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.

What Cell count defines malaria?

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QUESTION

What Cell count defines malaria??

ANSWER

If you are referring to the cell count for diagnosis, then really the answer is that if ANY malaria parasites are observed in a blood film, then the slide should be considered positive for malaria. Of course, some people can have low levels of parasite in their blood, which are not easily detected under a microscope, using a blood slide. These people are also obviously positive for malaria, but have less severe symptoms or indeed may not have any symptoms at all. If they have symptoms, they may need to seek an alternative form of diagnosis, such as a rapid diagnostic test (RDT) or PCR (polymerase chain reaction).

Malaria Symptoms and Diagnosis

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QUESTION

My husband is currently working in Mozambique, and is sick with a fever, headache, and pain in his joints. Can this be malaria?

ANSWER

It could be. Your husband should go to the clinic and get tested.  The standard diagnosis for malaria  depends on the demonstration of parasites on a blood smear examined under a microscope.  In some settings, where microscopic examination is not possible, or as a quick response,  clinics can use an RDT or rapid diagnostic test on a drop of blood.  If your husband is in a place without any available testing methods, the health worker may treat him on his symptoms alone (this is called presumptive treatment). It is important to seek care early because if it is malaria it can get serious very quickly.

Malaria: When is Lab Testing Not Recommended

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QUESTION

When is parasitological confirmation not recommended?

ANSWER

It is always best to get a laboratory or rapid diagnostic test for malaria (parasitological confirmation) to make sure the person actually has malaria before giving treatment, and to make sure the treatment is appropriate. 

There are four main types of malaria which infect humans: Plasmodium falciparum, P. vivax, P. malariae and P. ovale. P. ovale additionally can be split into two  sub-species, P. o. curtisi and P. o. wallikeri. Each of these five kinds has a subtly different life cycle which results in slight variations in symptoms and also in treatment, so knowing which one a person has is important for choosing the most appropriate treatment.  For more information on this, check out the Q&As on Malaria Symptoms and malaria treatment.

Early treatment of malaria is essential to saving lives, so in communities that do not have ready access to simple lab testing, international agencies like WHO and UNICEF have developed standardized algorithms, to guide community health workers in early identification and treatment of malaria (particularly in children) without laboratory  confirmation. While this approach has been taken to save lives, where possible, laboratory confirmation of malaria is recommended.

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: 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 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 and Menstrual Cycle

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QUESTION

Does malaria affect menstrual cycle?

ANSWER

Malaria usually does not last very long—people usually seek diagnosis and treatment within a few days (since symptoms can be severe) and then treatment and recovery follow swiftly, within another few days (100% recovery may take longer, up to a few weeks). Moreover, malaria does not usually interfere with reproductive organs or hormone production. As such, malaria usually does not interfere with the menstrual cycle. However, malaria can result in anemia; many women also experience mild anemia during and after menstruation, and it is possible that this iron deficiency could be exacerbated by malaria infection.

Free Medical Care for Malaria

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QUESTION

Can you get free medical help for someone In Nigeria that has malaria?

ANSWER

Theoretically, the Nigerian government should provide basic services, including malaria diagnosis, through primary care clinics which are administered by local government. In addition, Nigeria has recently instituted a National Health Insurance program, which again should assist in providing health care to many sectors of the population. However, in practice, public health care in Nigeria is still hugely underfunded and not very comprehensive—the World Health Organization (WHO) recently ranked it 187 out of 191 country health systems worldwide!

As such, I would be wary of the quality and accuracy of malaria diagnosis and treatment if you obtained it for free in Nigeria—while you might get perfectly decent care, the statistics suggest the chances of this are slim. You would probably be better off looking for a private clinic, where I imagine the cost will still be quite reasonable (especially if you are part of the National Insurance program there) and the quality of care might be more reliable. Having said this, I have no personal direct experience with health care in Nigeria, public or private, so if other readers of this site have other information, please share it in the comments section below.

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.