Headache and Chills with Malaria

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QUESTION

Could a person be infected by malaria without symptoms of headache and chills?

ANSWER

Malaria symptoms vary considerably, depending on the type of malaria, the severity of the infection and the patient’s natural immunity. It is certainly possible for a patient to have malaria without experiencing headache and chills; some people infected with certain forms of malaria, such as Plasmodium malariae, may not even experience severe fever and barely realise they are infected. However, most cases of malaria, especially in sub-Saharan Africa, are caused by Plasmodium falciparum, which is a faster-acting, more severe form of malaria and usually results in fever and chills, often accompanied by headache and nausea.

Post-infection Malaria Medication

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QUESTION

My daughter has recently returned from a trip to Borneo. Even with aggressive preventive anti-mosquito behaviour (long sleeves/pants, deet applications and mosquito netting) but not anti-malarial medication, she received over 30 bites. She is now exhibiting some symptoms (body aches, headache and severe fatigue). She has an appointment at the doctors in 2 days time. Is there some kind of post-trip medication (like doxycycline) she can take as a precaution even if the malarial test comes back negative at this early of a time. Thanks.

ANSWER

The important thing to note here is that if your daughter has symptoms of malaria, then she should be diagnosed and, if positive, treated with medication aimed at curing active malaria. Doxycycline is NOT a drug used for the treatment of malaria, so there is no point taking it if she is already exhibiting symptoms.

Furthermore, some types of malaria found in Borneo (notably P. falciparum and P. knowlesi) can become more severe very quickly – 2 days may be too long to wait. If you live in an area where malaria transmission occurs, you may be able to buy a self-testing kit (also known as a rapid diagnostic test, or RDT) for malaria in a local pharmacy. Otherwise, if your daughter’s symptoms get worse, you should take her to an emergency room and explain her travel history and subsequent risk of having malaria.

There is no substitute for taking prophylactic malaria medicine; it might be that if your daughter had started taking prophylactic medicine as soon as she started receiving multiple mosquito bites, then she may have been protected to some degree. However, malaria has a latent period, and so she would have had to continue taking the medication for a period of time after returning home as well – with doxycycline, this means taking the drug for a further four weeks.

Malaria in Africa

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QUESTION

What is the current problem for malaria in Africa?

ANSWER

Malaria is a particularly severe problem in Africa due to a number of reasons. First of all, transmission in many parts of Africa occurs year round, due to favourable conditions for the development of the mosquitoes malaria requires as its vector.

Secondly, the dominant and most widespread species of malaria in Africa is Plasmodium falciparum, which is most fast-acting and deadly form of the disease.

Thirdly, Africa has a very young population; birth rates are high across much of the continent, and in many countries, more than 40% of the population is under 15 years old. Given that young children are are higher risk of malaria than adults, this also increases the burden of malaria in Africa compared to other parts of the world.

Finally, access to health care and malaria control interventions in Africa has been plagued by more general issues of slow development. While national health systems are slowly emerging, many countries are still reliant on foreign aid and NGOs to provide even basic health services.

Even where these organisations can provide health care, they often face challenges such as reaching remote populations without good road access, finding ways to provide medical services without reliable electricity or communications networks and maintaining supply chains of diagnostic tools and crucial medicine.

However, signs of progress are being seen. Long-lasting insecticide treated bednets have been put forward as a key preventative measure against malaria, and to date millions have been distributed to people living in malarial areas in Africa, and particularly to high risk groups such as young children and pregnant women.

Simultaneously, other control initiatives, such as indoor residual spraying, are gaining traction and being deployed in more areas. An emphasis on local capacity building has encouraged community involvement in drug distribution and access to health care initiatives, as well as training local health workers in diagnostic methods in rural areas.

Encouraging reports from groups such as Malaria No More and the Roll Back Malaria consortium suggest that the number of deaths from malaria in Africa last year was the lowest in history, and efforts are underway to reduce that number to zero, worldwide, by the year 2015.

Where did malaria start in Africa?

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QUESTION

Where did malaria start in Africa?

