Malaria Recurrence and Treatment

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QUESTION

Since September 2011 I had malaria falciparum. The first medication I took was Coartem, after 2 weeks  I had the same symptoms then the test was +1.5 ,i took Coartem again. 2 weeks after the doctor gave me Malarone ,then 19 days it come back . the doc. gave me Quinine -tablets without doxycycline. but no thing change.

Until now each 14-25 days the malaria comes back, I ask my doctor to do any extra test or to do any thing else, but he told me that “I don’t have severe malaria.”  So why all this medication but i still sick??

On 10 feb 2012 I took Artequin. I feel better but after 15 days it came back , then I take Artequin again. I`m confused what to do?
PLEASE HELP!!!

ANSWER

I think I replied to the comment you made on the “Diagnostic Advice” Q&A post – I will copy the response I wrote there below:

It is certainly unusual to have such persistent malaria; usually Coartem cures it very quickly. Where are you obtaining your medication? It could be that the drugs you took were out of date (expired) or counterfeit; this can decrease efficacy and lead to a reduction of symptoms but not a complete cure. Also, what kind of test is your doctor using? If it is a blood smear, you might want to ask if another technician could read the slides, to double-check the diagnosis. I have seen cases elsewhere in Africa where doctors diagnose malaria by default without really examining the blood slide closely. You could try to get a malaria rapid diagnostic test; this looks for specific proteins associated with malaria infection in your blood, and can be more sensitive than blood slides. You can even perform these tests at home, so double check what the doctor tells you.

Otherwise, if you are truly getting re-infected very rapidly, you should look into more effective preventive measures against getting bitten by mosquitoes. This includes sleeping under a long-lasting insecticide treated bednet, wearing long-sleeved clothing at night and in the evenings and applying insecticide to exposed skin.

Is there malaria in North America?

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QUESTION:

Are there malaria-infected mosquitoes in North America?

ANSWER:

North America is usually defined as including Canada, the United States and Mexico. Of these, Mexico has known regions of regular malaria transmission; specifically the regions bordering Guatemala and Belize in the south (Chiapas, Quintana Roo and Tabasco), rural areas in the tropical lowlands slightly further north (parts of Oaxaca, Nayarit and Sinaloa) and a very localised section of northern Mexico, located across the states of Chihuahua, Sonora and Durango. Travellers to these areas are recommended to take measures to prevent against malaria infection, such as minimising mosquito bites or taking prophylactic medication. Both P. falciparum and P. vivax are known to be transmitted in Mexico, so you should consult with a travel physician before deciding which form of preventative (prophylactic) medication to take, depending on the length of your stay, your budget and the type of malaria most commonly found in the area to which you are travelling.

Malaria was once also widespread in the southern USA, though a concerted public health campaign that started in 1947 (mainly consisting of reducing the number of mosquitoes through insecticide spraying and control of stagnant water bodies) greatly reduced transmission and led to the disease being considered eliminated by the 1950s. Occasionally, small pockets of transmission will be reported, though stringent diagnosis and treatment quickly places these outbreaks under control once more.

However, there are additional cases of malarial mosquitoes occasionally also reported even from northern parts of the United States and Canada; these are when mosquitoes are accidentally transported from malarial regions, for example in airplanes, in luggage or in shipping containers. These mosquitoes almost never transmit the disease to people, and in most temperate regions, do not live long enough to be a public health threat or to enable the persistance of the disease.