Malaria in Pakistan

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QUESTION

4 years ago I traveled to FATA Pakistan and in every year in the month of August I caught malaria. Last few days I feel much Headache and fever in the evening and go to doctor. He diagnosed malarial parasites in blood and has advised me take tab artem ds 2 BD for three days after complete the course I feel same headache fever with shivering. Please recommend something.

ANSWER

I am not sure which malaria treatment you have taken—was it just artemisinin, or a combination drug which also included another anti-malarial? The latter type is what is recommended by the World Health Organization (WHO); treatments only containing artemisinin are very effective short term, but can sometimes leave a few parasites alive at the end of the course, which not only may result in a recurrence of symptoms (known as recrudescence) but is very bad in terms of leading to drug resistance in the malaria parasite. However, it is also possible that you are merely experiencing some slight side effects to the medication you took; often these mild side effects are very similar to the symptoms of malaria! If you don’t feel better in a few days, it might be worth visiting the doctor again to check that you don’t still have malaria parasites in your blood.

Malaria in Namibia

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QUESTION

could you please let me know, whether or not a malaria prophylaxe injection is necessary for a 3-weeks trip by car in Namibia, starting mid August.

ANSWER

It depends on where you are going in Namibia. According to the US Centers for Disease Control, malaria is transmitted in Namibia in the provinces of  Kunene, Ohangwena, Okavango, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa and in the Caprivi Strip. As such, if you are travelling to any of these areas, you should consider taking medication to prevent malaria. Three types of medication are considered equally effective in these regions: atovaquone-proguanil (Malarone), mefloquine (Lariam) and doxycycline. Which one you decide to take is mainly a matter of personal preference, based on details such as how often you will need to take a tablet (every day for Malarone and doxy, once a week for Lariam), how long you want to take the medication (Malarone is started the day before your trip, and should be taken for a week after, doxy is also started 1-2 days before travelling but must be taken for 4 weeks after returning and Lariam is started 2 weeks before travelling and for 4 weeks afterwards) and price (Malarone is the most expensive, and doxy usually the cheapest). In addition, each has different potential side effects (Malarone usually has the fewest; doxy can result in sun sensitivity, and Lariam may have psychiatric side effects, and is not recommended for anyone with a history of mental illness).

Malaria Test – Can Malaria Return?

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QUESTION

I am working in Tanzania. I felt sick about 10 days ago and I went for a test for malaria and the test was positive. The doctor gave me some pills and said I must come back in one week for a test again. I went back and it was negative but now I don’t feel too good. Is it possible for the malaria to come back after 10 days?

ANSWER

It is unlikely that the malaria has come back, and if your malaria test is negative, then you probably don’t have malaria any more, and you can be confident the treatment worked. It sometimes takes a few days or even a couple of weeks to fully recover from the infection, since it takes quite a toll on the body’s immune system. Also, the medication you take to treat malaria can also have side effects, such as nausea and headaches, which actually seem similar to the symptoms of malaria itself.

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.

Severe Head Pain with Malaria

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QUESTION

Can severe head pain be a symptom of mistreated malaria? My son just returned from an 8 month trip to Ghana. He had malaria 3 times and typhoid 1 time. He is now dealing with a severe head pain in his frontal lobe.

He took doxycycline every day and when he got really sick, he took Coartem. He was finally sent home because they couldn’t figure out why he has such severe head pains. Where do we go from here? He has an MRI scheduled and an appointment with an Infectious Disease Doctor. I am afraid they will not know what to do to help him. I am seeking more advice. Hopeful…CT

ANSWER

Severe head pain is not associated with mistreated malaria, nor indeed is considered a possible lasting effect of malaria infection. You are doing the right thing by going to see a doctor, including one who is an infectious disease specialist—I hope they also have experience with tropical medicine, since in the US and Europe, many very well-trained doctors are still not very familiar with the types of infections which are more commonly observed in the tropics.

Your son was right to take Coartem when he had malaria, but do you know whether he went to a clinic for diagnosis first? The symptoms of malaria are very general, such as fever, chills, nausea and aches, and many people in malarial areas (particularly visitors) often assume they have malaria when in fact their symptoms could be caused by a number of other things.

