What Cell count defines malaria?

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QUESTION

What Cell count defines malaria??

ANSWER

If you are referring to the cell count for diagnosis, then really the answer is that if ANY malaria parasites are observed in a blood film, then the slide should be considered positive for malaria. Of course, some people can have low levels of parasite in their blood, which are not easily detected under a microscope, using a blood slide. These people are also obviously positive for malaria, but have less severe symptoms or indeed may not have any symptoms at all. If they have symptoms, they may need to seek an alternative form of diagnosis, such as a rapid diagnostic test (RDT) or PCR (polymerase chain reaction).

Multiple Malaria Infections Each Year

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QUESTION

My name is Olumide and I live in Nigeria. I have had malaria too frequently and it’s giving me a lot of concern. I had one last August 2012 and am having another one this October as I am speaking with you. If I should count it, I’ll be having nothing less than 6 occurrences in a year. It’s always an headache induced malaria whereby after using the ACT combination recommended by WHO, two days after, am still having headache, am asthmatic though and can’t use more than Paracetamol. I am tired of all these and need your help.

ANSWER

One of the key things you should check is how you are being diagnosed with malaria—the symptoms of malaria are very general, such as headache, chills and fever. I have seen cases where people assume they have malaria and so take ACTs without getting properly diagnosed, and so they never actually go to the doctor to have their real illness diagnosed. Therefore, next time you feel sick, you should go to the doctor or to a clinic and make sure they do a proper malaria test. This will either be via taking your blood and looking at it on a slide under a microscope, or by using a drop of the blood in a rapid diagnostic test (RDT). I believe that in some parts of Nigeria, you can even buy the RDT in local pharmacies, and do the test yourself at home. Only if you test positive for malaria should you take ACTs; if the test is negative, you should go to a doctor and ask about other possible illnesses with similar symptoms (such as flu, pneumonia, etc).

At the same time, it could be that you are suffering from repeated malaria attacks, in which case you will need to improve your personal protection in order to prevent future attacks. Sleeping under a long-lasting insecticide treated bednet is crucial; you should also wear long-sleeved clothing at night and at the evening since this is when malarial mosquitoes in Africa are usually most active. You may also want to consider indoor residual spraying; this coats the inside walls of your house with insecticide, further reducing the number of mosquitoes that may bite you inside your home. For more information, please see our Malaria Prevention overview page: http://www.malaria.com/overview/malaria-prevention

Malaria or Kidney Infection?

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QUESTION

Two months ago my daughter was in Uganda working and when came back to the States she was hospitalized for 4 days with Malaria symptoms. Her tests came back negative they really didn’t act like they knew how to treat this. They kept telling her they didn’t know how to diagnosis Malaria. So they treated her for it. She now after 2 months is once again hospitalized with the same symptoms. They are telling her they think it is a kidney infection. Can malaria be misdiagnosed as a kidney infection. She once again has all the symptoms as malaria?

ANSWER

What tests did the doctors do to try to diagnose malaria in your daughter when she first got back to the States? Usually, malaria is diagnosed by a blood test, whereby a trained technician will look at the patient’s blood under a microscope. The technician looks for signs of the malaria parasite in the patient’s blood, and if seen, can determine the intensity of the infection as well as the species of malaria. This is important information for accurate treatment. Alternatively, rapid diagnostic tests, which utilize a droplet of blood in a device which looks similar to a pregnancy test, and can very quickly determine whether someone is infected with malaria. It is important to know that malaria cannot be diagnosed by looking at standard blood parameters. If you don’t think your doctors know what is afflicting your daughter, you should take her to a clinic which specializes in tropical or travel medicine. There, they will certainly know how to effectively diagnose your daughter.

Given that your daughter experienced a resurgence of symptoms two months after returning, if she did have malaria, then there are two kinds which she might have: Plasmodium ovale and Plasmodium vivax. The other types of malaria, including the most deadly kind, P. falciparum, are not able to come back and relapse once they are treated. However, in order to prevent future relapses, your daughter may also have to be treated with another form of medication called primaquine. I will emphasize again, however, that it is crucial to gain an accurate diagnosis before taking any form of treatment for malaria.

