Can malaria return?

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QUESTION

I got fever and weakness.  I went to the doctor and my malaria report is the ring stage of p.vivax. I take artemether and lumafetrime drug  but after ten days the fever  returns. What is this? Is this malaria or not?  Plz help. When my c.b.c was done before taking malaria drugs  my hemoglobin is 8.8 and leucocyte 6800 and sgpt is 52 but after treatment my sgpt is 45 and hemoglobin is 10.2 and leucocyte is 7800. Do I have malaria again?

ANSWER

The treatment for  uncomplicated P. vivax malaria as recommended by WHO (Guidelines for the Treatment of Malaria, 2nd edition 2010), includes a main malaria drug, i.e. choroquine in areas without choroquine resistance, and ACTs like artemeter and lumafetrine as in your case.  Along with this however, for cases of P. vivex, a course of primaquine should be given. The primaquine is effective in eliminating the form of vivax that can “hibernate” in the liver for months or years and resurface, causing relapse.  (Primaquine should not be taken if you have severe G6PD deficiency).  If your fever continues, however, you should return to the clinic so your doctor can examine you and take further tests to see if the malaria has been cured and if so, to determine what is now causing your fever.

P.

Can Malaria be Completely Cured?

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QUESTION

My 18 yo son in on a study abroad in Bangalore, India. He has been in India since July 1st and toured Northern India the first 6 days that he was there. He woke up yesterday with horrible chills/shakes, then transitioned into a fever for several hours, then fever broke and was sweating for another 3 hours, while having a migraine behind his eyes. He did you go to the doctor and was told he has Malaria. He has been on Doxycycline since 2 days before leaving to go to India. He is also taking Colloidal Silver everyday. The Dr gave him some medicine today (he has not told me the name yet) and told him to come back on Monday for a blood test. What I would like to know is—is it possible for this to be completely treated? Or will he always have some of the parasite left in his system?

ANSWER

A blood test can diagnose if malaria is present and which kind of malarial parasite is causing the illness. Usually it is done when the person first presents themselves at the clinic with malarial symptoms.   Sometimes, a health worker will treat the person based on symptoms alone, although having a blood test is recommended if available.

Malaria can come back in three ways: first of all, the person could have been successfully treated, but then re-infected again by being bitten by an infected mosquito. In these cases, the person should focus on improved malaria prevention, such as sleeping under a long-lasting insecticide treated bednet.

Secondly, the patient could have recrudescence: when the patient takes medication, the treatment kills most of the malaria parasites in the blood, and enough so the patient feels better again, but some parasites still remain. Then, after the treatment finished, the parasite is able to replicate again, they increase in number in the blood and the patient feels ill again. In this case, you would say the infection came back from the blood, and the patient should take another dose of anti-malarials, but of a different kind to that which they originally had, in order to kill all of the parasites.

Finally, there is what is called relapse, which only occurs with two types of malaria: Plasmodium vivax and Plasmodium ovale. These are able to form dormant stages in the liver, so even when all the parasites are killed in the blood by the malarial treatment, these dormant forms survive. Many weeks, months or even years later, these dormant liver stages can re-activate and enter the blood again, causing new malaria symptoms. In this case, the liver was the source of the parasites. Again, the active blood infection should be treated with anti-malarials, but the patient should also talk to their doctor about taking primaquine, a drug which can kill any remaining dormant liver forms and thus prevent future relapses.

I hope this answers your questions and that your son recovers soon.

Malaria from Vietnam War

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QUESTION:

If my husband contracted malaria from serving in the Vietnam War but has never been treated for it, what are the symptoms that he might have experienced in the past that could have been caused by malaria but not diagnosed correctly?

Also is it possible that malaria infection could cause any type of birth defects to his children?

 

ANSWER:

Most people with primary malaria infection experience fevers, chills, sweats, muscle and joint aches, often accompanied by headache, nausea and diarrhea. While these symptoms resemble those of other illnesses that cause fever, these are often more severe in malaria and tend to recur in one, two, or three day cycles.

Certain forms of malaria can relapse  years after infection, and the symptoms of these relapses are similar to the initial (primary) infection.  Anemia, enlarged spleen, and low platelets are also common abnormalities in malaria. If your husband experiences any episodes of these symptoms, blood tests taken during fever might help determine if the malaria parasite is present. Other blood tests can determine if he’s been infected in the past.

While maternal malaria during pregnancy can increase the risk of poor pregnancy outcomes, malaria is not known to increase the risk of birth defects from father to child.

 

Malaria Relapse

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QUESTION

I had malaria in Papua New Guinea 40 years ago and had many relapses. I had one 11 years ago and was in hospital for 3 weeks. I have been to a massage therapist who used a hand machine giving out pulses rather strong a bit like tiny electric shots could this activate malaria?

