Malaria Symptoms and Causes

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery (“congenital” malaria).

Malaria Symptoms

Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.

How soon will a person feel sick after being bitten by an infected mosquito?

For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 7 days or as late as 1 year later. Two kinds of malaria, P. vivax and P. ovale, can occur again (relapsing malaria). In P. vivax and P. ovale infections, some parasites can remain dormant in the liver for several months up to about 4 years after a person is bitten by an infected mosquito. When these parasites come out of hibernation and begin invading red blood cells (“relapse”), the person will become sick.

Infection with malaria parasites may result in a wide variety of symptoms, ranging from absent or very mild symptoms to severe disease and even death. Malaria disease can be categorized as uncomplicated or severe (complicated) . In general, malaria is a curable disease if diagnosed and treated promptly and correctly.

Malaria Incubation Period

Following the infective bite by the Anopheles mosquito, a period of time (the “incubation period”) goes by before the first symptoms appear. The incubation period in most cases varies from 7 to 30 days. The shorter periods are observed most frequently with P. falciparum and the longer ones with P. malariae.

Antimalarial drugs taken for prophylaxis by travelers can delay the appearance of malaria symptoms by weeks or months, long after the traveler has left the malaria-endemic area. (This can happen particularly with P. vivax and P. ovale, both of which can produce dormant liver stage parasites; the liver stages may reactivate and cause disease months after the infective mosquito bite.)

Such long delays between exposure and development of symptoms can result in misdiagnosis or delayed diagnosis because of reduced clinical suspicion by the health-care provider. Returned travelers should always remind their health-care providers of any travel in malaria-risk areas during the past 12 months.

Uncomplicated Malaria

The classical (but rarely observed) malaria attack lasts 6-10 hours. It consists of:

  • a cold stage (sensation of cold, shivering)
  • a hot stage (fever, headaches, vomiting; seizures in young children)
  • and finally a sweating stage (sweats, return to normal temperature, tiredness)

Classically (but infrequently observed) the attacks occur every second day with the “tertian” parasites (P. falciparum, P. vivax, and P. ovale) and every third day with the “quartan” parasite (P. malariae).

More commonly, the patient presents with a combination of the following symptoms:

  • Fever
  • Chills
  • Sweats
  • Headaches
  • Nausea and vomiting
  • Body aches
  • General malaise.

In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza, a cold, or other common infections, especially if malaria is not suspected. Conversely, in countries where malaria is frequent, residents often recognize the symptoms as malaria and treat themselves without seeking diagnostic confirmation (“presumptive treatment”).

Physical findings may include:

  • Elevated temperature
  • Perspiration
  • Weakness
  • Enlarged spleen.

In P. falciparum malaria, additional findings may include:

  • Mild jaundice
  • Enlargement of the liver
  • Increased respiratory rate.

Diagnosis of malaria depends on the demonstration of parasites on a blood smear examined under a microscope. In P. falciparum malaria, additional laboratory findings may include mild anemia, mild decrease in blood platelets (thrombocytopenia), elevation of bilirubin, elevation of aminotransferases, albuminuria, and the presence of abnormal bodies in the urine (urinary “casts”).


Severe Malaria

Severe malaria occurs when P. falciparum infections are complicated by serious organ failures or abnormalities in the patient’s blood or metabolism. The manifestations of severe malaria include:

  • Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities
  • Severe anemia due to hemolysis (destruction of the red blood cells)
  • Hemoglobinuria (hemoglobin in the urine) due to hemolysis
  • Pulmonary edema (fluid buildup in the lungs) or acute respiratory distress syndrome (ARDS), which may occur even after the parasite counts have decreased in response to treatment
  • Abnormalities in blood coagulation and thrombocytopenia (decrease in blood platelets)
  • Cardiovascular collapse and shock

Other manifestations that should raise concern are:

  • Acute kidney failure
  • Hyperparasitemia, where more than 5% of the red blood cells are infected by malaria parasites
  • Metabolic acidosis (excessive acidity in the blood and tissue fluids), often in association with hypoglycemia
  • Hypoglycemia (low blood glucose). Hypoglycaemia may also occur in pregnant women with uncomplicated malaria, or after treatment with quinine.

Severe malaria occurs most often in persons who have no immunity to malaria or whose immunity has decreased. These include all residents of areas with low or no malaria transmission, and young children and pregnant women in areas with high transmission.

In all areas, severe malaria is a medical emergency and should be treated urgently and aggressively.

Malaria Relapses

In P. vivax and P. ovale infections, patients having recovered from the first episode of illness may suffer several additional attacks (“relapses”) after months or even years without symptoms. Relapses occur because P. vivax and P. ovale have dormant liver stage parasites (“hypnozoites”) that may reactivate. Treatment to reduce the chance of such relapses is available and should follow treatment of the first attack.

Other Manifestations of Malaria

  • Neurologic defects may occasionally persist following cerebral malaria, especially in children. Such defects include troubles with movements (ataxia), palsies, speech difficulties, deafness, and blindness.
  • Recurrent infections with P. falciparum may result in severe anemia. This occurs especially in young children in tropical Africa with frequent infections that are inadequately treated.
  • Malaria during pregnancy (especially P. falciparum) may cause severe disease in the mother, and may lead to premature delivery or delivery of a low-birth-weight baby.
  • On rare occasions, P. vivax malaria can cause rupture of the spleen or acute respiratory distress syndrome (ARDS).
  • Nephrotic syndrome (a chronic, severe kidney disease) can result from chronic or repeated infections with P. malariae.
  • Hyperreactive malarial splenomegaly (also called “tropical splenomegaly syndrome”) occurs infrequently and is attributed to an abnormal immune response to repeated malarial infections. The disease is marked by a very enlarged spleen and liver, abnormal immunologic findings, anemia, and a susceptibility to other infections (such as skin or respiratory infections).

Source: Centers for Disease Control

Comments

  1. Tom W Simmons says

    Is reoccurring cases of malaria normal after 40+ years? I had malaria twice — both vivax and falciparum while serving in
    Viet Nam in ’67/’68.

    One case was Vivax and the other was falciparum
    the latter resulted in being in hospital for 10 days (of which I have no memory of time lost). Over the last 43
    years I continue to have malaria symtoms at least once or twice a year and some years more. Is this normal?
    I had tried numerous times to give blood, but I listed the malaria cases, I was never allowed to give blood and
    to present I am not accepted as a donor.

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    • Rick Wilder says

      I too served in Vietnam in 67/68 and contacted P falciparum and was hospitalized for 11 days. I remember my captain asking if I wanted him to contact my parents and I said no absolutely not. Here it is 40 years later and I have an enlarged spleen, liver & kidney failure, anemia and a blood disorder. One would think I am a casualty of war but in my case it took 43 years to manifest. Are you being compensated for this?

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    • Claire Standley, Editor says

      Here are some further comments on malaria re-occurrence, courtesy of Dr Etty Villanueva, an MD from the Netherlands:

      The re-occurrence of malaria needs some precision: A ‘relapse’ is a renewed manifestation of clinical symptoms (caused by parasitaemia, which means parasites in the blood) of a malarial infection, and comprises of two types: ‘recrudescence’ and ‘recurrence’, the latter of which is considered a true relapse.

      A recrudescence is a renewed manifestation of symptoms due to an increase in the surviving population of erythrocytic forms; in other words, infection in the blood persists. In P. malariae a small number of parasites in the blood stream can cause a recrudescence after up to 50 years. In P. falciparum the parasites persist in the blood for a much shorter period and recrudescences cause renewed bouts of fever for up to one or two years in persons in whom the infection is not completely eradicated.

      A recurrence/true relapse is a renewed manifestation due to multiplication of the parasites in the blood from an exo-erythrocytic (which means outside the blood cells) source, and most commonly from the liver cells. Dormant forms of the parasite, called hypnozoites, can become activated by some kind of trigger to resume growth and burst into circulation, invade red blood cells and cause a relapse. This ‘latency’ is only existent in P. vivax. It is absent in P. falciparum. Thus, although P. falciparum is much more dangerous than P. vivax, it is more easily cured by drugs, except where drug resistance has appeared.

      On the subject of donating blood: Transmission of malaria by blood transfusion is frequently due to P. vivax or P. falciparum, but P. malariae accounts for many cases and is of special importance because of its chronicity in blood donors and the difficulty in detecting it. That is the reason that most countries refuse donors who have had malaria or have been exposed frequently to malaria when traveling. Dried plasma prepared from malarial blood is safe. In the Netherlands if you are refused as a donor because of the aforementioned reason you are accepted to donate plasma.

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      • Alexis McElroy says

        Hi I’m Lexi and what I want to know is if you have malaria can it do anything to your body to mess up the functions in the human body? My grandfather and I have been wondering about that for quite some time…
        Can you Help???

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        • Claire Standley, Editor says

          Hi Lexi,

          Thanks for your question! Malaria certainly is a serious disease which messes up your body while you are infected with the parasite. Problems can include complications with the liver, spleen and kidneys, particularly if you have a serious case of P. falciparum malaria. P. falciparum is also known for affecting the brain, leading to impaired consciousness, coma and even death. However, most of these complications are reversible once the infection has been cured, which is usually easily achieved through oral medication (or intravenous drugs if the disease has already progressed to a severe state). Other than that, long term consequences of malaria infection are usually limited to effects such as reduced growth in children that have been severely affected by malaria, or enlarged liver and spleen in people who live in highly endemic areas or who may have latent infection, for example with P. vivax or P. ovale. Hope that was helpful!

          Cheers, Claire

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      • Krisztina Taylor says

        Hi Clair

        I have been travelling in South America for over 7 months – including the Amazon jungle.
        About 3 months ago I got very badly bitten in the Colombian jungle by mosquitos and until now I still have one bite that doesn’t seem to heal. I haven’t taken malaria pills during my trip as I was told the areas were safe.
        However the bite has a hard centre and it itches all the time.
        And I am wondering whether this is a potential malaria bite?

        Thank you for your comment in advance

        Kindest
        Krisztina

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        • Claire Standley, Editor says

          Hi Krisztina,

          Mosquito bites usually go away in less than two weeks, so what you have is probably something else. Also, bites which cause malaria are no different from other mosquito bites, and if you haven’t had any symptoms such as fever or chills, I doubt you have malaria. Instead, it could be some other kind of bite, such as a spider or sandfly, or you could have gotten something underneath your skin (like a tiny splinter) which has now become infected. Some flies in South America also lay eggs beneath the skin, which hatch into larvae and can cause painful and itchy welts. Since you’ve had it for so long, I would recommend getting it checked out by a doctor!

          Hope that helps.

          Claire

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    • keith says

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      • Claire Standley, Editor says

        Hi Keith, the quick answer is no, you can’t pass the parasite on to your child, but yes, in some cases the malaria can come back. The chances of this occurring depend on the type of malaria you had; when the doctor said you had “1 parasite”, that could either mean one species or strain (there are four different types that commonly infect people, and all have different subtleties to how they should be treated) or a very low parasite burden – either way, you should talk to your doctor about the type of malaria you have and what sort of treatment that implies. It was definitely good that you were taking your preventative medicine while you were in Angola; that certainly prevented a much worse infection, but it doesn’t mean that it will go away by itself, so you should consult a physician about receiving proper additional treatment.

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    • Clif says

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      • Claire Standley, Editor says

        Hi Clif,

        Thanks so much for this comment – you are absolutely right, and it’s a really important thing for people to know about the use of primaquine for preventing relapse of malaria. The information on G6PD testing is correct as well – this deficiency tends to run in families and populations so your doctor should know if you present a high risk case, and will test accordingly.

        Thanks again!

        – C

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    • James says

      I don’t think you’re ever completely the same again Tom. I’ve had P. Falciparum twice and P. Vivax three times all during my work travels in Africa. I’ve lost part of my hearing and have a permanent balance problem due to an overdose of intravenous quinine sulphate.

      I hear you with the blood donorship issue they won’t accept my blood either!

      Good luck to you.

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    • Anshul says

      Hi, I had the similar problem of Morelia relapsing and it almost happened 4 times in two years period. I was suggested to take Ayurvedic medicine for one year if I remember it correctly it was mahasudersun churn…I think one should consult the doctor and as well look for some kind of alternative treatment to allopathy….that should help

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  2. Bryce says

    Did You Know That……….

    Malaria kills more African children than any other disease.
    Children who survive episodes of severe malaria may develop learning impairments and brain damage.
    35 countries, 30 in which are in Africa, account for 98% of worldwide malaria deaths.

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    • Claire Standley, Editor says

      Hi Bryce,

      Thanks for your comment! Malaria certainly is the most deadly single disease for African children. However, it is important to note that according to the World Health Organisation, the leading cause of all deaths for infants and children under five in Africa is problems occurring immediately after birth, collectively known as ‘neonatal death’. 29% of fatalities in under-fives in Africa are due to these varied conditions, which include birth asphyxia and trauma, prematurity and low birth weight and neonatal infections.

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  3. Tasha Stewart says

    Hi my twin sister is in nigiria on a 5 month missions trip. She has just been diagnosed with Malaria, they believe she got it a year ago in El Savador and that it has been dormant in her system, she has week kidneys and has chronic high blood pressure due to childhood illnesses she has had her whole life. She is in the Northern part of Nigiria and the hospitals there are no real help, my questions is…. in your opinion should come home now to recover?? I am sure the type of Malaria she has, I have been doing lots of research and I am extremely concerned for her health. She has always had health issues and I am wondering if the malaria will be even worse for her given her pre existing health conditions. It is very hard to reach her so I am not able to ask her many questions, I know she is in pain, can’t keep food down and currently is not being treated in a hospital. Any thoughts or recommendations would be appreciated!!! ASAP Please!
    Thank You!
    Tasha Stewart

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    • Claire Standley, Editor says

      Hi Tasha,

      Sorry for the slow reply, I’ve been travelling. It sounds like your sister really needs urgent medical attention, and is not receiving that where she is in northern Nigeria. If possible, I would try to encourage her to seek further medical help, either in the area she is in or, if she is able to travel, in one of the major cities. If they have accurately diagnosed the type of malaria she has (which is presumably how they suspected she was infected in El Salvador, since it is likely not a species of malaria that is commonly found in Africa), it will be straightforward to give her treatment, but any physicians she sees must be made aware of her existing health conditions. If she has Plasmodium vivax, which is often found in Central America, she should also look into taking a course of drugs (called primaquine) which will prevent further recurrence of the disease at a later date. Hope this has been of some help and that she is on the road to recovery already.

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      • Claire Standley, Editor says

        In addition to the above, I have just received some advice from a medical doctor who is involved with our website:

        If she contracted it in El Salvador, then Plasmodium vivax most likely and not a particularly resistant strain (generally chloroquine sensitive west of Panama Canal). I think this could be easily treated in Nigeria so long as the diagnosis is clear and there are drugs available – almost any standard regimen would be effective. Did she have anything with her for prophylaxis or stand-by treatment? Chloroquine/mefloquine/Malarone shouldn’t need much adjustment for her kidneys, but it would help to know what her renal function is (GFR/Creatine). The pain and nausea/vomiting present a problem in keeping the medication down, however, even IV hydration is an option if she is becoming dehydrated from the illness. In general, more details are needed, as worsening kidney problems from hydration or gall bladder problems from not eating could complicate the picture, even if the malaria is treated. I don’t know where home is, but she should at least get to a town where basic blood work can be obtained, and anti-nausea medication/IV fluids are available.

