Cerebral malaria!!

**dirtshark** · 2014/04/15, 12:51 PM

Guys be very careful, there have been a lot of deaths in the last few weeks, from a serious strain of cerebral malaria, this is from hospitals in Durban alone!!

Weather you take precautions or not rather get yourself tested on your return, it will cost a few hundred rand and can save your life.
Some of the people who died took prophylactics so be aware of the false sense of security they may offer!

**Pietsweis** · 2014/04/15, 01:02 PM

Up here in the Nampula province this year's (for the first quarter) government recorded cases of Malaria is just about the same as the entire 2013.

I just had my second time in 3 weeks and third in about 6 months. Really bad up here at the moment and just heard of a death from Malaria where a south African went home to Gauteng, contracted it there and died in their home before anyone knew something was wrong.

**FMaartens** · 2014/04/17, 01:18 PM

Malaria is a big problem in Mozambique and one need to be very careful as it can be fatal. One important point to note is that cerebral malaria is simply a complicated form of the most common malaria strain found in Africa namely Plasmodium Falciparum. In other words - untreated Plasmodium Falciparum becomes cerebral malaria. Please feel free to contact me if you require any additional information. Regards, Francois Maartens (Integrated Malaria Control Consulting)

**WernerS** · 2014/04/17, 01:38 PM

Originally Posted by FMaartens

Malaria is a big problem in Mozambique and one need to be very careful as it can be fatal. One important point to note is that cerebral malaria is simply a complicated form of the most common malaria strain found in Africa namely Plasmodium Falciparum. In other words - untreated Plasmodium Falciparum becomes cerebral malaria. Please feel free to contact me if you require any additional information. Regards, Francois Maartens (Integrated Malaria Control Consulting)

If that is the case, tell me how does it happen that a friend of mine working in Maputu at a medical lab tested himself on the Thursday, came to Gauteng on Friday and by Monday almost died of cerebral malaria. Surely that can't be a case of untreated malaria.

**Stan Weakley** · 2014/04/17, 01:54 PM

FMaartens your presence on this forum is welcomed and should prove to be very helpful. There is still a lot of denialism about malaria and the need for prophylaxis about. There are a core of us with medical backgrounds or experience with malaria, continually beating the drum about its dangers. Please we would value your support and input.

**Stan Weakley** · 2014/04/17, 02:04 PM

WernerS. Working in a lab your friend should have known that not every patient with full blown malaria will test positive every time. He must have had symptoms to have wanted the test. It is well known that at times malaria only tests positive after repeated tests.

Cerebral malaria is when the massive load of untreated parasites in the blood causes alterations in blood clotting and the blood vessels to and in the brain clot up and cause severe damage to the brain or sections of it, on the basis that not enough blood perfusion means not enough oxygen. Brain cells have a very high oxygen requirement and they die off extremely rapidly in this setting.

**Q-Man** · 2014/04/17, 02:10 PM

Francois, do you encounter any cases of Plasmodium Vivax malaria ?

**WernerS** · 2014/04/17, 02:20 PM

Originally Posted by Stan Weakley

WernerS. Working in a lab your friend should have known that not every patient with full blown malaria will test positive every time. He must have had symptoms to have wanted the test. It is well known that at times malaria only tests positive after repeated tests.

Cerebral malaria is when the massive load of untreated parasites in the blood causes alterations in blood clotting and the blood vessels to and in the brain clot up and cause severe damage to the brain or sections of it, on the basis that not enough blood perfusion means not enough oxygen. Brain cells have a very high oxygen requirement and they die off extremely rapidly in this setting.

No, he tested himself almost weekly as precaution and seeing that its free for him. But if you say it might not come up positive every time I suppose it could happen that way. So basically you say that if you visited a malaria area one test is not enough when you come back.

**FMaartens** · 2014/04/17, 03:21 PM

WernerS - It sounds like a case of misdiagnosis as the normal incubation period in healthy non immune individuals is 10-14 days after the infected bite. Please can you indicate what method was used for the diagnosis i.e. rapid diagnostic test kit (RDT) or blood smear (microscopy)?

Stan Weakly - very good explanation of cerebral malaria.

Q - Man - I have come across very few Plasmodium Vivax cases in the last 15 years; the vast majority (90%) of cases in Africa is Plasmodium Falciparum.

**Pietsweis** · 2014/04/19, 12:19 PM

Originally Posted by WernerS

If that is the case, tell me how does it happen that a friend of mine working in Maputu at a medical lab tested himself on the Thursday, came to Gauteng on Friday and by Monday almost died of cerebral malaria. Surely that can't be a case of untreated malaria.

Well in my experience I consider malaria to be untreated if a few hours after to showing symtoms you are not on medication. My last 2 cases I was going from fine to shaking like a leaf and to a state of hardly being able to walk by myself within hours. I am talking like 3 to 5 hours.

