Diagnostic Advice

by

QUESTION

Healthy 30 year  old male, arrived in West Africa 2 weeks ago, using doxycycline as prophyaltic but not systematically—I know I missed a day or two, and had not taken it before arriving; lots of mosquito bites. Also believe my doxy to be expired—how long is it good for in capsule form? Doesn’t have expiry on my prescription. Symptoms showed up around day 7 in Mali: sore neck, headache, nausea, slight fever. Then left me for several days but returned strongly 5 or 6 days later at which time I went to pharmacy and began Artequin 600/750 (Artesunate + Mefloquine) – three day treatment. Felt better immediately after taking first dose. After second dose went to clinic for blood work for some reassurance but test came neg for Pl. falciparum; doc had warned that neg result is likely due to medication. The blood work showed my Lym # to be higher than normal range 74% vs range of 20-40%, however the clinician provided no comment and I only realized this after. Just took day three dose and don’t feel any worse but have some diareah, general discomfort. Not as intense as two previous waves of sore neck and nausea. Now resting but its awkward having no reassurance I have malaria. I read high lym (presuming this means lymphocyte—french blood result printout) count is generally due to viral infection.

Could I have a virus that may require a different form of treatment? Should I stay put at hotel hoping the malaise will pass or seek further medical assistance? (any consensus on what time frame for symptoms to pass?) Thank-you.

ANSWER

I have passed your question on to our advising medical doctors at malaria.com, and once they get back to me I’ll post it here. In the meantime, it might be worth knowing that although elevated monocyte levels can be associated with malaria infection, lymphocyte/general white blood cell counts tend to be decreased in malaria patients (I find it unusual that your value was given as a percentage rather than a number). As such, it suggests you might have some other infection, though it doesn’t have to be viral—there are other causes of elevated lymphocyte counts, such as bacterial infections, which can be tested for in a hospital.

Depending how long you are going to be in Mali for, you can either try to see a physician there who might be able to give you further tests (you should also have another malaria test a few days after you have finished the course of medication, especially if you still feel ill), or if you are feeling better, you could perhaps wait til you get home and talk to your primary care doctor there about other possible causes for elevated lymphocytes.

UPDATE: I’ve just heard back from one of our medical advisor. He suggests that it is quite unlikely you could have had malaria only 7 days after arriving in West Africa, since the incubation period is usually more like 2-3 weeks (and is often extended when people take anti-malarials). As such, it may be worth seeing a doctor to check whether you might have another infection, which is contributing to your illness and also might account for the high white blood cell count.

Malaria Treatment Time and Hiccups

by

QUESTION

I am suffering from pf malaria with enlarged liver and spleen under the treatment from last one week and the abdominal pain has subsided. But I am experiencing hiccups. How long it will take for complete recovery?

ANSWER

It is a good sign that you are already feeling better following your treatment for malaria. Interestingly, hiccups have been linked to infections with parasites, including malaria; in one case, it was discovered that the treatment the patient was taking (doxycycline) had actually caused some secondary problems of the esophagus which was causing the hiccups. The patient was given medicine which treated these secondary problems and cured the hiccups. So if you continue to experience hiccups after you have completed the treatment for malaria, you should ask your doctor if it is possible to arrange for an endoscopy, to check for any secondary problems caused by the medication.

As for recovery time otherwise, you will probably feel much better as soon as the course of medication is completed. However, many malaria patients still feel fatigued for weeks or even months after they have had the disease, so full recovery can take some time.

It is important, however, to visit your doctor again if you have any recurring symptoms of malaria after you have finished the medication (such as fever or nausea) since this could indicate that the infection was not completely cured the first time; another blood test may then be required, with another course of treatment if you test positive again for malaria.