Can malaria be dormant for years?

by

QUESTION

My child (age 5 at time) was bitten by something in Mexico that looked like a mosquito bite. About 7 days later we were home in the US and she developed high fever, headache, chills,sweating at night, extreme fatigue,abdominal pain, and swollen lymph nodes in neck. She had a fever for 40 days! I took her to the pediatrician almost every other day and had immediately informed them of the bite in Mexico and asked if they could test her for malaria. They laughed at me and said that is not high malaria area.

Her wbc was 30,000ish and liver enzymes 1000–tons of other blood work got lost. I had researched and agreed but told them it still exits there even if it is low. So 3 years later she still has swollen lymph nodes in neck that are bigger and now in the axillary and groin area, always sweats in the middle of the night, pale, and very tired. Dr. tells me not to worry about the lymph nodes but it is hard not to. I have bypassed her finally and talked with an infectious disease doctor that suggested we get a lymphnode biopsy. We have an appt w/an hem/onc Dr in 5 days. If they were to biopsy a lymph node could it show Malaria this late or would it have to be the liver or could they do a blood smear this late? She also has had low amounts of myoglobin in her urine for about a year.

ANSWER

I replied to an earlier version of this post—reading your subsequent details, I think it is unlikely that the cause is malaria, but rather an infection or indeed another disorder which would result in elevated WBC and enlarged lymph nodes. A biopsy at this stage would not be able to diagnose malaria—a blood test would only reveal an active, blood-borne infection, which would be associated with high fever and other “typical” malaria symptoms. If your daughter is experiencing these (though fever/sweats at night are not particularly associated with malaria), a blood test could put your mind at rest by eliminating malaria as a cause. However your pediatrician will be better placed to discuss other possible diagnoses which correspond to the symptoms.

Diagnostic Advice

by

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.

White Blood Cells and Malaria

by

QUESTION

Does malaria cause loss of white blood cells / antibodies?

ANSWER

The parasites that cause malaria reproduce in the human host by infecting red blood cells, then multiplying asexually and bursting out into the bloodstream, ready to infect more red blood cells.

As such, malaria parasites do not destroy white blood cells. However, patients with malaria may display reduced white blood cell counts during blood tests; this is usually thought to be due to relocalization of the white blood cells from the limbs (where blood is usually taken from during these tests) to the spleen and other internal organs also affected by the malaria infection.

As for antibodies, the malaria parasites contain antigens, which are proteins that cause an antibody response in the patient, thus usually resulting in an increase in antibodies during infection, especially if the patient has been exposed to malaria previously.