Secondly, doxycycline is considered a very effective preventive medication against malaria, but only if taken properly. Since doxycycline can cause mild stomach upset, many people take it with milk, which can lessen these symptoms; however, the calcium in the milk can bind to the drug, preventing successful absorption and reducing its efficacy as a malaria preventive.

If your son had a diet high in diary products or took antacids while in Ghana, this could explain why he suffered several malarial episodes. Alternatively, if he took the drug regularly and correctly, and particularly if he did not seek diagnosis via blood test from a clinic, that may be an indication that he wasn’t suffering from malaria at all, and other causes should be explored.

Finally, one of the very well-described side effects of doxycycline is its tendency to cause people to become very sun sensitive. While this usually manifests itself in skin sensitivity, it could also be that your son has become more visually sensitive to light, which in itself could lead to severe headaches. I hope he feels better soon!

Malarone and Mefloquine for Malaria

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QUESTION

Which drug is better for kids for anti-malaria – Malarone or Mefloquine. I have heard about lot of side-effects of Mefloquine. So, which is a safer drug out of these two or is there any other drug with no side-effects? Is it important to take anti-malaria pills keeping in mind the side-effects?

ANSWER

Both drugs are considered safe for children, though Malarone (atovaquone-proguanil) should not be given to pregnant women or those nursing a child under 5kg. Malarone is also available in a pediatric form in some places, where the dose is reduced specifically for prescription to children under 40kg in weight. Personally, I took both Malarone and mefloquine (as Lariam) when I was a child, and experienced no side effects from either, though certainly many more people do report side effects from mefloquine, including disturbed sleep and hallucinations, or increased anxiety, and it is therefore not recommended for people with a history of psychiatric illness or disorders.

If this does not apply to you or your children, then it really is a matter of preference, cost and practicality. Malarone is generally more expensive than Lariam, needs to be taken every day, but only needs to be taken a few days before departing for the malarial area and for only one week after you return. Lariam, on the other hand, is only taken weekly (which can be an advantage with small children), but needs to be started 2 weeks before travel and for 4 weeks afterwards, which can make it less convenient for short trips.

The other thing to consider, finally, is where you are going—some forms of malaria found in south-east Asia are resistant to mefloquine, meaning it is not a suitable anti-malarial for travel in those areas, so Malarone would be a better choice in that circumstance. Both mefloquine and Malarone are suitable for travel in all other malarial areas.

Coartem Treatment

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QUESTION

my husband has been taking coartem for 3 days now. He was fine yesterday and then last night the symptoms re-appeared like it was day one. Can I carry on with coartem and start another course? Or shall I switch to something else ? If so, what? We live in zambia by the way.

Thank you for your help.

ANSWER

If your husband still has strong symptoms after taking all doses of the Coartem, go back to see your doctor  or to the clinic for another blood test. If it is positive, then your doctor may recommend trying a different form of anti-malarial medication—artemisinin-based combination therapy (a group of medications that includes Coartem) is recommended as the first-line treatment against malaria, but a second line option could be atovaquone-proguanil (Malarone) or another medication. Please note that Fansidar (sulfadoxine and pyrimethamine) and chloroquine are not recommended for use in Africa as levels of resistance are high. 

It could be that the medication hasn’t had time to fully act, which is why it is important to wait until the full dose has been taken, and then to confirm that malaria is still present. Sometimes the side effects of anti-malarials can appear similar to malaria itself, such as nausea, chills, body aches, etc, so it is important not to start another course of treatment without further diagnosis.

We are actually very interested in learning about our readers’ experiences with anti-malarial medications, and so we would be very grateful if you might be able to take a few minutes to complete our malaria survey we are running on Malaria.com. We will post any findings that may be of interest to our readership on Malaria.com later this year—all submissions are completely anonymous. Many thanks for your time and help, and I hope your husband recovers fully soon.

Malaria Prophylaxis in Ghana, Africa

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QUESTION

My husband will be traveling to Ghana soon. We have Mefloquine and Primaquine. Which one do you think is best for prophylaxis in Ghana? He also has Fansidar, but we understand it’s best not to use this for prophylaxis. Thank you for your help!

ANSWER

There are positives and negatives associated with both of these medications. Mefloquine is recommended for travelers in Ghana (whereas the Centers for Disease Control does not explicitly recommend primaquine for this area, since primaquine is particularly effective against Plasmodium vivax malaria, which is almost completely absent from West Africa), and only has to be taken once a week (primaquine must be taken daily).

