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.

Malaria Fever

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QUESTION

My Father aged 65 years was diagnosed with 2 types of malaria almost a week back. he has been given medicines but temperature is fluctuating and not coming down. all other organs are functionining properly except platelet count which is little less.

Now he has been suggested new medicines for a duration of 14 days.
How fast can he recover from this malaria and when will the fever come down?

ANSWER

When patients are given the appropriate treatment against malaria, the fever is usually reduced very quickly and the patient will start to recover after a few days. The right kind of treatment depends on the severity of the infection and the type (or, in your father’s case, types) of malaria the patient is infected with.

If your father was infected with P. falciparum alongside another type of malaria (probably P. vivax, P. malariae or P. ovale), then he should have first received an artemisinin-based combination therapy (ACT) drug first. These drugs combine artemisinin or a derivative (such as artemether, artesunate or dihydroartemisinin) with another anti-malarial, such as lumefantrine. Common brand names of these ACTs include Coartem, Alu and Duo-Cotecxin.

There are no reported cases of resistance to these combination therapies at present, so if your father continued to feel sick after completing this treatment, he should be re-tested for malaria; it is possible that the malaria parasites were killed, and his continuing fever was an after effect either of the medication or just an indication that the body was recovering from the infection.

If he was re-tested and found positive, then other second-line drugs can be prescribed. However, it is important to note that malaria is resistant to chloroquine in many areas, and so this drug is not suitable for treatment in these places. Similarly, resistance is widespread to sulfadoxine-pyrimethamines, such as Fansidar, and in south-east Asia, P. falciparum is also resistant to mefloquine (Lariam) in some cases. As such, your father’s doctor should be careful to prescribe him an appropriate treatment for the area in which he is living.

In addition, if your father was found to be co-infected with either P. vivax or P. ovale, then there is a chance of later relapse into malaria again, weeks or even months after the initial infection has been treated. This is because the parasites in these types of malaria can form dormant stages in the liver, where they escape being killed by the normal forms of treatment. In this case, your father should ask about the possibility of being treated with primaquine; the course is normally 14 days, so it may be that this is what his doctors have currently given him. If so, this will kill the dormant liver stages and prevent relapse. Prior to taking primaquine, patients should be tested for G6DP deficiency, as patients with this condition may become dangerously anaemic when they take primaquine.

Breeding Site Characterization of Anopheles Sinensis Larvae in Chinese Villages

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Characterizing the breeding site of Anopheles sinensis is of major importance for the transition from malaria control to elimination in China. However, little information is available especially regarding the characteristics and influencing factors of breeding sites of An. sinensis in Yongcheng City, a representative region of unstable malaria transmission in the Huang-Huai River region of central China.

The aims of this study were to determine the breeding site characteristics of An. sinensis and related environmental and physicochemical parameters, to find out which breeding site characteristics could best explain the presence of An. sinensis larvae, and to determine whether the breeding habit of An. sinensis has changed or not.

Methods

Random repeated cross sectional study was undertaken in six villages of the Yongcheng city characterized by different levels of the historical incidence of P. vivax malaria. The potential breeding sites of An. sinensis larvae in each village were examined twice per month both in the household courtyards and the village surroundings. The larval sampling was done by the standard dipping method. Some important breeding site characterizations were recorded and characterized. The anopheline mosquito larvae and emerged adults were identified to the species level morphologically and to sub-species by the ribosomal DNA PCR technique. Chi-square analysis and logistic regression analysis were applied to determine the importance of factors for explaining the presence or absence of An. sinensis larvae.

Results

According to the ribosomal DNA PCR assay, all sampled anopheline mosquito larvae and emerged adults belonged to An. sinensis. Only 3 containers that were sampled from the household courtyards were found to contain An. sinensis larvae. There were no differences in the species composition of mosquito larvae among containers that contained water in the household courtyards (P > 0.05). An. sinensis larvae were shown to be present in a total of 60 breeding sites in the village surroundings, this included 8 (13.3%) river fringes, 26 (43.3%) ponds, 23 (38.3%) puddles, and 3 (5.0%) irrigation/drainage ditches. Logistic regression analysis revealed that the breeding site type, water depth, chemical oxygen demand (COD), ammonia nitrogen, and sulphate were found to be the key factors determining the presence of An. sinensis larvae. Approximately 94.9% of An. sinensis larvae inhabited relatively large and medium-sized water bodies, with depths between 0.5 m and 1.0 m (73.3%), COD lower than 2 mg/L (75%), ammonia nitrogen lower than 0.4 mg/L (86.7%), and sulphate lower than 150 mg/L (58.3%), respectively.

Conclusion

These results indicate that the majority of An. sinensis larval breeding sites were relatively large and medium-sized water bodies with depths between 0.5 m and 1.0 m, and containing low levels of COD, ammonia nitrogen, and sulphate, respectively. For effective An. sinensis larval control, the type of breeding site, water depth, COD, ammonia nitrogen, and sulphate should be given higher priority over other factors in areas where it is the primary vector.

