Malaria Relapse

Question: I had kidney transplant in 2014 from Pakistan. In 2016 I was diagnosed with severe malaria. First doctor did not recommend malaria test, they start giving me antibiotics injection but every week I suffered high fever with shivering & after 3 to 4 months they came to know it’s malaria.

They gave me ds artem plus 80/480, but after 6 months I was diagnosed with malaria again and again I was treated with Ds artem. Now after every 3 or 4 months again I have to suffer the same things but by passing of time it’s reducing its severity. Now I have fever but no shivering. Body cramps etc now I have done malaria test but report was negative, but I know it’s the same feeling of malaria but less extensive. I repeat the Ds artem course and feels better….. Please recommend me some good treatment

Answer: Did your doctor ever tell you which type of malaria you had? It sounds like you might be suffering from Plasmodium vivax, a type of malaria which is quite common in Pakistan. (As an aside, malaria can be transmitted via organ transplant though this is quite rare. If you live in Pakistan or travel there frequently, it is more likely you were infected directly by being bitten by an infected mosquito.)

This type of malaria can produce forms which “hide” in the liver, and emerge again after weeks, months, or even years to cause disease again. In between these episodes, while the malaria is hiding in the liver, a standard blood test for malaria would come up as negative. In order to be diagnosed, you will need to take a blood test while you are experiencing symptoms, and it needs to be a test that can distinguish between the different types of malaria.

Some rapid diagnostic tests do this, but you could also have a qualified technician perform a blood smear to identify the type of malaria. If indeed you have P. vivax, you should talk with your doctor about taking a course of a medication called primaquine, which can kill the form of malaria that hides in the liver, and thus prevent any future relapses. However, you will need to talk with your doctor about whether this medication is appropriate for transplant patients; it also cannot be given to people who have deficiency in an enzyme called G6PD, so you should make sure you are tested for this before taking primaquine.