Positive RDT After Malaria Treatment

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QUESTION

I have Pv malaria repeated 2 times in two month then doctor give arthemether, lumefantrine tablet for three days twice in a day and primaquine tablet for 14 days..after this treatment malaria show positive on rapid test by a faint line….what is this?

ANSWER

It sounds like your doctor has treated you appropriately. What the line on the rapid test means depends a bit on the type of test it was. Some of these rapid tests look for parts of the malaria parasite which the body recognizes as causing disease (called antigens)—sometimes, these antigens can persist a bit in the body even after the malaria infection has been cured. Therefore, that could explain a slight positive result in a  rapid test soon after treatment. It will be important to follow this up with a second rapid test, maybe in a week, just to make sure you do not have an active infection. You should also be aware that Plasmodium vivax can remain dormant in the liver (primaquine is used to kill these dormant forms), and if primaquine treatment does not work, you will still be ay risk of relapse but you will not have any malaria parasites in the blood, and thus even a rapid test will be negative.

Malaria Diagnosis

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QUESTION

How to identify malaria? My son has fever and headache for the past three days and also vomiting. Is treatment is necessary and what type of treatment he needs?

ANSWER

You need to take your son to the doctor or to a clinic where they can do a blood test to look for malaria. They will either look at his blood under a microscope or use his blood in a “rapid diagnostic test” (RDT), both of which can identify the presence of the malaria parasites in his blood. If he is positively diagnosed with malaria, then your son should receive treatment, probably a type of artemisinin-based combination therapy (ACT) – common brands include Coartem, Lonart and Alu (though there are many others). These are what the World Health Organisation recommends as first line treatment against non-severe malaria.

Given your son’s symptoms, you should certainly go for a malaria test, just in case. However, vomiting is not usually a symptoms associated with malaria, so it is also possible he has another infection, such as an intestinal parasite, or even a bacterial or viral infection. Unfortunately, the symptoms of malaria are very general, so you really need to have one of the blood tests I mention above in order to be sure that your son has malaria.

Untreated Malaria

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QUESTION

If I am infected with malaria and I get a wrong diagnosis and be treated for flu, can the other symptoms disappear but continue to experience severe headache especially on the right side temple and jawbone area combined with general weakness and numbness in the legs?

ANSWER

Certainly the symptoms of malaria can often be confused with other infections, including flu. Given that treatment for flu will often include anti-fever medications such as aspirin or paracetamol, these drugs may also ameliorate some of the symptoms associated with malaria, without actually curing them.

However, numbness in the legs is not usually characteristic of malaria infection, though headache and weakness could be—again, these are general symptoms of many other infections as well.

If you suspect you have been misdiagnosed and have malaria, you should ask your doctor for a blood test; these can also be carried out at any local hospital or clinic. There, by looking at your blood under a microscope or using it in a rapid diagnostic test, they will be able to determine accurately whether you have malaria.

Diagnostic Blood Test: Malaria in Nepal and India

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QUESTION

My daughter has returned from a 6 week trip to Nepal and then India. About 20 minutes into the flight home she developed pains and aches in her hips and legs, fever, generally feeling dreadful but no nausea or diarrhea. When she arrived after the 10 hour flight her temperature was 100.5. We were concerned about malaria, but when she saw her primary care doctor the next morning she felt much better and her temperature was normal.

Blood taken at that visit showed no sign of malaria, but the doctor said that she could develop a recurrence in 3-4 weeks time when blood test should be repeated to confirm malaria if present.

I don’t doubt her doctor, but do these symptoms suggest malaria? How common is it for an initial episode of malaria to show up as negative on blood tests? She started taking tablets 3 days before entering a high risk area and took them for 3 weeks, but stopped during a brief diarrheal illness and did not restarted her anti malaria tablets.

