Multiple Malaria Infections Each Year

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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

URGENT HELP ON MALARIA

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QUESTION

I 25 yr old male from Lagos, Nigeria. I have been having frequent malaria since 2006 till present. My symptoms are always weakness of the body, feeling cold sometimes not always and also my mouth got better most cases. I have been to the hospital several times and the doctor told me my frequent malaria is because my blood genotype is AA and also am having a malaria parasites. I was given drugs and injection in most cases. It got to a stage I had to stop consulting the doctor and start making use of self description because the malaria goes and comes back and its cost me much money in going to the hospital every time.

The weakness is always my problem because will be restless and unable to study well even during my exams. I remember there was a period I sat down in front of my house and started crying cos I was fed up on getting weak during Xmas period while my mates were having fun. I also remember cases where I walked into one of the biggest pharmacy in my area and ask the guy which malaria drugs is the most expensive cos I was thinking the most expensive should be the most effective. He brought out some drugs which I paid some money.

I was free from malaria for the past 4 months not of recent I started having heavily symptoms mentioned above. I have taken several drugs like chloroquine 2-2-1 and Combisunate(arthmeter and lumefactrine),still yet no positive response.The Cold had stopped but my body is till getting weaker. I am just confuses don’t know what to do. I even thought of going for a HIV test soon cos I believe am not the only AA that stays in House. Others, I mean some of my family and neigbours do have often and it disappears immediately after taking some drugs.

I am fed up seriously and really don’t know what to do again.I hope you can help.

ANSWER

Thanks for your question. Getting infected with malaria doesn’t have anything to do with whether you are blood type A or O or anything else. Some people do have natural resistance to some types of malaria—for example a lot of people in sub-Saharan Africa are “Duffy negative” which means they are resistant to Plasmodium vivax malaria; other people carry the sickle cell gene, which also provides some protection.

However, it is not common to have so many repeated attacks of 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.

Finally, I think it is important to make sure that you are diagnosed properly. In many places I have been to, hospitals don’t do a proper check, but if someone has even a few of the symptoms of malaria, they just give them treatment. This is not good—you need a proper diagnosis, both to see what kind of malaria you have (so you can get appropriate treatment) and also to make sure you actually have malaria, and not something else which is being ignored because they think you have malaria!

In fact, your symptoms of fatigue, weakness and cold are not very typical of malaria, which is usually characterized by very high fever interspersed with chills, nausea and body aches. As such I think you might want to talk to a doctor about other possible explanations for your symptoms, especially since they are so persistent.

Finally, in Nigeria, you should NOT be given chloroquine to treat malaria, unless your case is confirmed as not being caused by Plasmodium falciparum. Virtually all the Plasmodium falciparum in Africa is resistant to chloroquine, and so it is no longer an effective treatment. Instead, first-line treatment for malaria is recommended as an artemisinin-based combination therapy, such as Combisunate which you mention above.

Malaria Infection Even With Prevention

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QUESTION

Can you still get infected with Malaria even when taking a preventative such as doxycycline or Malarone?

ANSWER

Yes, no prophylactic medication is 100% effective though both Malarone and doxycycline are usually over 90% effective, when taken properly. It is important to make sure each tablet is taken approximately at the same time each day, and in the case of Malarone, it is important to take it with some fatty food as this assists in absorption. Conversely, doxycycline should not be taken within 6 hours of consuming dairy products, as the calcium present in milk can prevent uptake of doxycycline. For these reasons, it is important to also use other methods of preventing malaria, such as sleeping under a long-lasting insecticide treated bednet.

Malaria in Myanmar (Burma)

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QUESTION

Is Malaria an issue in Myanmar where I am going in June?

ANSWER from Malaria.com Editor

YES. Malaria is a risk in all rural areas of the country below 1,000 meters of altitude (anything below 3300 feet). Rangoon/Yangon and Mandalay do not have malaria.

You should take medication to prevent malaria (prophylaxis) throughout your stay, and also protect yourself from getting bitten by mosquitoes if you are travelling to risk areas for malaria. Personal protection measures including sleeping under an insecticide treated bednet, wearing insect repellent and wearing long-sleeved clothing, especially in the evenings, early morning and throughout the night, which is when the mosquitoes that transmit malaria are active and feeding.

Myanmar/Burma is known to have strains of malaria which are resistant to certain medications; specifically, chloroquine resistance is widespread, while some areas in addition have malaria which is resistant to mefloquine (sold as Lariam). As such, the CDC recommends atovaquone-proguanil (sold as Malarone) or doxycycline if you will be travelling in the provinces of Bago, Kachin, Kayah, Kayin, Shan, and Tanintharyi. In all other areas of the country, mefloquine should also be considered as an option.

Answer from Malaria.com medical advisor

For anyone planning a trip abroad its important to know the health risks in your destination. Malaria is an especially important concern for anyone traveling to tropical or subtropical regions. Here’s what I found on the CDC Travelers’ Health website. I find this is the best place to look for this information.

  • Areas of Burma with Malaria: Rural areas throughout the country at altitudes
  • If you will be visiting an area of Burma with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:
  • Taking a prescription antimalarial drug.
  • Using insect repellent and wearing long pants and sleeves to prevent mosquito bites. Sleeping in air-conditioned or well-screened rooms or using bednets.
  • Some areas of Burma have resistance to certain antimalarial drugs.

