Three Attacks of Malaria

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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.

Signs of Malaria

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Hello my question is how do I see malaria signs if i haven’t gone to check yet?

 

The key is to recognise whether you have any potential symptoms of malaria, or if you have been bitten a lot by mosquitoes recently and live in an area where malaria is present. 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. 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 you live in a malarial area, you can always visit a clinic and see if they will do a test to screen you for malaria, even if you don’t have the above symptoms. People who live in malarial areas develop partial immunity to the disease, meaning that new infections do not always present themselves as acutely as when they were children, or in people who are being infected for the first time. As such, some people can have low levels of parasite in their blood and while they may feel tired or a bit under the weather, do not have specific symptoms. This is especially the case for the less severe and deadly forms of malaria, such as Plasmodium vivax, P. ovale and P. malariae, so if you live in an area where any of these three are present, it might be worth getting a malaria test even if you don’t have symptoms.

However, it is very important not to accept treatment unless you are confirmed as having a positive diagnosis for malaria; taking treatment without having the disease can lead to resistance to the medication, and you may also experience side effects, which, though usually mild, are still probably better to avoid!

how can malaria affect our society?

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QUESTION

how can malaria affect our society?

ANSWER

There are many ways in which malaria can potentially affect our society, and particularly people living in highly endemic areas for transmission.

Most obviously, malaria has a huge burden on health services, as sick people require diagnosis, treatment and sometimes hospital care. These days of illness prevent people from going to work or children from going to school, and this can have a knock-on effect on a society’s economy. In fact, somescientists suggest that disease is a key factor “trapping” developing countries into poverty (see Jeffrey Sach’s work on the poverty trap, for example).

High levels of absenteeism from school can hinder efforts to improve literacy rates and stall the progress of education systems. Moreover, since children are one of the highest risk groups for infection with malaria, deaths occur disproportionately in children under the age of 5, contributing significantly to many countries’ high child mortality rates; high child mortality rates often result in high fertility rates, as families seek to replace children lost to disease or other causes. This in turn can lead to a rapidly growing population, which later on can result in a workforce which is larger than the number of available jobs, leading to high youth/young adult unemployment and dissatisfaction.

However, efforts to control malaria, as well as other diseases, have also had positive impacts on many societies, through building clinics for local health care as well as training health workers in the prevention, diagnosis and treatment of the disease. There is currently a huge global push to reduce the burden of malaria, and particularly to eliminate deaths from the disease by 2015, which will have enormous benefits to many societies.

Moreover, the process of international collaboration required for these initiatives can be seen to strengthen relationships between donors and recipient organisations in developing countries; these partnerships create benefits that surpass malaria control efforts alone, as they often have knock-on effects on other aspects of health care and development. As such, while malaria is undoubtedly a huge problem and a negative impact on society, by working together to control this disease the benefits to society may even outweigh the simple health improvements and cause lasting positive change.


Malaria Treatment Time and Hiccups

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QUESTION

I am suffering from pf malaria with enlarged liver and spleen under the treatment from last one week and the abdominal pain has subsided. But I am experiencing hiccups. How long it will take for complete recovery?

ANSWER

It is a good sign that you are already feeling better following your treatment for malaria. Interestingly, hiccups have been linked to infections with parasites, including malaria; in one case, it was discovered that the treatment the patient was taking (doxycycline) had actually caused some secondary problems of the esophagus which was causing the hiccups. The patient was given medicine which treated these secondary problems and cured the hiccups. So if you continue to experience hiccups after you have completed the treatment for malaria, you should ask your doctor if it is possible to arrange for an endoscopy, to check for any secondary problems caused by the medication.

As for recovery time otherwise, you will probably feel much better as soon as the course of medication is completed. However, many malaria patients still feel fatigued for weeks or even months after they have had the disease, so full recovery can take some time.

It is important, however, to visit your doctor again if you have any recurring symptoms of malaria after you have finished the medication (such as fever or nausea) since this could indicate that the infection was not completely cured the first time; another blood test may then be required, with another course of treatment if you test positive again for malaria.