A disadvantage with mefloquine is that you must start taking it 2 weeks before your trip, whereas primaquine can be started as little as 1-2 days before travel; mefloquine is also not recommended for people with a history of psychiatric or mental problems, as it can cause severe side effects. Even healthy individuals often report disturbing dreams or increased agression/anxiety while taking mefloquine. However, one major disadvantage to primaquine is that you must be tested for G6DP deficiency prior to taking it – your husband may have already done this, prior to being prescribed the drug. People with G6DP deficiency should not take primaquine.

Overall, the decision comes down to personal preference, though from a disease perspective, mefloquine would probably be the better choice for travel to Ghana, given the higher prevalence of P. falciparum malaria in this region, as opposed to P. vivax. Other options to consider would be atovaquone-proguanil (Malarone – expensive, taken daily, but very effective and very well tolerated by most people, with very low side effects) or doxycycline (very cheap, taken daily, is an antibiotic so can prevent some other infections but often results in sun sensitivity, which can be a problem in the tropics). Both of these can be started 1-2 days before arriving in the malarial area.

After you come back, I would be very grateful if you could take our malaria medication side effects survey, as we are very interested in hearing from our readers what their experiences with malaria prophylaxis and treatment have been.

Affected by Lariam… How to Help?

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QUESTION

Five years ago my husband was working in Africa. To get protection against malaria, he took Lariam. Since then, he became strange, poor sleep, constant depression, insecurity and distrust, inability to concentrate, forgetfulness, anger, strange behavior.

I insisted to see a doctor, but he refuses, saying that this is the problem of diabetes (he has type 2 diabetes) and stress at work.We living 12 years together, I can clearly see it’s more than that.
I tried many different things to prove that he was effected by Lariam to get help. But it did not work. All that I got “I m not crazy.” He’s not but not normal either. it’s ruining our family and lives. We have 2 kids.

Is there any method for establishing the presence of problems (blood test, etc.)?  I was hoping that after he stopped taking Lariam he will feel better. It took 4 years, but no significant changes. How to help him, and is it possible?

ANSWER

Thank you for your question—I am sorry to hear that your husband has been so negatively affected by Lariam. His symptoms are certainly consistent with some of the more unpleasant side-effects of mefloquine (the generic name for Lariam), which have been well reported over the years, and which many sufferers claim have continued long after they have stopped taking the drug.

Lariam was the anti-malarial drug of choice for the US military for many years, and a significant number of servicemen returning from Somalia and Iraq have reported back to the Army’s Surgeon General’s office regarding their on-going psychological symptoms. You can read a report about some of these Lariam cases here.

Roche, the pharmaceutical company that makes Lariam, has recently conceded some of the severe side effects that are associated with the drug, and “Lariam-induced psychosis” is a valid medical diagnosis for people who present with symptoms of paranoia, aggression, anger, hallucinations and other psychological side effects. As such, I think it is important for your husband to realise that you don’t think he is crazy, but that he might be suffering from the late-lasting after effects of a medication, similar effects to that felt by hundreds of US servicemen and other people who have taken Lariam.

Showing him the above document, or many other reports of people will long-lasting Lariam side-effects, might help him realise this is not about being crazy, but about side effects over which he had no control. If he is willing to see a psychiatrist, with the understanding that what he is experiencing is not his fault at all, then you might be able to find some solutions to his behavioural changes.

 

Malaria Drugs Side Effects

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QUESTION

I was affected by malaria 5 months back. I am feeling tiered and weakness and heart trembling symptoms.

Any suggestions to overcome weakness?

ANSWER

Your fatigue is probably not caused by the treatment—one of the potential residual effects of malaria infection is iron deficiency, which can lead to anaemia, and this can cause tiredness. Eating iron-rich foods or asking your doctor about iron supplements might help if indeed you find your iron levels are too low. Recovery from any illness can sometimes take a long time, and getting plenty of rest, eating well and keeping well hydrated will all help you to regain your strength.

If you have recently taken malaria medication, perhaps you would be willing to spend a few minutes to take our Malaria Medication Side Effects Survey? We are very interested in hearing about the experiences of people who have taken different types of malaria medication, and particularly any side effects they have experienced. The survey should only take a few minutes and will be anonymous; we will publish the results on the website for you to see. Many thanks for your assistance!