Long and Short Term Effects of Malaria

by

QUESTION

What are the long term and short term effects of malaria in brief please?

ANSWER

The symptoms of malaria as an acute infection vary somewhat depending on the type of malaria, but usual signs include high fever (often in a cyclical pattern, with fever one day, then no fever for one or two days, then a recurrence of fever), chills, body aches and nausea.

For Plasmodium falciparum, the most deadly form of malaria, the infection can progress rapidly if left untreated, with organ failure, impaired consciousness, coma and even death occurring as quickly as a few days after the onset of symptoms.

If the patient is able to survive the infection, or gets treatment in time, there are usually no long term affects of malaria infection. Some people who have suffered severe cerebral malaria (from P. falciparum) may experience some longer term neurological effects. 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.

Child with Fever – Malaria Symptoms?

by

QUESTION

Three yrs old boy having fever every 20 days for past 5 times. Remains for 2-3 days. Can it be malaria?
Never got blood tested.

ANSWER

Recurrence of malaria every 20 days is not that common, but could be caused by two different events: (1) true relapse, whereby the boy is infected with either Plasmosium vivax or Plasmodium ovale, and the parasite is disappearing from his blood but re-emerging from dormant forms in the liver (called hypnozoites), or (2) what is known as recrudescence, whereby the parasite never disappears fully from the blood, but reduced enough to stop symptoms from being felt, then flares up again.

Both options can be treated, but require a blood test, to ensure that malaria is the correct diagnosis and also to distinguish between options 1 and 2 above, and different treatment will be required.

A blood test should be performed during a period where the boy is experiencing symptoms, as with both options above, if the infection is not “active” (i.e. few or no parasites are visible in the blood) a blood test may prove negative. Rapid diagnostic tests which look for antibodies might be a good choice in this instance, as they may detect even a non-active infection.

I am getting malaria every 6 months

by

QUESTION:

I am getting malaria every six months, after taken chloroquine medicine tablets. Is this  normal,when my resistance is low, or is it coming aging, is there any medicine to clear the malaria?

ANSWER:

While taking chloroquine can be used to treat malaria, it will not prevent re-infection, unfortunately. One thing to check though is whether you are living in an area where the local types of malaria might be resistant to chloroquine; if so, it will be worth seeing if you can be treated with artemisinin-based combination therapies (ACTs), such as Coartem or Lonart, instead.

Again, these will not prevent re-infection, however, so you need to also take other preventative actions, such as sleeping under a long-lasting insecticide treated bednet and wearing long-sleeved clothing in the evenings and at night to prevent mosquito bites.

It sounds from your question like you live in an area where malaria is common; however, if you are actually only travelling to malarial areas regularly, you could also ask your doctor about the possibility of taking preventative medicine against malaria for the time that you are travelling (these are called “prophylactics”).

You should also check which species of malaria parasite you are infected with – this can be determined when you are diagnosed with the infection, either through looking at your blood under a microscope or by using a rapid diagnostic test (RDT). If you Plasmodium ovale or Plasmodium vivax, there is a possibility that even though the initial acute phase of the infection is responding to treatment with chloroquine, the parasite is remaining dormant in your liver, and causing the recurrences every 6 months. In this case, you should ask your doctor about the possibility of taking a drug called primaquine, which kills these liver stages and prevents further relapse of the disease.

Will malaria come back?

by

QUESTION:

As a result of a blood test I have just been informed that at some time I have had malaria. Though I have no idea when this was. I once was ill for 4 days with what I thought was flu and that is the only occasion I can remember. Therefore I have never been treated for malaria. Could you please tell me if there is any chance the disease will come back.

ANSWER:

That will depend on the type of malaria you had. I presume you found out you were infected through a blood test – it is likely a test that looked for antibodies to malaria in your blood. These tests can sometimes differentiate between the different species of malaria, and so it is definitely worth asking the clinic or doctor that performed the test if they can give you this information. Your location, or places where you have travelled in the last 4 years, may also assist in determining which type of malaria you had. Given that you barely registered being sick, I would suspect that you probably didn’t have Plasmodium falciparum, which is usually the most severe kind; it also cannot survive dormant in your system for long periods of time, so if you happened to have this kind, you wouldn’t need to worry about it coming back (though of course you can still be re-infected by all types of malaria, so prevention is still important!).

