Can malaria be dormant for years?

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QUESTION

My child (age 5 at time) was bitten by something in Mexico that looked like a mosquito bite. About 7 days later we were home in the US and she developed high fever, headache, chills,sweating at night, extreme fatigue,abdominal pain, and swollen lymph nodes in neck. She had a fever for 40 days! I took her to the pediatrician almost every other day and had immediately informed them of the bite in Mexico and asked if they could test her for malaria. They laughed at me and said that is not high malaria area.

Her wbc was 30,000ish and liver enzymes 1000–tons of other blood work got lost. I had researched and agreed but told them it still exits there even if it is low. So 3 years later she still has swollen lymph nodes in neck that are bigger and now in the axillary and groin area, always sweats in the middle of the night, pale, and very tired. Dr. tells me not to worry about the lymph nodes but it is hard not to. I have bypassed her finally and talked with an infectious disease doctor that suggested we get a lymphnode biopsy. We have an appt w/an hem/onc Dr in 5 days. If they were to biopsy a lymph node could it show Malaria this late or would it have to be the liver or could they do a blood smear this late? She also has had low amounts of myoglobin in her urine for about a year.

ANSWER

I replied to an earlier version of this post—reading your subsequent details, I think it is unlikely that the cause is malaria, but rather an infection or indeed another disorder which would result in elevated WBC and enlarged lymph nodes. A biopsy at this stage would not be able to diagnose malaria—a blood test would only reveal an active, blood-borne infection, which would be associated with high fever and other “typical” malaria symptoms. If your daughter is experiencing these (though fever/sweats at night are not particularly associated with malaria), a blood test could put your mind at rest by eliminating malaria as a cause. However your pediatrician will be better placed to discuss other possible diagnoses which correspond to the symptoms.

Is malaria possible years after bite?

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QUESTION

My child had a fever for 40 days after returning from a cruise 3 years ago. I begged the pediatrician to test for malaria because she got bit by something in Mexico but they laughed at me. She has had swollen lymph nodes on both sides of her neck for 3 years and all the docs tell me you can have swollen lymph nodes forever but now she has them in her groin and under arm on left side. She is pale and tired all the time. I took her back to the pediatrician and her cbc was normal so the dr is blowing it off. Malaria and Lymphoma are on my mind. My question is, Can malaria live in the body that long without it killing you?

ANSWER

Malaria can certainly survive in the body for a long time, but usually would present as recurring episodes of fever rather than enlarged lymph nodes (the malaria parasites reside dormant in the liver). There are two types of malaria that can reside in the body for extended periods: Plasmodium vivax and P. ovale. The former is found in parts Mexico, but cases of malaria are rare, especially in coastal areas. Unfortunately, malaria can only be detected when it enters the blood again – this occurs during the fever episodes. So, if your daughter does have a fever again, it might be worth asking for a malaria test, and specifically to look for P. vivax. If positive, there is a drug, primaquine, which can be taken to kill the remaining liver stages of malaria and prevent further relapses. However, overall, your daughter’s case doesn’t sound like malaria. What was your daughter’s Hb level? Anemia could explain the pallor and lethargy, though your pediatrician should have spotted that on the blood tests.

Is there malaria in North America?

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QUESTION:

Are there malaria-infected mosquitoes in North America?

ANSWER:

North America is usually defined as including Canada, the United States and Mexico. Of these, Mexico has known regions of regular malaria transmission; specifically the regions bordering Guatemala and Belize in the south (Chiapas, Quintana Roo and Tabasco), rural areas in the tropical lowlands slightly further north (parts of Oaxaca, Nayarit and Sinaloa) and a very localised section of northern Mexico, located across the states of Chihuahua, Sonora and Durango. Travellers to these areas are recommended to take measures to prevent against malaria infection, such as minimising mosquito bites or taking prophylactic medication. Both P. falciparum and P. vivax are known to be transmitted in Mexico, so you should consult with a travel physician before deciding which form of preventative (prophylactic) medication to take, depending on the length of your stay, your budget and the type of malaria most commonly found in the area to which you are travelling.

Malaria was once also widespread in the southern USA, though a concerted public health campaign that started in 1947 (mainly consisting of reducing the number of mosquitoes through insecticide spraying and control of stagnant water bodies) greatly reduced transmission and led to the disease being considered eliminated by the 1950s. Occasionally, small pockets of transmission will be reported, though stringent diagnosis and treatment quickly places these outbreaks under control once more.

However, there are additional cases of malarial mosquitoes occasionally also reported even from northern parts of the United States and Canada; these are when mosquitoes are accidentally transported from malarial regions, for example in airplanes, in luggage or in shipping containers. These mosquitoes almost never transmit the disease to people, and in most temperate regions, do not live long enough to be a public health threat or to enable the persistance of the disease.