How to Take BFMP Specimen for Malaria

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QUESTION

How to take a bfmp specimen?

ANSWER

BFMP, when relating to malaria, refer to blood films for malaria parasites. Usually, fingerprick or venous blood is collected from the patient and used to create both a thin and a thick blood film. If using venous blood, the sample should be mixed with an anticoagulant in a vacuum tube. For both thin and thick films, a drop of blood is first placed on a clean glass microscope slide. For the thin smear, take a second “spreader” slide, and place the short end at the edge of the drop of blood. Wait for the blood to seep along the whole edge of the spreader slide, then push the droplet forward quickly and smoothly to spread it thinly across the rest of the slide. For the thick film, take the corner of a second slide and use it to smear the droplet of blood into a circle of 1-2 cm diameter.

You should be able to read newsprint through it, but it should not be so large as to risk dropping off the edge of the slide. When both films have completely dried, thin films are fixed in 100% methanol before staining; thick films are not fixed. A variety of different stains can be used for detection of malaria parasites, though commonly used ones include Giemsa or eosin.

Slight Malaria

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QUESTION

Does “slight malaria”  mean you have malaria?

ANSWER

You have malaria if you are infected with the Plasmodium parasites that cause malaria. However, having a few of the parasites does not mean you experience symptoms of the disease.  Some forms of malaria, like P. malariae, can persist in a patient without causing any symptoms. However, in some cases, particularly P. falciparum and also P. knowlesi, a slight initial infection can rapidly increase in a severe, heavy infection, requiring immediate treatment. So it is important to to always consider a diagnosis alongside clinical symptoms as well as an appreciation of the different types of malaria and how they can progress.

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.

Child with Fever – Malaria Symptoms?

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QUESTION

Three yrs old boy having fever every 20 days for past 5 times. Remains for 2-3 days. Can it be malaria?
Never got blood tested.

ANSWER

Recurrence of malaria every 20 days is not that common, but could be caused by two different events: (1) true relapse, whereby the boy is infected with either Plasmosium vivax or Plasmodium ovale, and the parasite is disappearing from his blood but re-emerging from dormant forms in the liver (called hypnozoites), or (2) what is known as recrudescence, whereby the parasite never disappears fully from the blood, but reduced enough to stop symptoms from being felt, then flares up again.

Both options can be treated, but require a blood test, to ensure that malaria is the correct diagnosis and also to distinguish between options 1 and 2 above, and different treatment will be required.

A blood test should be performed during a period where the boy is experiencing symptoms, as with both options above, if the infection is not “active” (i.e. few or no parasites are visible in the blood) a blood test may prove negative. Rapid diagnostic tests which look for antibodies might be a good choice in this instance, as they may detect even a non-active infection.

My Malaria Refuses to Go Away

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QUESTION

The symptoms started about 2 months ago and I have used all kind of drugs. I have completed lumartem dose twice and I have used Coartem, I even took chloroquine injection and I am well for a few days and it comes back to the way it use to be, because of so many antibiotics I have taken I now have swellings in my body and in my leg and its making my leg ache and making walking difficult. What do I do?

ANSWER

Are you sure you have malaria? The most important thing is to get diagnosed accurately, either at a clinic or by a trained diagnostician. The most common form of diagnosis is a blood film on a slide, read under the microscope, but this can require expertise for accurate diagnosis. Another option is a rapid diagnostic test, now available in many places, which tests for the antibodies to malaria.

In my experience, in many places clinics will diagnose malaria purely on clinical symptoms, such as fever, which actually are very general to many diseases and so not necessarily mean malaria! So if you have been diagnosed without a blood test, go back to the clinic/doctor and demand a blood test.

There are no known strains of malaria that are resistant to Coartem which is why I suspect you may have something else, perhaps in addition to the initial malaria infection. Moreover, the drugs used to treat malaria are not antibiotics, and should not result in swollen legs; again, you should see a doctor or clinician before taking any further medication.

How soon can I take Coartem if I suspect Malaria?

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QUESTION

Does one have to wait for the symptoms of Malaria to show before taking Coartem? Will the Coartem still be effective in killing the malaria before it has entered the red blood cells and the fever has broken?

ANSWER

I believe that Coartem is only effective against the blood form of the parasite, hence why it is not effective in treating the liver forms of Plasmodium vivax and Plasmodium ovale.

