QUESTION
Healthy 30 year old male, arrived in West Africa 2 weeks ago, using doxycycline as prophyaltic but not systematically—I know I missed a day or two, and had not taken it before arriving; lots of mosquito bites. Also believe my doxy to be expired—how long is it good for in capsule form? Doesn’t have expiry on my prescription. Symptoms showed up around day 7 in Mali: sore neck, headache, nausea, slight fever. Then left me for several days but returned strongly 5 or 6 days later at which time I went to pharmacy and began Artequin 600/750 (Artesunate + Mefloquine) – three day treatment. Felt better immediately after taking first dose. After second dose went to clinic for blood work for some reassurance but test came neg for Pl. falciparum; doc had warned that neg result is likely due to medication. The blood work showed my Lym # to be higher than normal range 74% vs range of 20-40%, however the clinician provided no comment and I only realized this after. Just took day three dose and don’t feel any worse but have some diareah, general discomfort. Not as intense as two previous waves of sore neck and nausea. Now resting but its awkward having no reassurance I have malaria. I read high lym (presuming this means lymphocyte—french blood result printout) count is generally due to viral infection.
Could I have a virus that may require a different form of treatment? Should I stay put at hotel hoping the malaise will pass or seek further medical assistance? (any consensus on what time frame for symptoms to pass?) Thank-you.
ANSWER
I have passed your question on to our advising medical doctors at malaria.com, and once they get back to me I’ll post it here. In the meantime, it might be worth knowing that although elevated monocyte levels can be associated with malaria infection, lymphocyte/general white blood cell counts tend to be decreased in malaria patients (I find it unusual that your value was given as a percentage rather than a number). As such, it suggests you might have some other infection, though it doesn’t have to be viral—there are other causes of elevated lymphocyte counts, such as bacterial infections, which can be tested for in a hospital.
Depending how long you are going to be in Mali for, you can either try to see a physician there who might be able to give you further tests (you should also have another malaria test a few days after you have finished the course of medication, especially if you still feel ill), or if you are feeling better, you could perhaps wait til you get home and talk to your primary care doctor there about other possible causes for elevated lymphocytes.
UPDATE: I’ve just heard back from one of our medical advisor. He suggests that it is quite unlikely you could have had malaria only 7 days after arriving in West Africa, since the incubation period is usually more like 2-3 weeks (and is often extended when people take anti-malarials). As such, it may be worth seeing a doctor to check whether you might have another infection, which is contributing to your illness and also might account for the high white blood cell count.
Hi.
I`m in congo now, in september 2011 i had malaria falciparum,i took quartem. 2 weeks after the same sympt come back, i did another test it was positive.The doc. gave me again quartem,but after 16 days it come back again, then i took malerone,13 days after i took quinin (7 days) .but i `m not getting better.
Then quartem,then another injection (3 days)i don`t know whets its name .On 10 FEB i took Artequin,i got better at the first 10 days , but after no. On 24 i made another test it is positive?!!!!
I asked the doctor that this is unusuall, he agree but he told me that he cannot do any thing to me, just when the test is positive he is going to describe the medicin.
Please i need your help
Hi there, it is certainly unusual to have such persistant malaria; usually Coartem cures it very quickly. Where are you obtaining your medication? It could be that the drugs you took were out of date (expired) or counterfeit; this can decrease efficacy and lead to a reduction of symptoms but not a complete cure. Also, what kind of test is your doctor using? If it is a blood smear, you might want to ask if another technician could read the slides, to double-check the diagnosis. I have seen cases elsewhere in Africa where doctors diagnose malaria by default without really examining the blood slide closely. You could try to get a malaria rapid diagnostic test; this looks for specific proteins associated with malaria infection in your blood, and can be more sensitive than blood slides. You can even perform these tests at home, so double check what the doctor tells you. Otherwise, if you are truly getting re-infected very rapidly, you should look into more effective preventive measures against getting bitten by mosquitoes. This includes sleeping under a long-lasting insecticide treated bednet, wearing long-sleeved clothing at night and in the evenings and applying insecticide to exposed skin.