Multiple Malaria Infections Each Year

by

QUESTION

My name is Olumide and I live in Nigeria. I have had malaria too frequently and it’s giving me a lot of concern. I had one last August 2012 and am having another one this October as I am speaking with you. If I should count it, I’ll be having nothing less than 6 occurrences in a year. It’s always an headache induced malaria whereby after using the ACT combination recommended by WHO, two days after, am still having headache, am asthmatic though and can’t use more than Paracetamol. I am tired of all these and need your help.

ANSWER

One of the key things you should check is how you are being diagnosed with malaria—the symptoms of malaria are very general, such as headache, chills and fever. I have seen cases where people assume they have malaria and so take ACTs without getting properly diagnosed, and so they never actually go to the doctor to have their real illness diagnosed. Therefore, next time you feel sick, you should go to the doctor or to a clinic and make sure they do a proper malaria test. This will either be via taking your blood and looking at it on a slide under a microscope, or by using a drop of the blood in a rapid diagnostic test (RDT). I believe that in some parts of Nigeria, you can even buy the RDT in local pharmacies, and do the test yourself at home. Only if you test positive for malaria should you take ACTs; if the test is negative, you should go to a doctor and ask about other possible illnesses with similar symptoms (such as flu, pneumonia, etc).

At the same time, it could be that you are suffering from repeated malaria attacks, in which case you will need to improve your personal protection in order to prevent future attacks. Sleeping under a long-lasting insecticide treated bednet is crucial; you should also wear long-sleeved clothing at night and at the evening since this is when malarial mosquitoes in Africa are usually most active. You may also want to consider indoor residual spraying; this coats the inside walls of your house with insecticide, further reducing the number of mosquitoes that may bite you inside your home. For more information, please see our Malaria Prevention overview page: http://www.malaria.com/overview/malaria-prevention

Repeated Malaria

by

QUESTION

Since January 2011 I got three times malaria. Is it come regularly? Last week also I got maleria and I took medicine but still I have mild headache and sweating feeling tiredenes in between..

ANSWER

The timing of the repeated malaria episodes you have experienced means that it could be recrudescence (where treatment does not completely kill all the malaria parasites in your blood), relapse (where the malaria goes dormant in your liver, then comes back—this is only caused by Plasmodium vivax and Plasmodium ovale malaria) or even re-infection.

However, first of all, the most important thing is to make sure you are properly diagnosed with malaria and secondly, that you receive the right type of treatment for the kind of malaria that you have.

The symptoms of malaria are very general (fever, chills, nausea, tiredness, aches) and can also be caused by many other illnesses and diseases. As such, in order to confirm you actually have malaria, you should have a blood test (thick and thin blood smear, looked at under the microscope by a trained technician, or a rapid diagnostic test (RDT). In some places you can buy these RDTs from local pharmacies and do the test yourself at home).

Depending on where you live, there may be different types of malaria present; in this case, if you do have malaria, it is important to find out which one you have.

P. falciparum is the most common kind in sub-Saharan Africa and first-line treatment is an artemisinin-based combination therapy, such as Coartem – most areas have P. falciparum that is resistant to chloroquine, so this is not appropriate as treatment, nor are sulfadoxine and pyrimethamine combinations (such as Fansidar).

If you have P. vivax or P. ovale, chloroquine may be used, again depending on where you are and whether resistance is known from your area or not. In addition, you might also talk to your doctor about taking primaquine to prevent future relapse and recurrence of the infection.

Repeated re-infection can be prevented by protecting yourself more thoroughly against getting bitten by an infected mosquito. For example, you should sleep under a long-lasting insecticide treated bednet, screen your windows and doors and wear long-sleeved clothing at night and in the evenings. Indoor residual spraying, which coats your walls with insecticide, can also prevent mosquitoes from persisting inside your home.