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  4. says

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    • Claire Standley, Editor says

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    • Claire Standley, Editor says

      Hi Jen,

      Life-threatening malaria usually progresses incredibly quickly (within two or three days), and you feel very very sick. While normal, so-called “uncomplicated” malaria usually still makes you feel pretty bad, the symptoms tend to be quite general, such as a high fever (cycles of fever are characteristic of malaria infections, usually every 2 or 3 days), chills, nausea etc. Clinical markers associated with severe, life-threatening malaria include convulsions/seizures, coma, impaired consciousness, hypoglycemia, respiratory distress, very rapid pulse and hyperlactatemia (elevated plasma lactate). The chances of developing severe malaria while on appropriate malaria medication are low.

      You should always complete the full course of malaria medication, even if it doesn’t seem like the symptoms are going away. If you are still feeling sick after the full course of drugs, you should go back to your doctor. There are a number of reasons for treatment failure, such as resistance in the parasite (many types of P. falciparum malaria are resistant to chloroquine, for example) or counterfeit drugs, so it is important you get tested again to see if the malaria really is still there, and if so, you should take a different kind of medication to try to cure it. Your doctor might also want to test you for some other common diseases, such as bacterial infections, viral infections or even other parasites; the symptoms of malaria are quite non-specific and similar to lots of other infections, so if you tested positive for malaria your doctor might have focused on treating that and not looked for other potential co-infections.

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  6. Joanne says

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    • Claire Standley, Editor says

      Hi Joanne, this is a bit of a puzzling one, because Plasmodium falciparum infection is usually very severe at the time of infection but once it clears, it is not capable of recurring years later. So, your husband would probably have had to be treated (P. falciparum malaria can kill within a few days if left untreated) while he was in Vietnam, which would show up on his records. Relapses of infection are much more associated with infection with a different species of malaria, called Plasmodium vivax, which is also found in Vietnam. It is usually not as immediately severe as P. falciparum (though still can be deadly and so requires treatment), but can form stages which lie dormant in the liver for months or even years, causing relapses of disease later on. I would certainly encourage you to follow-up with the diagnosis of P. falciparum, and perhaps ask for confirmation that his infection is definitely not P. vivax – if it is P. vivas, there is a drug called primaquine which can kill the liver stages and prevent further relapses. If it is not P. vivax, then I think there are probably other health factors which are causing the recurring episodes of illness, and you should also talk to a physician about possible causes.

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      • Joanne says

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        • Claire Standley, Editor says

          Hi Joanne,

          Thanks for following up with us. You’re right in thinking that P. falciparum is usually the only type of malaria associated with brain/cerebral complications. One test can be used for all types of malaria, since each type looks subtly different under the microscope, and rapid blood tests can often also distinguish between different types, though usually not all four (often they just distinguish P. falciparum versus non-P. falciparum malaria). It is extremely unlikely that one person would be infected with all four kinds simultaneously (not least because all four do not occur in the same parts of the world!). I’m afraid without more information about the type of test used it is impossible to say whether the reference value for the test indicates exposure or infection; this would certainly be worth clarifying with a doctor if symptoms persist. I’m glad you found the site useful! Thanks again for your inquiry. – Claire

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  7. amrit says

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    • Claire Standley, Editor says

      Hi there, I presume the doctor gave you some medication to take, once you were diagnosed? If so, it certainly sounds like the parasite (malaria is caused by a single-celled parasite, not a virus!) has responded well to the treatment, which is great. Recovery times vary a lot, but especially in mild cases, it shouldn’t take longer than a week or two to feel back to normal. I do think it’s usually a good idea to get a second blood test, just to make sure that all the parasites in your blood have been killed – if they haven’t, once you stop the medication the infection can come back (this is called recrudescence). You should also check with your doctor that the kind of malaria you have isn’t capable of causing relapsing infection: two kinds of malaria, Plasmodium vivax and Plasmodium ovale, are capable of hiding in the liver and producing new infections weeks or months after you think you’ve been cured. However, you can take another medication, called primaquine, which kills these liver stages, so you should ask your doctor whether this might be a useful option for you.

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  8. Mohan says

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    • Claire Standley, Editor says

      I would recommend going to the hospital or your doctor straight away – children are at high risk for malaria, and Plasmodium falciparum in particular is known to cause severe disease very rapidly. In its early stages, it can be treated very effectively with oral medication, preferably artemisinin-based combination therapies (ACTs), such as Coartem, but if left untreated it can progress such that intravenous quinine is required as a first-line treatment. Moreover, P. falciparum is prone to causing cerebral malaria if left untreated, whereby the parasite affects blood cells in the brain, causing convulsions, impaired consciousness and even coma. Some of these neurological effects may be irreversible. As such, it is crucial that you seek treatment for your son as soon as possible.

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  9. Manohar says

    Hello,
    My mom is being treated for cerebral malaria at this moment. All the symtoms showed that and doctor confirmed after all the tests. Currently she is being treated in ICU with aggressive medication in one of the good hospitals. Her Platelet count was reduced to almost 18,000 and doctors have given her blood to increase the same.

    She had semi conciousness before being admitted to hosptials. This is her 5th day since the decease occured and she was admitted on the fourth day. (Initially we thought it was common fever). unfortunately this is tough time for us. She was never hospitalised this way and it was really heartbreaking to see her speaking in semi conciousness.

    Has there been any similar cases in the past where people have recovered from such condition and been normal. I know there are answers on this before, all I am looking for some words of confidence and hope that she recovers soon…

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    • Claire Standley, Editor says

      Hi Manohar,

      I can understand it must be very hard for you to see your mother like that. While malaria is a dangerous disease, treatment is usually effective and successful, and so if a patient is able to be seen by a doctor and given appropriate medication, the prognosis is often positive. I hope your mother has by now recovered.

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  10. Samadhan says

    Sir, I had maleria 5 days before. I had taken treatment and it was cured. But after 2 days I again had fever and weekness.Then I again went to doctor, then doctor did blood test and no malerial parasites were seen. Doctor also did blood tests to see RBC & WBC cound and it was in normal range.

    Could you please let me know why I am still having fever and weekness.

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    • Claire Standley, Editor says

      Malaria is a serious illness and can weaken the body significantly. I would suspect that weakness and maybe a slight fever after the main infection has been treated could just be your immune system getting back on track. Many people feel nauseous while suffering from malaria and unable to ingest sufficient foods and liquids, leaving them depleted of energy and dehydrated immediately after recovery. As such, I would recommend resting and making sure you take in plenty of fluids while recovering from malaria – if weakness and fever persist more than a week after your treatment finishes, then it may be worth talking to a doctor about other diagnoses.

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  11. Yvonne says

    Hi there
    I contracted both faliciparum and ovale malaria at the same time on a trip to Ghana six years ago. After a week of seemingly successful treatment in a western hospital I was sent home. In the several months after leaving the hospital I continued to feel extremely fatigued and although it improved somewhat, my energy levels never returned to what they were before the malaria. A few of the many symptoms I’ve felt over that time have been pain throughout my body that I can’t attribute to any cause, going to bed cold and waking up in a sweat and memory loss. The symptoms forced me to switch to a less demanding job several years ago and recently forced me to take an indefinite medical leave. My doctors are having a lot of trouble figuring out what’s wrong with me. Could my current symptoms be side effects from the malaria or the drugs (quinine, doxyclycline and primaquine) I was given to treat it? Any feedback would be appreciated.

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    • James says

      Hi Yvonne,

      I’ve had malaria a number of times including P. Falcipurum twice. I have not been the same since and feel that it has definitely changed my life. I have partial deafness and balance loss. I agree with you regarding the muscle pain and sweating at night because I get the same thing.

      Unfortunately I don’t think there’s not much to do about it.

      Chin up though.

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  12. JustWondering says

    Hi, My mum and I have travelled to India and she is feeling really cold (even though it is hot here), feels like vomitting, has a headache, a reaaly bad and painful stomach and is feeling very weak. Does she have malaria?

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    • Claire Standley, Editor says

      Hi there. It could well be malaria – it is important to visit a physician or clinic for a diagnosis, as they will then be able to recommend appropriate treatment.

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  13. Jackie Taylor says

    Hi – I travel to Gambia 3 times a year just for 7 or 14 days on holiday and take doxycycline before and during our stay then on the morning of the day we leave we go to the local clinic where they do a malaria test. We then leave and go to the airport for our flight home and stop taking medication as the test shows negative. The man in the clinic assures us that even if we had been bitten the night before the test by a malaria carrying mosquito it would show the following day. I just wanted this confirmed please as if there is any chance at all that the test might not have detected malaria that quick we will continue with doxycylcine but don’t want to take it unneccessarily. many thanks

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    • Claire Standley, Editor says

      Hi there,

      You MUST continue to take doxycycline after you leave a malarial area – indeed, you need to continue taking it for a full 4 weeks after returning home (other anti-malarials require a different amount of time). This is because malaria has what is called a pre-patent stage: when you are first bitten, the malaria parasites take some time to develop before signs of disease can be detected. The length of this pre-patent stage varies depending on a number of factors, including the type of malaria and whether you have been taking anti-malaria medication. Doxycycline and other anti-malarials prevent the parasite from developing into the stage that causes disease, hence why it important to continue taking the medication even after you have left a malarial area. Similarly, most blood tests for malaria CANNOT detect the pre-patent stage of malaria, as at this point the parasites are hidden in the liver and are not visible in the blood. Even tests that look for antibodies to malaria, which begin to be produced early in infection, may only work once the parasite has entered the blood stage. Therefore, even if the clinic you use in Ghana assures you they can detect very early stages of malaria (which they probably cannot), it is important to continue to take anti-malarial doxycycline after you return home. Hope that was helpful for your future trips!

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  14. Stella says

    I travelled to a national park in Kenya and got bites which i suspect must have been from a mosquito, can mosquitoes bite and leave big painful pimples that have fluid or n are very itchy or are these other insects?

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    • Claire Standley, Editor says

      Hidden due to low comment rating. Click here to see.

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  15. Ahmed says

    Hi, I contracted malaria (Plasmodium Vivax) about 14 months ago, initially it was diagnosed with a blood test and treated with a three day course of Chloroquine and I recovered fully. However, since first episode, I get a relapse every two months with the same symptoms and is cured by same three day course of Chloroquine. My doctor advised a G-6-PD test to see if a Primaquine course can be given to eradicate the parasite from liver, I took the test but unfortunately I showed deficiency and can not be treated with Primaquine. It now seems a regular feature to get a relapse every two months, is there something I can do to avoid these relapses?

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    • Claire Standley, Editor says

      There is dispute over what causes malaria relapse – some evidence shows that there is variation based on the geographical origin of the parasite, with longer relapse periods associated with higher latitudes and shorter relapse times more predominant in the tropics. Other studies show that mosquito bites can trigger relapse, as can infection with a different form of malaria (such as Plasmodium falciparum). In some cases, different treatment drugs may affect the length of time between relapses, but cannot prevent them entirely. While your doctor was correct to test you for deficiency for G6PD, in some cases of low levels of deficiency the drug can still be given as an intermittent therapy to prevent relapse. However, if you live in a malaria endemic area this therapy may not be suitable.

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  16. fahi says

    HI………
    If I get high fever and headache in night and morning is it normal (Its happening for 5days)……Is that a symptom of MALARIA?? please reply……….

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    • Claire Standley, Editor says

      Hi there,

      Fever can be a symptom of malaria, but fever is also associated with a lot of other infections and diseases. With malaria, the fever normally cycles, with a peak every 2 or 3 days, depending on the type of malaria, with periods of normal temperature and even chills in between. As such, what you are describing doesn’t sound like typical malaria infection, but it is still important to get diagnosed by a doctor or at a clinic, since sometimes malaria can manifest itself in different ways. The quicker you receive a good, accurate diagnosis, the quicker you can receive appropriate and effective treatment, regardless of whether you have malaria or something else.

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  17. says

    Hello there!
    I’m currently writing magazine article for our school’s literacy project and I’m writing about Malaria. This website has been really helpful to me and also you guy’s comments has been real helpful.

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  18. nathan says

    Hi i just came back from the dominican republic, puerto plata.
    i have been getting a slight fever, chills, a headace, muscle pains,
    and a cough. my fever and chills are gone now but now my
    headace and my cough has gotten worse. It hurts my head so much
    when i cough. I feel a lot of pressure on my head, can you please
    tell me the reason why my head hurts so much. Is this malaria?
    Thanks a lot hope to hear from you guys soon.

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  19. SK says

    Hello,

    I live in Seattle, Washington, USA & have recently been getting cyclical sicknesses that led me to get a malaria test which came back positive. I have been exhausted & had chills/sweats for years, but attributed it to my thyroid condition ~ it is only in the last 6 months that I have had severe enough symptoms to seek medical treatment. It is impossible to tell whether this is a new condition contracted in the US somehow or if this was contracted 7+ years ago on my travels. I don’t remember my sicknesses from the past, so can’t say whether or not I got sick after one of my travels.

    I don’t know what type of malaria I have yet & it is very hard to guess where in the world I contracted the parasite: I was in Mexico in 2000 & 2004, the Canary Islands in 2000, Tunisia in 1997, all over Central America in 1996 & Morocco in 1991. The only places I’ve traveled outside of the US in the past 7 years are Canada, England & Ireland.

    Have you heard of cases contracted in the United States? If so, what type of malaria are they usually?

    Have you heard of cases that don’t cause debilitating sickness for years?

    How worried should I be about the drugs that treat malaria (I don’t tolerate drugs at the best of times)?

    Lastly, I have an autoimmune disease, plus thyroid disease & urticaria/angiodema ~ can this cause any complications that I should know of before starting treatment?

    Thank you very much!

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    • Claire Standley, Editor says

      Hi SK,

      Thanks for your question. I’m going to ask one of our medical advisors for his comments regarding complications that might arise with treatment, given your medical history. Hopefully I’ll be able to post his response soon!

      In the meantime, I can make a few comments on the possible origin of your malaria. I think it is highly unlikely you contracted it in the United States – malaria transmission in the US is very rare, and limited to the south-eastern States, and then only at the height of summer, and very infrequently. Given the duration of your illness (i.e. many months), plus the length of time since you travelled in malarial regions, it sounds like you have either Plasmodium vivax or Plasmodium ovale (the former is much more common). These are the two that are known to cause relapses, months or even years after the initial infection. However, I suppose it is also possible that you have Plasmodium malariae, which is known to stay at sub-clinical levels for long periods of time, though never actually enters a dormant stage (technically, it “recrudesces”, whereas P. vivax and P. ovale are said to “relapse”). If your infection turns out to be P. malariae, then treatment will be a simple course of chloroquine. With P. vivax and P. ovale, you will need to take something like chloroquine to control the current infection in the blood, followed by primaquine to kill the latent liver stages. This drug may be contraindicated in people with G6DP deficiency, so you should be tested for that prior to getting a prescription.

