Malaria Drugs Side Effects

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QUESTION

I was affected by malaria 5 months back. I am feeling tiered and weakness and heart trembling symptoms.

Any suggestions to overcome weakness?

ANSWER

Your fatigue is probably not caused by the treatment—one of the potential residual effects of malaria infection is iron deficiency, which can lead to anaemia, and this can cause tiredness. Eating iron-rich foods or asking your doctor about iron supplements might help if indeed you find your iron levels are too low. Recovery from any illness can sometimes take a long time, and getting plenty of rest, eating well and keeping well hydrated will all help you to regain your strength.

If you have recently taken malaria medication, perhaps you would be willing to spend a few minutes to take our Malaria Medication Side Effects Survey? We are very interested in hearing about the experiences of people who have taken different types of malaria medication, and particularly any side effects they have experienced. The survey should only take a few minutes and will be anonymous; we will publish the results on the website for you to see. Many thanks for your assistance!

How Long for Malaria Medication to Start Working?

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QUESTION

After I treat my body with the malaria pill how long will it be to start working in my body?

ANSWER

The malaria medication will start working almost immediately after you take it. The way in which malaria pills work differ depending on the type of drug you are taking, but most act on the parasites which infect red blood cells in your body. As soon as the parasite’s life cycle in the red blood cells is disrupted, you will begin to notice reduced symptoms and feel better, though it is important to take the full course of pills given to you by the pharmacist or doctor, as this ensures that all the malaria parasites are destroyed.

If you have recently taken medication against malaria, perhaps you would be willing to complete a short survey on our website, designed to get information about the experiences people have with malaria medication and the side effects they might have experienced? We would be very grateful for a few moments of your time – the link to the survey is here: Malaria Medication Side Effects Survey.

Malaria Testing

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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!

How can I get malaria pills?

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QUESTION

I do have symptoms of severe malaria. How can I get malarial pills in Holland? I went to the hospital the doctors said nothing is wrong with me which is not true.

ANSWER

If you have the symptoms of severe malaria (high fever, chills, nausea, body aches) then you should go to an emergency room at a hospital immediately.

Malaria infection can be very serious if not treated promptly and with appropriate medicine. You must inform the doctors of your travel and medical history. Malaria is not transmitted in Holland so you must have been infected elsewhere.

Tell the doctors in particular if you have recently (in the past month) travelled to an area where malaria is transmitted (sub-Saharan Africa, South America, some parts of Central America, Haiti, Central Asia, South-East Asia, many of the Pacific Islands). I am certain that if you truly have the symptoms of severe malaria they will not turn you away from the hospital, and especially not if you make it clear that you may have been at risk for malaria.

However, if you have not travelled to malarial areas recently, then it is much less likely you have malaria. However, some forms of malaria can “relapse” after a long dormant period. If you have had malaria previously, and have suffered these relapses, then this is also very important information to tell your doctors.

It is important to take anti-malarial medication only if you have had a blood test to confirm that you have malaria. The symptoms are general enough that they are often mistaken for malaria when they are in fact caused by another disease. Moreover, in most parts of Europe, it is difficult to get malaria medication without a prescription.

It is very important that you visit an emergency room, hospital or your doctor as soon as possible to get tested for malaria and given the appropriate treatment if indeed you test positive for malaria.

Celebral Malaria and Blindness

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QUESTION

I live in Nigeria. Good friend of mine complained of headaches in Dec 2011. Did an MRI went to Germany had a general check up. Back in Nigeria in January, headaches increase, she gets blind in one eye, following day the other eye, now in Germany where they have induced her into a coma. They said that she got a brain Haemorrage from the malaria. Can malaria bring blindness. What are the chances of surviving and getting back eyesight.

ANSWER

Although rare, brain hemorrhage is sometimes associated with severe cerebral malaria (caused by infection with Plasmodium falciparum, the most deadly form of malaria). This bleeding in the brain could cause blindness—whether the visual impairment is permanent or not depends on the extent of the bleeding and how much damage it caused.