Test for Malaria?

by

QUESTION

Is there a way to verify that someone has had malaria? I had symptoms that were treated with only 10 days of proper 14 days prescription and had a relapse a year later. Have felt weak and keep my drinking to a very light level as a result. Is there test that can be taken to verify having/had plasmodium vivax?

ANSWER

The best way to test for relapsing malaria (i.e. Plasmodium vivax or Plasmodium ovale) is via a blood test while you are experiencing a recurrence of symptoms. Symptoms are associated with the parasite re-entering the blood, and so at this point, they can be visualized on a blood film, or their proteins detecting using a rapid diagnostic test. Other than that, you could also investigate having a serological test done (some forms of these tests are called ELISAs, standing for enzyme-linked immunosorbent assay).

These test for antibodies to specific proteins associated with malaria, and so can be designed to test for a particular strain, such as P. vivax. As antibodies can persist in the blood for weeks or even months after the initial infection has cleared, this could be a way for you to determine whether you had P. vivax without waiting for another relapse. This paper describes the development of a P. vivax-specific serological assay, though I am not sure whether such a test is commercially available as of yet.

If you are diagnosed with Plasmodium vivax, you should ask your doctor about the possibility of taking primaquine to kill the dormant liver stages and prevent future relapse. Primaquine is not recommended for people with G6DP deficiency, so you should be tested for this before taking the medication.

Cyclical Fever and Malaria Symptoms

by

QUESTION

My dad is not well from last one month. In the evening time he feels headache, neck pain and 102 Temp.

Can you please tell me can it be Malaria.

ANSWER

Those symptoms can be characteristic of malaria—cyclical fever is a key symptom, though usually the cycles are every other day or even every third day (depending on the type of malaria). However, in some cases the cycles are more frequent or the patient may even have constant fever.

One of the difficulties with diagnosing malaria is that its symptoms are very general and can therefore be mistaken for many other illnesses. Likewise, in areas of high malaria transmission, doctors may assume a feverish illness is malaria without thinking about other possible diseases. As such, it is crucial that you take your father for a blood test, which is the only accurate way to diagnose malaria.

The doctor or clinician will either make a blood film and look at it under the microscope, or use a tiny drop of blood in a rapid diagnostic test. Either way, it is important for them to see evidence of a malaria infection before they give your father treatment. The diagnostic test should also show which type of malaria your father has (if indeed he has malaria), and this will also help to determine which is the most appropriate type of medication.

When to Seek Malaria Treatment

by

QUESTION

I have been in New Guinea recently and 2 weeks on am exhibiting all the signs and symptoms of malaria. What is best course of action, considering I do not know what sort of mosquito was hovering about?

ANSWER

You should visit your physician or a clinic immediately. Depending on where you are, you may have to visit a specialist travel medicine clinic, to be sure that you will be seen by someone who understands how best to diagnose malaria. They should take blood and examine it under a microscope (using thick and thin blood films), or they may utilise a rapid diagnostic test. Either way, they will be able to determine whether you have malaria and if so, which type of malaria you have. 

This is important because some types of malaria, such as Plasmodium vivax (which is very common in PNG) can remain dormant in the liver after the initial infection has been treated, which leads to relapses months or years later. In order to prevent relapses, if you find you are infected with P. vivax you should inquire about the possibility of also being given primaquine, which is a drug that can kill these liver stages.

Late Malaria Confirmation

by

QUESTION

I was given a field diagnosis of malaria 1 1/2years ago and was treated. Can I still get a blood test to confirm if I truly had malaria?

ANSWER

That’s a very interesting question, and the answer is: it depends. Since you were treated, you will no longer have the parasites in your blood stream, and so you cannot use a traditional blood film, looked at under a microscrope, which is the standard diagnostic method in many places.

