Traditional Treatments for Malaria

by

QUESTION

What are some traditional treatments for malaria?

ANSWER

Many different cultures have had their own traditional ways of treating malaria. Perhaps the two best known come from the native tribes in the Western Amazon basin and the ancient Chinese.

Tribes in the Amazon used the bark of a shrub called Cinchona to treat fevers and shivering; Spanish priests in this region observed traditional Quechua healers using this bark and started using it themselves to treat the fevers associated with malaria. Many centuries later, the active ingredient from this bark was isolated and called quinine, which is still used in the treatment of malaria today.

In ancient China, traditional healers would use the plant sweet wormwood (Artemisia annua, to give it its full Latin name), also to treat fevers and the symptoms of malaria. For many hundreds of years, this traditional cure was forgotten about, until the 1970s when a concerted effort led by Mao Tse-Tung began to search for new anti-malarial compounds as part of their Vietnam war effort. Their scientists, led by Dr Youyou, re-discovered sweet wormwood and extracted a potent anti-malarial compound from it, called artemisinin. This compound and and its many derivatives, in the form of artemisinin-based combination therapies (ACTs), are now the mainstay of the World Health Organization’s first-line recommended treatment against uncomplicated malaria.

Drug Resistance May Make Malaria Parasite Less Resistant to Other Substances

by

Malaria parasites that develop resistance to the most effective class of anti-malarial drugs may become susceptible to other treatments as a result. The discovery could reveal potential new drug options, which would be essential in the event of resistance to the best anti-malarials.

In a new study, researchers have shown how the anti-malarials artemisinins attack the malaria parasite by inhibiting the action of a crucial protein, and that genetic mutations in this protein can reduce the effect of the drugs. While demonstrating this, however, they also discovered that a mutation that gives the parasite resistance to artemisinins makes it more sensitive to attack by another substance, cyclopiazonic acid (CPA). CPA is thought to be too toxic to be a suitable anti-malarial treatment, but the findings suggest it could be worth pursuing derivatives of the acid as treatment options.

The study was led by researchers at St George’s, University of London and has been published in The Journal of Infectious Diseases.

The artemisinin group of drugs are the most effective and widely used treatments for malaria – used most powerfully with other drugs as artemisinin-based combination therapies – but little is known about their mechanism of action on the malaria parasite. There are signs that the malaria parasite is developing resistance to artemisinin-based combination therapies, meaning further understanding of the drugs could be crucial to prevent them becoming obsolete.

The St George’s researchers have now demonstrated that artemisinins work by acting on a protein within the parasite called a calcium pump. Calcium is essential for all living organisms as it is needed for vital cellular processes. The calcium pump regulates calcium levels in cells, and if it is not functioning properly the parasite dies.

In previous studies, the team had witnessed the same effect on the calcium pump in genetically engineered malaria parasites. However, in these studies the parasites’ sensitivity to artemisinins fluctuated, so they did not give a clear indication of the drugs’ mechanism of action and the findings could not be confirmed.

To provide more consistent results, the latest study used yeast cells instead of parasite cells. Yeast can be a convenient way to display and test the function of proteins from other organisms.

After confirming that artemisinins inhibited the calcium pump in the yeast model, the researchers mutated the pump to mimic three mutations previously observed to give parasites resistance to the drugs. When they did this, they saw similar resistance.

Following this, they tested whether these mutations had any effect on the action of another five substances known to have an anti-malarial effect. They found that one particular mutation that gave the pump resistance to artemisinins made it more susceptible to CPA.

Their findings also showed that the yeast model could be used to identify other drugs that harm the parasite.

Lead author Professor Sanjeev Krishna said: “CPA is a compound used in science and not in clinical practice in any way. However, it points to a proof of concept that we can look for weaknesses in the more resistant strains of the parasite. The yeast model provides a convenient and reliable method to study anti-malarials and this particular mechanism of resistance to them.”

He added: “This new research supports our earlier work suggesting that the calcium pump is crucial for artemisinins’ action. Understanding how this lifesaving drug works on this calcium pump and how the pump can develop drug resistance will not only allow us to better understand how to use artemisinins more effectively, but it will help us contribute to the development of new drugs to counter the potentially serious effects of artemisinin resistance.”

Source: St George’s, University of London

The full journal article, “Expression in Yeast Links Field Polymorphisms in PfATP6 to in Vitro Artemisinin Resistance and Identifies New Inhibitor Classes’, is available at The Journal of Infectious Diseases.

