Symptoms of Malaria but Tests Negative

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QUESTION

My sister has been suffering from fever from past 22 days temperature varying from 102-106 with chills shivering, headache, body pain,nausea and muscle ache but tested negative for malaria. She also tested negative for dengue, swine flu, hiv, and many others.  So out of frustration we gave her mefloc 250 and she seems to be responding. She is still having fever that is after 12 hrs of medication but the temprature is ranging between 98-100 and there is no headache and no chills and shivers.  Now we are confused how to confirm that it is really malaria and when will the fever stop completely. Should we shift her to a some other hospital at present she is in Pune.

ANSWER

The diagnosis of malaria is confirmed by observing parasites on a blood smear.  There are also Rapid Diagnostic Tests (RDT) that can be done with a pin prick of blood, but the blood smear is the definitive test. It is possible, that in your sister’s case,  a proper malaria test was not done or not interpreted correctly, and she does have malaria and it is responding to the medicine.   Alternatively it could be that your sister does not have malaria, but suffers from another problem that coincidentally is resolving itself at the same time the anti-malarial medicine is given.  It is hard to determine exactly what is wrong, but the good news is that she is getting better.

Sometimes medicine is given on presumption of illness which is what happened in your sister’s case. However, if someone has uncomplicated falciparum malaria, (most prevalent in India)  WHO recommends Artemisimin Combined Therapy (ACT), which uses an artemisinin compound with another anti malarial, such as mefloquine, not mefloquine alone.  If your sister’s fever returns, make sure to have a blood smear taken to see if it is malaria or not, and if so what kind of malaria it is, to better tailor her medicine.

Can my 14 day old daughter have malaria?

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QUESTION

My 14 day old daughter has a body temperature of about 38.3 C and breathes a bit rapidly.  Can it be a sign of malaria?

ANSWER

In newborns, it is sometimes difficult to tell exactly what is wrong.   The majority of newborns who get sick after delivery,  get an infection (from bacteria, not malaria).  WHO and UNICEF have identified the following “danger signs.” If the baby has  one or more of the following signs, take the baby to a hospital with qualified personnel and drugs immediately. Once there, the staff can treat the baby and test for malaria if indicated.

 

  1. Not feeding since birth or stopped feeding
  2. Convulsions
  3. Respiratory rate of 60 or more
  4. Severe chest indrawing
  5. Temperature ≥ 37.5 C
  6. Temperature ≤ 35.5 C
  7. Only moves when stimulated, or not even when stimulated

or        Yellow soles (sign of jaundice)

Signs of local infection:

  1. Umbilicus red or draining pus, skin boils, or eyes draining pus

All newborns, infants and young children in malarial areas  need to be protected from malaria and should sleep under an long acting, insecticide treated bed net.

 

Relapsing Malaria

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QUESTION

I’m constantly on malaria drugs, fall ill every 2 weeks and always diagnosed with malaria.I’m getting really fed up and need a permanent solution to all of this. I want to live a healthy life and I’m tired of being on malaria drugs. How do I overcome malaria permanently?

ANSWER

It is very unusual to be reinfected so constantly with malaria. First of all, how are you getting diagnosed? You should be getting a blood test, and not relying on symptoms only; the symptoms of malaria are very general and it could be that you are suffering from something else entirely.

The two main methods for accurate diagnosis are blood smear and rapid diagnostic test. The blood smear is used throughout the world, but can sometimes miss light infections (though if you feel sick, your infection is likely heavy enough to be detected by this method). The problem is that it requires a trained technician to take the sample, prepare it properly, and read it thoroughly and accurately. In my experience, many clinics, especially if they are rushed and busy, will not take the time to read a blood slide properly, and will just diagnose malaria without looking. This is really bad!

It is very important to be properly diagnosed, so you can get the correct treatment, and if you don’t have malaria, you can be diagnosed for something else. The second kind of diagnostic is a rapid diagnostic test, or RDT. This looks for antibodies to malaria in your blood, and is very sensitive and quick. In an ideal world, you should try to have both done, to cross-check the results.

The next thing is to check whether you are receiving the correct treatment for the type of malaria that you have (if you are positively diagnosed with malaria). In many parts of the world, malaria has become resistant to some of the main medications used against it. Notably, this is the case in many places with Plasmodium falciparum, the most dangerous kind of malaria, which has become resistant to chloroquine in many parts of the world, to sulfadoxine-pyrimethamine (sold as Fansidar in many places) and also to mefloquine (sold as Lariam) in some places. As such, the World Health Organisation NEVER recommends these treatments be given as first line drugs against P. falciparum malaria—instead, they recommend artemisinin-combination therapies (ACTs), such as Alu, Coartem or Duo-Cotecxin. If you have been diagnosed with P. falciparum, you must try to take these kinds of drugs first. No resistance to ACTs has been reported, so if you take the full dose correctly, as prescribed by your doctor (and check to make sure the drugs are not expired), then you should be cured of malaria.