Authors: Xiao-Bo Liu, Qi-Yong Liu, Yu-Hong Guo, Jing-Yi Jiang, Dong-Sheng Ren, Guang-Chao Zhou, Can-Jun Zheng, Jing-Li Liu, Yun Chen, Hong-Sheng Li, Hua-Zhong Li and Qun Li

Full Article: Random repeated cross sectional study on breeding site characterization of Anopheles sinensis larvae in distinct villages of Yongcheng City, People’s Republic of China (PDF)

Source: Parasites & Vectors 2012, 5:58 doi:10.1186/1756-3305-5-58

Published: 23 March 2012

Copyright: © 2012 Xiao-Bo Liu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Malaria Countries and Map

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Geographic Distribution of Malaria Around the World

Where malaria is found depends mainly on climatic factors such as temperature, humidity, and rainfalls. Malaria is transmitted in tropical and subtropical areas, where:

  • Anopheles mosquitoes can survive and multiply
  • Malaria parasites can complete their growth cycle in the mosquitoes (“extrinsic incubation period”).

Temperature is particularly critical. For example, at temperatures below 20°C (68°F), Plasmodium falciparum (which causes severe malaria) cannot complete its growth cycle in the Anopheles mosquito, and thus cannot be transmitted. [Read more…]

Soil-Transmitted Helminths and Malaria in Pregnant Women on the Thai-Burmese Border

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Background: Deworming is recommended by the WHO in girls and pregnant and lactating women to reduce anaemia in areas where hookworm and anaemia are common. There is conflicting evidence on the harm and the benefits of intestinal geohelminth infections on the incidence and severity of malaria, and consequently on the risks and benefits of deworming in malaria affected populations. We examined the association between geohelminths and malaria in pregnancy on the Thai-Burmese border.

Methodology: Routine antenatal care (ANC) included active detection of malaria (weekly blood smear) and anaemia (second weekly haematocrit) and systematic reporting of birth outcomes. In 1996 stool samples were collected in cross sectional surveys from women attending the ANCs. This was repeated in 2007 when malaria incidence had reduced considerably. The relationship between geohelminth infection and the progress and outcome of pregnancy was assessed.

Principal Findings: Stool sample examination (339 in 1996, 490 in 2007) detected a high prevalence of geohelminths 70% (578/829), including hookworm (42.8% (355)), A. lumbricoides (34.4% (285)) and T.trichuria (31.4% (250)) alone or in combination. A lower proportion of women (829) had mild (21.8% (181)) or severe (0.2% (2)) anaemia, or malaria 22.4% (186) (P.vivax monoinfection 53.3% (101/186)). A. lumbricoides infection was associated with a significantly decreased risk of malaria (any species) (AOR: 0.43, 95% CI: 0.23–0.84) and P.vivax malaria (AOR: 0.29, 95% CI: 0.11–0.79) whereas hookworm infection was associated with an increased risk of malaria (any species) (AOR: 1.66, 95% CI: 1.06–2.60) and anaemia (AOR: 2.41, 95% CI: 1.18–4.93). Hookworm was also associated with low birth weight (AOR: 1.81, 95% CI: 1.02–3.23).

Conclusions / Significance: A. lumbricoides and hookworm appear to have contrary associations with malaria in pregnancy.

Author Summary: Intestinal worms, particularly hookworm and whipworm, can cause anaemia, which is harmful for pregnant women. The WHO recommends deworming in pregnancy in areas where hookworm infections are frequent. Some studies indicate that coinfection with worms and malaria adversely affects pregnancy whereas other studies have shown that coinfection with worms might reduce the severity of malaria. On the Thai-Burmese border malaria in pregnancy has been an important cause of maternal death. We examined the relationship between intestinal helminth infections in pregnant women and their malaria risk in our antenatal care units. In total 70% of pregnant women had worm infections, mostly hookworm, but also roundworm and whipworm; hookworm was associated with mild anaemia although ova counts were not high. Women infected with hookworm had more malaria and their babies had a lower birth weight than women without hookworm. In contrast women with roundworm infections had the lowest rates of malaria in pregnancy. Deworming eliminates all worms. In this area it is unclear whether mass deworming would be beneficial.

Citation: Boel M, Carrara VI, Rijken M, Proux S, Nacher M, et al. (2010) Complex Interactions between Soil-Transmitted Helminths and Malaria in Pregnant Women on the Thai-Burmese Border. PLoS Negl Trop Dis 4(11): e887. doi:10.1371/journal.pntd.0000887

Editor: Simon Brooker, London School of Hygiene & Tropical Medicine, United Kingdom

Copyright: © 2010 Boel et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This study was part of the Wellcome Trust Mahidol University Oxford Tropical Medicine Research Programme funded by the Wellcome Trust of Great Britain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

More information: Full text: Complex Interactions between Soil-Transmitted Helminths and Malaria in Pregnant Women on the Thai-Burmese Border (PDF)