However, the other three main types of malaria can linger in a patient’s body. P. malariae is the least acute of all the malaria species, and can survive for a long time in the bloodstream, meaning that some people can have the infection for long periods of time without really feeling sick. If the blood test you took looked directly for parasites in your blood, and you tested positive, it is likely you have this kind. Like all uncomplicated cases of malaria, it is easily treatable, and once cured, you won’t have worry about it coming back (again, you do still need to watch out for being bitten by mosquitoes and getting re-infected though!).

The final two types of malaria are P. vivax and P. ovale. These persist in the body in a slightly different way than P. malariae – these have a special life stage which can lie dormant in the liver. Months or even years later, these dormant stages can re-activate and enter the blood stream, causing the patient to feel symptoms again, such as fever and nausea. Therefore, if you find you tested positive for one of these two forms, it is very important to ask your doctor about receiving medication (called primaquine) that will specifically target the liver stages of the parasites, to ensure you don’t get a recurrence of the infection later on.

As I’ve mentioned a couple of times earlier in this response, a key thing to be aware of is that even if you don’t have a recurring form of malaria, or treat it successfully, you will still be susceptible to re-infection if you are bitten by an infected mosquito. As such, if you live in or travel to a region known to have malaria transmission, it is crucial to take steps to prevent infection. For example, sleeping under a long-lasting insecticide treated bednet greatly reduces your risk of being bitten by the mosquitoes that carry malaria; similarly, wearing long-sleeved clothing and insect repellent, especially at night when malaria mosquitoes are most active, is recommended. Finally, medication is available that can be taken to prevent malaria (these are called prophylactics). As they can be expensive and are not recommended to be taken over long periods of time, these tend to be used primarily by people travelling to malarial areas rather than residents. There are several different forms of these prophylactics available commercially; the one to use will depend on several factors, including where you are travelling to.

Illness from Uganda trip

by

QUESTION:

I just came back from a visit to Uganda Africa. I was unable to take Malarone as I had bad side effects. Vomiting. I was only exposed once when we walked into a swampy rain forest. This of-course was the only day I did not have repellent. We were taking the kids on a nature walk and the German volunteer got a little lost. I ran as fast as could out of the area. Started to feel tired and weak 7 days later, getting severe headaches and going from hot to cold. 5 kids ended up with Malaria shortly after our walk. (I found this out after my return).

A missionary on the plain said I must likely had malaria and gave me Lumartem. By the time I got home I was having sever diarrhea and real bad body aches, low grade fever. The doctor here took my blood but reported my results would take 7 days. I started taking the Lumartem, & I felt better, the runs slowed down the boy aches lessened. Now I am finished with my 3 day prescription Feel pretty good compared to how I felt b4. Still have stomach cramps and small runs. What now? Should I go have a blood test to see if its gone or just wait and see???

ANSWER:

Considering you were in Uganda, it is not unlikely that you didn’t also pick up some sort of intestinal bug or parasite, which might be responsible for the residual runs and cramps. However, it is certainly important to take a blood test to ensure that you have completely cured the malaria infection; P. falciparum is common in Uganda, and causes a very severe form of malaria. While it can’t come back directly once it has been cured, if treatment is not entirely successful small numbers can remain in your blood stream and then start reproducing again once you have stopped taking medication, resulting in what is called “recrudescence” of the infection.

If possible, try to find out from the doctor that performs the blood test what type of malaria you had/have, as this will also determine whether you need additional medication (called primaquine) to prevent recurrence or relapse of the infection at a later date. Recurrence is due to a dormant phase of the malaria parasite hiding out in your liver; while P. falciparum cannot produce these dormant phases (and therefore can only relapse if the initial blood infection is not completely cured), two other malaria parasites, called P. vivax and P. ovale, can have liver stages, and so you may need to take primaquine if you are found to have been infected with either of these types.

Primaquine for Malaria Treatment

by

QUESTION:

In India what is the duration of primaquine therapy in confirmed Malaria infection?

ANSWER:

Primaquine is usually used to kill the hypnozoite stages of Plasmodium vivax or P. ovale. This life stage of the malaria parasite can reside, dormant in the liver’s hepatocyte cells, even after the patient has completed the normal course of treatment for the infection; at this stage, the patient might not have visible malaria parasites in the bloodstream, and thus be considered “cured”. Despite this, the patient is actually potentially at risk from recurrence of malaria if the dormant liver hepatocytes re-enter the blood stream.

For this reason, patients with P. vivax or P. ovale should complete a course of primaquine in addition to the standard malaria treatment offered. The usual adult dosage for primaquine is 15-30mg base, taken orally, once a day for 14 days.