Travel Medicine / Vaccination / Immunization Expert Forum
Malaria?
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Questions in the Travel Medicine forum are answered by Dr. Philip D Parks, affiliated with Harvard School of Public Health. Topics covered include disease prevention, finding a doctor abroad, food and water safety, illness and injury abroad, mosquito and tick protection, resources for travelers, traveling with children or pets, traveling with special needs, vaccinations and immunizations.

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Malaria?

Hello!
I returned from Belize 10 weeks ago. I had started weekly Aralen 10 days prior to my departure and took 3 or 4 weekly doses but then stopped while in Belize because of perceived side effects. Two days there was a lot of mosquito exposure but we were out of those areas by evening.
1 week ago I started to experience some malaise and myalgia. 2 days later, while up in a chilly camper for a few minutes developed uncontrollable shaking chills. Fatigue and myalgias continued while camping and when returned home found a fever of 102.2. That broke later in the night with an absolutely drenching night sweat. A low grade fever has persisted since then, 99.5 to 100.4 with a very mild headache.
Did a CBC yesterday and it was remarkable for 22% monocytes and 9% bands. Platelets and H/H wnl. Awaiting results from a blood smear. My physical exam normal, the best I can tell, without rash, HSM, pharyngitis, jaundice. Yes I know the adage about "he who treats himself . . . . .". Will be contacting my family practitioner this week.
?Malaria? - with late onset caused by incomplete course of prophylactic?
Interesting case I think!
Tags: malaria, Fever
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Avatar_dr_m_tn
Hello,

Yes, interesting indeed. The monocystosis can be consistent with malaria in the context of your history.

I would encourage you to remember the caveats and recommendations concerning blood smears.

From emedicine.com @http://emedicine.medscape.com/article/221134-diagnosis

Thick smears:
Three thick and thin smears 12-24 hours apart should be obtained. The highest yield of peripheral parasites occurs during or soon after a fever spike; however, smears should not be delayed while awaiting fever spikes.

Thick smears are 20 times more sensitive than thin smears, but speciation may be more difficult. The parasitemia can be calculated based on the number of infected RBCs. This is a quantitative test.

Thin smears:
Thin smears are less sensitive than thick smears but facilitate speciation. This should be considered a qualitative test.

Treatment greatly depends on the identification of the Plasmodium species responsible for the infection.

Feel free to keep this line of communication open.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical or legal advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
5 Comments
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Avatar_m_tn
Dr. Parks,
Really appreciate the quick and helpful response. I did get to chat with one of the infectious disease docs in town and he pretty much had the same thoughts as you.
Smears pretty specific but not real sensitive, especially since mine was not done during a fever spike. Will let you know the smear result when I get it.
Plasmodium vivax is the only malaria bug in Belize according to the CDC. Not sure whether empiric treatment, assuming neg smear, would be justifiable.
Thanks again.
Jerry
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Avatar_m_tn
The smear came back negative and I have been afebrile with good energy for past 36 hours. Illness lasted 6 days.
Think I will just wait things out for now. Consider repeat of CBC in a few weeks? Maybe malaria IGG would be helpful? My doc will be back in town in another 10 days and I'll run it by him.
Do you know much about usefulness of the plasmodium IGG testing, I have read differing reports of its specificity and sensitivity.
Thanks.
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Avatar_dr_m_tn
Hello again,

Great to know that you are feeling better.

Did you have just a single blood smear? Thick or thin?

The repeat CBC makes very good sense.

In the absence of symptoms and signs, the malaria IGG will have poor sensitivity and specificity.


~•~ Dr. Parks

This answer is not intended as and does not substitute for medical or legal advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
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Avatar_m_tn
Did a repeat CBC and the monocytosis totally cleared. And I've been feeling fine.
The blood smear was ordered to look for malaria and I think they did thin and thick smears.
In any case will just chalk up the illness to some weird flu virus and hope it doesn't recur.
Again, appreciate your feedback.
Jerry
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