ANSWER 1 – From Malaria.com Editor:

I think your GP might be mistaken about this – the only way to diagnose malaria is through a blood test which is positive for the disease! I have never heard of any cases where the initial blood test is negative, followed by a positive recurrence several weeks later. There are cases were the initial level of infection is quite low, in which case sometimes the parasites can be missed when looking at the blood film; however, when symptoms are present, this is rare. Moreover, there is no biological reason for a recurrence in several weeks; usually, reoccurrence occurs when treatment is given and for whatever reason is unsuccessful, allowing the malaria parasites to come back (and this assumes they are positively observed in the first place!).

Another diagnostic option, if you want to double check, is to see if you can find a rapid diagnostic test for malaria, which uses a drop of the patient’s blood to look for proteins produced by the malaria parasite. Similarly, there are tests which look for antibodies against malaria; this kind of test, known as serology, is not good for diagnosing active infections since antibodies can persist after the infection has been cleared, but may give you an indication of whether your daughter was exposed to malaria at all during her time in Nepal. Both of these are even more sensitive than blood smears, and although not as common as blood smears, are available in many places, particularly through hospitals which have tropical medicine departments or experts. All in all, if your GP is insisting on a second malaria test in a few weeks, by all means there is no harm in doing that, but in the meantime I would seek a second opinion since I think it is more likely your daughter has another infection (possibly a gastrointestinal bug, or a viral infection) which may risk going undiagnosed if your GP fixates on malaria as the answer.

Regarding the symptoms, unfortunately the symptoms of malaria are very general and it is almost impossible to accurately diagnose the disease on the basis of symptoms alone, hence why a blood test is so important. The blood test, with positive observation of the malaria parasites, is also crucial to determine which species of malaria the patient has, which may have implications for the appropriate treatment.

Answer 2: From Malaria.com Medical Advisor (MD)

The diagnosis of malaria should always be considered for patients with a fever who have traveled to malaria endemic areas. Your concerns that this may be malaria are well founded. Malaria symptoms in the first few days of infection are similar to the early stages of many other febrile illnesses, including viral and bacterial infections. In malaria, the fever also typically waxes and wanes in the manner you described. Confirming the diagnosis requires detecting parasites or their products in a blood sample. The most common test involves inspecting blood under a microscope for the presence of malaria parasites. Sometimes early in the disease there aren’t enough parasites for detection by this method. For this reason, several blood smears taken at 12-24 hour intervals are sometimes required to rule out a diagnosis of malaria in a symptomatic patient.

Additionally, your daughter was vulnerable to infection because she stopped taking antimalaria medicines while traveling in a region of malaria risk. To offer protection, these medicines must be taken for the duration of the stay, and depending on the medicine, up to 4 weeks after the last possible malaria exposure.

Unfortunately most medical doctors in regions where malaria is very rare, like the the United States and Europe, have little experience diagnosing and managing malaria. I would advise you to seek attention at a travel clinic or infectious disease specialist without delay, where it is likely further blood tests will be undertaken immediately to establish laboratory confirmation, and the prompt initiation of treatment for malaria if present.

Can’t Get Rid of Malaria

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QUESTION

Each and every month I am suffering from malaria ..Treatment is also going on but I am unable to get rid of it.

ANSWER

It is very unusual to be reinfected so constantly with malaria. First of all, how are you getting diagnosed? You should be getting a blood test, and not relying on symptoms only; the symptoms of malaria are very general and it could be that you are suffering from something else entirely. The two main methods for accurate diagnosis are blood smear and rapid diagnostic test. The blood smear is used throughout the world, but can sometimes miss light infections (though if you feel sick, your infection is likely heavy enough to be detected by this method). The problem is that it requires a trained technician to take the sample, prepare it properly, and read it thoroughly and accurately. In my experience, many clinics, especially if they are rushed and busy, will not take the time to read a blood slide properly, and will just diagnose malaria without looking. This is really bad! It is very important to be properly diagnosed, so you can get the correct treatment, and if you don’t have malaria, you can be diagnosed for something else. The second kind of diagnostic is a rapid diagnostic test, or RDT. This looks for antibodies to malaria in your blood, and is very sensitive and quick. In an ideal world, you should try to have both done, to cross-check the results.

