Malaria Relapse

Question: I’ve been on a holiday to West Africa where I was infected with Malaria. After a treatment in the hospital of Abidjan (Ivory Coast) I recovered and had a flight back to the Netherlands (my home country). It is now nine months later, and to me it looks like I’ve the same symptoms again. Slowly (for almost 3 weeks now) the symptoms are getting back, I’ve the same muscle pain, temperature changes, etc., but less heavy.

1. Could this be a relapse of Malaria (I don’t know which type of Malaria I’ve had so that makes it a bit difficult to answer I guess)?
2. Can I recover on my own or is treatment necessary?
3. What is the best way to recover?
4. And at the end, is a relaps just as dangerous as the first infenction (so is there also a probability you could die)?

Answer: It’s certainly possible that you have experienced a relapse of malaria. While P. vivax malaria, the type that most commonly causes relapses, is thought to be quite rare in West Africa, it’s likely to still be present; moreover, there is another type of malaria, called P. ovale, which also causes relapses and is present throughout tropical sub-Saharan Africa. It is also possible that you are not experiencing a true relapse, but rather something called recrudescence, where your initial malaria infection was not completely cured through treatment – enough of the malaria parasites were killed that you felt better, but some remained, and by re-multiplying in your blood, are now numerous enough to make you ill again. Recrudescence is most common with P. falciparum malaria, and can occur when the treatment you were provided was not sufficient, for example if the dosage wasn’t high enough, you didn’t take it for long enough, or the medication itself was counterfeit or not fully potent.

You should definitely be tested again to make sure that you are in fact experiencing another malaria infection and not some other illness picked up during your trip. If it is malaria, you should be treated accordingly, and based on the type of malaria you have. While death is less likely from P. vivax or P. ovale malaria (compared to P. falciparum), all forms of malaria are potentially very dangerous and require treatment. If indeed there is a suspicion of recurring/relapsing malaria, you may also need to take primaquine, to prevent further relapses. Primaquine should not be taken by people who are deficient in an enzyme called glucose-6-phosphate dehydrogenase (G6PD) so you should be tested for this deficiency prior to taking primaquine.