Got it - dealing with Malaria
 

Hi there,

I just got a positive test for malaria tropica yesterday.

While I am now treating it with Malarone, I just checked the HUBB for experiences of other travelling patients, found lots of threads about avoiding Malaria but few posts of people actually having had the disease. So maybe a thread with shared experiences could be useful:

In my case, the parasite was discovered rather accidentally: I had a test made because my mate was tested positive after having moderate fever. I was (am) feeling fine and had no symptoms apart from diarrhia (however that is spelled).

I called the ADAC and had an interesting dicussion with a doctor from the ADAC (great service - he called me back and discussed the disease in detail).

I found particularly interesting that from the persons being bitten by mosquitoes infected with malaria tropica, only 50 % develop an infection. Out of the infected persons, again only 50% develop symptoms of the disease. Only 0,5% have a potentially fatal crisis.

I do not want to play down the seriousness of the disease, but in my mind malaria tropicana was almost equalled with death, so I found these figures quite comforting.

According to German standards, infected persons with fever should present themselves to a hospital on the grounds that the situation can deteriorate that fast that it could be difficult to bring that person into hospital in time.

Only thing that is worrying me now is that, although the treatment will be finished after three days of taking Malarone and a final Malaria test to confirm there are now parasites left, the doctor gave me the advice to have myself malaria tested basically in every case I am feeling slightly unwell. That could be quite often.

Any experiences with reappearing Malaria after finished treatment?

Regards

Lars

Sounds like you were pretty lucky to have found it when you did! I had malaria (not sure of which strain) about 15 months ago when I was travelling in East Africa. I was taking doxycycline (spelling?) so I'm not sure how long I had it before the symptoms started. But the doctor said that it would have been approx 2 weeks from what he could tell from the blood test.

I had been ill for about 5 days (of hell). In those days I had gone from climbing Mt Kilimanjaro, which I started to get sick at 4200m, kept going as I thought it was just altitude sickness, made it to 400m from summit (grrrr....) and started throwing up blood, so reluctantly decided it was time to go down, when my guide told me I would have to sign my life away. Half way down the summit (pitch black night, we stumbled, breaking my big toe and blackening both big toe nails.

Then stopped for the night (day2). the adrenalin in my body kept me going, this was the 3rd day with no food and very little water. when I got to the base I sat down for 15 mins and couldn't get back up.

The malaria had hit hard (day3). That night I slept for 18hrs straight, I had to get a friend to help me to got to the bathroom as I was having trouble waking all my mussels aching and seising up.

Then day 4 had to catch a nightmare of 4 buses (16hr journey) from Moshi, Tanzania to Nairobi, Kenya. 2 buses breaking down having to hitchhike and wait on the side of the road while they were fixed. All this time I had no idea I had malaria. I just thought I was tired and exhausted from climbing Kili and was being stupid.

Then after spending day 5 in Nairobi on the toilet with the runs, vomiting, sleepiness, headaches, fever, hot sweats, cramps, shakes, aches and pains and unable to walk (my friends had to piggy back me) I finally decided to go to the hospital (I think mum would have killed me if this didn’t) before getting on the plane to sort out this altitude sickness.

The people at the Nairobi Outpatient were really nice and friendly. Yet they couldn’t work out why I was still smiling and laughing when I found out what I had… I was just relieved to know I wasn’t imaging it all and going crazy.

Result: Throat and chest infection, Guardia, broken big toe and malaria! They even let me look at my malaria under the microscope!! It took about 2months to get over the runs and the lethargy and get back to normal but all seems to be good now. Did have a problem when I got home to Oz about a month later, every time I got bitten by a mozzie it swelled up like a golf/tennis ball but all good now.

reappearing Malaria
 

Not personally. But one guy here said he did. Had it treated by a 'tropical medicine' expert .. think major city etc. Had to time the treatment to occure at some point in the cycle of the bugs .. took quite a while but he thinks they got it.

Got it - but am I cured?
 

Last September I acquired the P. vivax type in Mexico (Puerto Escondido). It hit me weeks later in Guatemala (I was in non-malaria areas except for along the coast near P.Escondido for a few days). I was feeling "weak in the legs" for a few days, then one morning, between 7 am when I didn't feel any different, and 10 am, I had a god-awful headache, my muscles and joints ached something awful. It lasted 24 hours. I knew I needed medical care, so the next a.m. I was in a doctors office, had test results back that p.m. and started the drug treatment. I felt much better within the next 24 hours, with no relaps. It took well over a month before I felt I had my energy back.

However, your post got me thinking, so I checked into this a bit more.

From the CDC website
"Among the four malaria species that infect humans, Plasmodium vivax and P. ovale can develop dormant liver stages that can reactivate after symptomless intervals of up to 2 (P. vivax) to 4 years (P. ovale).
..
Chloroquine remains the treatment of choice for all P. vivax and P. ovale infections except for P. vivax infections acquired in Papua New Guinea or Indonesia.
...
In addition to requiring blood stage treatment, infections with P. vivax and P. ovale can relapse due to hypnozoites that remain dormant in the liver. To eradicate the hypnozoites, patients should be treated with a 14-day course of primaquine phosphate. CDC has recently changed its recommendations for treating hypnozoites by increasing the recommended primaquine phosphate dose to 30 mg (base) by mouth daily for 14 days. Because primaquine can cause hemolytic anemia in persons with glucose-6-phosphate-dehydrogenase (G6PD) deficiency, persons must be screened for G6PD deficiency prior to starting primaquine treatment. For persons with borderline G6PD deficiency or as an alternate to the above regimen, primaquine may be given at the dose of 45 mg (base) orally one time per week for 8 weeks ; consultation with an expert in infectious disease and/or tropical medicine is advised if this alternative regimen is considered in G6PD-deficient persons. Primaquine must not be used during pregnancy."