ANSWER

The reasons why malaria relapses are not well known. Malaria acquired in different places tends to have different relapse times (faster in the tropics, less frequent in sub-tropical or temperate regions) and there is also some evidence that being bitten again by mosquitoes can trigger relapse. I am not aware of any evidence that electric pulses could trigger relapse, but likewise cannot discount the possibility! On another note, there is medicine that can be taken to prevent further relapse, by killing the dormant liver forms of the malaria parasite. It is called primaquine, and is only effective is taken exactly as prescribed for a 2 week period. Some people with G6DP deficiency may also not be recommended this medicine, so before prescribing it, your doctor should test you for this deficiency.

Do I have malaria?

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QUESTION:

Hi, I went to Ivory Coast August/2003 back March/2004, took some pills to help prevent Malaria on my trip but ran out and did not get more. While I was there I got many mosquito bites.

Around October/03 became very sick, got tested for malaria at the hospital in Quebec but negative. Now May/2011 still have all the same symptoms, flu like symptoms, feeling cold most of the time, chills headaches, tired.

Is there any way I got it? I’ve gone to doctors and doctors and no one can seem to find what is causing this? I am tired of taking tylenols all the time for the body ache. My wife is from there and she’s so sure that I got it from seeing how I am since she’s been around it all her life. Can you help me?

ANSWER:

There are definitely types of malaria that can cause relapses of symptoms many months or even years after an initial infection. These types are not common in the Ivory Coast but if you had many mosquito bites then it is certainly possible that you were exposed. What kind of test did you have for malaria when you returned to Canada?

Often, the test is by looking at a microscope slide of your blood under the microscope—the problem with this test is that it is not very sensitive for low levels of malaria, for example, after the worst of infection, and especially with the types of malaria that cause relapse (these types, P. ovale and P. malariae being the ones you might expect from Ivory Coast, tend to cause less severe illness than the more common type of malaria in Africa, called P. falciparum, doesn’t relapse in the same way, but results in much higher levels of the malaria parasite in the blood, which makes it easier to diagnose on blood slides). Also, since malaria is relatively rare in northern countries like Canada, laboratory technicians are not as experienced at diagnosing the parasite as they are in countries where malaria is endemic.

Having said that, there are of course lots of other illnesses which also cause symptoms similar to that of malaria – fevers, chills, etc. What I would recommend is that you re-visit the doctor, and ask for a more sophisticated test for malaria. Mention that you have had a relapse of symptoms—this should prompt them to use more sensitive tests, such as PCR or a rapid diagnostic test, and to look specifically for P. ovale or P. malariae. Not only will this answer your question about whether you have malaria, but it will allow the doctors to give you the appropriate treatment for your current symptoms (probably chloroquine) as well as treatment to prevent any further relapses (primequine).

Hope this helps!

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.

Treatment for malaria in Africa

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QUESTION:

What is the treatment for malaria in Africa?

ANSWER:

The appropriate form of treatment for malaria, regardless of where you are, depends on the type of malaria you have. This can be determined through diagnosis; each of the main malaria parasites that ordinarily infect humans (P. falciparum, P. vivax, P. malariae and P. ovale) looks slightly different under the microscope, although you have to be well trained to tell them apart! Rapid diagnostic tests (RDTs) can also sometimes distinguish between malaria species, although many RDTs only test for P. falciparum, he most acute, severe and deadly of the species.

In much of Africa, P. falciparum is the most common and dangerous form of the disease. In some places, it can be treated with chloroquine, though in many places the parasite has developed resistance to this drug, so other treatment is necessary.

The most common drugs given in areas with known chloroquine-resistant strains of P. falciparum are ACTs (artemisinin-based combined therapies). There are some parts of Africa where other forms of malaria, such as P. ovale and P. vivax, can also occur – it is important to know whether a patient is infected with these species as they require an additional form of treatment, the drug primequine, in order to kill dormant liver stages that characterise these species and can lead to a relapse of infection months or even years after the initial exposure.

Malaria Treatment

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QUESTION:

What is the proper treatment for people with malaria symptoms?

ANSWER:

The proper treatment for malaria depends on the type of malaria parasite that the patient is infected with. Therefore, before treatment begins, the patient should be accurately diagnosed.

In most cases of non-Plasmodium falciparum malaria (the most deadly form of malaria, found throughout the world but most prevalent in sub-Saharan Africa), and even in some places where P. falciparum has not yet developed resistance, treatment with chloroquine is sufficient.

The dosage will depend on body weight (usually approximated by age). Where there is a risk of chloroquine-resistant malaria occurring, treatment of non-complicated cases will usually consist of orally-administered artemisinin-based combination therapy (or ACT) – again, the dosage will depend on age/weight.

For severe malaria, parenteral ingestion of drugs is required. For the treatment of cerebral malaria, caused by P. falciparum, quinine is the traditional drug of choice, though artemisinin has also been shown to be effective. Anti-convulsants and anti-pyretics (to reduce fever) should also be administered.

In cases of infection with P. vivax or P. ovale, the parasite can become dormant in the liver and result in a relapse of the disease if not treated properly. As such, patients with either of these forms of malaria should also be treated with primaquine.

If you have, or suspect you have a health problem, you should visit a physician for a medical diagnosis and treatment.