      Hopefully that helped!

      – Claire

      PS I’ve now heard back from our medical advisor – he says there are no contraindications for treatment of malaria. Any treatment regime that your doctor prescribes can be tailored so that it does not interact with your existing medications. So make sure your doctor treats you!

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  20. K.Mahima says

    Hi, i am also suffering from the same symptoms in malaria. I had fever, chills, headache and cold. But the test didn’t show if i have malaria.But still i have the symptoms.After recovering from fever i am having severe headache and cold. Can you tell me if i have malaria?

    Thanking you
    Mahima

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    • Claire Standley, Editor says

      If the test was negative for malaria, but you are experiencing symptoms, then you probably don’t have malaria, but some other illness. The symptoms of malaria are very general, and can easily be confused with a number of different diseases, even influenza. Given that your fever has gone away, you are probably on the road to recovery – if you still feel ill in a few days then it may be worth talking to a pharmacist or doctor about your remaining symptoms.

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  21. Jon says

    Hi Claire

    I believe I contracted malaria in Kenya in the 1980’s and was diagnosed some four years later by a Doctor in the then Zaire. I now live in Australia. For the first eight years or so I used to have recurring bouts every Christmas but spent some time in the Northern hemisphere where it seemed to abate. I have now been in Aus for three years and the last two Christmases I have experienced the usual malarial symptoms. The last one, yesterday, was one of the worst with painful kidneys (lower back) and the old “blackwater” when I urinated.

    Reading ont he web it appears that there are “cures” for this recurring malaria…..Is this so? and is this “annually recurring” malaria real or just co-incidence. I personally believe it is malaria every year and usually take leave during this time as I expect it with some confidence. I have never been to a doctor as I thought there was little point. My “attacks” usually last little more than a couple of days so have got used to putting up with it. Any advice you can offer is greatly appreciated.

    Regards

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    • Claire Standley, Editor says

      Hi Jon, thanks for the question. There is indeed a cure for recurring malaria – primaquine appears to kill the latent liver forms of the two species of malaria that are known to cause relapses (Plasmodium vivax and P. ovale). The drug needs to be taken every day for 14 days to be effective, and may not be appropriate if you have G6DP deficiency – you should be tested for this before being prescribed the drug. Since your last relapse was quite recent, you might also want to try to have a blood test to check for antibodies against Plasmodium species, and specifically the two mentioned above. While your doctor might still be happy to prescribe you primaquine, given your clinical history, double checking is always best! The test is very simple and uses only a droplet of blood – you can even buy self-testing rapid diagnostic tests (RDTs) online or in some pharmacies (depending on where you are in Australia – malaria products tend to be more common in northern Queensland and NT), some of which can distinguish between P. vivax and other forms of malaria.

      The reasons for the varying periodicity of malaria relapses aren’t fully understood, but some theories have been put forward based on field observations. For example, it seems that the forms of malaria from the tropics tend to relapse more frequently than forms from the sub-tropics, where transmission is seasonal. This makes sense from the evolutionary perspective of the parasite – it wants to maximise its chance of being transmitted, and so should reoccur when conditions are appropriate for transmission (i.e. when mosquitoes are around). This theory is supported by the observation that relapse may be triggered by mosquito bites, again suggesting that enhanced transmission might be the key to relapse timing. This matches your own observations of relapses around Christmas, in the Antipodean summer, when mosquitoes abound and you may have been bitten. Hope this helped! Good luck getting treated. – Claire

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      • Jon says

        Many thanks Claire for giving me such hope. I understand that Primaquine is no longer available in Australia but I have a year to go to get the tests done and to find some. After suffering this for so many years your comments are fantastic news to me. Before finding this site I was sure that there was no treatment for recurring malaria and I would have gone the rest of my life suffering each year. Again, many thanks.

        Jon

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  22. says

    Hi,

    I got malaria in 2002 while working in Tanzania. I got it in the 6th week I was there working in the village and I guess the symptoms developed after being bitten in training 2 weeks before. I was given Fansidar (spelling?) which cleared it up. I was probably severely ill for about a week, it came on very hard,. significant symptoms but then I was back up and about roughly a week later.

    2 weeks before leaving the village I had another dose of malaria which I’m not sure was a recurrence or a separate dose altogether. What I remember is that this time it was much more resistant to go. I was given metakefaline (spelling?) and then finally 10 days later a French drug called Arinate which seemed to finish it off.

    In the years immediately after returning I had far more flu type incidents year to year (averaging about 1 a year) compared with pre-Tanzania/malaria. Pre Tanzania I can only remember having flu once and that was at Uni in 1998. In recent years I have had flu type occurences but have always put it down to other things but some of the instances have reminded me very much of malaria, body ache, shakes, chill lasts for a few days then goes rapidly back to normal.

    Is there anyway of checking if these occurences over the years have in fact been the malaria returning? Can I get detailed blood tests somewhere to confirm whether I still have any of the parasites lying in the liver?

    Thanks very much,

    Rob Salter

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    • Claire Standley, Editor says

      Hi Rob,

      Thanks for the question. Of the various types of malaria that infect humans, P. vivax and P. ovale are the only ones that can remain dormant and then relapse weeks, months or even years after the initial infection. In places like Tanzania, P. falciparum, which cannot relapse, is the most common and deadly form of malaria, and gets a lot of media attention. However, P. vivax and even P. ovale are both present, and perhaps at higher prevalences than previously realised. Do you know which type you were diagnosed with initially? While experienced technicians can easily tell the different species apart based on their appearance in the blood, most clinics do not diagnose to this level of detail, unfortunately. Given that your later symptoms have felt to you like malaria, with the characteristic chills, fever, etc, then I would say there is definitely a possibility that you have been experiencing relapses, and especially if you were diagnosed initially with P. vivax. As far as I know, no tests are yet available for humans to check for the dormant liver forms; some blood tests can pick up antibodies to past infections, but given that your attacks are not very frequent, these antibodies may have broken down by the time you test yourself. However, I would recommend that as soon as you next experience those symptoms, you should visit a travel health clinic or tropical disease hospital to get tested for malaria. Once you have symptoms, it means that the malaria parasites have exited from the liver and are back in your blood stream, where they can be detected using a blood test, either for antibodies as described above (these are called rapid diagnostic tests, or RDTs) or microscopy of a blood film on a slide. If you test positive, and especially if you have not returned to a malarial country since Tanzania, you can be reasonably confident the source of your infection was the initial disease back in 2002. The good news is that there is a drug, called primaquine, which can be used to kill the liver stages of P. vivax and P. ovale, thus preventing future relapse events. If you test positive for malaria, talk to your doctor about taking this drug – you will need to have a test for G6DP deficiency beforehand. Hope this has helped! Good luck.

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  23. Amy says

    I know someone who is from papua new guinea and was treated in cairns for malaria. They are now blind following the drugs that were given to treat the condition. He can only see shades of light. Would there be any chance of fixing his eye sight?

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    • Claire Standley, Editor says

      Such severe side-effects are very rare from malaria medication alone – is it possible they were also treated for something else at the same time? Some anti-protozoan drugs, to treat diarrhea, can be very potent. In some cases, people who have been given quinine can develop a condition called cinchonism, which is related to the dosage they receive. Cinchonism can result in visual disturbances, which usually return to normal once the person stops taking quinine. Doses that are delivered too quickly or at concentrations above therapeutic level can result in more severe cardiotoxic events, some of which can potentially lead to blindness. Whether your friend’s condition is permanent or not will depend on the exact type of drugs they received, whether it was in combination with anything else, and also what the dosage was.

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      • Margaret says

        Would it have been possible for someone to develop a duodenal ulcer from malaria alone or if they had been treated with quinine and atebrine (mepacrine)?

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        • Claire Standley, Editor says

          Hi Margaret, duodenal ulcers are not associated with malaria infection – the malaria parasites do not interact specifically with the GI system at all, except in advanced falciparum infection by restricting blood flow (which in itself should not cause ulcers). Quinine, on the other hand, could have caused duodenal ulcers, though this is very rare. I have not heard of malaria being treated with mepacrine – I know it is used as an alternative to Flagil for the treatment of giardiasis, and may present GI side effects. Giardia infection itself has also been associated with duodenal ulcers in a number of cases, so in this instance, it might be difficult to determine the exact cause of the ulcer between quinine and Giardia.

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  24. Kate says

    I have recently returned from Accra, Ghana and am feeling really unwell. I was bitten on my legs quite badly, first time this has happened as I visit there often. I work for an airline who only issue us with DEET which is deemed adequate for protection.
    I don’t have a fever (yet?) but ache all over, am completely exhausted and cannot seem to get warm.
    My GP has said the chances of it being Malaria are quite slim and has suggested I call again on Monday if I feel no better.
    I have had a slight cold for a couple of weeks and am wondering if the hot weather has just made this worse?

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    • Claire Standley, Editor says

      Hi Kate, if it is indeed malaria, then the symptoms can get worse very quickly, in which case you should go to the emergency room and make sure they are aware of your recent travel history. Alternatively, if you are in the UK and can get to London, you can make an appointment to visit the Hospital of Tropical Diseases in Warren St. They are experts at travel medicine, and can easily, and quickly diagnose malaria if you presenting with any o the symptoms (and chills certainly can be a symptom). They will also be able to provide other suggestions if the test is negative. Of course, the option that it is a cold that got worse from travel or change of climates is not out of the question, but it is certainly better to be on the safe side where malaria is concerned! Keep hydrated and monitor yourself for fever in the meantime. Hope you feel better soon! – Claire

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  25. albert otto sommer says

    hi claire,

    I’ve been here on tanzania for almost a year. And now i am diagnose of having a malaria (2mps/500WBC), don’t know if its correct, they did not explain the details. I experienced the cold, slight sweat, back pain, and weak joints. But one of my co-worker also have been diagnose but he is not feeling anything. Is this normal?

    And also, before coming here I am examined to have fatty liver, Is there a great effect that the parasite is living in the liver? Can you give me an advice what to do?

    I am taking “artequin”. I finished the 3rd day of medication. I still feel weak, and this evening my feet feels hot. Can you explain if this is connected on having malaria? How can I be sure that the medicine kills the parasites, should I have another blood examination? Thank you so much. I am really worried with my situation.

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    • Claire Standley, Editor says

      Hi there,

      Thanks for your question. Your diagnosis is indicative of a low level malaria infection – what is slightly confusing is that the count is given per number of WBC, which usually stands for white blood cells. If anything, the count should be presented as per number of red blood cells, since these are the cells that are infected by the malaria parasite. More usually, the count is given per microlitre of blood examined. Artequin is a combination therapy consisting of mefloquine and artemisinin, and so is suitable for treatment of all types of malaria. The full course of medication should completely cure the infection, as there is no evidence yet for resistance against this drug in Africa. However, if you want, you could revisit the clinic for another blood test to be sure that there is no trace of the malaria parasite left in your blood (i.e. you are completely cured). If you continue to experience fever and other symptoms, you should ask your doctor for advice on other infections – my experience in some parts of Tanzania is that diagnosis of malaria is sometimes given even when it is not accurate, and other methods of diagnosis show that the patient does not have malaria. I suspect this has happened to your friend, since it is rare to be positive for malaria using microscopy and not experience symptoms (unless your friend grew up in a highly malarial area and experienced many malaria infections in childhood – in this case he might be able to tolerate low levels of malaria without symptoms). Another method of diagnosis you might want to try are self-testing rapid diagnostic kits (RDT), which you should be able to buy either from the clinic or a pharmacy. Using this RDT, you can test yourself at home for malaria, and the test is more sensitive and accurate than the blood microscopy done in most clinics.

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  26. LynnK says

    Hello there, I stumbled on this amazing site by chance since I’ve been diagnosed with Lyme disease and it’s two co-infections Bartonell and Babeisa. Babesia is malaria’s ‘cousin’ – hence my quest for some answers. I am under the care of a specialist. My sx are eerily like those above, chills followed by ‘feverish’ sx (land me in bed) every 2-3 days, headache, horrendous fatigue, etc. I’m having difficulty tolerating Mepron/Zithromax, my liver enzymes keep creeping up and I can’t keep starting/stopping tx, I can’t get better that way. I am neg for G6PD. Tried Clindamycin + Biaxin briefly last year, made no difference to my sx. I am at a loss. I have been bed-bound for over a decade (initial dx of ‘CFS’ and ‘FMS’) which kept me sick. I got sick a few weeks after a hiking trip. My illness started with fever, heart palps, sweats, brain fog, horrendosu fatigue, diff swallowing, the list goes on and on. And here I am a decade later trying to unravel this mystery. I realize you can’t give medical advice and I also know there are other meds to try… I also feel many people don’t realize they may have Lyme dx and/or babesiosis which can cause similar sx to malaria. My Hb and ferritin are always on the ‘low’ end of normal, my blood smears have always come back neg (tests for babesia is notoriously inaccurate). I did spend several years in India in the mid-90’s where I was very ill but never dx w/ malaria. I became ill about a5 yrs after that. Just looking for some insight from you and also wanting to relate my own diagnoses w/ others out there. Thanks!!

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    • Claire Standley, Editor says

      Hi there,

      Thank you SO much for your post. I hear a lot of stories about people who struggled for years with mysterious symptoms before finally being diagnosed with Lyme’s disease or other blood-borne parasites. As you say, diagnosis is notoriously inaccurate and treatment regimes can be tough – in developing countries in particular, where health infrastructure isn’t good, it can be very easy for clinics and hospitals to assume someone has malaria, give them treatment, and send them on their way, whereas in fact the person is suffering from something else.

      In terms of the specifics of your case, were you tested for malaria in India and not found positive, or never tested? There are some very interesting possibilities for research into the dynamics and effects of co-infections of diseases like malaria and Babesia, since, as you say, they are related and both utilise blood as a habitat. I don’t know how much is known about the symptoms of such co-infections, or what the implications for treatment efficacy might be, but it could be worth talking to your doc about this. Another thing to discuss could be possibility of residual malaria infection from your time in India (such as Plasmodium vivax or Plasmodium ovale, which have dormant liver forms) being implicated in your liver’s failure to tolerate your current drug regimen. Since you are G6DP negative, you could be a candidate for primaquine, which is the drug used to kill those dormant liver stages.

      Hope that helps, and thank you so much for sharing your story on http://www.malaria.com. I really believe that comments like yours are crucial in raising awareness about rarer blood-borne diseases like Lyme’s and Babesia to people who are suffering from symptoms that are proving difficult to diagnose.

