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.

 

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.

Cases of Malaria

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QUESTION:

What are reasons for the increasing number of cases of malaria?

ANSWER:

As I recently wrote in answer to another Q&A post, it is difficult to determine whether cases of malaria are indeed increasing or not. For one, a large number of cases are not reported every year, making accurate estimates difficult. Secondly, the world’s population is growing, and it is growing at the greatest rate in Africa, where the majority of malaria cases occur. As such, even if the proportion of people with malaria decreases over time, due to health initiatives such as distributing long-lasting insecticide treated bednets or free treatment, the total number of cases may still rise. Another problem we face in the fight against malaria is climate change: as the world’s patterns of rainfall and temperatures change, new areas become susceptible to malaria transmission, putting more people at risk. However, what is very encouraging is that deaths from malaria seem to be decreasing on a global scale. Malaria No More is an organisation dedicated to eliminating deaths from malaria by the year 2015; more information about their methods and some of their success stories can be found on their website.

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.

Clinical malaria, taking chloroquine

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QUESTION:

Patient having malaria. Taking chloroquine. Then temp becomes normal but headache occurred. What to do?

ANSWER:

One of our collaborating medical doctors kindly assisted in answering this question. She suggests more clinical information is required; what type of malaria is the chloroquine being used for, for example? Also, the headache should not be from the drug, suggesting there is another cause which should be investigated.

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).

What is “Pf” and “Pv” in relation to malaria?

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QUESTION:

What is pf and pv?

ANSWER:

“Pf” stands for Plasmodium falciparum and “Pv” stands for Plasmodium vivax. These are two different species of the parasite that causes malaria in humans. Pf causes the most acute, severe form of the disease, which can have a cerebral manifestation (“cerebral malaria”) and causes the most deaths worldwide. Pv is still a serious disease, but usually less severe. If diagnosed early, both forms are easily treated and completely curable.

high fever after malaria is cured?

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QUESTION:

My dad was infected with malaria,and his blood platelets were depleted to 35000. He was immediately admitted to hospital. Now after 5 days of being admitted, he is getting high fever around 102 degrees every morning and evening. His blood platelets have increased to 3lac and all other reports are normal. According to the doctor, the malaria is cured, but they are not able to detect the reason for periodical high fever…is such fever common after malaria? What might be the reason? Please help.

ANSWER:

One of our collaborating medical doctors has kindly assisted in providing this answer. Fever can be from co-infection with a second strain/type of malaria, or from the drug being used to treat the malaria.  If his platelets were that low, then the likely type of malaria causing the infection would be Plasmodium falciparum, or a particularly heavy P. vivax burden, or infection with both. If he was/is in the hospital, other causes for fever could also be the IV line/another drug being given, complications such as pneumonia from being at bedrest or so ill, cholecystitis from not eating due to illness, DVT or blood clots in legs from immobility….there are many possibilities. More information would be needed to distinguish between these options.

Malaria Re-occurrence

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QUESTION:

I’ve been infected with malaria vivax, for this i’ve taken the treatment for three days, after three days i don’t have any symptoms but after two days again I’m feeling the fever and abdominal pain which i’m having since the diagnosis is still persisting. Why is it happening? Are there any chances even after treatment for re-occurrence? My urine is yellow color but there is no jaundice?

ANSWER:

“Vivax” malaria, caused by the parasite Plasmodium vivax, is known for cyclical fevers every couple of days. As such, it may be that while the medication is working, you are still experiencing some mild symptoms as the infection is not completely cleared. For this reason, it is very important to take the full course of medication prescribed to you by your doctor; DO NOT stop taking it as soon as you feel better, as you might not have killed all of the malaria parasites in your blood, putting yourself at risk for the infection to persist. Alternatively, it might be that the strain of P. vivax you have is not responding to the medication you have been given; in parts of Papua New Guinea and Indonesia, for example, the local strains of P. vivax have been shown to have high levels of chloroquine resistance, which is usually used for treating P. vivax. If you are located in an area of known P. vivax resistance to chloroquine, your doctor should be able to recommend a different regimen of treatment to ensure that the infection is cured thoroughly. You should take a blood test after completing treatment to be sure that the parasite is no longer in your blood stream. In addition, P. vivax can produce dormant liver stages called hypnozoites that can remain within the liver hepatocyte cells and cause relapse or recurrence of the disease many weeks or months after the initial infection. To destroy these liver stages, and thus prevent relapse, you should ask your doctor about taking another drug once you have completed your initial treatment. This second drug is called primaquine, and will kill the P. vivax hepatocytes.