Malaria or Kidney Infection?

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QUESTION

Two months ago my daughter was in Uganda working and when came back to the States she was hospitalized for 4 days with Malaria symptoms. Her tests came back negative they really didn’t act like they knew how to treat this. They kept telling her they didn’t know how to diagnosis Malaria. So they treated her for it. She now after 2 months is once again hospitalized with the same symptoms. They are telling her they think it is a kidney infection. Can malaria be misdiagnosed as a kidney infection. She once again has all the symptoms as malaria?

ANSWER

What tests did the doctors do to try to diagnose malaria in your daughter when she first got back to the States? Usually, malaria is diagnosed by a blood test, whereby a trained technician will look at the patient’s blood under a microscope. The technician looks for signs of the malaria parasite in the patient’s blood, and if seen, can determine the intensity of the infection as well as the species of malaria. This is important information for accurate treatment. Alternatively, rapid diagnostic tests, which utilize a droplet of blood in a device which looks similar to a pregnancy test, and can very quickly determine whether someone is infected with malaria. It is important to know that malaria cannot be diagnosed by looking at standard blood parameters. If you don’t think your doctors know what is afflicting your daughter, you should take her to a clinic which specializes in tropical or travel medicine. There, they will certainly know how to effectively diagnose your daughter.

Given that your daughter experienced a resurgence of symptoms two months after returning, if she did have malaria, then there are two kinds which she might have: Plasmodium ovale and Plasmodium vivax. The other types of malaria, including the most deadly kind, P. falciparum, are not able to come back and relapse once they are treated. However, in order to prevent future relapses, your daughter may also have to be treated with another form of medication called primaquine. I will emphasize again, however, that it is crucial to gain an accurate diagnosis before taking any form of treatment for malaria.

Malaria: Should I See a Doctor?

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QUESTION

For the last couple of days I am suffering from all the symptoms that are mentioned on your website and I am taking tylenol for these symptoms thinking that it is flu but I am feeling better now. Should I still see a doctor or keep taking Tylenol?

ANSWER

Symptoms of malaria often include high fever, aches, chills, nausea, and headache.  When severe, malaria can lead to anemia, impaired consciousness and even coma or death.  The best course of action is to get a simple blood test to check if you have malaria, because if you do have it,  early treatment with the appropriate drug (for the type of malaria you have), is essential.

You should also know how to prevent getting malaria. The first thing to do is to make sure you are protecting yourself sufficiently from mosquito bites. You can’t get malaria if you aren’t bitten by mosquitoes, and the type of mosquitoes that transmit malaria usually bite at night. As such, it is crucial to sleep every night under a long-lasting insecticide treated bednet. If you have one, it might need to be re-dipped in insecticide to make sure it keeps working effectively. Also, you should make sure all your windows and doors are properly screened to prevent mosquitoes from coming in; many people also do something called “indoor residual spraying” where they spray insecticide on the walls inside their house to kill any mosquitoes which might come in. If you live in an urban area, this might not be necessary if you can get good screens, or indeed if you have air conditioning (mosquitoes do not like cooler environments). Finally, you should try to wear long-sleeved clothing in the evenings and at night, again to stop mosquitoes from biting.

Malaria Diagnosis

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QUESTION

How to identify malaria? My son has fever and headache for the past three days and also vomiting. Is treatment is necessary and what type of treatment he needs?

ANSWER

You need to take your son to the doctor or to a clinic where they can do a blood test to look for malaria. They will either look at his blood under a microscope or use his blood in a “rapid diagnostic test” (RDT), both of which can identify the presence of the malaria parasites in his blood. If he is positively diagnosed with malaria, then your son should receive treatment, probably a type of artemisinin-based combination therapy (ACT) – common brands include Coartem, Lonart and Alu (though there are many others). These are what the World Health Organisation recommends as first line treatment against non-severe malaria.

Given your son’s symptoms, you should certainly go for a malaria test, just in case. However, vomiting is not usually a symptoms associated with malaria, so it is also possible he has another infection, such as an intestinal parasite, or even a bacterial or viral infection. Unfortunately, the symptoms of malaria are very general, so you really need to have one of the blood tests I mention above in order to be sure that your son has malaria.

Paracetamol to Control Fever

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QUESTION

If I take paracetamol to help control my temperature will it affect my blood test results— can they fail to detect the plasmodium?

ANSWER

No—taking paracetamol (also called acetaminophen, and sold variously as Tylenol, Panadol and other brand names) is a good way to control your temperature during malaria infection, and it won’t affect your blood test results. If you haven’t done this already, if you think you have malaria you should go to a doctor or clinic to get a blood test for diagnosis. Once you have been positively diagnosed, you can be given appropriate treatment, probably one of a number of available artemisinin-based combination therapies (such as Coartem, Alu, Lonart, etc).

Rash and Malaria

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QUESTION

Is random rash-like swelling on parts of your body coupled with back pains and joint aches and cold sweats all malaria symptom? If so, what is the parasite type and the cure?

ANSWER

Rashes are not usually associated with malaria infection; the symptoms you describe are however consistent with several other infections, some of which can be quite serious, such as dengue fever. You should go to your doctor or a hospital to have a blood test which can assist in diagnosing you.