      – Claire

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  27. says

    i have got swelling on my hand but i am not felling in like vomiting and fever or in future will it cause malari plz reply me a good answer

    regards
    Kireet Rijhwani

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  28. sanjeev kumar says

    i had malaria,( august 2011) and it repeated for two times, now i am fit and have no malaria, but some pain occurs in my liver,, i don’t know why,,,,,,,, thanks for your advice in advance

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    • Claire Standley, Editor says

      Long term effects of malaria infection are rare, and liver pain is not usually associated with recovered malaria patients. Do you know what kind of malaria you had? Plasmodium vivax and P. ovale can form dormant liver stages, which perhaps could cause some inflammation and thus induce pain. Alternatively, you may have another ailment associated with the liver; you should visit your doctor for further advice.

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  29. says

    Hi there,
    i am suffering malaria and got 3rd time malaria relapse. why i am attack with recurrent malaria. i don’t know the cause, but i took treatment properly and i followed that. but still am suffering with malaria. please tell me the cause for malaria(relapse attack)

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    • Claire Standley, Editor says

      A recurrence of malaria infection can be due to three things. The first is true relapse: this occurs when you have infection with Plasmodium vivax or P. ovale, and while the blood infection is successfully treated with anti-malarials, the parasites are able to form dormant liver stages (hynozoites) and remain there for some time. Weeks or months, or even years, after the initial infection, these liver stages become activated again, re-enter the blood, and you experience another bout of malaria symptoms. The only drug currently available that is effective about these liver stages ia primaquine; it is not recommended for people with G6DP deficiency, so you should be tested for this prior to taking primaquine. The second recurrence type of malaria is recrudescence: this can occur for all types of malaria, but is most commonly seen with P. falciparum. This occurs when a malaria infection is treated, and the burden of malaria parasites in the blood reduced to a point where they are not easily detected using microscopy and the clinical symptoms of the infection subside, but the parasites are not completely cleared. Once the treatment finishes, the parasites are able to multiply again, causing renewal of the malaria symptoms. Recrudescence usually occurs within a few weeks of the initial infection, and to prevent it, patients should ensure they take the appropriate dose of anti-malarials, the appropriate type of medication, and for the full course. The third type of recurrence is re-infection, whereby the infection has been cleared, but immediately afterward, the patient is bitten again by an infected mosquito and gets malaria again. In these cases, if the person is living in a malarial area, they should improve their personal and household preventative measures against malaria. This includes sleeping under a long-lasting insecticide treated bednet, wearing long-sleeved clothing at night and in the evenings, and applying insect repellent to exposed skin. Indoor residual spraying, where insecticide is applied to the inner walls of a house, can further reduce mosquito numbers and thus reduce transmission.

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  30. says

    Hello:
    I’m looking for a second opinion, actually a third
    I was diagnosed with malaria a year ago, treated with chloroquine and primaquine and was told by the specialist that the diseases had beebread terminated.
    I contracted the malaria while visiting Roatan.
    Unfortunately I relapsed 4 months later, resumed the same treatment, and relapsed 4 months after that.
    The new specialist consulted with the CDC and they now have me on Chloroquine 500mg once a week for a year.
    I’m curious as to if you know anyone in the Los Angeles area that can get me through this once and for all.
    Do you have a referral?
    Should I look into Artiquin therapy?
    I can’t imagine being on this chloroquine weekly is good for my body and could contribute to resistance.
    Than you
    D yelinek

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    • Claire Standley, Editor says

      Hi,

      Thanks for the question. I have forwarded your query to our team of medical experts, and will let you know once I have heard back from them. Thanks for your patience!

      – Claire

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      • Claire Standley, Editor says

        Hi again,

        I have heard back from one of our medical experts. His first comment is that Artequin has no role in preventing malaria relapse, and should not be used as therapy in this case. Unfortunately primaquine is the only drug that has activity against the relapsing forms of P. vivax (I presume this is what you were infected with in Honduras?). If it is not working (as seems to be the case here) chloroquine prophylaxis for a year is a reasonable way to prevent additional relapses. According to our medical expert, you can be reassured that chloroquine for a year at the doses required for malaria prophylaxis is NOT damaging to your body and is NOT contributing to any resistance. If you have any additional questions you could call the malaria hotline (770)488-7788 and someone here could explain further.

        Hope that helps!

        – Claire

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        • Claire Standley, Editor says

          Another final comment: The usual course for primaquine is 14 days; however, another one of our medical advisors just got back to me and mentioned that some practitioners don’t think this is always sufficient. Therefore the primaquine failure could be due to insufficient time on the medication. In any case, she suggests that Dr Claire Panosian at UCLA would be interested in hearing your case of primaquine failure, so you should try to make an appointment at the UCLA Medical Center’s Travel and Tropical Medicine Clinic in order to talk to her about your case.

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  31. Margaret says

    Hello,

    I’m doing some historical research on a veteran who got malaria in Indonesia during the early months of WW II (Feb. 1942), and was apparently given a course of atebrine and quinine treatment (dosages of which I understand were experimental at the time).

    Over the subsequent year, however, he continued to experience cattharal fever every few months, and then was diagnosed with a duodenal ulcer in mid-1943. (A “thick-smear test” for malaria was also done at that time, and came up negative).

    He then, however, continued to suffer from cattharal fever every few months during the war, and the duodenal ulcer flared up again in 1945.

    My questions are:

    (1) what are the chances that he had recurrent malaria during the war (and it was somehow missed)?, and
    (2) is there a possibility that the malaria (or the treatments) might have caused his duodenal ulcer?

    (If “yes” to either, if there is a medical reference book which I could be pointed to, regarding this, it would be much appreciated.)

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    • Claire Standley, Editor says

      Hi again,

      See below for answers relating to the potential cause of the duodenal ulcers. In terms of references, this paper (http://www.wjgnet.com/1007-9327/11/6667.pdf) discusses the co-occurrence of giardiasis with duodenal ulcers. Evidence as to why quinine produces ulcers is harder to come by, apart from isolated case reports (and in less than 1% of patients on quinine). In fact, some experiments from the first half of the 20th century suggest that quinine may be inhibitory to gastric acid production, thus actually easing the symptoms of gastric and duodenal ulcers in some cases (see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1583295/?page=1 and http://www.springerlink.com/content/hw65481457nq1tk8/).

      As for the recurrent fever, it could very well have been malaria. Plasmodium vivax is common throughout the Indo-Pacific region and accounted for most of the malaria cases experienced by troops during WWII. One estimate suggests that in some areas of the Pacific, American troops suffered a malaria occurrence rate of 4000 per every 1000 troops, showing clearly the frequency of recurrent episodes (see the Encyclopaedia of Pestilence, Pandemics and Plagues, edited by J.P. Byrne: http://books.google.com/books?id=5Pvi-ksuKFIC&pg=PA383#v=onepage&q&f=false). P. vivax is able to form a dormant life stage, called a hynozoite, which resides in the liver. It can remain there, with no symptoms in the patient, for weeks, months or even years, before causing a recurrence by re-entering the blood. Once in the blood, symptoms such as fever and chills return. However, P. vivax malaria often does not reach high levels of blood parasite concentration (unlike Plasmodium falciparum infection, for example) and so can be harder to detect, especially since during the dormant phases the parasite is absent from the blood, so diagnosis can only take place during the “active” infection, when the patient is experiencing symptoms. Nowadays, there are serological tests available which can detect antibodies to malaria even when the patient is not experiencing symptoms, and even up to months or a year after the infection has been completed cured. However, this technology would not have been available in the 1940s.

      The only way to prevent further relapses of P. vivax is through the use of another medication, called primaquine. It is not known exactly how primaquine works, but it seems able to kill the hypnozoite dormant stages of P. vivax (and P. ovale, another form of malaria which also can cause recurrence) and thus prevent recurrence. There are some cases in which this treatment has not been successful, however, perhaps due to problems of dosage or the emergence of some resistance, and primaquine is not recommended for people with G6DP deficiency. This textbook gives comprehensive guidelines as to the treatment of different forms of malaria: http://helid.digicollection.org/en/d/Js13418e/11.3.html.

      I hope this has answered your queries!

      – Claire

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  32. santhosh kumar says

    gud eveng sir….
    iam suffering with maleria fever from 6 days..in the QBC test reports shows ” positive for malarial parasite plasmodium falciparum ring form present” wat does it mean? is ther any serious to me?which type of food i can take? plz tell me
    thank you sir

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    • Claire Standley, Editor says

      The blood test says you are infected with Plasmodium falciparum, which is one of the five types of malaria which infect humans. It is the form most capable of reproducing quickly and producing severe illness, so it is very important that you are given appropriate treatment (probably a type of drug called an artemisinin-based combination therapy, such as Coartem or Duo-Cotecxin) very promptly. With treatment, you should be cleared of infection quickly and complete recovery will come within a few days of completing the treatment.

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  33. David says

    Hello,

    Thank you for your efforts in responding to our concerns. I have just recently gotten over my first contraction of malaria. I am living/working in rural southeast Uganda and last week, after feeling odd the week before, came down with symptoms that indicated malaria. I had a blood smear which determined the presence of p. falciparum on Monday, 19 March 12 . I was then treated for three days with Lonart (Lumartem). At the end of the treatment period, I felt better but still weak. On the fourth day, I had another blood smear, which indicated just as many parasites as before. I began a treatment of 4 Malarone pills for three days. I have now tested negative for the parasites (since Monday, 26 March 12). However, I am very tired and weak. Is this normal? How long does such weakness and general lack of energy persist? I’ve had no recurrence of the extreme symptoms; however, I’ve experienced some of the stomach discomfort/pain I had last week and a few headaches. Also, checking my hemoglobin indicates that I am not overly anemic.

    What do you recommend, and do you think that I was treated with the correct medication? (Background: I’ve been using Mefloquin as prophylaxis but still contracted malaria. Currently, I am taking a daily dose of Doxy until a new supply of Mefloquin comes from the States — one theory is that the prophylaxis I purchased in Uganda was bad or counterfeit, although I understand that no prophylaxis is 100% certain).

    Thank you.

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    • Claire Standley, Editor says

      Hi David,

      Thank you very much for your comment. You’re right, no prophylaxis is 100% certain, though mefloquine is usually very reliable – you also cannot count out the possibility of counterfeit or expired drugs, it is true. While you are taking doxycycline, try to make sure the pills come in the original packaging so you can check the expiring date and the manufacturer’s mark for validity.

      As for your treatment, Lonart is an artemisinin-based combination therapy, which is the recommended first line treatment against P. falciparum. As such, I am surprised it didn’t work – again, expiration of the pills may be a problem (I have witnessed piles of expired malaria medication in clinics in Uganda!). It is good to hear that the Malarone then worked for you – Malarone is only effective if it has not been used as a prophylactic beforehand (as in your case, since you had been taking mefloquine) so it is good to see that your clinicians took this into consideration.

      I wouldn’t be too concerned about residual weakness after you have completed treatment – it sounds as if you had a significant parasite burden for quite some time, and that will take a toll on your system. Try to keep well hydrated and eat iron-rich foods to bring your haemoglobin levels back up. You should start to feel better after a few days of rest, and of course, you should visit a clinic or doctor immediately if you get renewed severe malarial symptoms (such as fever), to make sure the infection has not returned. If you are not already, make sure you sleep under a long-lasting insecticide treated bednet at night, as this wil greatly reduce your chances of getting re-infected, and also wear long-sleeved clothing at night and in the evenings.

      Hope that information was useful! We at MALARIA.com are actually very interested in hearing about personal experiences with malaria prophylactics and treatment, and have created a survey to get information specifically about side-effects. I would be very grateful if you could take a few minutes to fill out the survey, which can be found here: http://www.malaria.com/surveys/malaria-survey. It should only take a few minutes and is completely anonymous. Thank you!

      – Claire

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  34. varghese says

    i got malaria in 2 year before, now a days in duty time i feel fever ,chills then i take one paracetamol (fever tablet) after one hour i got normal. so i am very tenced about this condition .so kindly give replay urgently plz sir

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    • Claire Standley, Editor says

      If you are regularly getting a high fever and chills, particularly every other day, then this could be a symptom of malaria and you should go to a clinic or your doctor for a blood test. By looking at your blood under a microscope (or by using a rapid diagnostic test), the doctor or clinician will be able to tell if you are infected with malaria, and if you are, which type of malaria you have. Then they will be able to recommend the most effective form of treatment.

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  35. alex says

    i dont know if i have malaria after i got bit by a misquitoe its been a few hours and i have a headache i almost vomited and i got the chills in the middle of the day and can u list all the symptoms for a child because i need to know im only 10 someone please replie i am realy nervous

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    • Claire Standley, Editor says

      Hi there, don’t worry, it takes at least one week (and usually more) for malaria symptoms to appear after you have been bitten by a mosquito, so if it’s only been a few hours, it’s not malaria! Otherwise, the symptom of malaria for children is much the same as for adults – high fever (sometimes occurring in a cyclical way – in other words, fever every other day with periods of no fever in between), chills, nausea and body aches.

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  36. Julie-Ann Whitemoss says

    My brother contracted Malaria in Africa approximately 10 years ago. Not sure which sort but he was treated for this successfully on his return. He has been very poorly for the last week or so and the doctor thinks it maybe glandular fever, blood results pending. I am concerned that it may be a recurrence of his Malaria but am unsure what the symptoms would be and whether his doctor will take this suggestion seriously. Could you provide any advice around recurrence of the disease and how soon he should seek treatment if it is a possibility?

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    • Claire Standley, Editor says

      Hi there, that’s a really good question. Some types of malaria do relapse, so the first thing to do is ask your brother whether he knows which type of malaria he had. The only types which recur long periods of time after the initial infection are Plasmodium ovale and P. vivax. Neither are particularly common in Africa (where P. falciparum is much more prevalent) but cases do occur. The symptoms would be similar to the initial infection – high fever, chills, nausea, aches. Treatment is also straightforward – the important thing is to mention the possibility of malaria to your doctor, and see if they can do a blood test (either by looking at the blood through a microscope, or use a rapid diagnostic test) to see if he does in fact have malaria. Depending on where you are, you may have to go to a specialist tropical medicine or travel medicine clinic for the diagnosis. If positive, you should also inquire about a separate type of medication, called primaquine, which can prevent further relapse. It is not recommended for people with G6DP deficiency, so your brother might also need to be tested for that prior to taking primaquine.

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  37. Ladi says

    I was wondering how I could tell the difference if it’s Malaria or if it’s just the flu? I’m currently in Central America and have flu-like symptoms, but am not sure if I have malaria or if I just caught the flu from one of the kids I work with. Also, I have a few bites, but not a lot. Thanks!

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    • Claire Standley, Editor says

      The best thing to do if you’re not sure if you have malaria is to go to a local clinic or doctor and get tested. Either by using a rapid diagnostic test, or by examining a drop of your blood under a microscope, the clinician will be able to tell whether you have malaria. If you do, they will prescribe appropriate treatment, probably an ACT (artemisinin-based combination therapy), as much of the malaria in Central America is resistant to chloroquine. Diagnosis is key with regards to malaria since the symptoms are so general – as you say, they can easily be mistaken for the flu! So it is important you go visit a clinician to make sure.

