Malaria Medicine for Pregnant Women

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QUESTION

What medicine can be given to a pregnant woman who has malaria?

ANSWER

The type of anti-malarial that should be given to a pregnant women depends on the type of malaria they have, its severity and how long she has been pregnant. Chloroquine, quinine and artemisinin-derivatives can be given during all trimesters, but in many places malaria is resistant to chloroquine.

In general, the World Health Organisation recommends ACTs (artemisinin-based combination therapies) as the first line treatment against uncomplicated malaria. Mefloquine and pyrimethamine/sulfadoxine are able to be given the second and third trimesters; again, in some areas, resistance to mefloquine has been detected. Moreover, some people are allergic to sulfas, and so pyrimethamine/sulfadoxine would not be appropriate for these patients. Primaquine, doxycycline and halofantrine are contraindicated during pregnancy.

Malaria Recovery Time

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QUESTION

How long does it take to recover from malaria?

ANSWER

A number of different factors affect recovery time from malaria. These include the type of malaria, how quickly treatment is administered and the immune status of the patient. For example, children and pregnant women tend to get much more severe cases of malaria, due to their reduced natural immunity. 

The type of malaria will impact on the severity and length of the infection as well—P. falciparum is the most severe kind, and can result quickly in death if not treated promptly, whereas less rapidly progressing forms of malaria, such as P. malariae, may persist for longer but not cause severe disease. For most cases of uncomplicated malaria, once the appropriate form of treatment is started, the patient will start to recover within a couple of days.

Malaria in the Brain

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QUESTION

I would like to know how dangerous is malaria in the brain?

ANSWER

Only a certain kind of malaria, Plasmodium falciparum, is usually associated with causing problems in the brain. The P. falciparum parasite infects red blood cells and changes their surface structure, causing them to become “sticky”. These sticky red blood cells become lodged in the small blood vessels that flow through organs, causing blockages and reducing oxygen flow.

When this process occurs in the brain, the result is called “cerebral malaria”, and can result in impaired consciousness, coma and even death. As such, once malaria-infected blood passes into the brain, it can be very dangerous. Luckily, however, if people are diagnosed promptly and given treatment, it is usually possible to stop the progression of P. falciparum malaria before it enters the brain, allowing for a swift and uncomplicated recovery.

“Test and Treat” Model Offers New Strategy for Eliminating Malaria

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As researchers work to eliminate malaria worldwide, new strategies are needed to find and treat individuals who have malaria, but show no signs of the disease. The prevalence of asymptomatic or minimally symptomatic malaria can be as high as 35 percent in populations with malaria and these asymptomatic individuals can serve as a reservoir for spreading malaria even in areas where disease transmission has declined.

In a new study, researchers at the Johns Hopkins Malaria Research Institute found that a strategy of actively identifying undiagnosed malaria and then treating those with the disease resulted in significantly lower prevalence of malaria cases compared to a control group. Their findings are published in the February 3, 2012 edition of the journal PLoS ONE.

“New strategies are needed, particularly in areas of declining transmission. One strategy is to screen people for malaria and treat those who are infected, even those who are not sick enough to go to the clinic,” said lead author, Catherine G. Sutcliffe, PhD, an assistant scientist with the Johns Hopkins Bloomberg School of Public Health’s Department of Epidemiology. “Using artemisinin combination therapy can enhance this strategy, as treatment can reduce transmission to mosquitoes. In regions of declining transmission, the burden of malaria could be reduced to such an extent that elimination is achievable.”

The study was conducted in southern Zambia, with colleagues from the Johns Hopkins Malaria Research Institute in Macha. Researchers analyzed data from surveys conducted in 2007 and between 2008 and 2009. In both surveys, households were screened for malaria using rapid diagnostic tests and treated with artemisinin combination therapy when malaria was detected.

According to the new study, a proactive test-and-treat case-detection strategy resulted in a sixfold reduction in prevalence in 2008 and 2009, with the initial parasite prevalence at 4 percent. Test and treat showed a twofold reduction in 2007, when community prevalence was higher at 24 percent.

“Proactive case detection with treatment using artemisinin-combination therapy can reduce transmission and provide indirect protection to household members. If resources permit, this strategy could be targeted to hot spots to achieve further reductions in malaria transmission,” said William J. Moss, MD, senior author of the study and associate professor with the Johns Hopkins Bloomberg School of Public Health.

Worldwide, malaria afflicts more than 225 million people. The disease kills between 800,000 and 1 million people each year, many of whom are children living in Africa.

Authors of “Reduced Risk of Malaria Parastemia Following Household Screening and Treatment: A Cross-Sectional and Longitudinal Cohort Study” include Catherine G. Sutcliffe, PhD; Tamaki Kobayashi, PhD; Harry Hamapumbu; Timothy Shields, MA; Sungano Mharakurwa, PhD; Philip E. Thuma, MD; Thomas A. Louis, PhD; Gregory Glass, PhD; and William J. Moss, MD.