Fever

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QUESTION

I am suffering from fever—what should I do?

ANSWER

I am afraid I cannot answer your question adequately—this site is not intended for diagnosis or as a substitute for medical care, just to answer specific questions about malaria.

Did I have malaria before?

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I am from East Africa. On July 3rd,2011 I had chills and I consulted a doctor, he did a blood test and told me I had malaria and gave me medication.

Then after 10 days I had neck pain and I went again to the doctor, who did another blood test, diagnosed malaria and gave medication. Then after 10 days it repeated.

It’s now the 22nd august,2011. I have pain in my neck and I went to another doctor he told to take blood test and he told for the last one month you didn’t get attacked by malaria. Can I know whether I suffered from malaria for the past 1 month? Also he has told me to take saline with some medicine to flush out that malaria medication. Is it correct? Please advise me.

ANSWER:

One of our collaborating medical doctors has kindly assisted in providing this answer. If recurrent symptoms of malaria were from one exposure to malaria earlier this year, then a drug-resistant strain of Plasmodium vivax is likely. OR, he/she simply needs to take primaquine for 4-6 weeks to eradicate the liver phase. The recurrent blood phase (symptomatic phase) may be due to smoldering infection in the liver. In order to confirm this hypothesis, you would need to know what drugs you were given on your earlier trips to the doctor, as well as the type of malaria the doctor diagnosed, if possible.

 

Will malaria come back?

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QUESTION:

As a result of a blood test I have just been informed that at some time I have had malaria. Though I have no idea when this was. I once was ill for 4 days with what I thought was flu and that is the only occasion I can remember. Therefore I have never been treated for malaria. Could you please tell me if there is any chance the disease will come back.

ANSWER:

That will depend on the type of malaria you had. I presume you found out you were infected through a blood test – it is likely a test that looked for antibodies to malaria in your blood. These tests can sometimes differentiate between the different species of malaria, and so it is definitely worth asking the clinic or doctor that performed the test if they can give you this information. Your location, or places where you have travelled in the last 4 years, may also assist in determining which type of malaria you had. Given that you barely registered being sick, I would suspect that you probably didn’t have Plasmodium falciparum, which is usually the most severe kind; it also cannot survive dormant in your system for long periods of time, so if you happened to have this kind, you wouldn’t need to worry about it coming back (though of course you can still be re-infected by all types of malaria, so prevention is still important!).

However, the other three main types of malaria can linger in a patient’s body. P. malariae is the least acute of all the malaria species, and can survive for a long time in the bloodstream, meaning that some people can have the infection for long periods of time without really feeling sick. If the blood test you took looked directly for parasites in your blood, and you tested positive, it is likely you have this kind. Like all uncomplicated cases of malaria, it is easily treatable, and once cured, you won’t have worry about it coming back (again, you do still need to watch out for being bitten by mosquitoes and getting re-infected though!).

The final two types of malaria are P. vivax and P. ovale. These persist in the body in a slightly different way than P. malariae – these have a special life stage which can lie dormant in the liver. Months or even years later, these dormant stages can re-activate and enter the blood stream, causing the patient to feel symptoms again, such as fever and nausea. Therefore, if you find you tested positive for one of these two forms, it is very important to ask your doctor about receiving medication (called primaquine) that will specifically target the liver stages of the parasites, to ensure you don’t get a recurrence of the infection later on.

As I’ve mentioned a couple of times earlier in this response, a key thing to be aware of is that even if you don’t have a recurring form of malaria, or treat it successfully, you will still be susceptible to re-infection if you are bitten by an infected mosquito. As such, if you live in or travel to a region known to have malaria transmission, it is crucial to take steps to prevent infection. For example, sleeping under a long-lasting insecticide treated bednet greatly reduces your risk of being bitten by the mosquitoes that carry malaria; similarly, wearing long-sleeved clothing and insect repellent, especially at night when malaria mosquitoes are most active, is recommended. Finally, medication is available that can be taken to prevent malaria (these are called prophylactics). As they can be expensive and are not recommended to be taken over long periods of time, these tend to be used primarily by people travelling to malarial areas rather than residents. There are several different forms of these prophylactics available commercially; the one to use will depend on several factors, including where you are travelling to.

