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Doctors' Answers to "Frequently Asked Questions" - Malaria

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Question: In early August I traveled to Peru, and took Lariam to prevent Malaria. I got sick in Peru, and have been on and off ever since. My doctor gave me a general antibiotic course, and has done blood and stool lab work, all negative for parasites and malaria. I never know when it is going to hit, but every 3 to 4 days I come down with these symptoms: dizziness, nausea, hot and cold flashes, trembling, and diarrhea. My doctor suspects side effects to the Lariam, which I have now finished the course of treatment. Could the Lariam cause these side effects? And how long will it stay in my system, giving rise to these symptoms? Thanks for your advice.

Answer: It will last a couple of weeks. Unfortunately, I don't use the anti-malarials enough to give you good advice. I would consult an Infectious Disease Specialist if they persist, they would have more experience, it isn't a drug we use all the often in the US.

Question: I will be taking Diamox to avoid acute mountain sickness in Tibet. I understand that it should NOT be taken with certain medication to prevent Malaria. What Malaria drug can I take that will not interact badly with Diamox? Thank you.

Answer: Out of my information base, I'd contact Lederle's scientific dept 800-934-5556 to see if they have further information.

Question: A friend is in the Peace Corps, and has come down with and been treated for malaria. While he is cured, does the disease remain dormant in his system? If so, can he spread it when he is back in the US through mosquito bites and blood contact?

Answer: It depends on the type of malaria. Some are harder to treat and can reoccur. Usually treatment by competent physicians in the US will result in a complete cure. However, the Red Cross will not usually take blood from someone with malaria in the recent past due to the possibility (probably 1%) of reoccurrence.

Malaria - Plaquenil
Question: Next month I will be going birding in the Dominican Republic for a few weeks. Part of the time I will be near the Haitian border - an area for which the CDCs are recommending taking chloroquine preventatively against malaria. I am currently taking 200 mg of Plaquenil(hydroxychloroquine) twice a day for the treatment of SLE (along with naproxen) and have been doing so for almost four years. Can I assume I am well-dosed with chloroquine? It seems like I should be invincible against malaria if this is the same substance.

Answer: Plaquenil(hydroxychloroquine) is an anti-malaria drug which is very similar in activity to chloroquine. There are several different types of malaria species and some are resistant to some of the original drugs used to treat malaria. Plaquenil is also used in treating systemic lupus erythematosus and occasionally rheumatoid arthritis. Plaquenil is generally effective against P. malariae, P. ovale and P. vivax. It is a preventive only, and will not eliminate an infection that is already established due to its inability to eradicate certain dormant or latent parts of the parasites lifecycle. It is not especially effective against P. falciparum. When going to areas of the world prone to malaria, it is important to know if there is any P. falciparum or any resistant malaria. Treatment in these areas is different than usual. The CDC produces a trade advisory available to any physician with this information. There are also travel clinics in most cities which specialize in the necessary immunizations and the advice about medicines like malaria prophylaxis.

Question: How contagious is Malaria. I am taking Lariam and have strange side effects (i.e. bad dreams). Should I be concerned?

Answer: Malaria is caused by the transmission of parasites in the Plasmodium family and is infectious only by direct blood innoculation. This is usually done by insects; but, there are reported cases of blood transfusions and sharing needles with drugs causing transmission of malaria. Direct personnal contact is not thought to cause transmission of malaria.
Lariam (mefloquine hydrochloride) is used in treating malaria. Its method of action is not known and it is generally used in the treatment of Plasmodium falciparum and Plasmodium vivax, not Plasmodium ovale or malariae. Because it does not eliminate the hepatic phase of the parasite that causes malaria, it is subject to relapses. Although emotional problems have been reported while taking the drug, bad dreams are not one of the usual listed side effects. However, once you can stop taking the drug you will know if Lariam is the cause.

Question: Can you provide any information on the possible teratogenic effects of mefloquin.

Answer: Mefloquin is the generic name for an anti-malarial drug which can cause dizziness. Serious drug interactions with other drugs have been reported and subsequent treatment with other anti-malarials can cause serious problems. This drug has been shown to cause different kinds of cancer in rats and mice. Short term studies in humans have demonstrated no effects on the sperm. However, use in pregnant women would be risky. Post marketing studies have not demonstrated any marked ability to cause cancers with normal use.

Malaria Infection
Question: What are the chances of infection with malaria from casual contact with an infected person , or their pet ?

Answer: Malaria is only transmitted by mosquito inoculation or occasional blood transfusion of infected blood products. Casual transmission by contact is not possible.

Recurring Symptoms
Question: Is it possible for a person to have recurring symptoms of malaria (fever, chills, etc) 50 years after being infected? Can having had malaria (50 yrs ago) cause almost uncontrollable high blood pressure?

Answer: The symptoms can persist if the infection has not been eradicated. However, with newer medications this is rare indeed-especially in developed countries. There are only a few subgroups of malaria which will produce relapsing symptoms. These are usually easily identified and treated. After treatment, there shouldn't be any further fevers, chills etc. I don't know of any relationship between malaria and high blood pressure.
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