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  38. KIANA says

    hi, my friend got malaria when we traveled to India last month, after one month we found out he has malaria, from 2 weeks after we came back he was sick but nobody could understand what is wrong with him, now after 1 month he is very sick and he is in hospital and using Quinine and Doxycyclin but after 2 days, today again he had fever and he got liver problem, my question is.when he will be ok?what you will recommend for his treatment? Please answer my question

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    • Claire Standley, Editor says

      It sounds like your friend ended up with quite a severe case of malaria – that’s often the case when diagnosis is delayed and treatment isn’t given promptly. With intravenous quinine and additional medications, he should recover soon – at this point it sounds like he is getting the most appropriate treatment, so the doctors are doing their best.

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      • KIANA says

        Hello,

        Thank you for your answer.he was treated for 2 weeks in hospital with Chloroquine,Quinine, and artesunate. At the end of the treatment period which was 3 days ago, He felt better and his blood test was clear,but today in third day again he has fever and body pain, and feel very week and stomach pain.

        What do you recommend?do you think that he was treated with the correct medication?, because we are living in iran and we do not have all kind of medicine for malaria.

        Thank you

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        • Claire Standley, Editor says

          Hi,

          It sounds like your friend has received proper treatment, though it depends to some extent on the type of malaria he had (usually either Plasmodium falciparum or Plasmodium vivax) and whether resistance to chloroquine is known from the area where you were travelling. Sometimes the side effects of the medication against malaria can seem a lot like malaria itself, with fever, chills and nausea – as such, it may be worthwhile for your friend to get re-tested for malaria (preferably with a blood test) in a day or so, to check again whether he has any parasites in the blood. If no parasites are detected, then it is likely that the symptoms he is experiencing are a result of side-effects from the treatment. If he has parasites again in the blood, he may need a different course of treatment in order to fully eliminate the infection.

          I hope he feels better soon!

          – Claire

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  39. CJ says

    Dear Claire,

    As a conservationist working in southeast Kenya, I have been diagnosed P. falciparum twice within two years, This last time, likely due to a missed dose of doxycycline, which I was taking in the second month (for a three month course).

    Both times I have treated it with the brand name treatment Coartem (Artemether / Lumefantrime) available over the counter at chemist in Kenya, but initially prescribed to me at Nairobi Hospital. Obviously, working in an area where Malaria is common, despite preventive measures, i will likely aquire it again. My question is: could I eventually develop an immunity to the treatment at some stage? Additonally, since I have now already had it twice, does this clinically mean that any further cases will be less severe, meaning less of an emergency?

    Thank you.

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    • Claire Standley, Editor says

      Hi there,

      Many thanks for your question. It is great that you have access to Coartem – artemisisnin-based combination therapies (such as the artemether/lumefantrine combo of Coartem) are currently the World Health Organization’s recommended first-line treatment for uncomplicated Plasmodium falciparum. The good news is that as an individual, you are unlikely to develop any insensitivity to Coartem or other ACTs, and there is not currently any evidence for the malaria parasite developing resistance to the medication either. So, if you suspect that you are infected again, and you are positively diagnosed with P. falciparum, you shouldn’t hesitate to take Coartem again. It is worth getting diagnosed because there are actually other types of malaria present in East Africa – while present at much lower prevalences than P. falciparum, cases are reported every year, and increasingly being detected by more sensitive diagnostic measures such as PCR. These can also be treated with ACTs such as Coartem, but in many cases are also susceptible to older medications such as chloroquine. Some of these other types, namely Plasmodium vivax and P. ovale, can also form dormant liver life stages that can cause relapse of disease after the initial infection is treated – a different type of medication, called primaquine, is needed to kill these dormant life stages and prevent recurrence of disease.

      As for your query regarding future cases, there definitely is evidence that repeated exposure to malaria will lead to acquired immunity, reducing the severity of later attacks. However, the immune response is very complex, and may only be protective against specific strains of P. falciparum, leaving you just as vulnerable to another strain. Plus, it is not clear how much exposure is required before sufficient immunity is acquired; many young children in high transmission areas of sub-Saharan Africa (such as Western Kenya and Uganda) may have as many as 5-6 clinically significant malarial episodes per year, which only begin to lessen as they approach pre-adolescence. As such, it may be that two episodes of malaria will not be enough to reduce your symtoms significantly in the future. Above all, you should remain vigilant with regards to preventive measures – it is great that you are taking doxycycline, which is likely providing you with a large degree of protection against malaria. Sleeping under a long-lasting insecticide treated bednet will also be key to preventing bites from infected mosquitoes.

      By the way, I visited Tsavo a few years ago and thought it was spectacular (though I wasn’t lucky enough to see a cheetah!). It must be a wonderful experience to work there, and thank you for helping to protect such a unique part of the East African landscape.

      – Claire

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  40. nazi says

    Hi, I was suffering from the same symptoms in malaria when I came back to Dubai from India. I had chills, headache, and fever. After a week I gave test and they told me yes you have malaria and you attack by Falciparum, I was in hospital for 2 weeks, first they gave me Chloroquine and Quinine for 7 days, in second week they start other treatment which was Artesunate ,But still I had the symptoms. They took other test in other different places and they found out I never had malaria from beginning because they cheeked my first blood test again and they were wrong. By today after gave me wrong medicines I became very week and I am having severe headache and cold and heart down also I became very nervous and my heart is beating very fast. Can you tell me what I have to do for using wrong medications and have side effect on my liver and heart. How can I clean my body from these drugs?

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    • Claire Standley, Editor says

      Unfortunately, there is not that much you can do apart from wait – the drugs will eventually naturally leave your system, or be broken down and processed by your body. Anti-malarial drugs are not usually associated with severe side effects, except when therapeutic quantities have been exceeded, so it may also be that some of your symptoms are still due to whatever caused your initial illness. Needless to say, if your doctors now say you don’t have malaria, it is important to try to diagnose what caused those initial symptoms of chills, headache and fever!

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  41. Wendy says

    We visited Kenya and Zanzibar in 2007 took the usually anti-malarial drugs and were unaware that any of us had been bitten during the trip. My older son has just had a full medical and one of his blood tests came back with a high count for malarial anti-bodies for P. falciparum (he had a second blood test to confirm this). The doctor’s conclusion is that he has had malaria at some time. We’re puzzled as he has never experienced any illness since we came back from the trip. Can this happen? My younger son on the other hand has not been fully fit since returning from the trip. He has had various blood tests but nothing has shown up. Do you think he should be tested for malaria antibodies?

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    • Claire Standley, Editor says

      Hi, it certainly is possible to have been exposed to P. falciparum, but for your son’s immune system to have successfully fought off the infection before the parasite could become properly established and cause full-blown disease. In this case, he would have antibodies against the parasite, but would not have experienced any illness. As for your other son, malaria tends to present with very acute symptoms when it does rear its head – high fever, nausea, chills, aches. Without these symptoms, I would suggest your son does not have malaria. However, there is no harm in having a blood test, but I would recommend doing a thick and thin blood smear, if possible. This will allow the doctors to see whether your son has an active malaria infection, and thus needs anti-malarials. If no parasites are visible in the blood, then he likely does not have an active infection which is causing his symptoms; as you have seen with your other son, antibodies can persist even once a person is no longer exposed to the parasite, and so if your younger son was also exposed, an antibody test at this stage might muddy the waters, and suggest he has an active malaria infection when he might not. A blood smear will clarify this. In addition, it might be worth providing your doctor with a stool sample from your younger son; intestinal parasites are very prevalent throughout East Africa and can cause lethargy, stomach aches, diarrhea, nausea, tiredness, anemia and even fever. These parasites can be identified via a stool sample and used to treat him appropriately, if he is infected.

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  42. Robert says

    Hi
    I am doing a term project of the dieses of malaria and i am having trubles finding ways to prevent or treat.
    Can you help
    Thanks- Robert

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  43. Karolyn says

    hi there !!!

    I got bitten by a mosquito 2 days ago and the bite still iching, is there any diference between a normal mosquito bite and malaria mosquito bite?

    What time does the malaria mosquito bite? I got bite at 7.30 am in my garden.

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    • Claire Standley, Editor says

      Hi Karolyn,

      There won’t be a noticeable difference between the bite of a malarial mosquito and an uninfected one. Different species of mosquito feed at different times of the day; the genus that carries malaria, called Anopheles, tend to be night-feeders, but are also active around dusk and dawn, and sometimes even during the day, if they are in heavily shaded environments. Other types of mosquito, such as Aedes aegypti, the species that carries dengue fever, are active during the daytime.

      Hope that has been helpful!

      – Claire

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  44. Gloria Díaz says

    Hola, soy Gloria y soy monorrena desde los cuatro años y no sé si me podría afectar tomar la pastilla para prevenir la malaria para pasar una temporada en Kenia.

    Un saludo y gracias de antemano

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    • Claire Standley, Editor says

      Hola Gloria, y gracias por su mensaje. No conozco el término “monorrena” – quiere decir que tiene solamente un riñón? En este caso, puede tomar doxycyline (100mg) para prevenir la malaria sin problemas. Si quisiera tomar Malarone (menos efectos colaterales), debe ver con su doctor que su GFR esta mas de 30, y que usted puede despejar creatinine efectivamente. Que tenga un buen viaje!

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      • Gloria Díaz says

        Muchas gracias Claire. Efectivamente, eso quiere decir que solamente tengo un riñón.
        Un saludo

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  45. Charmaine Robinson says

    Hi there – I donated blood recently and declared I had visited South America Oct 2011 – I received a letter from the blood donation organisation stating that malaria antidbodies were present indicating that i have had malaria and been treated for it. However, I remember getting quick sick the second week after returning home and I thought I had the flu – I also have complained of headaches and feeling nauseas(sp?) in the months that followed but I never sought any medical advice and didnt get any worse – I have never felt 100% though. I guess what I am trying to find out is if it is possible to have had malaria and no longer have the parasite present in my blood without having had any treatment? A wee bit perplexing

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    • Claire Standley, Editor says

      Hi Charmaine,

      It is certainly possible that you had malaria but your immune system was able to clear the parasite without any treatment. This is more common with types of malaria such as Plasmodium vivax, which tend to produce less severe symptoms than Plasmodium falciparum malaria. However, Plasmodium vivax malaria is also able to “hide” in the body (it can stay as dormant cells in the liver for long periods of time) before recurring at a later date. As such, if possible, you should try to see whether you can have a blood test to check which type of malaria antibodies you have. If you indeed are positive for Plasmodium vivax, it might be worth looking into taking primaquine, which can kill those dormant liver stages of the malaria parasite, and thus make sure you won’t experience a relapse in the future!

      Hope that helps.

      – Claire

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  46. Renji david says

    Hello,
    I am a professional body builder and I was diagnosed with P.vivax and i underwent treatment for the same. I also had my 14 days course of malarid ds to prevent it from relapsing. And after that i took a week rest and i am planning to resume my workout regime. Is it advisable to do so? Or do i need to take more rest? If so then For how many days more?

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    • Claire Standley, Editor says

      While this is something you should probably discuss with your personal doctor (since they have a better knowledge of your health), my opinion would be that if you feel recovered, then you are probably ok to start working out again, albeit perhaps taking it slightly easy for the first week or so, to make sure. Remember that you are likely to have become somewhat dehydrated during infection with malaria, so make sure to be especially vigilant about keeping yourself hydrated, and stop exercising if you start to feel dizzy or weak.

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  47. Ben says

    Hey claire, if you don’t mind could you please describe 5 symptoms in very big detail of plasmodium vivax, please in detail, like why does shivering and fever occur, what happens to the blood of an affected person etc. (it’s for a biology project)
    thank you so much!

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    • Claire Standley, Editor says

      Hi Ben,

      Sorry for the slow reply! I hope you found most of the information you needed on our normal web pages.

      The symptoms of Plasmodium vivax are very similar to that of other types of malaria, namely fever (often in cycles – in the case of vivax malaria these cycles are every third day, or “tertian”, hence it’s old fashioned name of tertian fever), chills, nausea, muscle aches and headache. Patients may also become weak and dehydrated, due to the fever, and because their nausea prevents them from taking on sufficient food and liquids. Another potentially serious effect of malaria, though more common in Plasmodium falciparum infection than P. vivax, is anemia, which I will describe further down.

      The reason people get fever when they are infected with malaria is because the malaria parasite destroys red blood cells. In doing so, the blood become full of pieces of red blood cell, plus waste products from the malaria parasite. These foreign objects in the blood stimulate the immune system, which goes into overdrive – fever is a side effect of the immune system producing tons of what are known as “inflammatory cytokines”, which also attack and destroy infected red blood cells, to prevent the malaria parasites from spreading. This destruction of red blood cells, by the malaria parasites as well as the immune system, causes anemia (in addition, the immune system stimulates the bone marrow to stop producing as many red blood cells, which further contributes to anemia). The malaria parasites often work in a synchronized way – they invade red blood cells, replicate, and burst out all at the same time. For P. vivax, this cycle of invasion, replication and bursting takes about three days, resulting in the typical three day cycle of tertian fever (it is the burstig part which causes the fever to spike).

      While not technically a symptom, a very characteristic part of Plasmodium vivax infection is that it can form dormant stages which hide out in the liver. These are not killed by normal malaria medications, and so the parasite can survive for long periods of time. Weeks, months or even years later, these parasites can become active again and re-invade the blood stream, causing a recurrence of symptoms. This process is known as relapse, and makes P. vivax really hard to cure. Only one drug, called primaquine, is effective against these liver stages, and so must be used by people with relapsing malaria to make sure they don’t suffer further recurrences.

      Hope that helps, Ben! Let me know if you have any other questions.

      – Claire

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  48. says

    Hi,
    I am in Bali at the moment and have gotten 16 mosquito bites, I haven’t been taking malaria pills. Can you get malaria or dengue fever in Bali? If so, should I go to a doctor to check this out?

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    • Claire Standley, Editor says

      Hi Anderson,

      Most of Bali is considered malaria-free (and particularly the resort areas) by the US Centers for Disease Control, who publish up to date travel advisory information. However, dengue fever is found in Bali – there was an outbreak of a few hundred cases back in 2010, and just a few weeks ago, a case of dengue in an Australian tourist was traced back to Bali. Most cases of dengue, particularly in people who have not had the disease before, are relatively mild, and are characterised by high fever plus at least two of the following additional symptoms:

      • Severe headache
      • Severe eye pain (behind eyes)
      • Joint pain
      • Muscle and/or bone pain
      • Rash
      • Mild bleeding manifestation (e.g., nose or gum bleed, petechiae, or easy bruising)
      • Low white cell count

      There is no specific treatment for dengue, so if you suspect you are infected, just take painkillers (analgesics) containing acetaminophen (paracetamol, Panadol, Tylenol) and avoid those containing non-steroidal anti-inflammatories (i.e. ibuprofen, aspirin, Naproxen).