What does malaria cause?

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QUESTION:

What does malaria cause?

ANSWER:

Malaria is a disease. It is caused by tiny single-celled parasites called Plasmodium, which are transmitted through the bite of infected Anopheles mosquitoes. There are many symptoms that occur as a result of infection with malaria, namely fever, chills, headaches and nausea, among others. Malaria can be a very serious disease, especially if not treated promptly, and so when spending time in malaria-infection areas (such as many areas of low to moderate elevation in the tropics and sub-tropics) precautions should be taken to avoid mosquito bites and thus infection. If a person finds themselves suffering from some of the above symptoms after being in a malaria transmission region, it is crucially important they get diagnosed straight away; if they do indeed have malaria, then they can be given treatment to facilitate a quick and safe recovery.

Helping Those Affected with Malaria in Africa

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QUESTION:

What are some things that might be done to make the situation better for those most affected with malaria in Africa?

ANSWER:

Currently, the emphasis on decreasing the burden of malaria on those most affected in Africa is based on a combination of prevention, education, research and treatment. In more detail:

Prevention: This is arguably one of the keys to sustainably reducing malaria burdens and even eliminating infections. Central to this goal has been the distribution of long-lasting insecticide treated bednets, which prevent people from being bitten by infected mosquitoes while they sleep at night. Unfortunately, some recent research has just been published which suggests that bednets might be contributing to insecticide resistance in mosquitoes, as well as increased rates of malaria in adults due to decreasing natural immunity. As such, it may be that more research is needed in order to determine the most effective and efficient ways of using bednets to prevent malaria infection, particularly in high-risk groups like young children and pregnant women.

Education: Through education, people living in at-risk areas for malaria transmission can learn about ways to prevent the disease, as well as what to do if they suspect they are infected. Similarly, education is important for travellers visiting malarial areas, so they know the best ways in which to avoid being infected.

Research: Understanding the distribution, factors affecting transmission and the development of new strategies for control and treatment is going to be crucial in the fight against malaria, and particularly in high-burden areas such as Africa. Similarly, scientists are busily looking for new compounds to treat malaria, as well as the ever-elusive malaria vaccine. If such a vaccine could be developed, it would be a huge step forward in the fight against malaria.

Treatment: Hand in hand with treatment comes diagnosis; if a person can have their infection easily, accurately and cheaply diagnosed, then they will be able to access effective treatment more rapidly, thus improving their chances of a swift recovery. As such, countries in Africa are working hard to provide health systems capable of local diagnosis and availability of treatment, so that people don’t have to travel far to have their infections cured.

Taken together, these four strategies are having some success even in the world’s poorest and most malaria-endemic regions, especially in decreasing the number of malaria deaths. Decreasing the overall number of infections will be yet a greater challenge, but one which the world, especially through commitment to the Millenium Development Goals, is dedicated to overcoming.

Diagnosis of malaria or another condition?

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QUESTION:

Patient is responding to malaria intravenous medicines but the blood test are not showing any strains of malaria parasites.
Is it possible it is malaria or some other disease?

ANSWER:

I’m afraid it is hard to answer this without more information regarding what steps have been taken to diagnose infection, what medication is being given, and what other clinical information is available. Intravenous medication for malaria is usually quinine or artesunate, and it is unlikely that any medical institution or practitioner would give these unless they had seen malaria on testing, as these agents are generally reserved for severe disease. Another thought is that they are using doxycycline, which is an antibiotice with a broader spectrum of use, and the patient’s improvement is due to the drug taking care of something else other than malaria (Babesia, Bartonella, Borrelia).