Incubation Period for Malaria

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QUESTION:

What is the incubation period of malaria?

ANSWER:

That depends on the species of malaria. Plasmodium falciparum has the shortest incubation time, typically 10 to 14 days. For P. vivax, incubation is usually between 10 to 17 days, but can be much longer (up to a year; the longest incubation time recorded for this species was 30 years!). P. ovale has an incubation period similar to that of P. vivax, and can also be dormant for many months or even years. P. malariae is thought to have an incubatiom time of between 16-59 days.

G6PD and Malaria

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QUESTION:

Does one need to have a normal result in G6PD screening before he can take Malarial pills?

ANSWER:

In some cases, yes. When a patient has been diagnosed with Plasmodium ovale or Plasmodium vivax infection, in addition to medication such as chloroquine to target the blood stages of the parasite, an additional drug, called primaquine, may also be required. Primaquine kills the liver stages, known as hypnozoites, of these forms of malaria, preventing relapse of infection later on.

However, primaquine is known to cause severe haemolytic anaemia in people who are G6PD deficient. G6PD deficiency is restricted to certain populations or segments of populations; therefore it may be that not every person requiring primaquine will be tested for their G6PD status, only those considered high risk for potential deficiency. Patients with severe G6PD deficiency should not take primaquine; unfortunately at this stage there are no alternative drug regimens available. Patients with mild forms of G6PD deficiency should take primaquine at an alternative dose to G6PD-normal patients, usually 0.75mg/kg bodyweight once a week for 8 weeks (as opposed to 0.25mg/kg bodyweight once a day for 5 or 14 days, depending on the case history of the patient and the physician’s recommendation).

There is also some evidence that quinine can cause haemolysis in patients with G6PD deficiency; such patients may also have increased blood concentrations of mefloquine when taken concurrently with primaquine. As such, combinations of quinine or mefloquine with primaquine in G6PD-deficient patients is not recommended.

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.

Malaria After Blood Transfusion

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QUESTION:

How many days does it take to become symptomatic after a blood transfusion of malaria infected blood to patient?

ANSWER:

This depends on the strain and burden of malaria parasites in the blood being transfused. Onset of malaria symptoms can be very rapid if infected red blood cells begin to rupture immediately, say within 24-48 hours, or conversely symptoms can be very delayed (days/weeks/months) if only a few parasites are transfused. Depending on strain, the malaria parasites may need to cycle through the liver to mature before they infect the red cells (such as in the case of Plasmodium vivax or P. ovale).  Then, depending on the strain (P. vivax most commonly), the infected red cell “burden” often needs to approach 0.5 to 1% before synchronized rupture of red cells and release of the parasites is sufficient to produce acute fever and symptoms.


What is malaria?

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QUESTION:

What is malaria?

ANSWER:

Malaria is a disease caused by a parasitic single-celled animal known as Plasmodium. There are different species of Plasmodium, which cause different kinds of malaria. The main types which infect humans are P. falciparum, P. vivax, P. ovale and P. malariae. The parasite is transmitted by certain species of mosquito; the parasite lives in the human blood stream and so goes in to the mosquito when the insect feeds. When the same individual mosquito then feeds on another person, it transmits parasites into a new host.

The symptoms of malaria are caused by the actions that the parasite undertakes while in the human host. For example, part of its reproductive cycle involves invading and then multiplying inside red blood cells. Once several cycles of reproduction have occurred, the new parasites burst out of the red blood cell, destroying it. The cycles are times so that all the new parasites burst out of the red blood cells at the same time; this coordinated destruction of the red blood cells, either every 24, 48 or 72 hours, depending on the malaria species, causes the one day, two day or three day cycles of fevers and chills that characterize malaria infection episodes.

What pathogenic organisms cause malaria?

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QUESTION:

What pathogenic organism causes the disease?

ANSWER:

Malaria is caused by single-celled organisms, called protozoans, of the genus Plasmodium. Different forms of malaria are caused by different species of Plasmodium. The most severe and deadly form is caused by P. falciparum, which is responsible for 90% of the global deaths from malaria, the majority of these in Africa, and mostly in young children. Other species of Plasmodium which commonly infect humans include P. vivax, P. ovale and P. malariae. Recently, a fifth form, P. knowlesi, has been found infecting rural communities in south-east Asia.