However, treatment does not stop you from getting infected again, and this is where prevention comes it. Preventing malaria is a cornerstone of control efforts. Since malaria is transmitted by a mosquito, preventing mosquitoes from entering the house, and particularly stopping them from biting you at night, is crucial. Screening all doors and windows can help stop mosquitoes from getting in, and in high transmission areas, many people will also spray inside their houses every once in a while with insecticides to kill any lingering insects.

In addition, sleeping under a long-lasting insecticide treated bednet can drastically reduce the number of mosquitoes that are able to bite you at night. If you already have a net, it may be worth re-dipping it in insecticide (usually permethrin) to make sure it is still working effectively. The mosquitoes that transmit malaria feed at night, so if you are walking around outside in the evenings or at night, it is important to try to wear long-sleeved clothing, to prevent them from accessing your skin.

All of these efforts will help prevent you from getting malaria again in the future.

Malaria Statistics in South Africa

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QUESTION

What are the statistics of malaria in South Africa from 2002-2011 for males and females?

ANSWER

It is difficult to find statistics across time that are detailed enough to distinguish between the sexes. However, I have found a website collates information about malaria in southern Africa specifically, and this link will take you to a figure on that site which shows the number of cases for three regions of South Africa for almost the last 20 years: Malaria in Southern Africa.

Another source to look at is the World Health Organisation World Malaria Report from 2011, which for the first time, presented information on malaria cases and deaths from 99 individual countries. The website for that report, which can be freely downloaded can be accessed via this link: WHO World Malaria Report 2011.

Sterilizing Mosquitoes to Fight Malaria

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QUESTION

Is it possible to breed mosquitoes in the laboratory and then sterilize them and release them into the environment in order to reduce their rate of reproducing.

ANSWER

That is a very good question, and indeed efforts to genetically modify mosquitoes in order to control the various diseases they transmit are underway in many laboratories across the world.

For almost 15 years, scientists have had the ability to modify mosquitoes so that they are sterile. The aim, as you rightly describe, is then to release these sterile mosquitoes into the wild in order to reduce numbers. If the gene that causes sterility can be passed to future offspring, without any reduction in survival of the insect, then the eventual result will be a total population extinction.

To date, many of the major mosquito disease vector species have been successfully genetically modified, though there are many fewer instances of field testing of these modified insects. For example, in 2000/2001, a World Health Organisation-led project in India created sterile mosquitoes of one species of each of the three main disease vector genera: Culex, Aedes and Anopheles, the latter of which acts as vectors for malaria. However, the project did not, in the end, release any of the modified Anopheles vectors into the wild.

While many scientists applaud the benefits of this approach (such as being very species-specific and being more environmentally friendly than spraying), there are also causes for caution. For example, there are concerns that the loss of mosquitoes in the food chain will have a negative impact on animals that rely on them for food. Similarly, if mosquitoes vanish from an ecosystem, their “niche” may be filled by another organism that is equally or even more dangerous and destructive, such as a crop pest or another disease vector. There is also a worry that changing mosquitoes may have unexpected and dangerous effects on the disease itself, for example forcing it to evolve into a more severe disease or changing its epidemiological patterns in ways we cannot predict in advance.

Finally, not all scientists are convinced that the approach will work in the first place—the sterile mosquitoes will have to survive equally well or better than normal mosquitoes in order to establish in the population, and must be equally or more successful at reproducing. As such, while a lot of money is being poured into GM mosquitoes, it is still the center of vigorous debate.

Perhaps the best indication of this controversy came last year, when Oxitec, a British company, released sterile Aedes aegypti mosquitoes on the Cayman Islands. These mosquitoes are the vectors of dengue fever, and so all eyes are on this study to see whether indeed sterile mosquitoes can survive in a population, and if they do, what other effects they will have longer term on the population size of mosquitoes and the rest of the ecosystem. You can read more information about that here: Oxitec: GM Mosquito Factory.

What does the goverment do to help malaria?

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QUESTION

Does the goverment help malaria?