For future reference, if you did have malaria, you would still probably need to have a blood test to determine which species of malaria you had, and therefore what kind of treatment would be appropriate.

Untreated Malaria

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QUESTION

If I am infected with malaria and I get a wrong diagnosis and be treated for flu, can the other symptoms disappear but continue to experience severe headache especially on the right side temple and jawbone area combined with general weakness and numbness in the legs?

ANSWER

Certainly the symptoms of malaria can often be confused with other infections, including flu. Given that treatment for flu will often include anti-fever medications such as aspirin or paracetamol, these drugs may also ameliorate some of the symptoms associated with malaria, without actually curing them.

However, numbness in the legs is not usually characteristic of malaria infection, though headache and weakness could be—again, these are general symptoms of many other infections as well.

If you suspect you have been misdiagnosed and have malaria, you should ask your doctor for a blood test; these can also be carried out at any local hospital or clinic. There, by looking at your blood under a microscope or using it in a rapid diagnostic test, they will be able to determine accurately whether you have malaria.

Malarial Attack Recurring

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QUESTION

My Father aged 65 years was diagnosed with malaria 15 days back and was on medication. Fever was recurring frequently and he had developed a lung infection. Three days back fever stopped and did not occur for 2 days and malarial infection was reducing. Now the Fever has started coming but other parameters are normal. Can you please suggest what needs to be done?

ANSWER

If your father also developed a lung infection, was he treated with antibiotics? If not, his later fever could be caused by that infection, and could be unrelated to the malaria.

He should have another blood test, to look for the malaria parasites; if they are still present, then you should talk to his doctor about trying another type of anti-malarial medication—the World Health Organization recommends artemisinin-based combination therapies (ACTs), such as Coartem, Alu and Duo-Cotecxin, as the first-line treatment against uncomplicated malaria.

However, given that your father appears to have concurrent other medical conditions, it may be that other treatment is more appropriate, and as such it is very important that you check with your doctor before taking additional medication.

Severe Head Pain with Malaria

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QUESTION

Can severe head pain be a symptom of mistreated malaria? My son just returned from an 8 month trip to Ghana. He had malaria 3 times and typhoid 1 time. He is now dealing with a severe head pain in his frontal lobe.

He took doxycycline every day and when he got really sick, he took Coartem. He was finally sent home because they couldn’t figure out why he has such severe head pains. Where do we go from here? He has an MRI scheduled and an appointment with an Infectious Disease Doctor. I am afraid they will not know what to do to help him. I am seeking more advice. Hopeful…CT

ANSWER

Severe head pain is not associated with mistreated malaria, nor indeed is considered a possible lasting effect of malaria infection. You are doing the right thing by going to see a doctor, including one who is an infectious disease specialist—I hope they also have experience with tropical medicine, since in the US and Europe, many very well-trained doctors are still not very familiar with the types of infections which are more commonly observed in the tropics.

Your son was right to take Coartem when he had malaria, but do you know whether he went to a clinic for diagnosis first? The symptoms of malaria are very general, such as fever, chills, nausea and aches, and many people in malarial areas (particularly visitors) often assume they have malaria when in fact their symptoms could be caused by a number of other things.

Secondly, doxycycline is considered a very effective preventive medication against malaria, but only if taken properly. Since doxycycline can cause mild stomach upset, many people take it with milk, which can lessen these symptoms; however, the calcium in the milk can bind to the drug, preventing successful absorption and reducing its efficacy as a malaria preventive.

If your son had a diet high in diary products or took antacids while in Ghana, this could explain why he suffered several malarial episodes. Alternatively, if he took the drug regularly and correctly, and particularly if he did not seek diagnosis via blood test from a clinic, that may be an indication that he wasn’t suffering from malaria at all, and other causes should be explored.

Finally, one of the very well-described side effects of doxycycline is its tendency to cause people to become very sun sensitive. While this usually manifests itself in skin sensitivity, it could also be that your son has become more visually sensitive to light, which in itself could lead to severe headaches. I hope he feels better soon!

Swelling of Lymph Nodes and Malaria

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QUESTION

I would like to know if swelling of lymph nodes in neck is any way connect to malaria?

ANSWER

Swollen lymph nodes are often a sign that the body is trying to fight off an infection, and so swollen lymph nodes are certainly sometimes observed in malaria patients. However, most malaria infections would also be associated with other symptoms, such as fever, chills, nausea and aches.

In some cases (but not all), malaria patients experience cyclical fever, whereby they have a high fever one day and no fever the next, but the fever returns on the third day, and the cycle continues. One type of malaria exhibits a cycle of fever one day, then no fever for two days, then fever returns on the fourth day. However, many patients do not experience these cycles, which means their symptoms are very similar to those for many other illnesses, which is why if you are in or have been visiting an area where malaria is transmitted and you have some of the above symptoms, it is very important to visit a doctor or clinic to get diagnosed for malaria. This can be done with a simple blood test, and the results are usually available very quickly. Then, if you are diagnosed as positive for malaria, the doctor can recommend appropriate treatment and instruct you in the proper way of taking it.