Recurrence of Malaria Symptoms

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QUESTION

If a person suffering from malaria is given the proper treatment and he gets well but he again develops the symptoms of malaria..? These symptoms would arise from liver or blood? Who’ll be responsible for the recurrence of the symptoms?

ANSWER

Malaria can come back in three ways: first of all, the person could have been successfully treated, but then re-infected again by being bitten by an infected mosquito. In these cases, the person should focus on improved malaria prevention, such as sleeping under a long-lasting insecticide treated bednet.

Secondly, the patient could have recrudescence: when the patient takes medication, the treatment kills most of the malaria parasites in the blood, and enough so the patient feels better again, but some parasites still remain. Then, after the treatment finished, the parasite is able to replicate again, they increase in number in the blood and the patient feels ill again. In this case, you would say the infection came back from the blood, and the patient should take another dose of anti-malarials, but of a different kind to that which they originally had, in order to kill all of the parasites.

Finally, there is what is called relapse, which only occurs with two types of malaria: Plasmodium vivax and Plasmodium ovale. These are able to form dormant stages in the liver, so even when all the parasites are killed in the blood by the malarial treatment, these dormant forms survive. Many weeks, months or even years later, these dormant liver stages can re-activate and enter the blood again, causing new malaria symptoms. In this case, the liver was the source of the parasites. Again, the active blood infection should be treated with anti-malarials, but the patient should also talk to their doctor about taking primaquine, a drug which can kill any remaining dormant liver forms and thus prevent future relapses.

Malaria Beliefs

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QUESTION

How do beliefs and attitude affect the spread, treatment and prevention of malaria?

ANSWER

Accurate information and knowledge about how malaria is transmitted, diagnosed and treated is crucial to controlling the disease, for the general public living in malarial areas, travelers to these areas and health professionals. For example, many travelers are unaware that their destination is in a malaria transmission zone, so they do not take appropriate preventive precautions. Similarly, many travelers I have met believe that if they have had malaria once, they are immune and cannot get reinfected, so don’t bother protecting themselves from mosquitoes – this is not true, and they are inadvertently putting themselves at great risk.

In terms of endemic areas, the focus is on educating people about day-to-day preventive measures, such as sleeping under long-lasting insecticide treated bednets and indoor residual spraying. Educational campaigns that focus on simple, straightforward ways to prevent malaria are more likely to influence people’s attitudes and lead to better malaria control. Similarly, teaching people to seek accurate diagnosis and then ensuring they have appropriate treatment is an important step.

In some places, people feel they cannot afford to visit a doctor or clinic, or would rather place their trust in a traditional healer or healing herbs; since the most effective medications against malaria are treatments such as artemisinin-based combination therapies, which are available through official health sources such as clinics, believing in traditional medicine can lead to the malaria infection becoming very severe, and even resulting in death. As such, another component to control is making sure that medical services such as clinics are easily accessible even for the poorest people, provide good health care and are affordable.

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.

Malaria Recurrence and Treatment

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QUESTION

Since September 2011 I had malaria falciparum. The first medication I took was Coartem, after 2 weeks  I had the same symptoms then the test was +1.5 ,i took Coartem again. 2 weeks after the doctor gave me Malarone ,then 19 days it come back . the doc. gave me Quinine -tablets without doxycycline. but no thing change.

Until now each 14-25 days the malaria comes back, I ask my doctor to do any extra test or to do any thing else, but he told me that “I don’t have severe malaria.”  So why all this medication but i still sick??

On 10 feb 2012 I took Artequin. I feel better but after 15 days it came back , then I take Artequin again. I`m confused what to do?
PLEASE HELP!!!

