffering from malaria.

However, there are some forms of malaria which can cause relapses. Specifically, Plasmodium vivax and P. ovale can form dormant liver stages which can then re-enter the blood causing a relapse of malaria infection and a recurrence of symptoms. To diagnose malaria in your case, next time you have an episode of chills, go to your doctor and ask for a blood test to check for malaria. S/he will either look at your blood under the microscope or perform a rapid diagnostic test, which tests for malaria-specific proteins, called antigens, in your blood.

In either case, it will tell you whether you have malaria, and which kind. If you have one of the relapsing kinds (P. vivax  or P. ovale) then you may be able to take a course of a drug called primaquine which kills the dormant liver forms of the malaria parasite and thus prevents future relapses. However, people with G6DP deficiency should not take primaquine, so you should be tested for this deficiency prior to taking the drug.

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 Muscle Aches

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QUESTION

I am someone who has traveled to malaria-infected areas in the past and will do so again in the future. I also happen to have a form of musculr dystrophy (myotonic dystrophy type II) that, among other things, causes me to experience frequent episodes of muscular pain. Thus, the mere presence of muscle pain, in my particular case, can tell little about whether I might have malaria.

Though I do understand there are several other symptoms to look for, I also would still like to have a better understanding of what malarial muscle aches tend to feel like in the hope that this information could perhaps help me distinguish this particular form of muscle pain from the other muscle pains I already experience. For example, I have also occasionally experienced pulled muscles, or muscles that simply were overused during a recent, too prolonged session of resistance training. Thus I am familiar with how these feel and how they differ from the more usual pains caused by my muscular dystrophy. This helps me recognize what is likely causing a particular muscle pain on a particular occasion.

Can you describe malarial “muscle aches” in more detail? For example, which muscles are affected? (The muscular dystrophy tends to cause pain more often in certain muscles while others are more rarely, or not at all, affected … so this information alone could be helpful). Does the ache tend to stay in one set of muscles, or does it move around, hurting one set of muscles on Monday morning and another on Monday night, etc.? Is it a persistent, steady pain (hurting as much on Wednesday as it did on Tuesday) or does it fluctuate? Is it a sharp pain? Dull? Throbbing? What? Does moving or using the aching muscle make it hurt more? Does it come with joint pain, or not? What?

I do, of course, intend to educate myself further about malaria and am already aware of other symptoms that are more helpful for me to be aware of. (Headaches is NOT among these since I have so many of those also, but some of the other symptoms I’ve read are far more unusual for me and thus more helpful in signaling to me the possibility that I’m actually sick and not just having a “bad pain day”) But knowing more about typical malarial muscle pain would help give me an additional data point to consider.

Your assistance will be much appreciated.

ANSWER

I have checked in with one of our medical advisors here at MALARIA.com and this is what he has replied:

Unfortunately, there is no useful characterization of muscle aches associated with malaria. Malaria is not a subtle disease that needs to be detected by characterizing the location or quality of muscle pains.  The main symptoms of malaria are high fever and shivering/shaking chills.  The presence of these symptoms should prompt an evaluation for malaria.  That being said, it should not be an issue if the person takes malaria chemoprophylaxis and uses appropriate mosquito avoidance measures.

Hope that helps!

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.

Annual Blood Examination Rate in Bengal

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QUESTION

What is the annual blood examination rate in West Bengal?

ANSWER

The annual blood examination rate (ABER) is a measure of the level of diagnostic monitoring activity. Data from 2007 suggested the ABER in West Bengal was around 5%, which is well below the level of 10% which is recommended for active surveillance and is the target of the National Vector Borne Disease Control Programme.

However, within West Bengal there is variation in the ABER both geographically and temporally. One study showed that in Naxalbari block in Darjeeling district, ABER in 2003 and 2004 was as low as 3.5%. The region experienced a malaria outbreak in late 2005, and the average ABER for this year soared as high as 16%; however, from January to May of 2005, before the transmission season and the outbreak, the ABER was only 0.5%! This means that monitoring efforts at the start of the outbreak were probably insufficient to detect the emergence of the outbreak and therefore delayed the process of responding to the emerging disease threat. Maintaining sufficient levels of malaria surveillance monitoring is particularly important in West Bengal, since this state is one of the major endemic centres for malaria in India, contribution about 11% of all malaria cases and about 6% of all cases of Plasmodium falciparum.

Malaria from Dominican Republic?

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QUESTION

Hi i just came back from the Dominican Republic. I started to have a mild fever, chills, muscle pains, a headache, and a cough. Today the fever and chills are gone but my cough and headache have gotten worse. It hurts my head a lot when I cough, I feel a lot of pressure in my head. Can you please tell me why my head hurts so much.  Is this a symptom of malaria? hope to hear from you guys soon thanks!

ANSWER

Headaches can be caused by many things – they are usually classified as primary (tension headaches, migraines or cluster headaches), secondary (as a side effect to some other illness or syndrome, which can very commonly be an infection or response to an allergen) and neuralgia and “other” headaches (neuralgia is inflamed nerves). Malaria, as a serious infection, can cause secondary headaches, while other symptoms include fever (usually in cycles of 2 or 3 days), chills, nausea and aches. However, these symptoms are also consistent with a wide range of other illnesses, including influenza and other common diseases. Malaria symptoms will only appear at least one week after being bitten – if you have started feeling symptoms sooner than this, then you probably don’t have malaria.

Malaria is present in the Dominican Republic, with highest transmission risk in the western part of the country, near the Haitian border. The cities of Santiago and Santo Domingo are considered very low risk for malaria. It is actually recommended that all travellers to the DR take anti-malarial medication (called prophylaxis), to protect against malaria infection. If you were taking prophylaxis, then the risk of getting malaria is very low. However, if you were visiting areas outside of these cities, were not taking anti-malaria medication and it has been at least a week since you were bitten by mosquitoes while there, it may be worth going to your doctor or a hospital to have a malaria test. If you are diagnosed with the disease, then your doctor can quickly prescribe you effective treatment, which should clear up the infection in a matter of days. The type of malaria in the Dominican Republic (Plasmodium falciparum) can be dangerous if left untreated, though in this area, it responds readily to several different drugs, including chloroquine, so treatment will be uncomplicated.

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

Late Malaria Confirmation

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QUESTION

I was given a field diagnosis of malaria 1 1/2years ago and was treated. Can I still get a blood test to confirm if I truly had malaria?

ANSWER

That’s a very interesting question, and the answer is: it depends. Since you were treated, you will no longer have the parasites in your blood stream, and so you cannot use a traditional blood film, looked at under a microscrope, which is the standard diagnostic method in many places.

However, there are other blood tests which look for the presence of antibodies against specific malaria proteins. These antibodies can remain in the blood for a long time after the malaria infection – probably months, but perhaps even years, though the exact length of time may vary from person to person, as well as between antibodies. If you wanted, you could inquire in your hospital whether it would be possible to get a serology test for malaria (serology tests look for antibodies) – if they tell you the brand they use then you could also contact the manufacturer to ask if they have done tests on the length of time the antibodies stay in the blood.

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.

Fever and Body Aches with Malaria

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QUESTION

Is bad throat and fever with with body ache the symptom of malaria?

ANSWER

While fever and body aches are certainly some of the symptoms associated with malaria, a sore throat is well common, but could be the result of enlarged lymph nodes. It is important to note that these symptoms are also present with many other diseases; in fact, the symptoms of malaria are so general that sometimes it is difficult to diagnose, and a blood test should be performed to confirm that a patient is indeed suffering from malaria before treatment is given.