Diagnosing Malaria

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QUESTION

My sister had fever before 2 weeks, she take tablets, and then she is fine. Then after three days she had a urine infection, take blood test and also urine test, the test result shows malaria is negative. Now she has fever. Take blood test, malaria is negative. Can she be affected by malaria or just urine infection?

ANSWER

Since your sister had two blood tests for malaria and they were both negative, it seems likely that her fever is from the urine infection. However, if she continues to have fever (after treatment for the urine infection), she needs to return to the clinic for further investigation to find the source of the problem.

Effects of Malaria

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QUESTION

what are effects of malaria?

ANSWER

If a person becomes infected with malaria, they may start to experience the symptoms of the disease. These include high fever, aches, chills, nausea, headache, and sometimes more severe manifestations, such as severe anemia, impaired consciousness and even coma or death. These latter severe effects are more commonly associated with Plasmodium falciparum infection, the most deadly form of malaria.

Malaria or Flu?

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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

If you are no longer experiencing high fever, then it is likely just flu. However if you live in a malarial area and your symptoms persist, it would be worth seeing a doctor to get a malaria test, just to make sure you don’t require treatment.

Malaria Symptoms

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QUESTION

What are the symptoms of Malaria?

ANSWER

Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.

For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 7 days or as late as 1 year later. Two kinds of malaria, P. vivax and P. ovale, can occur again (relapsing malaria). In P. vivax and P. ovale infections, some parasites can remain dormant in the liver for several months up to about 4 years after a person is bitten by an infected mosquito. When these parasites come out of hibernation and begin invading red blood cells (“relapse”), the person will become sick.

Infection with malaria parasites may result in a wide variety of symptoms, ranging from absent or very mild symptoms to severe disease and even death. Malaria disease can be categorized as uncomplicated or severe/complicated. In general, malaria is a curable disease if diagnosed and treated promptly and correctly.

Malaria and Nausea

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QUESTION

Can malaria cause vomiting when a smell of petrol is inhaled?

ANSWER

One of the symptoms of malaria is nausea, and vomiting can also occur, but it would not necessarily be linked to certain smells. The most characteristic symptom malaria is a high fever, often also accompanied by periods of chills. See more malaria symptoms here.

Malaria Fever and Recovery

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QUESTION

My 21 year old daughter spent 4 months on a study abroad program in Dakar. A week before returning home she started having night fevers and would complain of retrosternal pain and rib and neck and shoulder pain. The next day she would be fine.

The episodes came every other day and eventually it occurred to her that it might be malaria. It was evening so she went to a pharmacy for a rapid diagnostic test which they didn’t have but they felt she had malaria based on her symptoms and gave her a 3 day course of artesunate-mefloquine.

She returned to the United States and a day after taking her last dose, she was seen by a physician and tests were done which showed that she had contracted Plasmodium falciparum malaria. Other than the smears, all her lab tests and CXR were normal and there were no abnormal findings on physical exam, in fact she was the picture of health.

We were told that she was cured and that no follow up was necessary and that she could continue with her planned trip to Thailand the next day. About 6 hours before boarding the plane to Bangkok she developed fever of 100.9 but had absolutely no other symptoms or pain. About an hour later she had a bout of diarrhea. She had one more low grade fever on the flight (99.8). I spoke to another physician who seems more familiar with malaria and was told that she is not actually cured and may continue to have episodic fevers and symptoms for a while or it’s possible she was just suffering from an ordinary garden variety gastrointestinal bug.

I have many questions. I understand that her malaria is the most virulent type. How is it that all her lab work and physical exam is normal 1 day after completing treatment? Can we expect it to remain normal? What causes the episodic fevers if she is supposedly cured? She is on doxycycline again prophylactically (which she was on in Senegal) while in Thailand. Should she be on something else since she did contract malaria on doxycycline? (She took it religiously). Thanks for any advice. She will be seeing a physician in Bangkok ASAP, but since I won’t be there to ask questions, I am hoping you can give me some answers. Your site is the best information I have found on malaria.