Symptoms of Malaria but Tests Negative

by

QUESTION

My sister has been suffering from fever from past 22 days temperature varying from 102-106 with chills shivering, headache, body pain,nausea and muscle ache but tested negative for malaria. She also tested negative for dengue, swine flu, hiv, and many others.  So out of frustration we gave her mefloc 250 and she seems to be responding. She is still having fever that is after 12 hrs of medication but the temprature is ranging between 98-100 and there is no headache and no chills and shivers.  Now we are confused how to confirm that it is really malaria and when will the fever stop completely. Should we shift her to a some other hospital at present she is in Pune.

ANSWER

The diagnosis of malaria is confirmed by observing parasites on a blood smear.  There are also Rapid Diagnostic Tests (RDT) that can be done with a pin prick of blood, but the blood smear is the definitive test. It is possible, that in your sister’s case,  a proper malaria test was not done or not interpreted correctly, and she does have malaria and it is responding to the medicine.   Alternatively it could be that your sister does not have malaria, but suffers from another problem that coincidentally is resolving itself at the same time the anti-malarial medicine is given.  It is hard to determine exactly what is wrong, but the good news is that she is getting better.

Sometimes medicine is given on presumption of illness which is what happened in your sister’s case. However, if someone has uncomplicated falciparum malaria, (most prevalent in India)  WHO recommends Artemisimin Combined Therapy (ACT), which uses an artemisinin compound with another anti malarial, such as mefloquine, not mefloquine alone.  If your sister’s fever returns, make sure to have a blood smear taken to see if it is malaria or not, and if so what kind of malaria it is, to better tailor her medicine.

Falciparum Long-term Outcomes

by

QUESTION

My husband was admitted to ICU for 22% falciparum parasite load (with some mild kidney and liver failure, as well as low blood pressure) after being overseas two weeks earlier.

They treated him with IV artesunate and oral Malarone and an exchange transfusion, and discharged him after a week, as his kidneys had improved and so had his blood pressure, and he wasn’t yellow anymore. He never went unconscious.

He’s still quite short of breath and having a challenging time climbing stairs which hasn’t really improved over the past week. It’s not outright respiratory distress, as he was having this in the hospital as well and never actually needed oxygen. He’s also still feeling warm (though no documented fevers).

I am wondering about: a) Whether testing for recrudescence is useful almost two weeks after symptoms started b) how long this shortness of breath is anticipated to last (and is it secondary to a mild transfusion reaction, as his chest Xrays were always normal in the hospital) and c) will there be long-term sequelae I should be aware of (as I can’t find anything except for “falciparum infection has poor prognosis if not treated promptly’) and d) what are his risks of becoming this sick again?

ANSWER

It sounds as if your husband received good care and that you are very well informed which is excellent.  Recrudescence can occur up to 28 days after initial infection but it isn’t common if the above treatment was given.  One of the side effects of malaria is anemia, and this can cause fatigue and breathlessness.  My hunch is that he probably is anemic and should be eating iron rich foods (meats, greens) and taking an iron supplement. It is best to check with your primary care physician who can order a simple blood test to check for anemia and advise you on supplements and nutrition.  There shouldn’t be a poor prognosis in the long term for people treated and recovered from falciparum malaria. I hope this helps.

Favism (G6PD Deficiency) and Malaria

by

QUESTION

My son has Favism (G6PD deficient). He is going to stay for 2 years in Chad (malaria-endemic country). It is contraindicated for him to take antimalarial drugs. What can we do if he gets a malaria infection? One physician said that he can use Artelum (Artemether + Lumefantrine) for protection. Is it a right prescription?

ANSWER

Yes, you are correct that Primaquine (which along with chloroquine is used to treat people diagnosed with Plasmodium ovale or Plasmodium vivax infection) generally should not be given for people with G6PD deficiency. However, other malaria drugs are okay. The most common type of malaria in Chad is Plasmodium falciparum, and your doctor is correct is saying that  Artemether + Lumetantrine is the drug of choice to treat falciparum malaria and can be used by your son.   It is best however to take precautions against mosquito bites.  Please see more information: Malaria Prevention.

Medicine for Malaria

by

QUESTION

is rotam and maladar malaria medicine?

ANSWER

I have never heard of Rotam, but Maladar is the brand name of a combination sulfadoxine-pyrimethamine, and is used to treat malaria. However, it should be noted that it is not recommended by the World Health Organization as a first-line treatment option, due to concerns about drug resistance, and also lack of efficacy against certain types of malaria.

Instead, first-line recommended treatment is of an artemisinin-based combination therapy, or ACTs, which combine an artemisinin derivative (such as artesunate, artemether or dihyrdoartemisinin) with another anti-malarial drug, such as lumefantrine, piperaquine or mefloquine. Common brand names include Coartem, Lonart and Duo-Cotecxin.