The Johns Hopkins Malaria Research Institute is a state-of-the-art research facility at the Johns Hopkins Bloomberg School of Public Health. It focuses on a broad program of basic science research to treat and control malaria, develop a vaccine and find new drug targets to prevent and cure this deadly disease.

The research was funded by the Johns Hopkins Malaria Research Institute.

Source: Johns Hopkins Bloomberg School of Public Health

Transmission of Malaria

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QUESTION

Why can the malaria parasite be transmitted from mosquito to human, but not from human to human (via blood)?

ANSWER

This is a very good question, and actually, malaria can be transmitted via human blood directly to another person, but this occurs relatively rarely!

It has to do with the life cycle of the malaria parasite. When a mosquito bites a human host, it injects sporozoites from its salivary glands into the blood. This life stage first migrates to the liver, where it undergoes a cycle of multiplication, before entering the blood stream. Here, in the so-called “erythrocytic” portion of the life cycle, the parasite reproduces a series of times in red blood blood, before finally forming gametocytes, which are required to be ingested by a mosquito vector during another blood meal for the life cycle to be continued. As such, when blood is passed between people, they would have to pass infected red blood cells, and not gametocytes (which are not infective to humans, only to mosquitoes) in order for the other person to become infected.

As such, when a person who is infected with malaria donates blood, there is a chance that they might pass on some red blood cells which are infected with mature trophozoites or schizonts; these could then go on to infect more red blood cells in the person who received the blood. However, in most countries, blood is screened for malaria, and in fact, in many places, people who might have been exposed to malaria are not allowed to donate whole blood, only plasma (in which the red blood cells have been removed, and therefore there is no risk of transmission). Given the high levels of malaria prevalence in some endemic countries, however, preventing people from donating blood who are positive for malaria may result in too little blood being collected; in these cases, other strategies, such as treating donors or closely monitoring patients post-transfusion, may prove to be a better strategy.

malaria life cycle schematic CDC

Schematic of the malaria life cycle, courtesy of CDC (www.cdc.gov)

How is Malaria Treated

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QUESTION

How is malaria treated today?

ANSWER

Several different medications exist which are used for the treatment of malaria. The exact drug and method of treatment depends somewhat on the type of malaria the patient is infected with.

In most cases of non-complicated (i.e. when the patient is stable and conscious) malaria, the World Health Organisation recommends an orally-administered (in the form of solid pills) artemisinin-based combination therapy (ACT), such as Coartem (a combination of artemether and lumefantrine). Other types of medication include atovaquone-proguanil (Malarone) and sulfadoxine-pyrimethamine (Fansidar). In some locations, where chloroquine-resistance is not a problem, chloroquine can also be used as a treatment. For complicated malaria, where the patient is in a more severe state, intravenously administered quinine is usually the first-line treatment.

If diagnosed early and the patient is given appropriate medication, virtually all cases of uncomplicated malaria can be effectively treated.

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!

Cure for Malaria

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QUESTION

Is there a cure for Malaria?

ANSWER

Yes. Several different medications exist which are used for the treatment of malaria. The exact drug and method of treatment depends somewhat on the type of malaria the patient is infected with. In most cases of non-complicated (i.e. when the patient is stable and conscious) malaria, the World Health Organisation recommends an orally-administered (in the form of solid pills) artemisinin-based combination therapy (ACT), such as Coartem (a combination of artemether and lumefantrine). Other types of medication include atovaquone-proguanil (Malarone) and sulfadoxine-pyrimethamine (Fansidar). In some locations, where chloroquine-resistance is not a problem, chloroquine can also be used as a treatment. For complicated malaria, where the patient is in a more severe state, intravenously administered quinine is usually the first-line treatment.

If diagnosed early and the patient is given appropriate medication, virtually all cases of uncomplicated malaria can be effectively treated.

Tested Positive for Malaria

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QUESTION

I was found with malaria 0.25% positive in my test report….. will this make to reject my application from a Malaysian university?

ANSWER

Malaria is an infection with a parasite of the genus Plasmodium; all types are very treatable, and so even if you have tested positive, you can easily get medication which will allow you to recover fully from the disease. While some  universities require a health test, since malaria is completely treatable, a positive test for this disease should not stop you from being admitted to the university. However, you should get treated as soon as possible; ask your doctor what kind of medication is most appropriate for the type of malaria you have.

Treatment of Malaria in India

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QUESTION

In India how to treat a child and adult suffering from malaria?

ANSWER

Chloroquine-resistant malaria has been observed in India and so the first line drug of choice should be an artemisinin-derivative in combination with another drug (this group of medications are more generally known as “artemisinin-based combination therapies” or ACTs). A common example of this is artemether in combination with lumefantrine, which is marketed as Coartem. Coartem is also used to treat malaria in children over 11 pounds (5 kg) in weight.