ANSWER

Many governments around the world assist in controlling malaria. Some countries, like Australia and the United States, used to have malaria transmission occur within their own borders, but through dedicated control programs, have managed to eradicate the disease locally. In these cases, the government coordinated huge programs of draining standing water, spraying insecticides and ensuring that health clinics were equipped to diagnose and quickly treat any human cases.

Nowadays, the governments of the US and Australia, along with many other countries which do not have malaria, still assist in the fight against malaria by funding malaria control programs in other countries, either directly (for example, the US funds international health projects through the US Agency for International Development) or indirectly, through international organisations like the World Health Organisation and the Global Fund for HIV, TB and Malaria. They also provide training in technical expertise to scientists, doctors and clinicians from malaria-endemic countries.

The governments of countries which have malaria are also deeply engaged in fighting the disease, mostly through their respective Ministries of Health, which often have specific malaria departments. In India, for example, malaria control is carried out by the National Vector Borne Disease Control Programme (NVBDCP), which is part of the Directorate General of Health Services. The NVBDCP carries out a multi-pronged strategy to combat malaria, including early case detection and treatment, vector control (with spraying, biological control and personal protection), community participation, etc. In Uganda, the Malaria Control Programme also carries out the above activities, and also provides intermittent preventative treatment against malaria for young children and pregnant women and has in the past engaged in large-scale distribution of long-lasting insecticide treated bednets. Both countries also explicitly include monitoring and evaluation as part of their control strategies, to make sure that any interventions or control efforts they make are having a positive impact on reducing malaria morbidity and mortality.

How Many Malaria Deaths in Africa?

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QUESTION

What is the estimated number of deaths in Africa caused by malaria each year?

ANSWER

The exact numbers of deaths caused by malaria every year is very difficult to measure accurately, due to difficulties in diagnosis and also failure to report cases. However, the Roll Back Malaria partnership, coordinated by a host of international organisations including the World Health Organisation, estimates that last year approximately 801,000 people died of malaria in Africa, which represents over 90% of the total annual worldwide deaths. Of those, the vast majority of victims were children under the age of five.

Malaria Deaths by Country

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QUESTION

Where are the most deaths of malaria?

ANSWER

Over 90% of the deaths from malaria occur in sub-Saharan Africa, and in children under the age of five. According to the World Health Organisation’s 2011 World Malaria Report, the countries with the five highest numbers of reported malaria deaths for 2010 are (and number of reported deaths): Kenya (26,017 deaths), Democratic Republic of Congo (23,476), Tanzania (15,867), Burkina Faso (9,024) and Uganda (8,431).

However, it is important to note that this indicates the number of reported deaths that were confirmed as malaria; there are other countries in Africa which may have similar levels of malaria mortality but insufficient health infrastructure for accurate diagnosis of cause of death or reporting. Even in countries where reporting levels are high, causes of death are not always accurately determined.

Malaria, Hepatitis and Cholera Deaths

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QUESTION

Up to now how many people died of malaria?

Up to now how many people died of Hepatitis A?

Up to now how many people died of Cholera?

ANSWER

It is believed that malaria is singly responsible for the most deaths of humans in history. However, the exact number is impossible to know. Our modern concept of disease as caused by a particular organisms or pathogen is very new, having only really developed in the 19th century, though dating back to the work of Anton van Leeuwenhoek in the late 17th century (he has since been described as “the father of microbiology”).

As such, in the past, diseases were often mistaken for each other, and particularly since malaria has such general symptoms (fever, aches, chills—these are commonly seen in many other illnesses as well), it is hard to determine what people actually died from malaria and which died from other causes. Indeed, this difficulty remains today, making it hard to estimate accurately the number of people who die from malaria even now. The World Health Organisation currently estimates that approximately 700,000 people died last year of malaria, from close to 700 million cases – this actually represents a very low death rate, thanks is large part to global efforts to improve access to diagnosis and treatment.

Hepatitis A is far less common than malaria; there are an estimated 1.4 million cases per year. Most of these are asymptomatic or mild, with a low fatality rate (4 deaths per 1000 people infected in people under 50; that rises to 17.5 per 1000 for people over 50, as older people tend to have more severe manifestations of the disease and a greater risk of subsequent liver complications – note that these data are from the CDC back in 1991). There is a very safe and effective vaccine available against hepatitis A virus (HAV)—almost 100% of people given the vaccine develop antibodies against infection.

Cholera is slightly more common than HAV (3-5 million estimated cases each year, according to the World Health Organisation) but similarly, most cases are of mild severity. Less than 20% of patients develop “typical” cholera with severe, life-threatening dehydration. 100,000-120,000 people are estimated to die from cholera each year.