      The more severe manifestation of dengue is dengue hemorrhagic fever (DHF). Watch for warning signs of this as your initial temperature declines 3-7 days after the initial symptoms appeared. You must IMMEDIATELY go to an emergency room or hospital if any of these additional warning signs appear:

      • Severe abdominal pain or persistent vomiting
      • Red spots or patches on the skin
      • Bleeding from nose or gums
      • Vomiting blood
      • Black, tarry stools (feces, excrement)
      • Drowsiness or irritability
      • Pale, cold, or clammy skin
      • Difficulty breathing

      As with dengue, there is no specific treatment for DHF, but with prompt clinical diagnosis and appropriate treatment for some of the effects (i.e. treatment for shock, fluid replacement, etc), effective treatment can be done. This usually requires hospitalization.

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  49. George says

    Hi Claire

    I returned from working in Korea in 1984 what seems like a lifetime ago and about 9 months later was struck down with a severe bout of fever aches etc and off work for 2 months. Blood tests showed i had an issue with White Lyphosites (excuse spelling) but this cleared up. But for many years after i would have short bouts severe fever etc up to 2000 when it all stopped. Then last year it returned with a vengance this time with severe fatigue i was sleeping 23 hours a day for a while. Blood tests revealed little and it was assumed i had a virus. I have now been diagnosed with CFS as i am still very tired and get aches and fevers.
    But i now wonder having found your website should i have been tested for malaria i had never linked the Korean episode with being sick as it was almost a year later and as far as i am aware have never been tested for it since. could my doctors have been barking at the wrong tree for all this time.

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  50. George says

    Hi Claire

    i also forgot to mention i had a bout of what was diagnosed as Viral Pleurisy in 1999 severe chest pains etc plus severe fever with sweats and fatigue after working in australia for a few months similar thing again.

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    • Claire Standley, Editor says

      Hi George,

      Thanks so much for your message. It certainly is a possibility that you were originally infected with Plasmodium vivax malaria, which was undiagnosed and thus persisted for many years, causing periodic relapses. Certainly this would explain how your symptoms would come and go, and the aches and fevers are characteristic of malaria. However, your description of the original diagnosis mentions lymphocytosis – I assume you mean elevated white blood cell count? Malaria infected is actually usually associated with a decreased number of white blood cells (also called leukocytes or leucocytes), so in fact if your doctors noticed reduced white blood cells immediately after your time in Korea, that actually could be another indication of malaria infection.

      In terms of what to do, unfortunately the answer is: not much! You can talk to your doctor about having a serological test for malaria, which looks at your blood for signs of past infection, and will be able to tell you if you did indeed have malaria. If you get another relapse, you should immediately go to your doctor (or better, a travel health or tropical medicine specialist clinic), where they can look at your blood under the microscope to look for signs of active infection, i.e. parasites in the blood. Confirmation of the species of malaria you have can also be done at this stage, after which the active infection will be treated (usually with artemisinin-based combination therapies, or ACTs, such as Coartem). If you are confirmed as having Plasmodium vivax, you can then talk to your doctor about the possibility of taking primaquine, a drug which kills the dormant forms of this type of malaria, to prevent future relapse. It is not recommended for everyone, and notably it is not suitable for people with G6DP deficiency, hence why you should consult with your doctor prior to taking a course of primaquine.

      I hope this has been of some use to you!

      Best,

      – Claire

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  51. Evie Snow says

    Hi Claire,

    I’m currently volunteering in Togo, West Africa – have been since beginning of February and I have about 6 weeks left here. When I arrived there were basically no mosquitoes but recently because of the rainy season I seem to have been eaten alive despite putting on DEET etc all the time! I am taking antimalarials – Larium – but was wondering whether it’s common to have malaria without developing symptoms such as fever/chills and vomiting etc. I don’t feel particularly unwell, but often wake up with a slight headache which then can improve during the day, and am tired a lot. Unfortuntaely, taking a malaria test here without symptoms, just to see is pretty complicated not to mention expensive – they will treat any fever with malarial treatment, but taking a test just because isn’t really the way things go…

    The question is really – should I be worried, and should I try and get a test anyway just to check?
    Thanks in advance!

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    • Claire Standley, Editor says

      Hi Evie,

      Thanks for your message. To be honest, your symptoms don’t really sound like malaria – more like a slight viral infection, or even allergies. Malaria, particularly the form most commonly found in West Africa, which is Plasmodium falciparum, is usually characterized by much more severe symptoms, namely high fever, chills, aches and nausea. If you start to experience any of these symptoms, then I would suggest you go to a doctor or clinic for a malaria test, but right now it sounds like you are fine. Be aware that malaria has a “pre-patent” stage, whereby the malaria has infected the patient but is undergoing reproduction in the liver, and the patient does not experience symptoms. It is only once that stage is complete, and the malaria parasites move from the liver and into the blood, that the symptoms start in earnest, and the parasite can be detected using a blood test. This pre-patent stage can last from as little as 7 days to several weeks (patients who have used chemoprophylaxis often experience longer pre-patent stages), so be aware of this after you leave Togo, as if you begin to experience symptoms once you are back at home, it still could be malaria.

      – Claire

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  52. Evie Snow says

    PS

    I have also what in England would be put down to a cold – sneezing, running eyes etc. Don’t know if that’s included in malaria…?

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  53. yg says

    Hello, I recently took an overnight trip to Surama, Guyana, in South America, where I was bitten quite a few times by mosquitoes. I was only there for one night and did not take any Malaria medications. It’s only been 3 days and I haven’t felt any chills or symptoms, but I’m wondering if it’s too early to tell? How long should I wait before I can get a blood smear test, even if I don’t feel any symptoms? Do I need to wait for symptoms before I get a test, or can a smear let me know if I have Malaria or not even if I don’t have symptoms? Also, if it is dormant in the kidney, will a smear also be able to tell me if I have it or not, or is there another test that can look into this? Please advise.

    Thank you.

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    • Claire Standley, Editor says

      Hello, thanks for your question. Malaria has what is called a pre-patent stage, where the parasite undergoes replication in the liver, before entering the blood stream. When it enters the blood stream, the patient will start to experience symptoms, while in the pre-patent stage, they will likely feel completely normal. The length of the pre-patent stage varies depending on a number of factors (the type of malaria, whether the person was on anti-malarials, their immune status, even the strain of the parasite) but is usually around 7-14 days. The way malaria is diagnosed is by looking for signs of the parasite in the blood – as such, after only 3 days, you would not be able to tell if you had malaria, because you wouldn’t have symptoms yet, and the parasite would not have made it into your bloodstream yet.

      There is no need to get a blood test if you don’t experience symptoms. However, if you do start to experience high fever, aches, nausea or some of the other symptoms of malaria, you should definitely visit your doctor or a clinic to get a blood test for diagnosis. If you contract Plasmodium vivax or Plasmodium ovale, the two types of malaria which are able to form dormant types in the liver (not kidney!), they cannot be diagnosed by the normal malaria blood test (blood smear) unless the patient has an active infection and is experiencing symptoms. As above, when the parasites are dormant, they are not in the blood, so cannot be observed there. However, a different kind of blood test, based on serology and known as an ELISA (enzyme-linked immunosorbent assay) looks for proteins your body makes when it is infected with malaria. These proteins, called antibodies, persist for months or even years after the infection, so this test might be able to tell you whether you have had a malaria infection in the past, and thus confirm whether you might have a dormant infection.

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    • Claire Standley, Editor says

      Yes, no one is completely resistant to malaria, even after being infected once or many times. A small degree of immunity may build up after a person has been infected multiple times by malaria, but even then they are capable of becoming very ill. Also, there are five different types of malaria that infect humans, and even if you have slight immunity to one, you would still be vulnerable to the other types. As such, people who live in malarial areas should learn of ways to prevent infection, which mainly revolve around killing mosquitoes and preventing them from biting. Examples of ways to achieve these aims include indoor residual spraying (where the inside walls of a house are sprayed with insecticide to kill mosquitoes), screening doors and windows (to prevent mosquitoes from entering), removing stagnant water sources from near houses and in villages (since mosquitoes require still or stagnant water to breed) and sleeping under a long-lasting insecticide treated bednet at night (to prevent mosquitoes from biting; the type of mosquitoes that carry malaria usually feed at night).

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  54. Susana Torres says

    Hi,

    Can you please help us? My husband got severe malaria and now he’s blind.
    We live in Portugal. My husband came back from Africa (Angola) on 2nd June 2012. On 3rd June he started feeling ill. He got worse next days. The symptoms were strong headache, high fever, chills, delirium, vomit, couldn’t breathe and weakness. He went to hospital on 7th June. On 8th June was diagnosed with Malaria (Plasmodium Falciparum). Doctors induced him in a coma (10 days) so he could breathe through a machine. He got kidney’s failure, cardiovascular collapse (he needed to be reanimated) and severe anemia. Doctors thought he would die… He woke up from coma on 18th June. On 19th June he couldn’t see anything, it was all dark… First Doctors told us it was due to the quinine treatment, that when quinine come out from the blood he would recover vision. Later exams revealed optic nerve damages. Sometimes he sees images only during few seconds… Can you help us? Do you think this blindness is reversible? Is there any treatment we can do? He has 35 years old, we are in panic… Thank you in advance, SusanaTorres.

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    • Claire Standley, Editor says

      Thanks for your post – your husband’s illness must have been very scary for both of you. Quinine toxicity (from the high doses sometimes required to cure severe/complicated cases of malaria) is unfortunately known to cause blindness. However, at least one of the case reports I have found on this have observed the patient to regain normal vision with time. A link to this article is here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1041412/. Perhaps you can show it to your doctors in order for them to suggest appropriate treatments to assist your husband’s recovery process.

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  55. liz oneill says

    hi,hoping u can help me *incidently i do have the doctors tomoro* travelled to canada fom the uk,badly bitten by mosquitos,57 bites on my legs,ive been home 3 weeks now and im feeling horrendous,sweating so badly and the sickness feeling is awful,slight headache too–(only happening every other day,sore bones too,but as i said i get these symptoms ever other day,i thought i was going to pass out 3 days ago with the sweats n sickness feeling,but today im fine……thanx liz

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    • Claire Standley, Editor says

      Canada is free from malaria, so at least you can be sure you don’t have that! The symptoms you report are consistent with a number of different infections and illnesses, many of which are not even transmitted by mosquitoes, so I think your best bet is to see what your doctor says once he has examined you in person.

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  56. Louise says

    In 2000 i contracted both falciparum and ovale malaria in Mozambique. I had black water fever, encephalitis, hyperpyrexia, you name it. In 2001, I was admitted to hospital with fever (unknown origin) headaches, nausea and dehydration in a country that doesn’t have malaria. Reoccurring malaria is what I suspected the problem was, nothing was discovered as to the cause.

    I have had “episodes” of malaise, mild fever, aches and pains lasting for 2-3days but no real symptoms other than those over the past 10yrs only about 8 times. Now, 3days ago i had severe rigors, yesterday terribly achy and all my skin and joints terribly sore to touch, today fever and sweats. Can it be related to the ovale 12 yrs earlier? Thanks

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    • Claire Standley, Editor says

      It is definitely possible for very long term relapses of Plasmodium ovale to occur. P. ovale is moreover challenging to diagnose, since levels of the parasite in the blood are often low, making them hard to see in a standard blood test. As such, even if you have a blood test, and it is negative, given your medical history one might expect your doctor to give you chloroquine anyway, just in case. This will treat the active infection in your blood, and address the symptoms. In addition, you should talk to your physician about taking primaquine, which kills the dormant malaria parasites hiding out in the liver, thus curing you completely and eliminating the possibility of future relapse.

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  57. Mike says

    I have had malaria while working in equatorial guinea. It is a scary feeling and a sence of uncertainty when dealing with an abnormal illness in a forgien place I know. But this was 4 years ago and I was treated while I was there. Best advice to anyone is sure you think you would be better off back home in a familiar clinic but the reality is ” for me at least ” USA doesn’t know much about malaria treatments cause we don’t have it. So where you get it in my case west Africa they know what they talking about and Probally your best shot at treatment.

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    • Claire Standley, Editor says

      That’s a great point, Mike. I’ve often heard from people who had their diagnosis and treatment delayed because their doctors back home refused to consider the possibility of malaria – it just wasn’t part of their day to day experience.

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  58. cecila says

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    • Claire Standley, Editor says

      Hi Shiva, thanks for your question.

      First of all, while chloroquine is used in some places to treat vivax malaria, resistance has been reported, including a few cases in India (though mainly in Oceania). As such, if available, it might be worthwhile asking your doctor to treat you with an artemisnin-based combination therapy drug (ACT, such as artemether-lumefantrine). An artemisinin-derivative combined with sulfadoxine-pyrimethamine is not recommended for vivax malaria. I have never heard of four weeks of chloroquine being given for malaria treatment – this is extremely strange. The World Health Organization (2010) describes chloroquine dosage as follows: an initial dose of 10 mg base/kg body weight followed by either 5 mg/kg body weight at 6 h, 24 h and 48 h or, more commonly, by 10 mg/kg body weight on the second day and 5 mg/kg body weight on the third day. Do not take chloroquine as a long-term treatment for malaria again; instead, ask about taking ACTs.

      To prevent relapse, primaquine is the only drug available. A 14-day regimen of primaquine has been shown to be the most effective at preventing relapses (as opposed to a 5 day regimen, which does not prevent relapse adequately), and the usual recommended WHO dose is 15 mg base (0.25 mg/kg body weight per day), but in some areas of the world (notably south-east Asia and Oceania), higher doses have been required (up to 0.5 mg/kg body weight per day). It is important to complete the full regimen of primaquine, and also to take it with food to prevent stomach discomfort.

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        • says

          Sorry for the delay in getting back to you. One thing not to ignore is the effect of anemia, which if I remember correctly your son has. Anemia can cause fatigue and shortness of breath. If your son is anemic he should be taking an iron supplement and eating foods rich in iron (meats, beans green vegetables like spinach etc). It also can take time to recover from malaria as it takes it toll on the body. However if he still isn’t recovering, you should consider finding a doctor/medical center with tropical medicine experience (call your local health authoriy for recommendations or the CDC).

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  62. Akash singh says

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    • says

      Unfortunately you are describing very general symptoms – it will take further information to determine what might be causing your illness. Malaria is usually primarily identified by a high fever, but then must be confirmed with a blood test. If you live in a malarial area, it might be worth visiting your local clinic or hospital to have a malaria test, to rule out that possibility.

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  63. Zack says

    Hello! All of your great advise is much appreciated. I have a question… I am in southeast India right now and forgot to start taking my Doxy before flying here. I was out the second night I was here and was bitten 70(!) times by mosquitoes. The next morning I woke up, saw all the bite marks and instantly started taking the doxy (first 100mg twice a day for 3 days, than 100mg per day after).Today, five days later, I am feeling kind of weak and have stomach cramps and diarrhea.