ANSWER

Many thanks for the comprehensive information you have provided regarding your daughter’s condition. Even though your daughter did have the most virulent form of malaria, she was very smart to seek treatment relatively promptly, and lucky to receive appropriate medication (artemisinin-based combination therapies, such as artesunate-mefloquine, are recommended by the World Health Organization as first-line treatment against malaria). It is likely due to this prompt and effective action that her lab tests and blood parameters were all normal so soon after treatment; had she waited longer for treatment, the consequences could have been much more severe. No resistance to this medication has been detected in Africa as of yet, so she should be fully cured and thus her health should remain stable; a blood smear, where her blood is examined under a microscope, can determine this; this is a very standard procedure so could easily be carried out in Thailand if she wants.

Fever is a side effect of the body’s immune system responding to a disease threat, so it is not uncommon for some symptoms to carry on after treatment. In addition, mild side effects of anti-malarial medication can often mimic the symptoms of malaria itself, including fever and nausea.

Given also the (entirely reasonable) possibility of an additional, unrelated stomach bug, I suspect that your daughter has successfully beaten off this malaria attack, and while she should remain vigilant if similar symptoms arise again, her health in the future should not be adversely affected at all by this episode.

Also, as mentioned briefly above, medical professionals in Thailand should be well equipped to diagnose and treat malaria if she suspects she has been reinfected. It is worth noting that malaria in south-east Asia has shown signs of resistance to mefloquine (as well as other drugs, such as chloroquine and sulfadoxine-pyrimethamine), so if she does require treatment while there, she should make sure the medication they provide does not contain any of the afore-mentioned compounds.

Regarding doxycycline, it’s great that your daughter took it religiously—that is certainly the first step towards protection. Randomized placebo controlled trials have shown it is between 92-96% effective in preventing P. falciparum malaria, which is very good, but obviously not 100% perfect – even when taken perfectly, some infections do occur. In addition, there is some data which suggests that dairy products, taken together with doxycycline, may limit  the uptake of the drug. This is rarely communicated to patients, who are instead contrarily told sometimes that taking the pills together with dairy products can reduce side effects! As such, please let your daughter know that she should avoid dairy products for 2-3 hours around the time she takes her doxycycline.

Malaria and Weight Loss

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QUESTION

Can malaria make you lose weight? Can malaria cause itching in the body.

ANSWER

Since malaria is often associated with extreme nausea and high fever, this can often cause people to lose their appetite and not eat properly while they are experiencing infection, leading to weight loss.

However malaria is usually quite an acute infection, lasting a few days to at most a few weeks (there are exceptions, whereby patients have been observed to be chronically infected for much longer periods of time, though they rarely experience frequent symptoms during these longer periods and as such would not be expected to lose weight), and so the period of time in which weight loss would occur is very short. Itching is not a symptoms commonly associated with malaria, though muscle aches and pains are common.

Malaria Effect on Host

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QUESTION

What is the effect of malaria on host?

ANSWER

In the human host, malaria can often make a person very sick, though the exact symptoms and severity of the disease depends on the type of malaria (five different kinds of malaria infect humans). Many people will have a high fever, chills, nausea and body aches. In a symptom very typical of malaria, a patient will experience cyclical fever, with periods of no fever in between, lasting between one and two days. In infections with Plasmodium falciparum, the most dangerous kind of malaria, patients may experience impaired consciousness, a sign of “cerebral malaria”, which can lead to loss of consciousness, coma and even death.

In terms of the mosquito host (more commonly called the vector), the insect does not experience “illness” in the same way as the human host, and the parasite does not seem to have a particularly negative effect on the mosquito. However, some research has shown that infection with malaria may cause a mosquito to seek out blood meals more frequently, which scientists argue is an adaptation of the malaria parasite to ensure that its life cycle is continued.

Malaria or Not?

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QUESTION

I went to Luanda, Angola and Port Hartcourt, Nigeria, Onne, Nigeria and Warri, Nigeria a few times. I suffer with voice problems, muscle control on my right side and some joint pains that have not been explained by my doctors.