Malaria Medication During Breast Feeding

by

QUESTION

I am a breast-feeding mother, and I am on the lumartem dosage. Will this affect my baby? He is 9 months old.

ANSWER

The US Center for Disease Control says that it is safe for a breastfeeding mother to take lumfartem if the baby is over 5 kilos (or 11 pounds).    Since your baby is 9 months old, he should weigh more than 5 kg so you should be fine. If you have any questions you should talk to the health care provider who gave you the medication.  Make sure you and the baby sleep under a long acting insecticide treated net to prevent further episodes of malaria.

Malaria Diagnosis

by

QUESTION

My body is getting hotter after taking artesunate and mtivitamen tablet, the pain subsides, but later in the evening my body starts getting hotter, I have taken almost four artesunate, yet the body pain and headache refuse to go, pls sir is it malaria or what.

ANSWER

Unfortunately the symptoms of malaria are quite general, and just having a fever could be a sign of malaria but also of many other diseases. You should go to a doctor or clinic to have a blood test—there, they will take some of your blood and look at it under the microscope to determine whether you have malaria parasites in your blood. If you do, they will give you appropriate treatment—it is actually not recommended to take artesunate by itself, and rather it should be taken together with a secondary anti-malarial drug, in a combination known as an artemisinin-based combination therapy (ACT).

Common forms of ACTs available in Africa include artemether-lumefantrine (sold as Alu, Lonart or Coartem) and dihydroartemisinin-piperaquine (sold as Artekin or Duo-Cotecxin). Artesunate comes in combination with amodiaquine, and is often abbreviated as ASAQ.

If you do not get properly diagnosed in a medical facility, you risk treating yourself with unnecessary drugs if in fact you actually have another infection, or you might find you are giving yourself the wrong type of treatment for your malaria infection.

Trophozoites of Plasmodium Vivax

by

QUESTION

What should I take in this condition? After treatment I came to know that Rechocin should be taken for 6 months 2  weekly.

ANSWER

I am not sure I understand your question, but if you have been diagnosed with trophozoites of Plasmodium vivax in your blood, then you can be treated with normal anti-malarials (the World Health Organization recommends artemisinin-based combination therapies for first line treatment of uncomplicated malaria, but depending where you are, you might even just be able to take chloroquine), as these kill the blood stages of malaria. To prevent relapse, caused by hypnozoites dormant in the liver, you should talk to your doctor about the possibility of also taking a course of primaquine, which usually lasts 14 days. This drug is not suitable for people with G6DP deficiency, however, so you may need a test for this condition before you can take the treatment.

Doxycycline After Malaria Diagnosis

by

QUESTION

My daughter is 24 and in rural Uganda for 4 months. She has been diagnosed with malaria (plasmodium falciparum) and is taking treatment now. Treatment is 3 tablets of Neosidar tablets contain of sulfadoxine BP and of pyrimethamine followed tonight and for the next 3 days by 4 tablets of Lumarten in the morning and at bedtime with milk. Lumarten is a mix of artemether and lumefantrine. Her doctor in Entebbe recommended she should stop taking doxycycline: “the doxy is like a lock on the door, and now someone has broken the lock, so it’s better to treat the malaria as it comes (while still using nets, bug spray, long sleeves, etc. to avoid bites) rather than keep taking the doxy every day.”

Should she stop taking doxycycline and should she be taking the Lumarten with milk? Thank you very much.

ANSWER

I am not personally familiar with Lumarten, but these antimalarials are often taken with food. Of more concern is that she has been given a sulfadoxine-pyramethamine treatment—these are no longer recommended as first line treatment against malaria, and so she should just take the artemisinin-based combination therapy (artemether-lumefantrine is such a combination therapy).

In terms of the doxycycline, I do not understand the doctor’s advice. There is no harm in continuing to take doxycycline after having malaria, and in fact it might prevent re-infection! Of course this depends on how long she is still in Uganda for—the doxy must be taken for four weeks after leaving the malarial area, so if she is returning home soon, she should weigh up the continued preventive benefit against the inconvenience of a long continuation of taking the medication. In general, I don’t like the doctor’s attitude that your daughter should just accept continuing infections with malaria, and “treat them as they come.” It’s much better to use all available methods for prevention. One thing to consider is that dairy products inhibit the uptake of doxycycline, so if your daughter was also taking her doxy with milk (some doctors mistakenly advise this, to prevent stomach upsets when taking the medication), that might have been one reason why she still got infected.