However, there are other blood tests which look for the presence of antibodies against specific malaria proteins. These antibodies can remain in the blood for a long time after the malaria infection – probably months, but perhaps even years, though the exact length of time may vary from person to person, as well as between antibodies. If you wanted, you could inquire in your hospital whether it would be possible to get a serology test for malaria (serology tests look for antibodies) – if they tell you the brand they use then you could also contact the manufacturer to ask if they have done tests on the length of time the antibodies stay in the blood.

Malaria Detection

by

QUESTION

what’s the newest form of malaria detection?

ANSWER

While the traditional form of malaria detection has been through microscopy of a blood film slide, two new technologies have recently emerged. The first is the use of reagent strips, which are impregnated with molecules that bind to various other proteins present in the blood during a malaria infection. These reagent strips are usually manufactured as part of a rapid diagnostic test (RDT) kit, whereby a patient only has to provide a single drop of blood, and the result can be read within minutes, a bit like a pregnancy test. The other new method which has emerged is based on PCR (polymerase chain reaction) technology. This method looks for malaria DNA directly in the patient’s blood, using specific sequences of DNA that are unique to the malaria parasite. This method is expensive and takes several hours at minimum, but is very sensitive, and even very low levels of malaria can be detected.

Diagnosing Malaria

by

QUESTION

Where in Malaysia (Kuala Lumpur) can I diagnose malaria? Is it possible within 24 hours?

ANSWER

Given that malaria is endemic in Malaysia (though not usually found in Kuala Lumpar) you should be able to get a malaria test at most clinics or hospitals. The most common test is a thick and thin blood film, read under the microscope by a qualified technician—in some places, clinics are also using rapid diagnostic tests (RDTs). Both of these methods are rapid to prepare and analyse—microscopy may take a couple of hours, depending on the business of the medical staff, whereas an RDT should be ready in about half an hour. In some areas, you can also buy RDTs over the counter at a pharmacy for self-testing.

Cyclical Fever

by

QUESTION

My husband has been suffering from recurring fever every 3rd or 4th day for the past 7 months. All blood tests are normal, esr ,crp, cultures of urine and blood all normal, chest ct full body pet heart echo all normal. Tested positive for montoux and quantiferon gold, with no symptom other than fever, was put on ATT on 4th JULY 2011 fever persists with no other symptoms. Has been on ATT for more than 4 months with no respite and as per doctor TB is ruled out but 6 month course mandatory. Please help. Fever comes with mild chills and head ache at times.

ANSWER

Cyclical fever every few days is one of the characteristic signs of malaria, and the length of the cycles can help identify the type of malaria. Specifically a fever every three days is indicative of Plasmodium malariae infection, which also fits with the long, chronic persistence of the illness.

This parasite can be hard to diagnose as it is often present in low concentrations in the blood. If you haven’t had a blood film done already, ask your doctor to make a thin and thick blood film to look for the presence of Plasmodium malariae in your husband’s blood.

If the first films are negative, continue with daily films for a further 2 or 3 days. Another diagnostic option is a rapid diagnostic test, which can detect antibodies to the malaria parasites in the blood. P. malariae is easily treated with chloroquine.

Unfortunately, without further information and a more complete medical history it will be impossible to make a further diagnosis of your husband’s condition, but certainly checking for Plasmodium through a blood test would be a good first step.

Timing of Malaria Microscopy

by

QUESTION

Contrary to our past beliefs we came to know that malaria slides should be taken during afebrile periods when RBCs remain intact, enabling easier diagnosis of malarial parasites. Is this true?

ANSWER

That is a very interesting question, which I passed on to a diagnostic expert who serves as an advisor to Malaria.com. His response is as follows:

Blood films should be collected from someone who is sick with a febrile illness after they have been in an area where malaria transmission occurs.  That does not mean that the smears need to be collected during particular times during the fever cycle.  If the first set of films is negative they should be repeated every 12-24 hours for a total of 3 sets.  During that time period, in general, the parasitemia if present will be rising—increasing the likelihood of detection.

It is worth noting that blood films are of little to no value as a screening test of asymptomatic travelers.