QUESTION:
Hello, I have had malaria four times in Papua New Guinea, the last time was the “brain” type – sorry don’t know the name. The other times were ‘regular’ malaria. I have been free of it for 21 years now; could it still recur in me?
thanks,
Jay
ANSWER:
Hi Jay, thanks for your question. The “brain” type you are referring to is probably Plasmodium falciparum, which is known for causing cerebral malaria in serious cases. Actually, the majority of malaria cases in PNG are caused by this parasite, even the so-called “normal” cases, which don’t get as serious as to become cerebral.
The good news about P. falciparum is that it does not have a latent stage in the body, so patients cannot get relapses. However, there is another type of malaria in PNG, called Plasmodium vivax, which is less virulent (doesn’t cause as severe symptoms), but if not treated properly, does have the ability to leave latent stages of the parasite in the liver. These liver forms can become active a long time after the initial infection; usually the maximum limit for relapse is a couple of years though (one case in Italy reported a patient with relapse after 4 years, which was considered very unusual – the citation for this paper is Mangoni et al., 2003, ‘Case report: An unusual late relapse of Plasmodium vivax malaria, in American Journal of Tropical Medicine and Hygiene, volume 68, pages 159-160), so you should be fine after 21 years being malaria-free!
In your case, unless you were diagnosed otherwise at the time, I would think you probably were infected with P. falciparum all four times, and so there is no chance of a relapse; if you’re really worried about it, you can have a malaria test to see if you still possess antibodies against malaria, which would suggest there are still parasites in your body, and might indicate P. vivax infection (there are some blood tests which can distinguish between these different types of malaria). Then, you can take a drug called primequine, which eliminates the liver stages and ensures no further relapse.
Hello, I went on the Sinfonia to the Portuguese Islands, Mozambique and Maputo. We got off Maputo and walked in the town. This was in April, I fell extremely ill on the 16 of June, vomiting, bad headaches, body extremely sore, cold shivers, running low temperatures. My Doctor said I had body flu. I went back to 2 different Doctors and they just kept telling me its a Viral Infection. I landed up in hospital, there also they had no idea. I had been suffering for 3 months and all types of medicines and nothing helped. I then started to get really bad pains in my joints especially my shoulders and hips, I couldnt even get up. I went to a homeopath and he took blood from my finger and put it under the microscope and by him just listening to me at first told me it is Malaria and then confirmed it. My house Doctor still says it is not or was not Malaria. What I want to know is this, will this come back and when, will I be this sick as the Homeopath said I would be? I have already started with the neck pain and heachaces and joints being sore. I want to know if it was Malaria and if it is coming back
The only way to know for sure if it was malaria is either by taking a serology test (where they look for antibodies against malaria in your blood) or by blood test while you are feeling ill. This blood test can either be a blood film looked at under the microscope by a trained medical professional, or a rapid diagnostic test. You should ask your doctor to perform one of these tests next time you have the symptoms. It is rare for the incubation time of malaria to be so long (i.e. several months) but not unheard of. Were you taking medication to prevent malaria (i.e. prophylaxis)? This can sometimes delay onset of symptoms.
As part of your diagnosis, you should also confirm what type of malaria you have. If it is Plasmodium vivax or Plasmodium ovale, then there is a chance it will come back – this process is called relapse, but can be prevented by taking a medication known as primaquine. You should be tested for G6DP deficiency prior to taking primaquine, however.
If you have another type of malaria (such as Plasmodium falciparum) then there is no chance of a true relapse, and if you are treated with the appropriate medication (i.e. an artemisinin-based combination therapy, such as Coartem) you should recover fully in a few days and should not experience a renewal of symptoms, especially if you are no longer in an area where malaria is transmitted. If you do have symptoms again, it is likely due to treatment failure – it is crucial to always take the appropriate dose of medication, and for the full amount of time.
Once again, however, I want to emphasise that before taking any medication against malaria you should have the diagnosis confirmed by a doctor or hospital technician who is trained in malaria diagnosis. This will prevent you taking unnecessary or incorrect medication for your condition.
My friend is 80 years old, and had malaria as a 5 year old child while living in Baytown TX. He was treated for malaria at that time, and has been fine until about 8 years ago when he began to have seasonal (warm weather) symptoms that are very similar to the original symptoms of malarial infection: chills, low grade fever, nausea, vomiting, and extreme tiredness. And, since the weather has been so warm in Houston, TX over the past two years, his symptoms are recurring with greater frequency.
Could it be possible that he has recurring malaria?
Mira
It’s certainly possible, though the chance is quite small – it’s pretty rare for malaria to reoccur after such a long time period, though there are definitely cases in the literature of malaria recurring after a number of decades (though I think this might be a record, if indeed it is malaria!). Your friend might want to consider going in for a blood test next time he experiences symptoms – a tropical medicine or travel clinic should be able to perform the blood test to see if there are any malaria parasites.