Malaria Relapse Again and Again

by

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!

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.

Malaria Medication Side Effects

by

QUESTION

My mother is an old patient of arthritis. She has also had a long stint with asthma and tuberculosis. She has presently been diagnosed with urine infection but was treated with malaria medicines artesunate and primaquine phosphate.

What side effects could she possibly develop by wrong administration of malaria medicines?
ANSWER

Luckily there are few major side effects associated with either artesunate or primaquine. Mild side effects of the former include ones similar to malaria: nausea, headache, loss of appetite and vomiting. Side effects of primaquine are very similar to this, but can also include intense itching and anemia in some people (mainly of Mediterranean or African descent). The main thing to be aware of with primaquine is that it can be dangerous for people with G6DP deficiency, so patients should be tested for this before taking primaquine.

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.

 

Recurrent Malaria; Coartem Side Effects

by

QUESTION

I get recurrent malaria 2 to 3 times per year in Feb, March and Sept. I take Coartem which just about kills me.

I had it in early Sept this year and it was back 3 weeks later. Please can you advise how to stop it recurring. It has been a regular health problem since the 1980’s. I have had 3 Primaquine treatments to eradicate the liver parasites. The treatment did not work.

Your advice will be most appreciated.

ANSWER

Thanks for your question. First of all, is it of concern that you write that taking Coartem “nearly kills” you—do you mean you get very bad side effects? Side effects are rare with Coartem, and when they occur, they are usually mild and transient, such as headache, nausea, cough, or fever. Occasionally, patients report more significant side effects, such as tinnitus, back pain or itching. If you have more serious side effects than these, you should talk to your doctor about switching to a different formulation of malaria medication.

Given that you are based in sub-Saharan Africa, I would certainly recommend that you stick to artemisinin-based combination therapies (Coartem, for example, is a combination of artemether, which is an artemisinin-based compound, and lumefantrine), but there are different combinations, which may be more effective for you.

Second of all, in sub-Saharan Africa, Plasmodium falciparum is by far the most common form of malaria. Importantly, this parasite does NOT cause multiple episodes or recurrence, months after the initial infection, unlike Plasmodium ovale or Plasmodium vivax, both of which are found in Africa but are not nearly as common. Plasmodium falciparum infection can cause what is call “recrudescence,” which is where the number of parasites in the blood is reduced sufficiently so as not to be detectable, but then bounces back after treatment ceases, causing another bout of infection a few days or within a few weeks of the initial malarial episode—this might explain your most recent malaria experience.

Primaquine is only effective against recurring malaria when it is used to target the dormant liver stages of P. vivax and P. ovale. Therefore, in your case, it is extremely important that you are accurately diagnosed in terms of which malaria parasite you have, and each time you get infected as well. This will help determine whether you are continually being re-infected, for example with P. falciparum, or if you are indeed suffering from recurrences of P. vivax or P. ovale. If it is the latter, then primaquine is usually about 80% effective, based on global epidemiological analysis on P. vivax.

There is some evidence that strains of malaria from different regions, for example Thailand and Papua New Guinea, may be more resistant to primaquine than strains from other places. The good news about having P. vivax or P. ovale is that they are much more likely to respond to initial treatment with chloroquine, which you might tolerate better than Coartem.

So, in summary, if you have not done so already you should make sure your doctor diagnoses the species of malaria parasite that you have, either through microscopy (the different types of malaria look different under the microscope) or, preferably, through a serological blood test, which are even available as self-testing kits. At that point, alternative treatment options to Coartem can be discussed with your doctor, as well as whether it is appropriate to try primaquine again.

Three Attacks of Malaria

by

QUESTION

I am right now recuperating from a third attack in less than one year’s time. What could have gone wrong ?

I am awaiting to hear your advice.

ANSWER

There are a number of reasons for multiple malaria attacks. One is that although malaria can be easily treated, these treatments often don’t prevent re-infection. There are separate drugs which can be used to prevent malaria (known as malaria prophylactics), but these must be taken all the time to be effective (usually either once a week, once a day or twice a day, depending on the specific drug), and so usually aren’t appropriate (due to the unknown health risks of taking the drugs for that long, plus the prohibitive cost) for people living in areas where malaria occurs.

For people living in malarial areas, other means of prevention are required, of which avoiding being bitten by mosquitoes is paramount. For this, it is recommended to sleep under a long-lasting insecticide treated bednet at night, when many malarial mosquitoes are active. Similarly, wearing long sleeved clothing, especially if it is impregnated with an insecticide such as permethrin, can help avoid the bite of infected mosquitoes.

Second of all, there are some types of malaria which cause repeat episodes of illness, even after only a single infection. Specifically, Plasmodium vivax and Plasmodium ovale (the former is common in many parts of Asia in particular) can form life stages called hypnozoites which rest dormant in liver cells, even after the parasites in the blood have been cleared.

During this time, the patient will have no trace of malaria if they take a blood test, and they will feel fine. However, if these hypnozoites become active again, they will re-invade the blood, and the symptoms of disease will reoccur – at this stage, the parasite will once again be observable in the blood, and so the patient will be diagnosed as positive for malaria. As such, it is very important to find out what type of malaria you have, and if it is one of the above two species, then you can talk to your doctor about taking another type of medication, in addition to that which cures the blood infection, called primaquine—primaquine kills the hypnozoite liver stages of malaria and thus prevent recurrence of the disease.

Thanks for your question—since we think other people may benefit from the questions in this forum, I have removed your name and contact information to preserve your anonymity.

How is Malaria Cured?

by

QUESTION

How is malaria cured?

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.

Symptoms of Malaria

by

QUESTION

What are the main symptoms of malaria?