I have been to doctors in Houston, Tx., New Orleans, La., New Iberia, La. and Franklin, La. and they all say the same thing. They don’t know what’s wrong with me. It maybe malaria that has laid dormant for nearly three years. I need to find out who can diagnose this for me and get me some help. My symptoms go back to 2009 with the balance being the first problem I noticed. The loss of my voice came later. I took off work for 5 months. Help me find someone close that might be able to help.

ANSWER

Although joint pains are associated sometimes with malaria infection, the most common symptoms are high fevers and chills—it would be unusual to suffer problems of with balance, the voice or muscle spasms.

A blood test is the only way to test for malaria for sure—this may be possible at a local travel clinic or any hospital which has a tropical medicine specialist.

I am not sure of any such exact clinics/hospitals in your area. However, I believe the CDC website has a list of local resources for tropical medicine. Otherwise, the CDC itself is located in Atlanta, GA, and they are certainly able to perform malaria testing, as well as give you advice as to whether you might be suffering from some other disease acquired internationally.

Vaccine for malaria? Differences with yellow fever?

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QUESTION

Is there a vaccine to prevent malaria?
What is the difference between yellow fever and malaria?

ANSWER

In answer to your first question, no, there is not currently a vaccine available to prevent malaria. The best current candidate, the RTS,S vaccine which was developed by GlaxoSmithKline, is currently undergoing Phase III clinical trials in Africa. Although preliminary results showed up to a 50% rate of protection against malaria in some age groups, the trials will not conclude until 2014 and so full results will not be known until after that date.

As for your second question, while yellow fever and malaria are both transmitted by mosquitoes, they share few other similarities. Yellow fever is caused by a virus, for example, whereas malaria is caused by a single-celled parasite of the genus Plasmodium. The group of organisms that Plasmodium belongs to is often called “Protista” (the exact grouping and classification constantly changes!), and they more generally belong, based on cell type, to the Eukaryotes, an enormous group of organisms which also includes all mammals and even humans! Viruses, on the other hand, are tiny pieces of genetic material wrapped in a protein coating, and can hardly be described as alive in a conventional sense.

While both yellow fever and malaria are transmitted by mosquitoes, yellow fever is transmitted by the genus Aedes, whereas malaria is exclusively transmitted by the genus Anopheles (at least in humans, and all other mammals for that matter).While spraying inside households may reduce the prevalence of  both types of mosquitoes, Aedes mosquitoes tend to feed during the day, so sleeping under an insecticide-treated bednet is less protective against yellow fever than it is against malaria. Also, a vaccine is available for yellow fever (and has been available for over 50 years), whereas as I describe above, no such vaccine yet exists for malaria.

Finally, while superficially the symptoms of yellow fever and malaria may seem similar (fever, nausea, aches), other manifestations of the disease can be very different. Yellow fever is technically considered a hemorrhagic disease, since it can cause increased tendency to bleed in patients. Also, in some patients, the initial symptoms are followed by an acute liver phase, causing jaundice which can turn the patient yellow (and hence the name). Malaria can also affect the liver, and cause ild jaundice, but usually not to the extent of yellow fever.  Once a patient has been diagnosed with yellow fever, there is no specific treatment, and the patient is merely treated based on symptoms, to ease their discomfort. Vaccination is the mainstay of control of this disease, and has been very successful in many places; the total number of worldwide cases is estimated by the World Health Organization to be around 300,000, with 20,000 deaths, mainly in Africa.

The burden of malaria is also mainly felt in Africa, though the number of cases and deaths is vastly higher – globally, there are approximately 200 million cases of malaria in 2010, with almost 700,000 deaths. Along with the general symptoms of fever and nausea, the most dangerous manifestation of malaria is when it causes cerebral symptoms; this is usually only caused by Plasmodium falciparum malaria, and can lead to impaired consciousness, coma and even death. Also in contrast to yellow fever,  the mainstay of control is a combination of prevention (mostly with vector control, i.e. using bednets, indoor residual spraying and destruction of breeding habitats and larvae) and treatment (using a variety of medications).