Lasting Effects of Malaria

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QUESTION

What are the lasting effects of malaria?

ANSWER

Most people who get malaria and receive the correct treatment in time, usually have no long term affects of malaria infection.

However some people who have suffered severe cerebral malaria (from P. falciparum) may experience some longer term neurological effects. There have been reports that up to 25% of young children with severe malaria experience neurological, behavioral or motor problems afterwards.

Other types of malaria, such as P. ovale and P. vivax, can form dormant life stages which hide in the liver for weeks, months or even years, leading to relapse at a later date. However, apart from these recurrences, there are also no long term effects of infection with these types of malaria.

Can I Catch Malaria from Someone?

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QUESTION

My fiancee contracted malaria a few years ago. It was diagnosed as recurring. Could I contract malaria from the infected person, I have had similar symptoms which last a day or two, recurring with regular two week intervals, of which the most concerning are malaise, fever, stiff neck, headaches and severe pains over abdomen spreading into my mid back. What should I do?

ANSWER

Malaria cannot be directly transmitted between two people—it is almost always transmitted by the bite of an infected mosquito, and cannot survive at low temperatures (under about 17 degrees C). In some very rare cases, malaria can be transmitted through organ transplant, blood transfusion and pregnancy, since it infects red blood cells. Given these restrictions, it is close to impossible that you contracted malaria from your fiancee, and you should talk to your doctor about alternative explanations.

Also, if your girlfriend has recurring malaria, she should talk to her doctor about taking primaquine. While not suitable for everyone (namely people with G6DP deficiency should not take it), it can kill the dormant stages of the malaria parasite and prevent recurrence.

Is Malaria Deadly?

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QUESTION:

Can malaria come back, and is it deadly?
ANSWER:

In some cases, and if not treated properly, malaria can come back. One example of when malaria comes back is when the infection is not completely cleared from the blood, for example if the full course of treatment is not taken. This is more common with Plasmodium falciparum malaria, as it can multiply rapidly in the blood. This characteristic makes it the most dangerous form of malaria, and if left untreated, is can often be deadly.

Other forms of malaria come back through different methods; for example, Plasmodium falciparum and Plasmodium ovale, have forms of the parasite that can sequester in the liver and remain dormant for long periods of time, even years. Once these liver stages return to the blood and start multiplying again, the patient will get a recurrence of malaria symptoms. It is possible to treat these liver stages, through taking specific medication; for this reason, it is crucial that if you suspect you might have malaria, you are diagnosed accurately to ensure that you receive the correct forms of medication to prevent the malaria coming back in any way.

Can I get malaria again?

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QUESTION:

Hello, I have had malaria four times in Papua New Guinea, the last time was the “brain” type – sorry don’t know the name. The other times were ‘regular’ malaria. I have been free of it for 21 years now; could it still recur in me?
thanks,
Jay

ANSWER:

Hi Jay, thanks for your question. The “brain” type you are referring to is probably Plasmodium falciparum, which is known for causing cerebral malaria in serious cases. Actually, the majority of malaria cases in PNG are caused by this parasite, even the so-called “normal” cases, which don’t get as serious as to become cerebral.

The good news about P. falciparum is that it does not have a latent stage in the body, so patients cannot get relapses. However, there is another type of malaria in PNG, called Plasmodium vivax, which is less virulent (doesn’t cause as severe symptoms), but if not treated properly, does have the ability to leave latent stages of the parasite in the liver. These liver forms can become active a long time after the initial infection; usually the maximum limit for relapse is a couple of years though (one case in Italy reported a patient with relapse after 4 years, which was considered very unusual – the citation for this paper is Mangoni et al., 2003, ‘Case report: An unusual late relapse of Plasmodium vivax malaria, in American Journal of Tropical Medicine and Hygiene, volume 68, pages 159-160), so you should be fine after 21 years being malaria-free!

In your case, unless you were diagnosed otherwise at the time, I would think you probably were infected with P. falciparum all four times, and so there is no chance of a relapse; if you’re really worried about it, you can have a malaria test to see if you still possess antibodies against malaria, which would suggest there are still parasites in your body, and might indicate P. vivax infection (there are some blood tests which can distinguish between these different types of malaria). Then, you can take a drug called primequine, which eliminates the liver stages and ensures no further relapse.

Can malaria come back?

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QUESTION:

If you had malaria once, can it return for a second time without being in a malaria area?

ANSWER:

Yes. There are several ways in which malaria can come back without being re-infected again. The blood forms of the parasites can sometimes persist at low numbers, so that the patient no longer has any symptoms; if these blood forms begin to reproduce again, the patient will once again begin to feel sick and have malaria symptoms. This is known as ‘recrudescence’ and can occur as quickly as within the same year as the initial infection but also as long as fifty years later, depending on the type of malaria! Treating the infection thoroughly, and being tested for parasites after treatment, is one way to avoid recrudescence.

The other way in which malaria can come back is through ‘recurrence’, which is when the malaria parasite enters a dormant phase which resides in the liver. Again, the patient will feel no symptoms while the malaria is dormant, but once these liver stages change into the blood stages and reproduce, symptoms will reoccur. This form of relapse only occurs with Plasmodium vivax and P. ovale infections, and can be prevented through taking an additional form of medication, called primequine, at the same time as the normal malaria drugs when diagnosed. This extra medicine kills the liver forms of malaria and thus prevents recurrence. For more details on this, please see the comments I made, on behalf of Dr Etty Villanueva, on the post ‘Malaria Symptoms and Causes’, published on the 22nd of February, 2011.