Long term health effects of malaria when young?

QUESTION

I’m trying to find out if having malaria at a young age can have long term effects on health.

Around 25 years ago when I was 4 years old I contracted malaria when living in central Africa. Unfortunately I do not know the type of malaria, only that I received medication and recovered without complications.

Over the last few years I’ve had a general feeling of poor health and fatigue. Blood tests indicate I have some level of liver damage but I’m at a loss for the cause.

Is there any chance of having picked up liver damage (or other long term effects) from contracting malaria at a young age?

ANSWER

There is little evidence for any long term complications associated with uncomplicated malaria infection. One thing to investigate might be the type of malaria you had as a child; Plasmodium vivax and Plasmodium ovale, while not as common as Plasmodium falciparum in Central Africa, both occur in this region, and differ from P. falciparum in that they can have a dormant liver stage.

While I still have not heard of liver problems being associated with dormant malaria parasites, it is conceivable that if you had one of these two types of malaria and did not have the liver stages treated, you might later feel some ill effects; relapse from P. vivax has been known to occur decades after the initial infection. The good news is that there is a drug available, called primaquine, which can kill these liver stages (known as hypnozoites). So, if you know you had P. vivax or P. ovale, you could mention this possibility to your doctor—prior to taking primaquine you should have a test for G6DP deficiency, as such as deficiency makes it dangerous to take this medication.

If you have ever taken anti-malaria medication, please take Malaria.com’s brief Malaria Medication Side-effects Survey: Treatment and Prophylaxis.

Comments

  1. Krysia Davis says

    I had malaria nearly 60 years ago, but am wondering if I am now feeling the effects of some damage that was caused then. My digestive system is terrible and has been getting increasingly worse over the last four or five years. I’m wondering if its possible that my liver has been compromised somehow?

    Like or Dislike: Thumb up 3 Thumb down 0

    • Claire Standley, Editor says

      The liver is not very directly related to digestion, so it is unlikely that the effects you are feeling are due to malaria, especially several decades ago. Malaria, especially if treated appropriately and successfully, rarely has long-term effects on the body.

      Like or Dislike: Thumb up 0 Thumb down 2

    • aimee krouskop says

      Krysia, I have been trying to determine the same question, having experienced 5/6 rounds of malaria in 3 years.
      (One was a vivax/falcip. combo). My suspicion is that my liver’s ability to detoxify has become compromised, and that is what causes my intestinal issues, which are showing up as intolerance to the gluten protein and night shades.

      Claire, could you point us to the research done on the long term effects? I havent been able to find any.

      Like or Dislike: Thumb up 2 Thumb down 0

      • Claire Standley, Editor says

        Hi Aimee,

        There actually isn’t a lot of evidence for any physiological long-term effects of malaria infection. That is not to say it never happens – just that long-term effects are probably rare, and so not often observed in longitudinal studies where people who have been infected once or multiple times are followed up years later. Most of the studies of this type have focused on the long-term effects of having repeated malaria attacks as a child (i.e. for communities living in endemic areas), or the long-term cognitive impacts of having suffered severe cerebral malaria (i.e. caused by Plasmodium falciparum). I have provided a link to a review of the scientific evidence for long term cognitive impact of malaria below; in addition, I have provided a link to Jeffrey Sachs & Pia Malaney’s comprehensive overview of the social and economic burden of malaria.

        Holding & Snow, 2001

        Sachs & Malaney, 2002

        In addition, I also recently found a very interesting study which looked at the long-term consequences of malaria chemoprophylaxis in children living in an endemic area. The full paper can be freely accessed online and the link is here: Jukes et al, 2006.

        Like or Dislike: Thumb up 0 Thumb down 1

      • Thomas says

        Hi Aimee,
        I am very interested in what you’ve said here as I have been experiencing something which sounds very similar. My wife and I are aid-workers who have spent most of the last 20 years in malaria zones in South-east Asia, South-Asia, East Africa and Central America. My health started deteriorating with constant bouts of illness and after 10 years or so I was finally diagnosed by the Liverpool School of Tropical Medicine with Vivax malaria hypnozites in my liver (as well as an active falciparum attack at the same time), explaining the constant bouts of ill health spanning years (I never used malaria prophylaxis). The intestinal problems were not diagnosed at the time.

        Since then, I have finally figured out that I have a rather extreme intolerance to gluten now and it is absolutely debilitating when I mistakenly end up eating food with gluten in it. The effects seem to go far beyond the gastro-intestinal with gluten contamination, with pains in my legs, and various muscles and joints, and a cloudy brain and memory in a pattern I now recognise very well lasting about 10 days to two weeks. This took a while to figure out as I was sure it was some parasite causing my intestinal problems. I have also been experiencing a recurrence of the vivax over the last couple of years, and am currently trying to get primaquine to deal with the malaria once and for all as I now live in Europe away from malaria.