ANSWER

Malaria has been present in Africa for tens of thousands of years; given this ancient history, it is very difficult to know exactly where it first entered the continent. Also, there are several different types of malaria in Africa, which have likely had different histories, and malaria researchers continually unearth new evidence regarding the origins of these different species.

For example, it has long been thought that Plasmodium falciparum, the most deadly form of malaria, emerged somewhere in the western Congo Basin in Central Africa. Originally, it was thought to have crossed over into humans from a closely related species found in chimpanzees, but recent research, published only in 2010, has suggested that a new species, found in gorillas, is actually the closer relative.

Plasmodium vivax, the most geographically widespread species of malaria that infects humans, has less clear origins. Many of its closely related species occur in south-east Asia, which leads some researchers to suggest this is where it emerged, passing into Africa as humans and their livestock moved across Asia towards the Middle East and North Africa, or possibly via  migration through Madagascar. However, other researchers argue that the high prevalence of certain genetic mutations which protect against Plasmodium vivax malaria found in populations in Africa and of African descent, and particularly West Africa, is evidence that P. vivax actually originated on this continent.

Annual Blood Examination Rate in Bengal

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QUESTION

What is the annual blood examination rate in West Bengal?

ANSWER

The annual blood examination rate (ABER) is a measure of the level of diagnostic monitoring activity. Data from 2007 suggested the ABER in West Bengal was around 5%, which is well below the level of 10% which is recommended for active surveillance and is the target of the National Vector Borne Disease Control Programme.

However, within West Bengal there is variation in the ABER both geographically and temporally. One study showed that in Naxalbari block in Darjeeling district, ABER in 2003 and 2004 was as low as 3.5%. The region experienced a malaria outbreak in late 2005, and the average ABER for this year soared as high as 16%; however, from January to May of 2005, before the transmission season and the outbreak, the ABER was only 0.5%! This means that monitoring efforts at the start of the outbreak were probably insufficient to detect the emergence of the outbreak and therefore delayed the process of responding to the emerging disease threat. Maintaining sufficient levels of malaria surveillance monitoring is particularly important in West Bengal, since this state is one of the major endemic centres for malaria in India, contribution about 11% of all malaria cases and about 6% of all cases of Plasmodium falciparum.

Lasting Headaches and Malaria

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QUESTION

I had malaria in July of 2011, returned to the U.S. in August, and had an occurrence of P. falciparum a little more than a month later. It was quickly treated, but I continue to get headaches. They occur about daily, and exercise induces a very severe headache. Is this a common lasting symptom of malaria?

ANSWER

Once successfully treated, malaria almost never has recurring or lasting side effects, nor are lasting headaches a known side effect of treatment with ACTs (artemisinin-based combination therapies, which is the recommended first-line treatment against P. falciparum). If your headaches are made worse through exertion, you should talk to your doctor about making sure they are not a symptom of a more serious condition.

Malaria from Dominican Republic?

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QUESTION

Hi i just came back from the Dominican Republic. I started to have a mild fever, chills, muscle pains, a headache, and a cough. Today the fever and chills are gone but my cough and headache have gotten worse. It hurts my head a lot when I cough, I feel a lot of pressure in my head. Can you please tell me why my head hurts so much.  Is this a symptom of malaria? hope to hear from you guys soon thanks!

ANSWER

Headaches can be caused by many things – they are usually classified as primary (tension headaches, migraines or cluster headaches), secondary (as a side effect to some other illness or syndrome, which can very commonly be an infection or response to an allergen) and neuralgia and “other” headaches (neuralgia is inflamed nerves). Malaria, as a serious infection, can cause secondary headaches, while other symptoms include fever (usually in cycles of 2 or 3 days), chills, nausea and aches. However, these symptoms are also consistent with a wide range of other illnesses, including influenza and other common diseases. Malaria symptoms will only appear at least one week after being bitten – if you have started feeling symptoms sooner than this, then you probably don’t have malaria.

