QUESTION

I was in Zambia 3-4 weeks ago and had yellow fever shot and malaria pills. A week ago I got a severe headache. I suffer from migraines now and then but it wasn’t one. The headache has not passed. 4 days ago I was feeling really ill. I was extremely tired and disorientated. I am nauseated, but not all the time. Have no appetite. I generally feel ill, like something isn’t right. Exhausted and almost confused. I just don’t have a fever and haven’t had the entire time—that’s why I haven’t been to doc for tests. Is having a fever the main symptom for Malaria? I am not pregnant and am generally a very healthy person.

Not sure if I should go for tests or just wait a few more days?

ANSWER

Fever is certainly a key symptom associated with malaria, due to the way the disease progresses through the human body. However, if you were taking malaria pills, it might be that they suppressed the infection sufficiently to reduce your symptoms. I would certainly recommend having a malaria test, if just for peace of mind. If you test positive you can immediately be treated, and if you are negative and still feeling unwell, you can discuss other possibilities with your doctor. One thought might be worm infections – helminths such as hookworm, roundworm (Ascaris or Strongyloides) or whipworm are very common in Zambia and are associated with symptoms of tiredness, listlessness, headache and nausea. The tests for these diseases are usually easy to perform from either a stool sample or blood test, and treatment is likewise very straightforward, with a single dose of albendazole or mebendazole for Ascaris, whipworm and hookworm, and a series of doses for Strogyloidiasis (this parasite can be harder to get rid of, though it is still very treatable. Ivermectin is another possible drug for this helminth).