See the malaria information for Burma to find out which antimalarial drug is appropriate for the area you plan to visit in Burma.

Do I need malaria tablets to live in Nigeria?

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QUESTION

Do I need malaria tablets to live in Nigeria? I was born and bred in the UK and want to go back to live in Nigeria for about 2 years, do I need malaria tablets?

ANSWER

It is not usually recommended to take malaria tablets for long periods of time (i.e. more than a few months). People living for extended periods in areas with malaria should focus on other methods of prevention, such as sleeping under a long-lasting insecticide-treated bednet.

The mosquitoes that carry malaria, Anopheles, feed mostly in the evenings and at night, so it is particularly important to protect yourself during these times. Screening windows and doors tightly can help prevent mosquitoes form entering, as can air conditioning inside the house (it makes the climate less suitable for the mosquitoes).

In many parts of Africa, insecticide is sometimes sprayed indoors, again to prevent mosquitoes from being inside the house. Personal protection is also important; wearing long-sleeved clothing, particularly at dawn, dusk and at night, can prevent mosquitoes from biting you, as can wearing mosquito repellent, particularly kinds containing the chemical DEET.

Regarding tablets to prevent malaria, if you really want to pursue this option, the only medication which is recommended for long-term use is doxycycline, but you should consult with your doctor about its suitability for periods of longer than 6 months, and they should also explain to you the possible side effects associated with taking it.

While the above mentioned forms of prevention should be the mainstay of your efforts to avoid malaria, it is also important to know what the symptoms are and what to do if you suspect you might be infected.

Malaria is characterized by high fever, chills, aches and nausea most commonly, and if you think you may be infected, you should immediately go to a doctor or a clinic for diagnosis. The doctor/clinician should take a blood sample and either look at it under a microscope to look for malaria parasites or they will use a drop of blood in a rapid diagnostic test. In both cases, you should only take medication to treat malaria if you are positively diagnosed.

Malaria in Kitwe Zambia

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QUESTION

Is it dangerous for my children two years old in Kitwe?

ANSWER

Kitwe has been part of the Roll Back Malaria campaign to control malaria in Zambia—the program has been very successful, reducing deaths by malaria by over 65% nationwide. However, there still is a risk of contracting malaria in most parts of the country, and so preventative measures should be taken when visiting or living in Kitwe, such as sleeping under a long-lasting insecticide treated bednet, wearing long-sleeved clothing in the evening and at night and screening doors and windows to prevent mosquitoes from entering.

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.

Malaria Relapse

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QUESTION

Why do I suffer from constant malaria attack? The doctor has prescribed different prescriptions every time I get an attack but its still coming back. What could be the problem?

ANSWER

There are a number of possible answers to your question. First of all, your doctor might not be prescribing the right type of treatment for the type of malaria that you have. The World Health Organisation now recommends that all uncomplicated cases of malaria should be treated with artemisinin-based combination therapies (ACTs), such a Coartem. However, in some places, doctors still prescribe other drugs, such as Fansidar or chloroquine. This can be a problem, as in many areas, the local kinds of malaria have become resistant to these earlier drugs, and so you may not be cleared of the infection. This is called recrudescence—when a malaria infection is not cleared completely from the blood and so symptoms come back once the treatment has stopped.

Alternatively, if there is a longer time interval between your episodes of illness, you may be suffering from relapses. This occurs with two particular types of malaria: Plasmodium vivax and P. ovale. These types of malaria can form liver stages which remain dormant even after the treatment you take kills all the malaria in your blood. Therefore it will appear like you have been cured, but really you still have an infection in the liver.

These liver stages can re-activate and re-enter the blood, causing another episode of malaria symptoms months or even years after the initial infection. If your doctor finds that you are positive for one of these two types of malaria, you should talk to him/her about the possibility of taking primaquine. This drug kills the liver stages of the parasite, but is not appropriate for people with G6DP deficiency, so you should be tested for that first.

Finally, there is the possibility that you are continually being re-infected with malaria. In this case, you should take more preventative precautions. For example, sleep under a long-lasting insecticide-treated bednet, wear long-sleeved clothing (especially at night) and cover exposed skin with insect repellent. All of these measures will help prevent mosquito bites, which transmit malaria. In addition, you could consider indoor residual spraying, which coats the walls inside your house with insecticide to further eliminate the presence of mosquitoes.

Malaria Test for Infant

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QUESTION

What can I do if my infant (6-12 months) gets malaria and how can I tell if they have it?

ANSWER

Your infant can easily be diagnosed by a blood test, so visit a clinic, doctor or hospital immediately. The diagnosis will either be done by looking at a thick and thin blood film under a microscope, or by a rapid diagnostic test.

It is important that a blood test is done in addition to a clinical diagnosis—the symptoms of malaria are very similar to many other infections but the treatment may vary. If found to be positive for malaria, the doctor will recommend appropriate treatment and dosage for the type of malaria they have and their weight/age.

If you live in a malarial area, it is also important to take measures to prevent malaria, such as having your child sleep under a long-lasting insecticide treated bednet, and perhaps spraying your rooms in the evening with insecticides to reduce the number of mosquitoes.