Malaria is present in the Dominican Republic, with highest transmission risk in the western part of the country, near the Haitian border. The cities of Santiago and Santo Domingo are considered very low risk for malaria. It is actually recommended that all travellers to the DR take anti-malarial medication (called prophylaxis), to protect against malaria infection. If you were taking prophylaxis, then the risk of getting malaria is very low. However, if you were visiting areas outside of these cities, were not taking anti-malaria medication and it has been at least a week since you were bitten by mosquitoes while there, it may be worth going to your doctor or a hospital to have a malaria test. If you are diagnosed with the disease, then your doctor can quickly prescribe you effective treatment, which should clear up the infection in a matter of days. The type of malaria in the Dominican Republic (Plasmodium falciparum) can be dangerous if left untreated, though in this area, it responds readily to several different drugs, including chloroquine, so treatment will be uncomplicated.

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

How many types of malaria are there?

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QUESTION

How many types of malaria are there?

ANSWER

There are four species of malaria parasite that commonly infect humans. These are: Plasmodium falciparum, P. vivax, P. ovale and P. malariae. In addition, a fifth species, P. knowlesi, is starting to draw public health attention as an infection in humans in south-east Asia, and particularly Borneo – previously, it was thought to only infect macaque monkeys.

Apart from these five species, there are many other species of Plasmodium, which infect other primates (including gorillas, chimpanzees and orangutans), rodents, birds and reptiles. A closely related group of parasites, called Hepatocystis, infects monkeys, squirrels, hippopotamus and bats.

Child Has Recurring Malaria

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QUESTION

My two year old daughter was affected by malaria 9 months back we took proper course and also the follow up course of 6 weeks. After 2 months post 6 weeks she was infected again by malaria and now again she is getting fever and fear this could be malaria again.

ANSWER

If you suspect she might have malaria again it is important you go and get her tested immediately, as then the doctor can prescribe appropriate treatment. This is particularly important for young children, as they are most susceptible to severe malaria. You should also try to find out what type of malaria she had/has. Repeated attacks of malaria can occur three ways. The first is re-infection – the first infection was cured by the medication, but then your daughter was exposed to malaria again, through the bite of an infected mosquito. Preventative measures, such as making sure she sleeps under a long-lasting insecticide treated bednet, can help reduce the risk of re-infection. Secondly, it could be what is called “recrudescence” – this is when the treatment brings the number of parasites in the blood below detectable levels, and low enough so that symptoms subside.

However, once the treatment course stops, the parasite is able to replicate in the blood again, and symptoms return. This is rare if the full, proper course of medication is taken – in most circumstances, Coartem (artemether plus lumefantrine) should be the first line of treatment and it is very effective against preventing recrudescence. Finally, there is relapse. This only occurs with two species of malaria: Plasmodium vivax and Plasmodium ovale. In this case, the parasite is cleared from the blood by the treatment, but some parasites escape by laying dormant in the liver. These can then reactivate weeks, months or even years after the initial infection. Normal malaria medication can be given to treat relapses of infection, but an additional drug, called primaquine, should also be given, to kill the remaining dormant liver stages. Your doctor should be able to tell you whether he would recommend this drug for your child – they should also be tested for G6DP deficiency prior to taking the drug.

Why is Malaria Dangerous?

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QUESTION

How does Malaria become so dangerous?

ANSWER

Malaria in humans can be caused by a number of different parasites – the most dangerous, and the one which is responsible for over 90% of the worldwide deaths from malaria, is Plasmodium falciparum.

The reason that P. falciparum is so dangerous is because it affects the behaviour of red blood cells. Red blood cells that are infected with P. falciparum become “sticky”, and as they pass through the the small blood vessels inside the body’s organs, they become stuck – this process is known as “sequestration”. As the number of red blood cells stuck inside the small blood vessels increases, blood flow to the organ is reduced, which can result in further complications. When sequestration occurs inside the blood vessels in the brain, the result is what is clinically recognised as cerebral malaria – complications can include impaired consciousness, coma and even death.

If diagnosed and treated promptly, most cases of P. falciparum can be resolved quickly and without complications, using oral medication. However, the parasite can reproduce very quickly, meaning that cases can become more serious within days and even hours. As such, if P. falciparum infection is suspected, and particularly in high-risk individuals such as young children, pregnant women and immunocompromised individuals, diagnosis should be sought immediately so that appropriate treatment can be delivered.