More to the point, if you don’t have symptoms of malaria you shouldn’t take any medication to treat it—improper use of treatment medication can lead to resistance to Coartem developing in the malaria parasite, which would be a tragedy as it is currently the front-line treatment for many millions of people affected by malaria around the world.

On a personal level, taking Coartem unnecessarily can also lead to unpleasant side effects. As such, you should always get tested and diagnosed as positive for malaria before taking treatment. As a rule of thumb, if you don’t have symptoms, you probably don’t have malaria (though if you live in a highly endemic area, you may be able to tolerate a certain burden of malaria without symptoms…but then you would also be very familiar with the symptoms). Generally speaking, testing asymptomatic people isn’t worthwhile.

Cyclical Fever

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QUESTION

My husband has been suffering from recurring fever every 3rd or 4th day for the past 7 months. All blood tests are normal, esr ,crp, cultures of urine and blood all normal, chest ct full body pet heart echo all normal. Tested positive for montoux and quantiferon gold, with no symptom other than fever, was put on ATT on 4th JULY 2011 fever persists with no other symptoms. Has been on ATT for more than 4 months with no respite and as per doctor TB is ruled out but 6 month course mandatory. Please help. Fever comes with mild chills and head ache at times.

ANSWER

Cyclical fever every few days is one of the characteristic signs of malaria, and the length of the cycles can help identify the type of malaria. Specifically a fever every three days is indicative of Plasmodium malariae infection, which also fits with the long, chronic persistence of the illness.

This parasite can be hard to diagnose as it is often present in low concentrations in the blood. If you haven’t had a blood film done already, ask your doctor to make a thin and thick blood film to look for the presence of Plasmodium malariae in your husband’s blood.

If the first films are negative, continue with daily films for a further 2 or 3 days. Another diagnostic option is a rapid diagnostic test, which can detect antibodies to the malaria parasites in the blood. P. malariae is easily treated with chloroquine.

Unfortunately, without further information and a more complete medical history it will be impossible to make a further diagnosis of your husband’s condition, but certainly checking for Plasmodium through a blood test would be a good first step.

Timing of Malaria Microscopy

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QUESTION

Contrary to our past beliefs we came to know that malaria slides should be taken during afebrile periods when RBCs remain intact, enabling easier diagnosis of malarial parasites. Is this true?

ANSWER

That is a very interesting question, which I passed on to a diagnostic expert who serves as an advisor to Malaria.com. His response is as follows:

Blood films should be collected from someone who is sick with a febrile illness after they have been in an area where malaria transmission occurs.  That does not mean that the smears need to be collected during particular times during the fever cycle.  If the first set of films is negative they should be repeated every 12-24 hours for a total of 3 sets.  During that time period, in general, the parasitemia if present will be rising—increasing the likelihood of detection.

It is worth noting that blood films are of little to no value as a screening test of asymptomatic travelers.

Blood Test After Child’s Malaria Exposure

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QUESTION

Our 2 year old son was exposed and bitten about 10 times on Friday, 21st of Ocober in Malindi, Kenya. This was our last day in Kenya after 3 days on the coast preceded by 4 in Masai Mara. On October 28, our son started vomiting. This lasted a day. He did not have a fever at the time. The doctor diagnosed him with rota virus. Our 2 year old took his last dose of Malarone on the same day the vomiting started.

We believe he did not keep it down. Since the doctor visit our son has developed a cough and has had a low constant 38 C fever for a day and a half. Given the risk of a small child to malaria, is there any reason we should not request a blood test for Malaria?

ANSWER

Generally speaking, coughing is not a common symptom of malaria, and fever more usually comes in cycles, so the clinical presentation suggests that your son may be suffering from another illness.

However, as you say, small children are particularly at risk from malaria, so I would say it is worth getting a blood test for malaria, to be on the safe side. It only requires fingerprick blood, and the results can be available very quickly.

It is also important to remember that Malarone (including Malarone Paediatric, the version marketing for children over 11kg in weight) should be taken for 7 days AFTER leaving a malarial area, to prevent latent stages of malaria developing into a full infection.

With small children, other preventative measures are also especially important, such as sleeping under an insecticide-treated bednet, wearing long sleeved clothing in the evenings and early mornings and using insect repellent on exposed skin.