        I would dearly like to compare notes with you to see if our experience in this is similar. I’ve often wondered if the malaria was a trigger for setting off the gluten intolerance, or was somehow related. It certainly complicated finding the original diagnosis as I was sure the intestinal problems and the symptoms from malaria were part of the same problem…and my GP initially didn’t have a clue what to do with my symptoms. I don’t know the policy for posting email addresses on this site, but I would be happy for the site administrator to share my email address with you.

        Regards,

        Most Popular. Like or Dislike: Thumb up 5 Thumb down 0

  2. Aimee Samara Krouskop says

    Claire, Thanks for your comments, the links, and for coordinating Thomas’ email to me…
    Although, I’m a bit unclear; it sounds like you mean to indicate there has been no observation of physiological long-term effects of malaria infection because studies have not been done. Is that correct?

    If this is true, then it seems we don’t actually know how rare it is? Or am I missing something?

    If true, its surprising to me that longitudinal studies of this sort have not been done, as the potential impacts on the liver, resulting from the medication at the least, seems an obvious inquiry. Perhaps we need to lobby for the research.

    Thomas, ‘glad to hear your note…. To be honest, I’ve become frustrated with my failed attempts to garnish some collaborative imagination from either or natropaths or allopaths on this idea. As I mentioned, I suspect for me, its as simple as: my liver’s ability to detoxify has been compromised, thus my body’s reaction to gluten as a toxin and steroidal glycoalkaloid solanine as a toxin from nightshades is more severe. My intent is to do what I can to support my liver health.

    I’ve sent you a direct email, and I look forward to more conversation.
    Aimee

    Most Popular. Like or Dislike: Thumb up 4 Thumb down 0

    • Claire Standley, Editor says

      Hi Aimee,

      My understanding is that little research has been done on the long term effects of malaria infection. However, it is difficult to know for sure, since one of the shortcomings of the process of scientific publishing is that negative results rarely make it out into press. That’s to say, if a long term study showed some sign of liver damage, then you can be sure it would have been published straight away, but if it was done and nothing was found, it probably wouldn’t be, since this is what everyone expects is the case. It’s frustrating at times – I often think that there should be a special scientific journal for negative results of this kind, so they could at least be available to the public!

      Furthermore, I imagine that one of the complications is that the people most likely to suffer from malaria infection are often infected multiple times throughout their lives, and often have many other conflicting infections (schistosomiasis has a liver aspect, for example). As such, controlling for the effect of malaria alone, let alone a single malarial infection, can be difficult.

      Since I last wrote, I did find one study which looked at malaria seroposivity, hepatitis infection and primary liver cancer in Vietnam. Over 500 patients were surveyed, and while there was an association between hepatitis and liver cancer, there was no link between whether a person had ever had malaria and if they had liver cancer. This is an extreme case, but is a tangential piece of additional evidence that malaria does not have severe long term consequences for health, as far as we know now.

      If you see my response to Thomas’ post, I am also trying to get hold of a case study of an aid worker who thought they had a long term parasite infection which turned out to be a gluten insensitivity. There are hints that there might be a causal relationship, which I hope to read more about once I receive the article, and I can pass it on to you as well if you are interested. Your idea of the malaria infection compromising the liver’s ability to break down toxins is really interesting – I will see if any of my research colleagues have any insight into that.

      Best,

      Claire

      Like or Dislike: Thumb up 0 Thumb down 1

      • Aimee Samara Krouskop says

        Claire, Thank you again for your research and thoughts. I’m finding that even small leads like these are revealing important pieces to the puzzle.
        Warm Regards,
        Aimee

        Like or Dislike: Thumb up 2 Thumb down 0

  3. Claire Standley, Editor says

    Hi Thomas,

    Thanks so much for sharing your experience, and I believe our administrator has enabled Aimee to contact you directly as well. I want to draw your attention to this scientific report which describes a situation extremely similar to yours – an aid worker returning from a long posting in East Timor was convinced she had a long term gastrointestinal infestation but in fact was eventually diagnosed with celiac spure (gluten intolerance) and responded very well to a gluten-free diet. I cannot access the full article at this point, but the abstract implies that an original intestinal infection (of which I have sure you have also had your fair while living overseas, in addition to malaria!) might have “unmasked” the gluten intolerance. I have requested a copy of the full article, which I can email to you directly if you are interested, once I receive it. A link to the abstract is here: http://informahealthcare.com/doi/abs/10.1080/00365520410009366

    Best,

    Claire

    Like or Dislike: Thumb up 2 Thumb down 0

  4. Wendy Milligan says

    Wow have just read these posts, I have been suffering in recent years from digestive issues that have been diagnosed as gluten intolerances, parasitic infestations, impaired liver function by my GP as well as Naturopaths. Now I don’t feel like I am going mad! I had malaria a couple of times 40 years ago, maybe all these symptoms can be attributed to the malaria.

