Malaria IgG Test

by

QUESTION
My uncle has been ill since returning from Belize, where he was bitten by multiple mosquitoes. He has every symptom of malaria, and did a malaria antibody IgG test, which came back high at 1.49 that was ordered by his primary care physician.

He has now been to a hematologist/oncologist and even an infections disease doctor who have both ignored the lab result. He has since done multiple biopsies and lab tests that reveal nothing. He continues to worsen, but they refuse to even consider malaria as an option of disease process. Please advise on steps that we can take to help get him well. We live in Oklahoma City, Oklahoma.

ANSWER
Transmission of malaria in Belize usually only occurs in mainland areas away from Belize City; as such, if your uncle was only there visiting the islands, for example, then while he may still have been bitten frequently by mosquitoes, it is unlikely he was infected with malaria.

Has your uncle ever traveled to other malarial areas of the world? I ask because one of the problems with the IgG test is that it looks for antibodies to malaria – as these can persist for a long time (weeks, months or even years) after the malaria infection has cleared, a positive IgG test just means that the patient was infected by malaria at some point, and doesn’t necessarily mean they have an active infection.

To check this, your uncle should ask his doctor (or better yet, an infectious disease or travel medicine specialist) to
check for an active malaria infection. This can be done two ways: either by looking at your uncle’s blood under a microscope (usually via thick and thin blood smears, the latter of which may be Giemsa stained) or by putting a drop of his blood into a malaria rapid diagnostic test (RDT). Both of these methods test for active infection, and depending on the type of RDT, both methods can also usually show which type of malaria has caused the infection. This is important in terms of ensuring the patient receives appropriate treatment.

I don’t know how you can convince your uncle’s medical team to give him a blood test, but that is the only definitive way to show he has malaria, if indeed that is what is causing his symptoms.

What Cell count defines malaria?

by

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

by

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

Positive RDT After Malaria Treatment

by

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 Self-Diagnosis

by

QUESTION:

I live in Nigeria and was wondering if there are ways to find out if I malaria without going to the doctor or a hospital?

ANSWER:

The current “gold-standard” for malaria diagnosis, at least of active infections, is through microscropy, where a trained technician looks at a droplet of your blood on a slide, and sees if any of your red blood cells are infected with the malaria parasite. Given the expertise required for this procedure, it is usually only available through a doctor or in a hospital setting. Moreover, this technique is not reliable for very low numbers of parasites, though most active malaria infections will be positively diagnosed.

However, in the last ten years, there has been a rise in the availability and effectiveness of so-called rapid diagnostic tests (RDTs) for malaria, which can be self-administered and so are able to be bought in a pharmacy and used at home. There are a wide variety of these tests, which work by using antibodies to detect the antigens produced by the malaria parasites. As such, the tests seem to be able to detect even low levels of parasitaemia, and in some cases can even tell you which kind of malaria you have. The tests usually come with all necessary materials, which include a lancet for pricking the fingertip for a drop of blood, although you should always check that everything is within the packaging (I have bought tests in Uganda which came without the buffer solution; this had to be purchased separately in this case). The WHO maintains a list of currently available RDTs (PDF).

Make sure the test you purchase is suitable for the type of malaria that is found in your region; many only test for P. falciparum, for example, which might not be appropriate for a region with high levels of P. vivax or other species.