Falciparum Long-term Outcomes

QUESTION

My husband was admitted to ICU for 22% falciparum parasite load (with some mild kidney and liver failure, as well as low blood pressure) after being overseas two weeks earlier.

They treated him with IV artesunate and oral Malarone and an exchange transfusion, and discharged him after a week, as his kidneys had improved and so had his blood pressure, and he wasn’t yellow anymore. He never went unconscious.

He’s still quite short of breath and having a challenging time climbing stairs which hasn’t really improved over the past week. It’s not outright respiratory distress, as he was having this in the hospital as well and never actually needed oxygen. He’s also still feeling warm (though no documented fevers).

I am wondering about: a) Whether testing for recrudescence is useful almost two weeks after symptoms started b) how long this shortness of breath is anticipated to last (and is it secondary to a mild transfusion reaction, as his chest Xrays were always normal in the hospital) and c) will there be long-term sequelae I should be aware of (as I can’t find anything except for “falciparum infection has poor prognosis if not treated promptly’) and d) what are his risks of becoming this sick again?

ANSWER

It sounds as if your husband received good care and that you are very well informed which is excellent.  Recrudescence can occur up to 28 days after initial infection but it isn’t common if the above treatment was given.  One of the side effects of malaria is anemia, and this can cause fatigue and breathlessness.  My hunch is that he probably is anemic and should be eating iron rich foods (meats, greens) and taking an iron supplement. It is best to check with your primary care physician who can order a simple blood test to check for anemia and advise you on supplements and nutrition.  There shouldn’t be a poor prognosis in the long term for people treated and recovered from falciparum malaria. I hope this helps.