QUESTION
What is the treatment of chronic Vivax malaria?
ANSWER
Blood stage infection with Plasmodium vivax can usually be treated successfully with chloroquine, though resistance is spreading in some areas (notably the Pacific Islands, Papua New Guinea, parts of south-east Asia and especially Indonesia, and Peru). P. vivax is also sensitive to artemisinin-based combination therapies (ACTs) and as no resistance to artemisinin has been reported, these are widely recommended (though combinations which include sulfadoxine-pyrimethamine should be avoided as many strains of P. vivax appear to be resistant to pyrimethamine).
Liver stage (i.e. relapsing) P. vivax can only be treated with one drug: primaquine. Instances of liver stage treatment failure are relatively commonplace, and may be strain or dosage dependent. Primaquine is not recommended for people with G6DP deficiency, so potential patients, and particularly those from locations or ethnic groups known to have high levels of G6DP deficiency, should be tested prior to treatment.
I have 5 (five) year old son who has been diagnosed with malaria every time he goes for check up. He gets treatment but when he is not well may be due cough and we visit the hospital/clinic, they always find malaria. What could be the problem/cause? Which treatment should he get to recover fully from the chronic malaria? what could be the effects of the chronic malaria and what advise would give me to handle the situation?
Thank you
Chronic malaria has recently begun to gain attention within the research community, and may perhaps be much more common in endemic areas than previously thought. The causes and options for treatment depend a bit on the level of malaria transmission in your area, and also the type of malaria your son has been diagnosed with. For example, malaria caused by Plasmodium vivax or P. ovale can be considered chronic when it persists in the patient’s liver, producing relapses of infection weeks, months or even years after the initial infection. In between malarial attacks, these patients show no signs of the malaria parasite in the blood, but during the relapse, the parasite re-enters the blood from the liver and can be detected (it is this phase, when the parasites are in the blood, that symptoms begin to show). These patients should have each relapse treated with anti-malarial medication (the World Health Organization recommends artemisinin-based combination therapies for all first-line treatment of uncomplicated malaria), and then should discuss with their doctor the possibility of taking primaquine, an additional drug which will kill the dormant liver stages and prevent future relapse.
However, from your description of what has happened with your son, it sounds more likely that he has a different type of chronic malaria, whereby a low level of parasites are always detectable in the blood, even when your son isn’t exhibiting symptoms strictly associated with malaria. In these cases, your son might have another illness (say a cough, as you mention), but when you take him to the hospital, they find the low levels of malaria parasites in his blood and thus diagnose him with malaria. This type of infection is particularly associated with Plasmodium malariae infection, which tends to be less severe than other types of malaria, meaning the patient may often go for long periods of time without realizing they might be infected, yet all the while, the parasites are in their blood. Long term, this type of chronic infection has been associated with something called childhood nephrotic syndrome, particularly in West Africa and Papua New Guinea. However, given that your son has been periodically treated with anti-malarials, I would be surprised if he continued to have chronic P. malariae infection. In other cases, and particularly in high transmission areas, patients have also been observed to carry chronic P. falciparum infections. P. falciparum is the most dangerous and severe type of malaria, but it seems that in places with high transmission, where people are frequently exposed to this type of malaria, they quickly acquire sufficient immunity to keep the parasite at low levels in their body, without severe effects. Again, as with P. malariae, treatment should kill off even the last few parasites, thus breaking the chronic infection, but in many places, P. falciparum has become resistant to the main forms of treatment. You must ensure that your son is given a weight-appropriate dose of an artemisinin-based combination therapy – some examples of this type of anti-malarial include artemether-lumefantrine (sold under names such as Coartem, Lonart, Alu and Rianet), artesunate-mefloquine (called ASMQ), artesunate-amodiaquine (called ASAQ), dihydroartemisinin-piperaquine (Duo-Cotecxin) and many others.
Hello,
I have been diagnosed with malaria every time when I’m not feeling well for about two months now. I took different medication to treat malaria but always ended unsuccessful.. Malaria symptoms occur immediately after taking the full dose of antimalarias such as Alu, duo cotexin and artequin. During administration of artequin I didn’t get relief at all. Now am taking artemether injection and still am feeling malaria symtoms during the course of treatment while I have left only one injection to complete the dose. My body weight is 90kg and am in Tanzania. Could you give me some advice please?
Hello,
It is possible that your clinic is overdiagnosing malaria – I have observed in certain areas (including Tanzania) that sometimes nurses and doctors in clinics are concerned about the serious implications of failing to diagnose a patient with malaria, with the result that if a patient is feeling unwell, they will automatically prescribe malaria medication. Given that you have been taking all the right forms of medication, and there is no known resistance to those medications in Tanzania, yet not having any relief, I think the most logical conclusion is that you don’t have malaria, but instead, should be seeking an accurate diagnosis. Please tell your doctor that you have taken successive rounds of anti-malarials and they have not been successful in curing your symptoms – a good doctor should then perform a blood test, either to look for the malaria parasites in your blood, or to use the blood in a rapid diagnostic test (RDT). These latter tests are becoming more widespread in Tanzania, and are a fast and accurate way to diagnose malaria.
A final possibility, though unlikely given the number of different medications you have tried, is that the drugs you took were either counterfeit or expired. Check to make sure your pills are in their original packaging, and preferably the original box, with the expiry date clearly marked as later than the current date.
IT IS GOOD.