The disease is caused when the parasite enters the patient’s red blood cells, reproduces rapidly and then bursts out of the cell, destroying it in the process. The resultant immune response, combined with the chemicals and debris produced by theparasites, induces the fever, nausea, aches and other symptoms of a malaria infection.

How quickly should patient take medicine for malaria?

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QUESTION:

My sister has been suffering from malaria for three months. She consulted with doctor in the first symptom of malaria but doctor gave only fever medicine at that time. Blood test was not done at that time. So my question is: “within how many days or months malaria patient has to immediately take medicine?”

ANSWER:

One of our collaborating medical doctors has assisting in providing this answer:

It depends on the type of malaria….with Plasmodium vivax infection she could have a low burden due to concurrent treatment or recent prophylaxis which is breaking through because of low grade resistance. Alternatively, it could be P. malariae or P. ovale, both of which sometimes cause only mild disease that may or may not progress.  P. falciparum shouldn’t act this way; it is usually a much more severe, aggressive infection. Another option is that she might not have malaria at all.  She needs qualitative and quantitative smears to confirm the diagnosis, together with a comprehensive travel/exposure history to support any clinical suspicions.

 

 

Plasmodium Vivax Shows Malaria Infection?

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QUESTION:

If there is Plasmodium Vivax present, then is the patient infected with malaria or not?

ANSWER:

Yes! Plasmodium vivax is one of the several different species of malaria that can infect humans and cause disease. The other main species found in humans are Plasmodium falciparum, P. ovale and P. malariae.

Malaria Fever

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QUESTION:

How many days will the fever last?

ANSWER:

There is no set amount of time for the duration of a malaria fever, and in fact it will depends on several factors, namely the type of malaria the patient has, their level of acquired immunity, whether they were taking preventative medicine for malaria (prophylaxis) at the time of infection and how quickly they receive appropriate treatment.

There are, however, known “cycles” to the progression of fever during a malaria infection. Plasmodium falciparum, P. vivax and P. ovale, three of the types of malaria that normally infect humans, are known as “tertian” malarias, as they produce fevers that peak every two days. P. falciparum, due to its severity and rapid increase in the human host, can sometimes present with more frequent, or even constant, fever. P. malariae, on the other hand, is considered a “quartan” malaria, as it produces fever in approximately three-day cycles.

Illness from Uganda trip

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QUESTION:

I just came back from a visit to Uganda Africa. I was unable to take Malarone as I had bad side effects. Vomiting. I was only exposed once when we walked into a swampy rain forest. This of-course was the only day I did not have repellent. We were taking the kids on a nature walk and the German volunteer got a little lost. I ran as fast as could out of the area. Started to feel tired and weak 7 days later, getting severe headaches and going from hot to cold. 5 kids ended up with Malaria shortly after our walk. (I found this out after my return).

A missionary on the plain said I must likely had malaria and gave me Lumartem. By the time I got home I was having sever diarrhea and real bad body aches, low grade fever. The doctor here took my blood but reported my results would take 7 days. I started taking the Lumartem, & I felt better, the runs slowed down the boy aches lessened. Now I am finished with my 3 day prescription Feel pretty good compared to how I felt b4. Still have stomach cramps and small runs. What now? Should I go have a blood test to see if its gone or just wait and see???

ANSWER:

Considering you were in Uganda, it is not unlikely that you didn’t also pick up some sort of intestinal bug or parasite, which might be responsible for the residual runs and cramps. However, it is certainly important to take a blood test to ensure that you have completely cured the malaria infection; P. falciparum is common in Uganda, and causes a very severe form of malaria. While it can’t come back directly once it has been cured, if treatment is not entirely successful small numbers can remain in your blood stream and then start reproducing again once you have stopped taking medication, resulting in what is called “recrudescence” of the infection.

If possible, try to find out from the doctor that performs the blood test what type of malaria you had/have, as this will also determine whether you need additional medication (called primaquine) to prevent recurrence or relapse of the infection at a later date. Recurrence is due to a dormant phase of the malaria parasite hiding out in your liver; while P. falciparum cannot produce these dormant phases (and therefore can only relapse if the initial blood infection is not completely cured), two other malaria parasites, called P. vivax and P. ovale, can have liver stages, and so you may need to take primaquine if you are found to have been infected with either of these types.