I have found one case in the literature where severe malaria caused a brain hemorrhage which resulted in permanent blindness, and the authors report their case is only the second they have heard of, so this is rare indeed. Similarly, her survival will depend on how well she responds to treatment, which will likely be intravenous quinine, at least at first. Given that she is in Germany, where health care is excellent, I would say her chances are as good as they would be anywhere else in the world. I hope she makes a full and swift recovery!

Malaria Recurrence and Treatment

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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.

P. Falciparum Malaria Treatment

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QUESTION

I dont have high fever yet have been diagnosed with P. falciparum malaria. How can this disease be treated and is it completely curable?

ANSWER

Don’t worry, if diagnosed early and given appropriate treatment, P. falciparum infection is very easily cured. You should be given a type of medication called artemisinin-based combination therapy (ACT). An example is Coartem, which is a combination of artemether and lumefantrine.

Other artemisinin derivatives that are commonly used include artesunate and dihydroartemisinin. You should start to feel better after just a few days and will make a complete recovery. Make sure you get the correct dose for your age and weight from the doctor, and take the medication for the full length of time the doctor tells you – this is very important to make sure the infection is completely cured, otherwise the infection may be able to come back.

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.

Dangerous

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QUESTION

Why malaria so dangerous?

ANSWER

Malaria can be dangerous for a number of different reasons, some of which relate to each other. First of all, there are five different types of malaria that infect humans, and each varies in terms of its severity and potential for severe consequences. Even within these types, the severity of the disease caused (termed “virulence” by scientists and doctors), can even vary by strain or geography. Generally, the most dangerous form of malaria is caused by Plasmodium falciparum. One reason why this species of malaria is so dangerous is that is replicates very quickly in the blood. This means that infection levels can build up very quickly; if a person infected with P. falciparum does not get diagnosed and treated within a few days of feeling sick, the infection can progress to a point where the disease becomes very severe. This rapid accumulation of infection is also observed with P. knowlesi, a much rarer form of malaria found in south-east Asia. The parasites of P. knowlesi have a 24-hour reproductive cycle in the blood, the quickest for any type of malaria that infects humans. However, P. falciparum also has other characteristics which make it even more dangerous, and which do not occur with P. knowlesi. For example, when P. falciparum infects red blood cells, it causes their shape to change, and makes them “sticky”. This stickiness causes the red blood cells to become lodged in the blood vessels leading in to major organs, in a process known as sequestration. Sequestration creates blockages of these blood vessels, reducing blood flow and resulting in oxygen deprivation. When this process occurs in the blood vessels in the brain, the outcome is known as cerebral malaria, characterised by impaired consciousness, coma and even death. It is this pathology which is associated with most cases of severe malaria, and causes the most number of deaths.

However, if treated promptly with the correct drugs, even P. falciparum malaria is usually easily controlled. Therefore, one of the additional reasons why malaria is so dangerous is that in many places, and particularly sub-Saharan Africa, people do not have access to medication, or not the right types of medication. Many strains of P. falciparum have become resistant to chloroquine, once the first line treatment for malaria, and so this drugs is now ineffective in many cases. Instead, the World Health Organisation recommends now that artemisinin-based combination therapies (ACTs, such as Coartem) should be given as first-line treatment against all uncomplicated malaria, to prevent additional resistance from developing.

Dietary recommedations

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QUESTION

Can I have the dietary recommendations please.

ANSWER

I am afraid I do not completely understand your question. There are no known dietary measures that can be used to prevent malaria infection, nor are there and recommended ways of treating malaria with common foods. In the past, people drank tonic water, which contained quinine, as a way of preventing and treating malaria. However, in modern times, tonic water contains very low levels of quinine, insufficient to protect against malaria. More effective means of prevention, such as prophylactic medication and sleeping under a long-lasting insecticide treated bednet, are recommended instead.