Malaria Outbreaks

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QUESTION

What is the largest outbreak in the world from malaria?

ANSWER

Most parts of the world don’t suffer from malaria “outbreaks” in the traditional sense of the world. Instead, malaria is “endemic,” which means that transmission is on-going all of the time. In some cases, transmission is seasonal, but each year’s level of disease incidence is similar to the next year’s. Having said this, despite no major and obvious “outbreaks” malaria has probably killed more people in history than any other disease.

Outbreaks of malaria do occur in places where malaria is not usually found, though these are usually small and isolated. For example, while Jamaica was previously malaria free, an outbreak in 2006/2007 resulted in 370 cases. By the end of 2007, it had been declared malaria-free once more, as transmission was interrupted. In 2002, a man with Plasmodium vivax caused an outbreak among 10 fellow campers at a camp site in Northern Queensland, Australia. In the US in 2008, almost a thousand cases of malaria were reported, though most of those were imported cases from travellers who had recently returned from malaria endemic areas, and therefore did not get infected within the US.

Who Discovered Malaria?

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QUESTION

Who discovered malaria?

ANSWER

People have known about malaria for thousands of years—the first record of it comes from 2700 BCE, in an ancient Chinese medical text. Other ancient peoples, such as the Egyptians, Greeks and Romans, also knew the symptoms associated with malaria. But it wasn’t until the 19th century that the causes of malaria were understood. In 1880, a French physician named Charles Louis Alphonse Laveran first saw the parasites that cause malaria in the blood of a patient. By 1886, Camillo Golgi, an Italian physiologist, had observed that there were at least two separate types of malaria, which produced different length cycles of fever during the clinical presentation. These two forms were later called Plasmodium vivax and Plasmodium malariae. It wasn’t until more than a decade later, in 1897/1898, that the method of transmission of malaria was first understood – Ronald Ross, a British army doctor, showed that malaria could be passed from a human patient to a mosquito vector, and also between infected hosts using mosquitoes. He won the Nobel Prize for medicine for his work in 1902.

Since then, research on malaria has expanded exponentially, with particular attention giving to understanding ways in which the parasite can be therapeutically halted, thus leading to the discovery of new malaria medications.

Long term health effects of malaria when young?

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QUESTION

I’m trying to find out if having malaria at a young age can have long term effects on health.

Around 25 years ago when I was 4 years old I contracted malaria when living in central Africa. Unfortunately I do not know the type of malaria, only that I received medication and recovered without complications.

Over the last few years I’ve had a general feeling of poor health and fatigue. Blood tests indicate I have some level of liver damage but I’m at a loss for the cause.

Is there any chance of having picked up liver damage (or other long term effects) from contracting malaria at a young age?

ANSWER

There is little evidence for any long term complications associated with uncomplicated malaria infection. One thing to investigate might be the type of malaria you had as a child; Plasmodium vivax and Plasmodium ovale, while not as common as Plasmodium falciparum in Central Africa, both occur in this region, and differ from P. falciparum in that they can have a dormant liver stage.

While I still have not heard of liver problems being associated with dormant malaria parasites, it is conceivable that if you had one of these two types of malaria and did not have the liver stages treated, you might later feel some ill effects; relapse from P. vivax has been known to occur decades after the initial infection. The good news is that there is a drug available, called primaquine, which can kill these liver stages (known as hypnozoites). So, if you know you had P. vivax or P. ovale, you could mention this possibility to your doctor—prior to taking primaquine you should have a test for G6DP deficiency, as such as deficiency makes it dangerous to take this medication.

If you have ever taken anti-malaria medication, please take Malaria.com’s brief Malaria Medication Side-effects Survey: Treatment and Prophylaxis.

Malaria Relapse Again and Again

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QUESTION

Hi, I have malaria, after every 2 to 3 months.  I had malaria positive when I was pregnant at 3 mnths I was hospitalized, it was P.vivax, it aggravated my pregnancy symptoms even, I had blood transfusion as Hb was 7, then aftr completion of 10 tab chloroquin course on discharge doctr advice me to take 2 tab chloroquin once a week for my whole pregnancy, I stopd taking drug at my 7 mnth as I got fed up of treatment, n hyperemesis whenevr I took chloroquin, then I had malaria in last days of my pregnancy again, it was vivax again then I had premature delivery with antepartum hemorage following c.section, after one month I had p.vivax malaria again, I am breast feeding mother, doctor again after completion of 10 tabs chloroquin advice 2 tabs chloroquin a week til I breast feed, I am fed up of taking chloroquin, its effects and malaria again and again, pls help me to ERADICATE from my blood, can I take Primaquine to help myself even I am breast feeding? And is it sure primaquine stop relapsing malaria?
I dont know why but I also had chest pain these days, I have enlarged spleen tip, Hb. 9, trophozites again in blood.
how to completely get rid of it? pls help me!

ANSWER

Thanks for your question – it sounds like you have had a very grueling time getting through these malaria episodes! I have forwarded your question to the medical experts who advise us here on malaria.com, but in the meantime I will try to at least partially answer your question.

As far as I am aware, there is not a lot of safety testing of primaquine in breast-feeding mothers. The main concern is with hemolysis, if either the mother or baby is G6PD deficient. However, I have heard of breast-feeding mothers being given primaquine in some cases, if the G6PD status of her and her baby has been determined to be normal. Primaquine, when taken for the full dosage period, is very effective at killing hypnozoites, which are the latent form of malaria that cause relapses. If you are interested in taking primaquine, you should talk to your doctor about the risks associated with taking the drug, and certainly have yourself and your infant tested for G6PD deficiency before starting treatment.