    Do you think its possible that I have contracted Malaria? I know that once in the liver, only anti-malaria pills can stop the parasites and not Doxy, but I thought that Doxy was supposed to destroy any parasites in the blood (therefore hopefully preventing manifestation by killing the parasites once they leave the liver… obviously I would have to get tested once I got home)?

    Any advise?

    Thanks!

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    • says

      Hi Zack,
      Your tummy troubles are probably from bacteria..either from water or food. After being bitten by infected mosquitoes, it takes 7 – 30 days for malaria to manifest itself. Continue taking the doxy daily, and continue for 4 weeks after you return home. Typical symptoms of malaria include high fevers, chills, sweats, etc. If you have any of these symptoms, go to a clinic and get a blood test for malaria.

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  64. pau says

    hi im just bk from holiday 2 days ago in majorca/alcudia and was bit by mosquitos on my right leg the first week but had cleared up within a week but then on the second week on the last day i was bit again on me left leg a few times and since im bk home i have had lower bk pain and feel tired can u get malaria in that country as im a bit worried.cheers

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    • says

      Hi Paul,

      There is no malaria in Majorca, so don’t worry. Anyway, the main symptoms of malaria are high fever, chills and headaches. Cheers.

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  65. Aks says

    Hi,

    During last year in july ,I experienced slow progressive fever which became high grade fever and it was accompanied by headache,extreme weakness my MP,Typhoid,Urine test were normal so doctor gave me medicines for general fever but it was of no use.My fever comes back when my medicines used to get over.After 6 months P. Vivax was diagnosed I took the medication for it upto 3-4 times but its not of much use.

    Its one year and 2 months now…

    My

    Malaria antigen,
    FNAC on right cervical line,
    Axiliary nodes biopsy,
    widal test,
    sonograohy,
    echo cardiography,
    blood culture,
    urine test,
    HRCT Test,
    Antinuclear antibodies,
    Mantoux,
    ADA,
    Thyroscreen ,
    TBGold test

    all have come NORMAL,but I still have that feeling of fatigue,heaviness of head and eyes,dizziness,headache,tiredness this feeling is experienced 1 or 2-3 times a day and highest temprature for last one month is 99.4 F

    So can u plz give ur views about it whether these are are due to malaria or something else????

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    • says

      Hi. Sorry you have been so ill. Some people do not feel better for a long time after malaria. Malaria can cause anemia which can make you feel tired and listless. You can get a simple blood test to see if you are anemic, and if you are, you should be taking an iron supplement and eating iron rich foods (meat (if you aren’t a vegetarian), beans, greens like spinach etc).

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  66. says

    for transmittion via transfussion of blood infected with falciparum, please tell me how long will it take to show symptoms of malaria

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    • says

      Transmission of falciparum malaria via blood transfusion can show up like malaria from an infected mosquito bit (about 7 days onwards) or take up to 2 months depending on the number of parasites in the blood. Improved screening and guidelines on who can give blood can greatly reduce the umber of people getting malaria through transfusions.

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    • Claire Standley, Editor says

      Given that malaria can be a huge burden on your immune system, it is definitely possible that it could delay the onset of menstruation. People who have had malaria may also be anemic, which could be exacerbated during menstruation, so it is important for women in particular who have had malaria to ensure they get sufficient iron, either through their diet or with supplements.

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  67. Clara says

    I contracted drug-resistant p. vivax in Papua New Guinea in 1996. Had two boughts over two years until right dosage eliminated the dormant form out of my liver. Ever since my second outbreak, I’ve had elevated bilirubin. It’s not gone back to normal levels for 17 years. What caused this and should I be concerned?

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    • Claire Standley, Editor says

      Elevated bilirubin is associated with malaria infection in some cases, but usually returns to normal as soon as the infection is cleared. It’s also important to note that there are many other causes of elevated bilirubin, which may be completely unrelated to malaria, so these conditions should be considered as more probably alternatives until they are ruled out.

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  68. Jess says

    Hi
    I’m doing an assignment in college on malaria. I’m having some trouble finding out why these symptoms occur. Maybe you could help me? I’d be very grateful.
    Jess

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    • Claire Standley, Editor says

      Thanks, Jess – please refer to my earlier response to Katherine S. Many of the symptoms of malaria are a result of the massive immune reaction the body creates in response to infection by malaria parasites. Other symptoms are caused by the effect that infection with malaria has on infecte red blood cells – when they become sticky and lodge in the blood vessels, this reduces blood flow to major organs. Another notable symptom of malaria is hepatomegaly and splenomegaly – these are terms for the enlargement of the liver and the spleen, respectively. This occurs as the body tries to contain the malaria infection by capturing and destroying red blood cells which may be infected by the malaria parasites, and so sequesters them in the liver and spleen, where they can also become stuck due to the above-mentioned “stickiness”.

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  69. says

    Hi i’m currently doing a unit for my science course at college and i need some information on the impact of malaria upon the individual. I am unable to find the required information on any website I have looked at because they only tell me of the symptoms but not how it impacts upon that person. Could you help me please, i would very much appreciate it

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    • Claire Standley, Editor says

      I think it really depends on what you mean by “impacts” – infection with malaria puts a huge burden on the patient’s immune system. It is this series of reactions and responses which actually cause the high fever, chills and many of the other symptoms associated with malaria infection. With some types of malaria (notably Plasmodium falciparum), blood flow can also be restricted to the major organs as the malaria parasite infects red blood cells, and can make them “sticky”, causing them to block up blood vessels which lead to the organs. When this occurs in the brain, the result is “cerebral malaria” a very serious condition associated with P. falciparum infection.

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  70. Katie says

    I found my friend today in his house unconscious with green fluid coming from his mouth, I called the ambulance and he is now in the hospital the test shows he has malaria but don’t know how serious. He is unconscious and didn’t even acknowledge the ambulance or doctors. What’s happening? Is he dying?

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    • Claire Standley, Editor says

      Malaria is a very serious condition – however it is very treatable, especially once the patient has received medical attention. In cases of severe malaria, such as your friend, the usual treatment is intravenous artesunate, or sometimes quinine.

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  71. Linda says

    My brother does mission work in Uganda, and recently returned from there in August. He had a stroke at the beginning of November ( no risk factors for a stroke), and seemed to be recovering and the prognosis was excellent. Since that time he has been back in the hospital for almost three weeks now and the physicians are still looking for a cause. His Sx were severe nausea, vomiting, fevers to 103.5. normal white count, severe HA, with neck pain and stiffness, vision issues, tremors, etc. The physicians think it may be malaria, but his fevers have been now running low grade and they say it is hard to detect malaria with a blood smear unless his fever is high again. Is there any other definitive test for malaria?

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    • Claire Standley, Editor says

      The doctors could try a rapid diagnostic test, which looks for small proteins (called antigens) produced by the malaria parasites. These tests tend to be more sensitive. However, if your brother is sick enough to be presenting with symptoms, then malaria parasites should be visible in his blood! Have the doctors thought about dengue as a possibility? The body aches, vision impairment and fever are all consistent with dengue.

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  72. Alexandra Culvin says

    Hi,
    Great articles! I am probably asking what everyone asks but me and my girlfriend are in SE Asia and have travelled in Thailand and Vietnam, we have travelled through ‘low risk’ malarial areas but my she has recently developed flu like symptoms. We are taking Doxy but was not in Thailand as it was considered as pointless by our doctors at home?
    She has runny nose, vomiting, sore throat, headaches limited energy and tiredness. Wondering if this is malaria? We are still in Vietnam and are reluctant to get a blood test here.
    Any advice would be excellent.
    Thank you

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    • Claire Standley, Editor says

      Hi, her symptoms don’t sound too much like malaria (which is really characterized by very high fever, chills and aches, often in cycles of a day or so with fever followed by a day without), but it is always worth getting a blood test. The quality of malaria testing obviously varies from place to place, but in some ways you are better off having a blood test in Vietnam than in Europe or the US – doctors in non-malarial areas so rarely have to think about malaria that they often aren’t appropriately trained to diagnose it, whereas many clinics even in rural areas in malarial countries are adept at recognising and diagnosing malaria. I would still try to find a larger clinic or hospital, preferably in a larger town or hospital – if you have been traveling with a first aid kit, you might want to bring your own hypothermic needle or make sure a fresh, unused one is used to take your friend’s blood.

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  73. Dean says

    So i went to the dominican republic in june and had taken no protective medication beforehand and felt fine when i got home. In late august i began developing flu like symptoms! Wheezy cough, shortness of breath. It just felt like any other time i had flu.

    However we’re in december and this flu has came and gone about 4 times since august and each time gradually getting worse. So i’ve been researching the past few days because the lemsips, flu plus and other over the counter medication doesn’t do the trick, it was then i stumbled onto the malaria symptoms and was reading thinking no way i have this, until i read that the symptoms can kick in months or up to a year after you return from traveling! I have 4 of the symptoms, breathing problems, occasional muscle pain, random bouts pf diarrohea and occasional fever!! Should i contact my doctor about it or am i being over dramatic?

    Thanks

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    • Claire Standley, Editor says

      Actually, the type of malaria found in the Dominican Republic is Plasmodium falciparum, which doesn’t cause relapses. The only types of malaria which cause relapses are Plasmodium vivax and P. ovale, neither of which is found in DR. So, your symptoms are probably being caused by something else.

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  74. Kate Phillips says

    Hi there! This is very informative. I recently learned that an undiagnosed illness may have been p. vivax (the smear result was accidentally filed without being addressed by my doctor.) This illness was many years ago – 15. Are relapses still possible at this time? The article says “years” but I can’t quite tell whether the four years referenced are for relapses or for recurrences of the initial infection. Wondering if I need treatment. Thank you!

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    • Claire Standley, Editor says

      Hi Kate, recurrences and relapses usually refer to the same thing – technically there are slight differences, but in normal parlance, people generally mean the same thing, which is a renewed bout of symptoms without being infected anew by a mosquito bite. And indeed, some people are infected with vivax malaria and go years or even decades before suffering from a relapse – some people never get relapses at all. Whether a patient experiences a relapse or not is poorly understood, and may have something to do with their own immunity, the strain of vivax with which they were infected and perhaps even external factors such as climate. Since you are still not sure whether you actually had vivax or not, I would probably recommend you don’t worry too much about relapses – if you start to experience symptoms of malaria (high fever, chills, aches, etc), then you should definitely suggest malaria as a possibility to your doctor, and ask for a blood test. It might be worth checking around your local area to find a clinic or hospital which is able to perform the blood test with the necessary expertise, just in case. If you do end up having a relapse, the symptoms will be treated straight away, probably with chloroquine, but you should also talk to your doctor about the possibility of taking a course of primaquine, which can kill the dormant malaria parasites and prevent future relapse. The drug is not suitable for everyone (it is not recommended for people with G6PD deficiency) so you may need to be tested for this before taking the drug.

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  75. Robert Cochrane says

    I contracted cerebral malaria in Papua New Guinea many years ago. My doctor at the time advised me that sudden dramatic changes in climate temperature can facilitate a recurrence. Last week I returned to China where I now live after a trip to Cambodia … the temperature in Siem Reap was 37 and in Nanjing -2 … now I have all the symptoms but the best hospitals here cannot find evidence of the parasite. Comments?

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    • Claire Standley, Editor says

      The first thing I should mention is that cerebral malaria is caused by Plasmodium falciparum, which is not able to ay dormant in the human body and thus does not cause recurrences. The only types of malaria which can recur are Plasmodium vivax and Plasmodium ovale, neither of which are associated with cerebral malaria. However, it is interesting that you were warned about temperature changes – I have also heard that temperature changes can trigger a recurrence, but in truth, the mechanisms for recurrence are not that well understood, and may vary greatly depending on where the infection was first obtained. So, for instance, some scientists have suggested that malaria from sub-tropical or temperate zones, such as the Middle East, are more responsive to temperature since this is likely to indicate an appropriate season for mosquitoes to be active, and thus to ensure onwards transmission. In your case, however, since you were likely infected with Plasmodium falciparum the first time and thus not at risk from recurrence, I suspect that you are actually suffering from something else – or indeed you may have been infected anew with malaria! 7 days is about the minimum incubation time, but it’s possible. However, without evidence of the parasites in your blood, either through blood smear or rapid diagnostic test, it is impossible to say for sure. You should ask your doctors to keep checking for malaria parasites, but to also consider other possibilities.

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  76. says

    I have been in a rural area of the Philippines where there is a lot of malaria and dengue. I had falciparum malaria once before and my symptoms were mostly gastrointestinal, but I also had fever. My son was just diagnosed with dengue with the NS1 test and after four days of fever of 104 he is very red all over with a rash and his WBC and platelets are dropping. I am wondering if I should have him tested for malaria, too as he still has fever and is so weak.

    I have had stomach pain and diarrhea, and pharyngeal congestion and cough for several days, and even drinking a little water caused great pain and immediate diarrhea. I had a stool exam and that was normal. Yesterday I was severely prostrated with chills, fever, body aches and weakness. Today the fever is gone but I still have chills, weakness, stomach pain and diarrhea. I am wondering if I should get a blood smear now or wait for the fever to come back as I know that the best time to get a blood smear is when one is having fever. However we have had patients who didn’t show a positive blood smear for falciparum malaria until just before they died, so not sure what to do.

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    • Claire Standley, Editor says

      Hi Margaret, thanks for your question. A high fever and rash is very consistent with dengue – while there is no harm is taking a blood smear as well, it is probably better for your son to recover from his dengue infection before you start to think about malaria. For you, if you think you have malaria, then I would recommend going in straight away for a blood test. If you are sick enough to be exhibiting symptoms then you should have sufficient parasites in your blood to be detectable by microscope. If you are finding that people are sick enough to die from falciparum malaria and your clinic is not detecting it in time, then I would seriously question the level of training and equipment of the clinicians. It might be prudent to try to get a supply of rapid diagnostic tests (RDTs) which are becoming increasingly prevalent in malaria endemic areas – these are also known as self-testing kits, since they are easy to perform on oneself, even at home. They are usually more sensitive than blood smears, though some do not differentiate between the different types of malaria.

      With regards to your other comment about building up resistance to malaria, many long term volunteers take malaria prophylaxis anyway (Peace Corps volunteers take mefloquine for two years in some cases). There is no evidence that long term use of certain prophylactics is dangerous. However, I understand how this may not be possible in your situation, but I would still recommend that you protect yourself from mosquitoes as much as possible, such as sleeping under a long-lasting insecticide treated bednet at night, keeping windows and doors screened or tightly shut and wearing long sleeved clothing. You should also be aware that the mosquitoes which cause dengue are different to those which carry malaria – dengue mosquitoes (of the genus Aedes) are day-biting, so sleeping under a bednet won’t protect you. Long-sleeved clothing and insect repellent will be helpful, but also look around your house and try to remove any possible sources of still or stagnant water – these are ideal mosquito breeding places. Adding insecticide to water, or a layer of oil on top, will further help to eliminate mosquitoes.