-----------
There was no Primaquine phosphate available at any pharmacies in Quetzaltenango, so I was prescribed another drug (which I don't have the name now - sent that info back to my archives back in the states).

So, how does one find out if they are infected but its in a dormant stage?

hmmm....

After feeling ill for some time i checked myself into the missionary hospital in Bamenda, Cameroun. Diagnoise: Malaria. I was in a bad state at that time, I had trouble focussing and with balance, not to great if you are driving a motorbike. Diariahaa tool. Taking Larium supressed the symptoms for a long time but finally got the better of me.

While staying at the missionary the gave me a they 3 day treatment, no clue what they gave me but after the final blood test i was clear.

Back home i did another check for parasites / malaria the works, all clear...

P. vivax
 

I got P. vivax in Nicaragua in '99 and have had no symptoms since. I was treated (I believe) with the same drug used as a prophylactic in that area: mefloquine hydrochloride. No recurrences, but I can no longer donate blood. I was told that in later years, as my immune system weakens, I may have recurrences.

I was taking doxycyline and got it, probably in Zambia or Botswana, but it hit me in Capetown. I felt pretty bad and went to the hospital on the third day. The blood test came back at around midnight and the doctor gave me two types of medicine. By morning, I felt 75% better and a few days after that, I was good as new (once I was able to eat properly). That was almost two years ago and it never came back, so I hope I am cured.

Not just malaria comes from Mozzies
 

Mosquitos can spread other "nasties", such as:-

BBC NEWS | Health | Mosquito virus arrives in Europe

I deduce that prevention of biting by insects is still important.

Very very very interesting articles about malaria and treatments have been published by dr. Stockley in Uganda,

fortunately, they are also to be found online :
Malaria, Mozzies and a Mzungu
Malaria, Mozzies and a Mzungu Part 2
Malaria, Mozzies and a Mzungu Part 3

Malaria, Mozzies and Mzungu: Part 4

Health: Malaria, Mozzies and a Muzungu Part 5

I'm scared now
 

Fascinating and scary info there UGANDURO, I travelled widely through Africa without taking prophylactics , and was planning the same this time. I now know that I didn't have a mild dose of Malaria that time in Sumatra and am not a natural tropical acclimatised warrior.
I'm sure most observers here have met people who claimed a natural immunity to malaria evidenced by years spend in endemnic areas without precautions and no sickness. I'm now discounting most of those warrior stories.

Does anyone know anything about availability of the natural malaria remedy Artesium - can it be got in pharmacies, is it effective? Dont want to pay the big bucks for malorone and prefer to stay away from Doxy/lariam

neem tree
 

I haven't heard of artesium, but a guy in eastern Kenya told me that to combat malaria, many Kenyans brush their teeth with branches from the neem tree, which naturally contains quinine.

artemisinin
 

this is the word I was looking for. Used widely in Africa and Asia where there is resistance to chloriquine (not sure of spelling). Wikipedeia says its taken in liquid form three times a day, as in brewing tea and this form of application makes it unsuitable. There are meant to be no side effects. Its a natural remedy grown from a plant and may be related to the neem plant you heard about roadsacallin.
I wonder does it taste ok

Artesunate
 

The artesunate stuff is easy to get in Africa and cheap. It comes in different brands names and different strength (take the strongst you can get)
Be carefull however; I believe it is normally not used as a profilax (to prevent malaria) but to combat it when you already got malaria. At least that is what the locals and expats do (who have had malaria before and have some resistance) . If you rely on it without taking the normal medicine (lariam/malarone) you run the serious risk that you will think what 90% of all malaria victoms think in the first couple of days, namely; oh probably a mild flu and then things can get sirously wrong! Thats the dangerous part of malaria. With the regular profilaxes you at least have already built up resistance!!

Cheers
Noel

3 times in 6 months.
 

Don´t know if it was a recurrence or reinfection, but whilst working in West Africa last year I tested positive for malaria 3 times. The symptoms in each case ranged from mild flu to full on fevers, diarrhea and in bed for 4 days and not back to full health for weeks. Luckily at the time I was working for a medical relief organisation and treatment was very close at hand in the form of Coartem. If you can get some before you leave, definately use it to treat your on the road malaria.
Malaria is especially dangerous to under 5 year olds who have not yet developed a full strength immune system and are probably under nourished to boot. I´ve heard stories about natural immmunity, however I was working with Kenyan & DRC expats who also suffered malaria bouts. This was in Sierra Leone, so maybe you can get resistant to your local strain perhaps?
Why did I get it? I never remember to take daily medicines and I can´t sleep with Lariam...
Interestingly, the first bout was the mildest. I was the second that knocked me down.
For my 2 cents, for travel I´d try again with Lariam.
Cheers!