by Malaria Q&A
QUESTION
Can I take paracetamol (acetaminophen) with Coartem?
ANSWER
Yes – there are no known drug interactions or contra-indications between these two medications. Paracetamol (known as acetaminophen in the USA) is a very effective way of reducing fever so can be used to this end, together with specific anti-malaria medication such as Coartem, during a malaria attack.
by Malaria Q&A
QUESTION
My sister has been suffering from fever from past 22 days temperature varying from 102-106 with chills shivering, headache, body pain,nausea and muscle ache but tested negative for malaria. She also tested negative for dengue, swine flu, hiv, and many others. So out of frustration we gave her mefloc 250 and she seems to be responding. She is still having fever that is after 12 hrs of medication but the temprature is ranging between 98-100 and there is no headache and no chills and shivers. Now we are confused how to confirm that it is really malaria and when will the fever stop completely. Should we shift her to a some other hospital at present she is in Pune.
ANSWER
The diagnosis of malaria is confirmed by observing parasites on a blood smear. There are also Rapid Diagnostic Tests (RDT) that can be done with a pin prick of blood, but the blood smear is the definitive test. It is possible, that in your sister’s case, a proper malaria test was not done or not interpreted correctly, and she does have malaria and it is responding to the medicine. Alternatively it could be that your sister does not have malaria, but suffers from another problem that coincidentally is resolving itself at the same time the anti-malarial medicine is given. It is hard to determine exactly what is wrong, but the good news is that she is getting better.
Sometimes medicine is given on presumption of illness which is what happened in your sister’s case. However, if someone has uncomplicated falciparum malaria, (most prevalent in India) WHO recommends Artemisimin Combined Therapy (ACT), which uses an artemisinin compound with another anti malarial, such as mefloquine, not mefloquine alone. If your sister’s fever returns, make sure to have a blood smear taken to see if it is malaria or not, and if so what kind of malaria it is, to better tailor her medicine.
by Malaria Q&A
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.
by Malaria Q&A
QUESTION
Where can I find information on the ratio of malaria cases treated annually globally or per country?
ANSWER
A great resource for information on malaria is the World Health Organisation (WHO). They publish an annual malaria report which also includes lots of statistics about numbers of cases, numbers treated, and numbers of deaths from malaria. Some of the data is even available at the country level, I believe. You can download these reports, and also find out a lot more information about malaria, at the World Health Organisation malaria page.
by Malaria Q&A
QUESTION
is rotam and maladar malaria medicine?
ANSWER
I have never heard of Rotam, but Maladar is the brand name of a combination sulfadoxine-pyrimethamine, and is used to treat malaria. However, it should be noted that it is not recommended by the World Health Organization as a first-line treatment option, due to concerns about drug resistance, and also lack of efficacy against certain types of malaria.
Instead, first-line recommended treatment is of an artemisinin-based combination therapy, or ACTs, which combine an artemisinin derivative (such as artesunate, artemether or dihyrdoartemisinin) with another anti-malarial drug, such as lumefantrine, piperaquine or mefloquine. Common brand names include Coartem, Lonart and Duo-Cotecxin.
by Malaria Q&A
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.
by Malaria Q&A
QUESTION
Are there any home remedies for symptoms of malaria?
ANSWER
Quinine is a natural chemical which has anti-malarial properties, and tonic water is a good example of an everyday foodstuff which contains quinine. For this reason, over the last hundred-odd years, expatriates living in malarial countries have enjoyed drinking gin and tonic! There are also reports that grapefruit contains a quinine-like substance, and so might help prevent malaria or indeed increase recovery from malarial episodes, but I am not sure if this has been scientifically established as fact. There are a number of other plants, herbs and fruits which advocates of traditional, home remedies suggest may help prevent or treat malaria, but I can’t find ANY solid scientific basis for these claims, nor any reports of trials where these remedies have been shown to be effective.
Overall, the best thing to do if you think you have malaria is to get diagnosed (either at the doctor, a hospital or using a self-diagnosis kit) and then seek medical treatment. Local clinics will be able to tell you what kind of malaria you have, and therefore what treatment is recommended.
by Malaria Q&A
QUESTION
I would like to know about the P. knowlesi – treatment compared to P. falciparum? preventive medicine?
ANSWER
At this point in time, P. knowlesi is completely susceptible to chloroquine, and so can be treated successfully using this drug. P. falciparum, on the other hand, is known to have widespread resistance to chloroquine, and so the World Health Organization recommends that chloroquine should not be used to treat P. falciparum malaria. Instead, for non-complicated malaria, the WHO recommends treatment with artemisinin-based combination therapies (ACTs). These drugs can also be used against other forms of malaria, including P. knowlesi, particularly if the hospital also treats cases of P. falciparum regularly and so has supplies of ACTs on hand. One study even showed that treatment with ACTs (specifically artemether-lumefantrine) was more effective than chloroquine in treating P. knowlesi. Severe cases of either infection should be treated with intravenous artesunate or quinine.
Prevention for both is roughly similar – chemoprophylaxis should be taken by people travelling to an area where transmission of these types of malaria occurs. However, given P. knowlesi‘s susceptibility to chloroquine, this drug is effective as a prophylactic for this malaria species, whereas it is not appropriate for P. falciparum, given high levels of resistance. In terms of prevention of mosquito bites, this differs due to the types of mosquito vectors each of these species of malaria uses. P. knowlesi is only found in south-east Asia, where the mosquitoes that transmit it tend to be forest dwelling. As such, people who spend time in the forest in the evening and at night are most at risk of contracting P. knowlesi. Wearing long-sleeved clothing and insecticide while in the forest may help prevention in this case. P. falciparum is found throughout the world, and uses many different species of mosquito vector. In Africa, the mosquitoes which transmit P. falciparum tend to rest indoors and thus bite people at night while they are sleeping. Therefore, in these settings, it is especially beneficial to sleep under a long-lasting insecticide treated bednet. Indoor residual spraying, which coats the inside walls of a house with insecticide to kill indoor-resting mosquitoes, can also be beneficial.
by Malaria Q&A
QUESTION
Can malaria or the fever of malaria (or the medication) cause a teen to become depressed and suicidal 18 months on.
ANSWER
That is unlikely. Malaria, when treated, usually resolves completely, without any lingering effects. In some cases, people with severe cerebral malaria can have lasting neurological impacts, such as altered behaviour and difficulties with learning. Some studies have also shown that combat veterans who experienced cerebral malaria were more likely to suffer psychological effects after returning home, which included depression. However, again, a key feature of possible psychological conditions after malaria is that the patient experienced severe, cerebral, P. falciparum malaria. In other, non-complicated, cases of malaria, I have not found evidence for lasting psychological effects.
by Malaria Q&A
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.