The next thing is to check whether you are receiving the correct treatment for the type of malaria that you have (if you are positively diagnosed with malaria). In many parts of the world, malaria has become resistant to some of the main medications used against it. Notably, this is the case in many places with Plasmodium falciparum, the most dangerous kind of malaria, which has become resistant to chloroquine in many parts of the world, to sulfadoxine-pyrimethamine (sold as Fansidar in many places) and also to mefloquine (sold as Lariam) in some places. As such, the World Health Organisation NEVER recommends these treatments be given as first line drugs against P. falciparum malaria – instead, they recommend artemisinin-combination therapies (ACTs), such as Alu, Coartem or Duo-Cotecxin. If you have been diagnosed with P. falciparum, you must try to take these kinds of drugs first. No resistance to ACTs has been reported, so if you take the full dose correctly, as prescribed by your doctor (and check to make sure the drugs are not expired), then you should be cured of malaria.

However, treatment does not stop you from getting infected again, and this is where prevention comes it. Preventing malaria is a cornerstone of control efforts. Since malaria is transmitted by a mosquito, preventing mosquitoes from entering the house, and particularly stopping them from biting you at night, is crucial. Screening all doors and windows can help stop mosquitoes from getting in, and in high transmission areas, many people will also spray inside their houses every once in a while with insecticides to kill any lingering insects. In addition, sleeping under a long-lasting insecticide treated bednet can drastically reduce the number of mosquitoes that are able to bite you at night. If you already have a net, it may be worth re-dipping it in insecticide (usually permethrin) to make sure it is still working effectively. The mosquitoes that transmit malaria feed at night, so if you are walking around outside in the evenings or at night, it is important to try to wear long-sleeved clothing, to prevent them from accessing your skin. All of these efforts will help prevent you from getting malaria again in the future.

Repeated Malaria

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QUESTION

Since January 2011 I got three times malaria. Is it come regularly? Last week also I got maleria and I took medicine but still I have mild headache and sweating feeling tiredenes in between..

ANSWER

The timing of the repeated malaria episodes you have experienced means that it could be recrudescence (where treatment does not completely kill all the malaria parasites in your blood), relapse (where the malaria goes dormant in your liver, then comes back—this is only caused by Plasmodium vivax and Plasmodium ovale malaria) or even re-infection.

However, first of all, the most important thing is to make sure you are properly diagnosed with malaria and secondly, that you receive the right type of treatment for the kind of malaria that you have.

The symptoms of malaria are very general (fever, chills, nausea, tiredness, aches) and can also be caused by many other illnesses and diseases. As such, in order to confirm you actually have malaria, you should have a blood test (thick and thin blood smear, looked at under the microscope by a trained technician, or a rapid diagnostic test (RDT). In some places you can buy these RDTs from local pharmacies and do the test yourself at home).

Depending on where you live, there may be different types of malaria present; in this case, if you do have malaria, it is important to find out which one you have.

P. falciparum is the most common kind in sub-Saharan Africa and first-line treatment is an artemisinin-based combination therapy, such as Coartem – most areas have P. falciparum that is resistant to chloroquine, so this is not appropriate as treatment, nor are sulfadoxine and pyrimethamine combinations (such as Fansidar).

If you have P. vivax or P. ovale, chloroquine may be used, again depending on where you are and whether resistance is known from your area or not. In addition, you might also talk to your doctor about taking primaquine to prevent future relapse and recurrence of the infection.

Repeated re-infection can be prevented by protecting yourself more thoroughly against getting bitten by an infected mosquito. For example, you should sleep under a long-lasting insecticide treated bednet, screen your windows and doors and wear long-sleeved clothing at night and in the evenings. Indoor residual spraying, which coats your walls with insecticide, can also prevent mosquitoes from persisting inside your home.