Malaria After Doxycycline?

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QUESTION

I recently spent a month in Asia. I took doxycycline tablets for malaria. I took them for the month I was away and when I returned. I took the full course and had been fine. Within two days of completing the course I became ill. This has be going on for about a month now with severe headaches, nausea, dizziness, very tired all the time and feeling like I’m going to faint. I have been to the doctor five times, they think this is a virus, I have been tested for malaria and dengue fever. I am only just now starting to feel better. What could this be?

ANSWER

Since you are beginning to feel better, I would go with your doctors’ diagnosis of a viral infection of some kind. It is also possible that you were infected with intestinal amoebas or even worms. A more accurate diagnosis would require faecal sample and possibly blood tests. You did the right thing by getting tested for malaria and making sure you didn’t have dengue.

Diagnostic Advice

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QUESTION

Healthy 30 year  old male, arrived in West Africa 2 weeks ago, using doxycycline as prophyaltic but not systematically—I know I missed a day or two, and had not taken it before arriving; lots of mosquito bites. Also believe my doxy to be expired—how long is it good for in capsule form? Doesn’t have expiry on my prescription. Symptoms showed up around day 7 in Mali: sore neck, headache, nausea, slight fever. Then left me for several days but returned strongly 5 or 6 days later at which time I went to pharmacy and began Artequin 600/750 (Artesunate + Mefloquine) – three day treatment. Felt better immediately after taking first dose. After second dose went to clinic for blood work for some reassurance but test came neg for Pl. falciparum; doc had warned that neg result is likely due to medication. The blood work showed my Lym # to be higher than normal range 74% vs range of 20-40%, however the clinician provided no comment and I only realized this after. Just took day three dose and don’t feel any worse but have some diareah, general discomfort. Not as intense as two previous waves of sore neck and nausea. Now resting but its awkward having no reassurance I have malaria. I read high lym (presuming this means lymphocyte—french blood result printout) count is generally due to viral infection.

Could I have a virus that may require a different form of treatment? Should I stay put at hotel hoping the malaise will pass or seek further medical assistance? (any consensus on what time frame for symptoms to pass?) Thank-you.

ANSWER

I have passed your question on to our advising medical doctors at malaria.com, and once they get back to me I’ll post it here. In the meantime, it might be worth knowing that although elevated monocyte levels can be associated with malaria infection, lymphocyte/general white blood cell counts tend to be decreased in malaria patients (I find it unusual that your value was given as a percentage rather than a number). As such, it suggests you might have some other infection, though it doesn’t have to be viral—there are other causes of elevated lymphocyte counts, such as bacterial infections, which can be tested for in a hospital.

Depending how long you are going to be in Mali for, you can either try to see a physician there who might be able to give you further tests (you should also have another malaria test a few days after you have finished the course of medication, especially if you still feel ill), or if you are feeling better, you could perhaps wait til you get home and talk to your primary care doctor there about other possible causes for elevated lymphocytes.

UPDATE: I’ve just heard back from one of our medical advisor. He suggests that it is quite unlikely you could have had malaria only 7 days after arriving in West Africa, since the incubation period is usually more like 2-3 weeks (and is often extended when people take anti-malarials). As such, it may be worth seeing a doctor to check whether you might have another infection, which is contributing to your illness and also might account for the high white blood cell count.