ANSWER

I think I replied to the comment you made on the “Diagnostic Advice” Q&A post – I will copy the response I wrote there below:

It is certainly unusual to have such persistent malaria; usually Coartem cures it very quickly. Where are you obtaining your medication? It could be that the drugs you took were out of date (expired) or counterfeit; this can decrease efficacy and lead to a reduction of symptoms but not a complete cure. Also, what kind of test is your doctor using? If it is a blood smear, you might want to ask if another technician could read the slides, to double-check the diagnosis. I have seen cases elsewhere in Africa where doctors diagnose malaria by default without really examining the blood slide closely. You could try to get a malaria rapid diagnostic test; this looks for specific proteins associated with malaria infection in your blood, and can be more sensitive than blood slides. You can even perform these tests at home, so double check what the doctor tells you.

Otherwise, if you are truly getting re-infected very rapidly, you should look into more effective preventive measures against getting bitten by mosquitoes. This includes sleeping under a long-lasting insecticide treated bednet, wearing long-sleeved clothing at night and in the evenings and applying insecticide to exposed skin.

Child Has Recurring Malaria

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QUESTION

My two year old daughter was affected by malaria 9 months back we took proper course and also the follow up course of 6 weeks. After 2 months post 6 weeks she was infected again by malaria and now again she is getting fever and fear this could be malaria again.

ANSWER

If you suspect she might have malaria again it is important you go and get her tested immediately, as then the doctor can prescribe appropriate treatment. This is particularly important for young children, as they are most susceptible to severe malaria. You should also try to find out what type of malaria she had/has. Repeated attacks of malaria can occur three ways. The first is re-infection – the first infection was cured by the medication, but then your daughter was exposed to malaria again, through the bite of an infected mosquito. Preventative measures, such as making sure she sleeps under a long-lasting insecticide treated bednet, can help reduce the risk of re-infection. Secondly, it could be what is called “recrudescence” – this is when the treatment brings the number of parasites in the blood below detectable levels, and low enough so that symptoms subside.

However, once the treatment course stops, the parasite is able to replicate in the blood again, and symptoms return. This is rare if the full, proper course of medication is taken – in most circumstances, Coartem (artemether plus lumefantrine) should be the first line of treatment and it is very effective against preventing recrudescence. Finally, there is relapse. This only occurs with two species of malaria: Plasmodium vivax and Plasmodium ovale. In this case, the parasite is cleared from the blood by the treatment, but some parasites escape by laying dormant in the liver. These can then reactivate weeks, months or even years after the initial infection. Normal malaria medication can be given to treat relapses of infection, but an additional drug, called primaquine, should also be given, to kill the remaining dormant liver stages. Your doctor should be able to tell you whether he would recommend this drug for your child – they should also be tested for G6DP deficiency prior to taking the drug.

Typhoid and Malaria

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QUESTION:

Since i was suffering with fever for 5 days I consulted a doctor, have undergone blood test, and got typhoid as positive, but the treatment didn’t work. I was tested for malaria and result was positive. Ii’ve been given chloroquine for three days and primaquine for 28 days. After chloroquine was completed I started using primaquine. During this time I got fever and I got typhoid positive. My question is though iI’ve been treated for typhoid before malaria is conformed why it has come again?

ANSWER:

Typhoid and malaria are very different illnesses, caused by different disease organisms. Typhoid is caused by a Salmonella bacterium, whereas malaria is caused by single-celled animals, called protozoa, of the genus Plasmodium.

Typhoid is usually transmitted by eating food or drinking water which has been contaminated by sewage or handled by someone else with typhoid fever. It is usually treated with antibiotics; however, these antibiotics do not prevent re-infection with the disease. The best way to prevent re-infection is through washing food thoroughly in clean (boiled) water and by washing hands regularly, especially after going to the bathroom. There is also a vaccine against typhoid which you can get which will prevent further re-infection. As such, if you think you have typhoid again, you will need to visit your doctor again for more treatment, as it is unrelated to your malaria infection (apart that you might have been weakened by one infection, leaving you more susceptible to a second disease). While at the doctor, you should also have another test for malaria to ensure that the treatment was successful.