    Most Popular. Like or Dislike: Thumb up 4 Thumb down 0

  5. Graham says

    Can any one help. I believed I caught malaria 10 years ago working in the Delta in Nigeria. I now suffer night sweats/hot/cold. Not all the time but when I get a bit run down. I go to the doctor. I have no temperature and blood tests are fine yet I feel fevirish/trembly and weak. Is this a possible side affect. I took Larium without fail when in all these places. yet it seems when I get down I get cold sweats/then hot sweats and the shakes. Can anyone advise. my docs do not seem to consider it. I have also worked in Sakhalin Island ,althrough asia and middle east. Could I have got this just thinking I had the flu.
    Graham

    Most Popular. Like or Dislike: Thumb up 4 Thumb down 0

    • says

      Hi Graham,
      Your best bet is to have a specific blood test for malaria the next time you have these symptoms. If you have malaria the parasites should be identifiable on the blood smear. The symptoms you describe would not be a side effect of Larium ten years on. That’s all the advice I can give. I hope you get better soon.

      Like or Dislike: Thumb up 2 Thumb down 1

  6. Jane says

    I was born with malaria (most likely P. vivax) in Mississippi and had recurring bouts until the age of 18. Following this age, I continued to have excessive fatigue and muscle aches throughout life into older adulthood. This condition is now diagnosed as fibromyalgia. I have an enlarged spleen. Is there any evidence of persistent muscular pain and fatigue occurring as a result of chronic malaria contracted at or near birth?

    Like or Dislike: Thumb up 2 Thumb down 0

    • Claire Standley, Editor says

      As far as I know, there are no long-term studies available which have examined the long term consequences of malaria infection from near-birth, particularly in the developed world. In developing countries, such as in sub-Saharan Africa, there is evidence that congenital malaria (having malaria from birth) can impact newborn birthweight, anemia and other short term indicators (which themselves have implications for later health) but these have not been directly related to specific medical conditions later in life. I think it is unlikely that persistant muscle fatigue and pain many years after infection would be attributed to malaria many years earlier as a child, but it could be worth talking with your doctor about this possibility.

      Like or Dislike: Thumb up 2 Thumb down 2

  7. Eva Wilhelm says

    In 2009, with 52, I was diagnosed with Malaria (Plasmodium vivax). I was treated (even though almost too late) and recovered. Since then however, I have had a number of complaints, I have never had before. I often have problems with digestion (acidity), and fluctuating energy levels. I also don’t seem to be able to loose weight although, I got very thin while ill. I also have reoccurring head aches, something I never experienced before the decease. I came to this site because for some reason, I feel it has to do with my liver although I do not have any evidence for this. It is as if something isn’t right and I cannot figure out what it is.

    Most Popular. Like or Dislike: Thumb up 7 Thumb down 0

  8. Mary Flavell says

    In 2001 whilst working at mission hospital in northern Uganda I became very unwell and was diagnosed with Malaria from Plasmodium Falciparium. I did not have the usual fever and my temp. was instead low. My count was extremely high and I was put on Quinine drip. It took many months before I was well again. The quinine treatment has left me partially deaf and with tintitus. Recently I have had heavy profuse head sweats and blood tests have shown up abnormalities in Liver Function tests. I am now going to have xrays to rule out Tb.
    I am also having test with regard to vestibular neuritis. Like previous commentors I too wonder if the symptoms are because of the Malaria. My only symptom with regard to the malaria is that I went to bed after work very tired and my husband let me sleep 36 hoursbefore realising something was wrong ( He ran the Lab!!!) I am now 72.

    Most Popular. Like or Dislike: Thumb up 4 Thumb down 0

    • Claire Standley, Editor says

      As you’ll have seen from previous posts, there really isn’t a lot of good evidence for patients experiencing long term effects of malaria infection – the vast majority of people recover completely and never experience any abnormal symptoms again. However, it is not beyond the realm of possibility that in some cases, patients do experience lingering effects – there just isn’t enough hard data to say for sure. Another point to consider is that, as you know, quinine is a very toxic medication – I am not that familiar with the literature on quinine toxicity, but I wonder if maybe quinine could cause permanent damage to a patient in such a way that they might experience symptoms consistent with yours many years after the fact. The tinnitus that you mention, for example, is actually a reasonably common effect of long term /high dosage quinine use.

      Like or Dislike: Thumb up 2 Thumb down 0

  9. Mary Flavell says

    Dear Clare,
    Thank you for your reply. My xray results are normal. So just have to see if time will help and the sweats will stop. Regards Mary .

    Like or Dislike: Thumb up 1 Thumb down 0

  10. Jane Holt says

    Thank you for replying to my earlier post which I would like to elaborate on. The treatment for the continuing childhood bouts of malaria was for years quinine, changing in late teenage years to atabrine. Besides the lifelong muscle aches and debilitating fatigue, as a child and adult, I had what was later called spastic colon. Since all of these symptoms felt so much like malaria, I associated the combination of symptoms with malaria througout my lfetime and have wondered if there not a connection.

    Like or Dislike: Thumb up 2 Thumb down 1