ANSWER

Malaria can have many different symptoms, but the initial signs are similar to a flu-like illness, with high fever, chills, headache and muscle soreness or aches. A characteristic sign of malaria is cyclical fever, with peaks of severity every two or three days. Additionally, some people will experience nausea, coughing, vomiting and/or diarrhea.

Because these symptoms are quite generic of a wide variety of illnesses, if you live in a malaria-endemic region, it is crucial to be tested when you develop such symptoms, rather than assuming it’s just the flu and soldiering on! If you have recently traveled to a malarial area and start to experience these signs of infection, similarly you should inform your doctor of your travel history, as otherwise they might not recognize your symptoms as potentially that of malaria.

If treated rapidly and with the correct medication, malaria is almost always completely treatable; it is only if treatment is delayed that it becomes more serious, with long-lasting and potentially fatal consequences. Similarly, if you take sensible precautions while living or traveling in malarial areas, such as taking prophylaxis (and taking them as per the instructions, for the full required amount of time!), avoiding being bitten by mosquitoes and sleeping under an insecticide-treated bed-net, you vastly reduce your chances of getting infected in the first place.

It’s also worth noting that different species of Plasmodium, the parasite that causes malaria, cause slightly different manifestations of the disease, and also require different forms of treatment. Plasmodium falciparum has a unique way of affecting the red blood cells it infects, which eventually can result in loss of function of internal organs. ‘Cerebral malaria’ is a particularly deadly version of this, whereby the function of the brain is affected. The cycles of fever, mentioned above, are caused by synchronous rupturing of the red blood cells in the body by the malaria parasite; P. falciparum, P. vivax and P. ovale, complete this cycle every 48 hours, resulting in fever cycles of roughly two days (though P. falciparum can be unpredictable); P. malariae, on the other hand, has a cycle lasting 72 hours, so three day cycles of fever are expected. Finally, although many types of malaria can be successfully treated with the drug chloroquine, some strains, and notably of P. falciparum, have become resistant to this treatment. In these cases, artemesinin-based treatment is recommended, usually in combination with other therapies (artemesinin-combination therapy, or ACT). P. vivax, in addition, requires an additional drug, called primaquine, which is used to treat lingering liver stages of the parasite, to prevent recurrence of the infection.

Paludisme Depuis 5 Mois (Malaria for 5 Months)

by

QUESTION:

En fait je souffre d’un palu que le médécin a mal traité après une analyse sanguine. J’aimerais savoir comment faire pour m’en débarrasser car je traine ce palu maitenant depuis 5 mois.

ENGLISH TRANSLATION:

In fact I suffer from malaria which the doctor has treated poorly after a blood test. I would like to know how to clear myself of this because I have been carrying this malaria now for 5 months.

ANSWER:

C’est rare de souffre telle longtemps que 5 mois continuellement avec palu; plus commun c’est de observer plusieurs episodes d’infection en serie, si la traitement n’est-ce pas un succes. Mais tout ca depend un peu du type du palu. Vous devrez tenir un autre test sanguine pour determiner ce type du palu, de preference au hôpital ou dans un clinique de santé. Avec celle information, le médécin peut vous recommender un traitement approprié. Par example, si vous avez un infection de Plasmodium vivax ou P. ovale, le parasite peut rester en repos dans le foie pendant plusieurs semaines ou bien plusieurs mois. Des médicaments qui traitent l’infection dans le sang, comme chloroquine ou ACTs, ne touchent pas cette stages de vie dans le foie. Dans ce cas, vous devez parler avec votre médécin sur un autre médicament, qui s’appelle primaquine, qui tue a les parasites dans le foie et previent encore plus de rechutes.

ENGLISH TRANSLATION: It’s rare to suffer from malaria continuously for five months; it is more common to see multiple infections over and over in series, if the disease is not treated appropriately. But all of this depends on the type of malaria that you have. You need to have another blood test to determine the type of malaria, and based on this information, the doctor can give you appropriate treatment. For example, if you have Plasmodium vivax or P. ovale, the parasite can rest dormant in the liver for several weeks or even months. The drugs which treat the initial infection in the blood, such as chloroquine or ACTs, don’t affect these liver stages. In this case, you must talk to your doctor about taking another medication, called primaquine, which kills the liver stages of the malaria parasite and prevents further relapses of the disease.

Typhoid and Malaria

by

QUESTION:

Since i was suffering with fever for 5 days I consulted a doctor, have undergone blood test, and got typhoid as positive, but the treatment didn’t work. I was tested for malaria and result was positive. Ii’ve been given chloroquine for three days and primaquine for 28 days. After chloroquine was completed I started using primaquine. During this time I got fever and I got typhoid positive. My question is though iI’ve been treated for typhoid before malaria is conformed why it has come again?

ANSWER:

Typhoid and malaria are very different illnesses, caused by different disease organisms. Typhoid is caused by a Salmonella bacterium, whereas malaria is caused by single-celled animals, called protozoa, of the genus Plasmodium.

Typhoid is usually transmitted by eating food or drinking water which has been contaminated by sewage or handled by someone else with typhoid fever. It is usually treated with antibiotics; however, these antibiotics do not prevent re-infection with the disease. The best way to prevent re-infection is through washing food thoroughly in clean (boiled) water and by washing hands regularly, especially after going to the bathroom. There is also a vaccine against typhoid which you can get which will prevent further re-infection. As such, if you think you have typhoid again, you will need to visit your doctor again for more treatment, as it is unrelated to your malaria infection (apart that you might have been weakened by one infection, leaving you more susceptible to a second disease). While at the doctor, you should also have another test for malaria to ensure that the treatment was successful.