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  77. Johnny Mum says

    Hi about 5 years ago I was in Africa for six months. I got falciparum malaria twice. Both were obviously treated successfully.

    Over about the last twelve months I have been getting attacks with “flu-like” systems. Three times if I remember correctly. Each attack only lasts 36 to 48 hours. It is recovering from the last attack (this morning) that I am starting to suspect that I could have a form of malaria.

    My feeling is that each attack is getting worse. This last attack put me in bed for the last 36 hours. This morning I feel more or less ok, but this time yesterday, I had difficultly getting up to go to the toilet.

    I am in a non malarial country (Canada). I would like to be tested to either confirm or deny the presence of malaria.

    Can you tell me when I should be tested for malaria.

    I know malaria remains dormant in the liver, and an attack is required to detect the presence of malaria.

    Should I wait until the next attack or can I go now and do a “blood test”.

    regards ….. Johnny

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    • Claire Standley, Editor says

      Hi Johnny, thanks for the question – you can only detect the malaria parasite during an episode when you are experiencing symptoms. When the malaria is dormant and hiding out in the liver, it is impossible to detect. So, I would recommend finding a doctor or travel clinic nearby where you can quickly get an appointment for a malaria blood test next time you start to experience symptoms. They will be able to tell you then whether you are suffering from recurrent malaria.

      One thing to keep in consideration, however, is that by far the most common form of malaria in Africa is Plasmodium falciparum – this type of malaria is not able to maintain dormancy in the liver, and thus does not recur. The only types of malaria which do recur are Plasmodium vivax and Plasmodium ovale, both of which are much less common. If you are diagnosed with one of these two species of malaria, you should talk to your doctor about taking a course of primaquine, which is a drug that can kill the dormant liver forms of the parasite. It is not recommended for people with certain types of G6PD deficiency, however, so you may need to be tested for this before being allowed to take the drug.

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  78. says

    I should mention that I also had dengue fever when I was last sick with falciparum malaria. Could that be what caused the severe gastrointestinal symptoms? And could that be the cause of my symptoms now or is it impossible to have dengue without a high continuing fever?
    I have not taken prophylaxis now for a number of years as the doctor there recommended we build up our natural immunity to malaria if we were going to be doing volunteer work there long term. That has worked pretty well, though recently I lost several nights of sleep due to a tropical storm and my son being sick with dengue.

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  79. Kondwani Mulenga says

    Hello Editor,
    I come from Malawi a country which is highly infested with Plasmodium falciparum species. Recently, LA (Lumefantrine-Artemether combination) has been introduced as first line treatment regime for uncomplicated malaria.
    Previously, three tablets of SP taken at once could treat such uncomplicated Malaria and it was easy treatment for me once infected. Unfortunately, it was reported that there was development of drug resistance hence introduction of LA. A complete dose of LA consists of 24 tablets taken in divided doses for 3 days.
    I feel doing justice to my self if I take SP to which I am quite responsive, can there be any complication with this?

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    • Claire Standley, Editor says

      The problem with taking SP is that if drug resistance has developed in your area, even if the treatment has worked well for you in the past, it might not continue to be as effective, since the parasites will be able to resist it. Moreover, you may be accidentally increasing the level of resistance in the malaria by using SP when the recommended drug in your area is lumefantrine-artemether. As such, I would advise you, both for your own health and for the health of other people in Malawi, to follow the World Health Organization’s recommendation and take lumefantrine-artemether (or indeed any other artemisinin-based combination therapy) if you become infected with Plasmodium falciparum.

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  80. says

    Thank you for offering such an informative website. I am a fiction writer, currently writing a book set in 1860 New Orleans. A character contracts malaria, so all the information off your site has been very helpful. I am wondering if it is it possible for someone to go blind from malaria?

    I saw the previous post, where the woman’s husband went blind from the medication, but that particular medication doesn’t appear to be in use in the 1860’s. The only medicine I can find that they would have used is regular quinine, which doesn’t appear to cause blindness. Is this right? Any information you can offer would be greatly appreciated.

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    • Claire Standley, Editor says

      Actually, overdoses with even normal quinine are known to sometimes cause blindness, and even mild overdoses can cause visual impairment. In most cases, sight returns as soon as the patient stops taking quinine, though in some instances therapeutic interventions are required. There have even been reports of permanent loss of vision from quinine overdose. Quinine, or rather the bark of the cinchona tree, from which it was later derived, became known to the Spanish when they colonized the Americas in the late 1500s; the dried bark was widely used in Europe to treat malaria from the 17th century onwards, and so would certainly have been well known as a remedy in mid 19th century New Orleans. Moreover, the active compound in the bark was isolated in 1820 by two French scientists, who named it “quinine” – it was used in the Civil War, to prevent malaria in troops on both sides. This purer form could have made it easier to take a large dose, thus running the risk of blindness, and without the modern medical interventions available to us now, it is conceivable that a patient could have suffered irreversible blindness.

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      • says

        Thank you, Claire. This information is exactly what I need. I am grateful for your response! I will let you know when my book is published.

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  81. says

    Hello,

    I have malaria recurrence for about three years now. the symptoms does apeears almost every 4-5 weeks after taken the malaria drug. sometimes after diagnosis,the result doesnt confirm malaria infestation but when i take the malaria drug it works perfectly for a few weeks and the symptoms are back.
    what could be causing that. I am from Ghana

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    • Claire Standley, Editor says

      If the test for malaria is not positive, then you should not take anti-malaria medication, but instead your doctor should try to determine what is actually making you feel sick – because the symptoms of malaria are very general (fever, chills, aches), it can be mistaken for many common ailments, such as respiratory infections or influenza, or even intestinal parasites. Moreover, in Ghana, most malaria is caused by Plasmodium falciparum, a type of malaria which does not re-occur after one initial infection – the only way to have multiple attacks of malaria is if you get re-infected each time. If this is happening, then it suggests you may need to take more care to prevent mosquitoes from biting you, and thus stop yourself from getting malaria. Common methods to control mosquitoes include sleeping under a long-lasting insecticide treated bednet at night (which must be re-dipped every few years so as to retain its effectiveness at killing mosquitoes), wearing long-sleeved clothing at night and in the evenings and even spraying the inside walls of your house with insecticide, to kill any mosquitoes which rest there during the day. Making sure your windows and doors close tightly or are completely screened is also a good way to stop mosquitoes from getting in.

      In rare cases, people in Ghana can be infected with Plasmodium vivax or Plasmodium ovale. These types of malaria do sometimes cause relapses. This is why it is very important to make sure you actually test positive for malaria before taking treatment – the test can also tell you what kind of malaria you have. If you have P. vivax or P. ovale, you may also want to talk to your doctor about taking primaquine, which is a drug that can prevent future relapses by killing the dormant forms of P. vivax and P. ovale that hide in the liver between relapses. This drug is not suitable for everyone, and can cause serious side effects in people with certain types of G6DP deficiency, so you may need to be tested for this condition before being able to take the drug.

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  82. Barbara Johnson says

    Hi. My husband was diagnosed with malaria while working in East Timor more than 30 years ago. He was airlifted to Darwin and spent a week in hospital but doesn’t know what drugs were given to him at the time. Since that time, he has a recurrent illness every January (summer here in Aus) which presents with severe muscle aches, fever, headache and malaise. Some years the illness is short- lived, in others, as this year, he is sick for more than 2 months. He is fed up with our medical system here and can get no help whatsoever. They tell him every year to come back next year when he is again acute. But he has recently started to see a naturopath who has put him on artemisinin. Would you suggest this treatment and is there any reason to think it could affect liver parasites or does he need to go to the more toxic drugs?

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    • Claire Standley, Editor says

      While artemisinin (or better yet, it’s derivatives – artemisinin itself is not very soluble and thus hard for the body to absorb) could be effective against the acute symptoms, it will not have any action during the relapse phase, nor prevent relapse. Additionally, using artemisinin by itself is NOT recommended by the World Health Organization (WHO) due to the likelihood of contributing to drug resistance in malaria. WHO instead recommends that people only use artemisinin-derivatives in combination with another anti-malaria drug, such as mefloquine, piperaquine or lumefantrine.

      What your husband should ask about (and this would have to be within the conventional health system) is whether he can take a course of primaquine. This drug can kill the latent liver stages of malaria which cause relapses. However, the drug is not appropriate for people with certain types of G6DP deficiencies, so your husband might have to be tested for that before taking the drug. I would also recommend that your husband be tested for malaria during an acute phase before taking the primaquine (to ensure he actually has P. vivax or P. ovale, the two forms of malaria which can cause relapses), but I can appreciate that it is not convenient waiting a year for a diagnosis, if the relapses occur annually!

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  83. Briana says

    Hi ,my boyfriend is currently diagnosed with malaria.I was wondering if anyone would know any good medicines that i could suggest to him.He has been having some of the symptoms too.he’s been very weak ,hot and his temperataure is rising.I don’t really know what to do because i’ve never experienced someone with malaria ,but hopefully someone could also give me advice…

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    • Claire Standley, Editor says

      Hi Briana,

      Sorry for the slow reply – the type of medication that should be recommended depends somewhat on the type of malaria your boyfriend has. However, a good bet is usual an artemisinin-based combination therapy (ACT) as these are effective against all types of malaria. Common brand name include Coartem, Alu and Duo-Cotecxin.

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  84. says

    Hi,

    I work in a hospital laboratory and was told by a member of staff that if a patient presents at A&E with ? Malaria, and the RDT is negative, the A&E staff sometimes send another sample at night as the parasites come out of hiding at night. Is this person getting confused with the actual Mosquitoes which come out at night or does a change in body chemistry bring out the parasites within the body at night?

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    • Claire Standley, Editor says

      It is true that there are often cycles of fever with malaria, which correspond to cycles of higher parasite densities, but throughout the cycle you can see the parasite in the blood of the patient. Plus, for most malaria species, the cycle is longer than 24 hours (usually 48 or 72; the exception is P. knowlesi which is 24 hours), and not necessarily in any way associated with day versus night. In fact, I think the staff member you mention is getting confused with lymphatic filariasis, another parasitic disease found in tropical regions of the world, and caused by a parasitic nematode worm called Wuchereria bancrofti. With that illness, the microfilariae (tiny larvae of the parasite) migrate to the peripheral blood vessels at night (presumably so they are more accessible by mosquitoes, for further transmission), so when diagnosing lymphatic filariasis, it is important to make a blood film at night to detect the microfilariae.

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  85. Vanessa says

    Dear Clare,
    I am currently in Liberia on a field trip for work. I tried/and stopped taking doxycycline (after 3 days) as the tablets were making me sick. I have been very careful to not get bitten by mosquitoes for the first 3 weeks of my trip, however in the last 3 days I got bitten over 30 times by mosquitoes… I am wondering if there is a test I can take to detect malaria prior to symptoms appearing – if yes, when would be the best time to take it? Can Malaria be treated pre-symptoms appearing? In Liberia I am more likely to get falciparum malaria.
    Many thanks for your help!

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    • Claire Standley, Editor says

      Hi Vanessa,

      What were your side effects from the doxycycline? Usually they are quite well tolerated.

      In any case, it is difficult to detect malaria before symptoms appear, and you also cannot effectively treat it until that point. You could try using a rapid diagnostic test, which might pick up traces of the parasite before full symptoms appear, but it would only be effective shortly before you got symptoms anyway.

      Another approach could be to try taking a different anti-malarial, if you can find one in Liberia. My recommendation would be Malarone, but it might be difficult to find where you are. Mefloquine (often sold as Lariam) would be another option. You would have to take both doxycycline and the other anti-malarial for a few days, and then also remember to continue taking the new anti-malarial after you return home (7 days for Malarone, 4 weeks for Lariam). Malarone, like doxy, is taken once a day, whereas Lariam is taken once a week.

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  86. David Murphy says

    David, 9th Marines, 67-68, Northern I Corps.

    I had the infamous FUO, fever unknown origin, over 105 degrees. Our Corpsman and the field doc ( not evaced to to the hospital ship) advised not to donate blood, suspected malaria. All the classic malaria symptoms.
    Just coming out of what may be a relapse, about number 5 over the years. ALL the symptoms. Likely that is what it is? And i have been diagnosed with an atypical case of Crohn’s Disease- classic GI tract narrowing but no other symptoms. No meds or treatment. Can all of this be related?

    Also important to me, can the malaria parasite or whatever, be inheirited, is it genetic? My daughter has some inflammatory, auto immune process ( they think) that they have not been able to definitely identify. Any chance this could be related to my situation?
    Thanks.

    Luckier than most!

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    • Claire Standley, Editor says

      David,

      Thanks for your comment. First of all, please let me reassure you that malaria is no way inherited, in terms of passing from a father to a daughter. In highly endemic areas, mothers who get infected during pregnancy can pass it on to their children through the placenta – this is known as “congenital” malaria, and is the only form of vertical transmission of malaria.

      It certainly sounds like you have been suffering from malaria relapses. Next time you have the symptoms, you should get tested – if it comes back positive for P. vivax or P. ovale (the relapsing forms of malaria) you should ask your doc about taking a course of primaquine to prevent future relapses. I don’t think your malaria is related to your Crohn’s disease (malaria rarely has long-term effects), but particularly if you do test positive, it might be worth bringing it up with your physician as well, just in case.

      – Claire

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  87. Guy says

    Hi Claire

    I have been to Nigeria for three weeks and was taking a mifloquine antimalrian drug. Is it possible to have malaria symptoms such as a headache and sore throat without fever three weeks after my return from my trip or it might be a side effect of the antimalaria drug that I was still taking at that time. Moreover, is it possible to check the existnence of the parisite by any lab test if there are no sypmptoms?

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    • Claire Standley, Editor says

      Hi Guy,

      Without fever, it is likely that your symptoms are being caused by something other than malaria (as you say, it could be side effects of the medication, or likewise it could just be a slight cold or something like that). Soem rapid diagnostic tests might be able to pick up malaria before symptoms start but you would have to check what exactly the test is looking for and how sensitive it is – most lab tests are only accurate either just before symptoms start (i.e. when there are already quite a few malaria parasites in your blood stream) or once they have started.

      I hope you enjoyed your trip to Nigeria – I am actually in Lagos right now!

      Thanks for your comment.

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  88. Emma says

    Hi, I just got back from Burundi and Rwanda, Africa I was bit over 30 times in 2 nights while there! I am not sick but it has only been 1 week since I got back. I am wondering if I can get tested before symptoms start? Or if you have to wait until you are sick let me know!! Thanks

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    • Claire Standley, Editor says

      It depends – the symptoms are the result of lots of parasites invading your red blood cells. As such, just before symptoms start, you may be able to see some of the parasites in your blood using a microscope. Similarly, a rapid diagnostic test might be able to pick up traces of the malaria antigens, which are produced once the parasites start destroying red blood cells. However, the latent period can sometimes be up to 4 weeks, so it would be difficult to judge when, prior to symptoms starting, actually to test. If you don’t have symptoms, I would suggest that there isn’t much point in getting tested.

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