Slight Malaria

by

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.

Recovery Time

by

QUESTION

My friend was diagnosed with P. Falciparum today. She was suffering from high fever, shivering and all the symptoms related to Malaria. She is now hospitalized after 1 week of these symptoms and her medication has started. I know this malaria is dangerous. Can you please tell me how much time it would take to be in the normal state and time to recover? Do reply, I’m waiting for your comments.

ANSWER

It is good to hear that your friend sought out diagnosis and is now being treated. Most people recover within a few days of starting treatment, so she should be feeling better very soon, although it is likely she may feel weak for up to a week or two after completing the treatment.

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.

Antimalarial Drug Therapeutic Life

by

QUESTION

Why do some antimalarial drugs have long therapeutic life while others have short therapeutic lives?

ANSWER

Different anti-malarial drugs target slightly different aspects of the malaria Plasmodium parasite, and so are made with different chemical structures.

The differences in therapeutic life across different malaria drugs has to do with the specific pharmacokinetic properties of the chemical compounds from which the drugs are made. Even drugs designed around the same principal chemical compound can persist for different amounts of time in the human body, depending on the other chemicals with which the active compound is bound. The length of time it takes for a chemical compound to halve in concentration, or for its pharmacological effect to reduce by half, in the human blood stream is known as its “half life.”

For example, the common anti-malarial drug chloroquine has a half life of about 10 days, and is based on a chemical compound called 4-aminoquinoline. However, another drug also based on 4-aminoquinoline, called amodioquine, has a half life of only 10 hours.

Proguanil (combined with atovaquone in the drug Malarone) is dihydrofolate reductase inhibitor with a half life of about 16 hours, while mefloquine (sold as Lariam), is made from quinoline methanol and has a half life ranging from 10-40 days. These differences in length of therapeutic action also affect the efficacy of the compounds against malaria at various stages in its progression, and can also be implicated in the propensity to resistance developing to the drug in the malaria parasite.

My Malaria Refuses to Go Away

by

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?

by

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.

Can malaria affect one’s mental fitness?

by

QUESTION

Can malaria affect ones mental fitness?

ANSWER

Given that malaria is often associated with severe fever and flu-like illness, I would say that is usually enough to prevent someone from feeling completely mentally fit! However, in addition to these general symptoms, there are other specific ways in which malaria can affect a patient’s mind.

With a particular type of malaria, called Plasmodium falciparum (the most common form in Africa and the most deadly worldwide), the disease can sometimes progress to what is called cerebral malaria, where the malaria parasite stick to red blood cells that clog up the tiny red blood cells in the brain. This condition is very serious, and can lead to impaired mental function, loss of consciousness, coma and even death.  Luckily, these effects are usually reversible and there are rarely permanent mental consequences of infection with malaria if treated promptly and effectively.

Cyclical Fever

by

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.

Malaria Symptoms, Cures, and Prevention

by

QUESTION

What is malaria cure, prevention, symptom and course?

ANSWER

I am not sure what you mean by “course” – however, links to information on malaria treatment, prevention and symptoms can be found on the main page of our website. For your convenience, I have provided them here:

As for malaria treatment, I have copied here an earlier answer in response to a question about malaria cures:

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.

 

Artemether, Lumefantrine Given with Ceftriaxone

by

QUESTION

Can ceftriaxone be given with artemether/lumefantrine for treatment of malaria?

ANSWER

As far as I know, there are no known interactions between cefriaxone and artemether/lumefantrine, and no specific contraindications. However, you should consult with a physician before taking both in combination.

Also, since ceftriaxone is usually used to treat bacterial infections, it may be that it is a better to treat the malarial infection and the concurrent bacterial infection one at a time, as heavy antibiotics in addition to the anti-malarials may stress the immune system and liver of the patient unnecessarily, particularly if the patient is already weakened.