If you have taken medications for malaria, please help Malaria.com by taking our Malaria Medication Side-effects Survey: Treatment and Prophylaxis. Thank you!

Malaria Cure

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QUESTION

What is the cure for malaria?

ANSWER

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.

For more information, see the WHO recommendations for malaria 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.

Malaria and Seizures

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QUESTION

Is it possible to contract malaria early in life and have a seizure 20 years later?

ANSWER

I think it is highly unlikely. There are only two types of malaria that can reoccur long after the initial infection (Plasmodium vivax and Plasmodium ovale) and neither of these usually results in seizure or other cerebral effects. Looking through the literature, I can only find one case of P. vivax infection which had cerebral involvement (Beg et al., 2002, ‘Cerebral involvement in benign tertian malaria’, published in the American Journal of Tropical Medicine and Hygiene, volume 67, issue 3, pages 230-232).

Recurrent Malaria

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QUESTION

Malaria has been with me since the late 1980’s after 6 years in Malawi.
During the 90’s I had it twice per year in Feb and Sept. Blood tests always came up negative. Treatment was with Chloroquine, later Halafantrin and then Co Artem. 2 or 3 treatments were required as symptoms appeared 2 weeks after completion of initial treatment.

In 2004 I treated with a bodyweight specific dose of Arinate and did not have another bout until 1 week into a Southern Mozambique visit in Aug 2008. (I was on doxycycline as a prophylactic but discontinued due to it causing diarrhoea.) Treatment was with Artecospe (unsuccessful) and CoArtem (successful.) In Nov 2010 after a visit to N Botswana another bout – treated twice with CoArtem.
Sept 18 2011 it struck again. (I have not been near a malaria area since Nov 2010). CoArtem unsuccessful 3 times with Artecospe have not worked and now on Co Arinate.

Have I some resistant strain of Malaria? Does eating during a malaria bout reduce the efficacy of treatment?

ANSWER

So far, no strains of malaria have been discovered to be resistant to Coartem. Moreover, recurrent malaria is only caused by Plasmodium vivax and Plasmodium ovale—neither of these are nearly as common in Malawi as Plasmodium falciparum, which can recrudesce (parasites re-appear in the blood) if not treated appropriately but will not relapse or reoccur months or years after the initial infection—if you have tested positive for malaria in your more recent bouts of illness, you should ask your doctor whether it could be P. vivax or P. ovale.

If it is one of these two species of malaria, you should ask about the possibility of taking primaquine to kill the dormant liver stages of the parasites and prevent future recurrence. You will need to be tested for G6DP prior to being able to take primaquine.

However, since you tested negative in Malawi initially, I suspect you did not have malaria at all at that point, and should have been tested further to determine what was causing your symptoms. Moreover, chloroquine should not have been the first treatment of choice, as resistance is rife in sub-Saharan Africa.

The symptoms of malaria are notoriously non-specific and therefore diagnosis is crucial prior to treatment, as many other infections will present with similar clinical symptoms, such as fever and nausea. Therefore, if you have any further symptoms which you suspect might be malaria, please visit a doctor or travel medicine clinic straight away for a blood test. If it is not malaria, there is no point taking further doses of Coartem or other anti-malarials and further tests might reveal another diagnosis.

Injections for Malaria Treatment?

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QUESTION

I have a friend that just told me that she has Malaria. She said she has to go to the hospital every day for an injection for around the next 2 weeks. Is this a typical treatment. Why not just take pills? I`m just trying to wrap my head around this and understand the different treatments.

ANSWER

This is certainly not typical treatment for malaria. Uncomplicated malaria is usually treated with oral medication, and the type depends on the type of malaria you have. The most severe form of malaria, Plasmodium falciparum, is often resistant to chloroquine (still the first-line drug of choice for P. malariae, P. knowlesi and P. ovale infections, as well as for P. vivax in most parts of the world) and so first-line treatment is now usually an artemisinin-based combination therapy (ACT), such as Coartem.

As far as I am aware, it is only in cases of complicated, severe malaria that intravenous or intramuscular treatment is used (usually quinine), and in those cases, treatment would not be administered on an outpatient basis. It may be that your friend has a specific medical requirement for a non-oral form of medication, but it is definitely unusual!

Is Malaria Fatal?

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QUESTION

Can you die from malaria?

ANSWER

Yes. If left untreated, certain types of malaria in particular can cause severe complications, and can even lead to death. Plasmodium falciparum is the most dangerous form of malaria and is responsible for 90% of the approximately 700,000 annual deaths caused by malaria.

However, P. vivax infections can also be very serious, and more recently, cases of P. knowlesi in south-east Asia have been shown to develop into severe disease very rapidly, thus making it dangerous for people who are not close to health care services and thus delay getting treatment.

The people most at risk from severe malaria are children under the age of five and pregnant women, as well as travellers to malarial areas who are not taking adequate preventative measures (such as not taking anti-malaria medication or not sleeping under a long-lasting insecticide treated bednet).

However, malaria is still dangerous to all people, so if you think you might be infected, it is crucial to seek out diagnosis immediately, so that you can be quickly given appropriate treatment. If diagnosed early, malaria is usually very easily treated and full recovery occurs quickly.