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**Thugscub** · 2014/04/19, 12:31 PM

Stan you hit the nail on the head. Malaria kills and very quickly too. Worst case scenario I saw was a guy flew into East Africa and nearly dropped dead in 48 hours. Never been out of the UK in his life before the incident. I still get nailed every now and again, I use Coartim for treatment.

**frankmac** · 2014/04/19, 01:02 PM

[QUOTE=Stan Weakley;2200096]WernerS. Working in a lab your friend should have known that not every patient with full blown malaria will test positive every time. He must have had symptoms to have wanted the test. It is well known that at times malaria only tests positive after repeated tests.

Couldn't agree more, Stan. After having contracted the Falciparum variety on 5 occasions, I now know the symptoms fairly well but the first time took 3 rapid test kits before I showed positive and by that time I was fairly down and out.

Rapid diagnosis is essential and fortunately all our site paramedics are well versed in such matters

Regarding the incubation period, people tend to forget after a few weeks that they have been in a malaria area and upon arriving back home, ignore the flu-like symptoms at their peril. We had an extreme incubation case a number of years back where one of the Romanian guys left site in Uganda and only contracted malaria 6 months later at home. He was very fortunate that one of his colleagues happened to mention Uganda in conversation to the doctors (he was on their national TV as a result of his close call)

**MrDeeSA** · 2014/04/20, 11:34 PM

Originally Posted by FMaartens

Malaria is a big problem in Mozambique and one need to be very careful as it can be fatal. One important point to note is that cerebral malaria is simply a complicated form of the most common malaria strain found in Africa namely Plasmodium Falciparum. In other words - untreated Plasmodium Falciparum becomes cerebral malaria. Please feel free to contact me if you require any additional information. Regards, Francois Maartens (Integrated Malaria Control Consulting)

FMaartens sometimes I wonder what would happen if you as precaution after having symptoms drink the malaria pills, but maybe it is not malaria, maybe just flu? Will it do harm if you just start drinking it (The 3 days course)

**Mal Hannes** · 2014/04/21, 12:20 AM

In 2012 we were in Ethiopia for mission work and a friend contracted Malaria. He then went to India and through a long process of misdiagnosis etc etc. He hovered on the edge of death for weeks.

Although he has recovered now he has lost hearing in one ear and is not as strong as before.

BE CAREFUL!

I am glad for the advice and support we have here.

**hbannink** · 2014/04/21, 12:59 AM

Great to have another drummer in the line up

Welcome Francois. I think an important point has just been strengthened here in that the bulk of malaria cases are all due to Plasmodium Falciparum. The speed of which it affects and how it presents itself varies but the old saying of fever in the morning and death at night is a real possibility with Malaria hence the call never to fool around with it.

**dazza** · 2014/04/22, 09:10 AM

What is the best option then since I am going to be in Ponta Do Ouro this weekend? I have malaria tabs which I will obviously be taking but should I get tests done as soon as I am back and regularly thereafter?

**FMaartens** · 2014/04/22, 12:22 PM

Originally Posted by MrDeeSA

FMaartens sometimes I wonder what would happen if you as precaution after having symptoms drink the malaria pills, but maybe it is not malaria, maybe just flu? Will it do harm if you just start drinking it (The 3 days course)

MrDeeSA - It is always better to get accurately diagnosed and treated by a Dr but if you are in a remote area and you have an effective treatment course i.e. Coartem with you that has been stored correctly and is still within its expiry date I will take it. I will however still go to a Dr ASAP to ensure that you are clear of all the malaria parasites.

**FMaartens** · 2014/04/22, 12:30 PM

Originally Posted by dazza

What is the best option then since I am going to be in Ponta Do Ouro this weekend? I have malaria tabs which I will obviously be taking but should I get tests done as soon as I am back and regularly thereafter?

Dazza - It is important to finish your prophylaxis as subscribed as the course is designed to knock out any parasites if you are infected. If you come down with any of the following symptoms after your return go and see a Dr.

Flu like symptoms - chills and fevers
Headaches and tiredness
Pains in body joints - especially neck
Loss of appetite
Nausea, Vomiting
Sweating

NB: remember to inform the Dr that you were in a malaria area as some cases are misdiagnosed as flu or other infections.

**Pietsweis** · 2014/04/22, 12:31 PM

Originally Posted by dazza

What is the best option then since I am going to be in Ponta Do Ouro this weekend? I have malaria tabs which I will obviously be taking but should I get tests done as soon as I am back and regularly thereafter?

Not at all. Symptoms typically show from 7 to 21 days after infection.

It is pointless testing for malaria if you have no symptoms, even if it is in you and dormant and you are not showing symptoms it will test negative. If you develop sensitive skin, joint pain, fever, headache and any other flu like symptoms get tested and preferably while you have a fever.
Chances of you picking it up in Ponta is VERY! low if you take a bit of care and use tabard and all the other precautionary steps