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Taken medication for malaria. Have fever, nausea, headache, weakness, loss of appetite. Needs to be checked?

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General & Family Physician
Practicing since : 2001
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My husband aged 41 , was diagnosed with malaria 12 days back , he completed his 3 day anti - malarial course and now is currently taking pmq 15 mg for 15 days. Also since his fever didn't subside post anti-malarial drugs , GP advised to undergo a CBC , Widal , and LFT. Widal was negative ,CBC - Blood counts were perfect , except for SGPT to be 115 ,, all other Liver Function Tests were Normal and within range. Abdomen USG was also done , and reports were normal except for mild hepatomegaly. Currently he is taking Par IT D for acidity in the morning , Pecef 200 mg twice a day , Udiliv 300mg twice a day before food and Neutrosec After food and PMQ Inga 15mg at bedtime. Apart from that he is taking crocin for fever .Fever has still not got cured completely , it's around 99 - 100 especially during evenings accompanied by nausea and headcahe, and not throughout the day , lot of weakness and loss of appettite is also there.Are we on the right track for treatment or anything else needs to be checked? How many days does the fever subside in? How much time would he need for recovery and any specific medicine needs to be added or altered? Thanks.
Sat, 8 Sep 2012 in Infections
Answered by Dr. Michelle Gibson James 1 hour later

Malaria is caused by plasmodium protozoa (type of parasite) which is transmitted by mosquitoes.
There are 5 types of plasmodium species and it is important to identify is present because the prognosis and response to treatment varies. The types are usually identified in the lab when the technicians look at the blood smear.
After a person is biten by a mosquito, the organisms in the mosquito go to the liver then after a few weeks back in the blood where they enter into the red blood cells (the parts of the blood that carry the oxygen to different parts of the body). These blood cells then burst to release some of the parasites and this is what causes the fever.
They then go back into more red blood cells again and the cycle repeats itself with another episode of fever and so on.

In most cases of uncomplicated malaria there is big improvement of symptoms within 2 days and most persons are fever free within 3 days.
Having said that ,one of the types of parasites can actually cause symptoms for 3 to 6 months.

The blood tests that you stated were done are correct- CBC, LFT, widal. Some doctors also do kidney function tests, check for breakdown of red blood cells (done by looking at the CBC and other tests) and electrolyte levels since these can also be abnormal.
Blood smears can also be done to check response to treatment, usually the parasite disappears from the blood within 2 to 3 days, so your doctor can check to see if this has happened. Remember some of the parasites are resistant to some of the drugs so if the response is inadequate some doctors may consider using alternative therapy.

Pecef is an antibiotic, it is not normally used for malaria but may in this case being used to treat another infection that is thought to be occuring along with the malaria.
Udiliv is used to treat gallstones and some conditions of biliary tree ( part of the liver that transport bile)
Neutrosec is also used in liver disease. These were likely given as a result of the mild hepatomegaly which is a possible complication of malaria though the liver not working as it should in malaria is rare and mostly occurs if there is underlying liver disease.
PMQ inga is an antimalarial drug and may actually contribute to the nausea that your husband is experiencing, it is one of the side effects. It is normally used to prevent relapses and kill any parasites that remain in the liver.

So in summary blood smears can be done to ensure that the parasite is gone and possibly a blood culture to check for any other bacteria causing continued fever.
Consider screening for any other liver diseases such as hepatitis.
As stated earlier normally persons feel improved within 2 days and the fever resolves within 3 days.

I hope this information is helpful to you and your husband soon feel well again, feel free to ask any additional questions
Above answer was peer-reviewed by
Follow-up: Taken medication for malaria. Have fever, nausea, headache, weakness, loss of appetite. Needs to be checked? 2 days later
Thanks Doctor.

Overall my husband is feeling better except for the weakness , joint pain and the fever part and the problems arising with fever. He gets fever in the afternoon around 1 - 2 Pm and then at night around 11 - 12 PM. Before the onset of fever he starts getting chills , followed by a temperature upto 101 F . After giving him Paracetamol , fever and chill comes down in an hour's time and then he starts sweating heavily. Following that he feels much better , but extremely fatigued. His reports are normal , also the SGPT was repeated on 16th and it has come down within normal range. On visiting the GP , he felt it could be clinical typhoid , though not confirmed in blood test , and he advised to start Tricef - O , i.e Cefixime 200 mg and Ofloxacin 200mg , twice a day. He has completed 3 days on Tricef - O now. Also he is still continuing with PMQ Inga , which would be ending tomorrow. Udiliv and Neutrosec are no longer given as the liver reports are back to normal. His appettite is also very low and his limbs are usually cold before and during fever.This fever episode is really bothering us , and can't figure out the reason for the same. As i said earlier his abdominal scan , chest x-ray , pathological tests are all normal. Please advise if further tests need to be taken or if its suspected typhoid case , how many days would it take for the antibiotics to work and when can we expect the fever to subside? If it could be something else , please advise. Thanks for your help.
Answered by Dr. Michelle Gibson James 22 hours later

In terms of typhoid the widal test may be negative in the first week and positive there after. Blood cultures , as mentioned earlier , can also be done to identfy the bacteria in typhoid or any it can be used to identify any bacteria present , especially in a case of continued fever.
In some cases of typhoid , stool cultures and bone marrow cultures are also done to identify the pathogen.
If the fever is not responding to the antibiotics , it may, in some cases indicate resistance, the cultures would normally tell you what antibiotics would work best with a particular bacteria.

In general a response is expected within a few days (2-4) of initiating therapy for any infection, the continued symptoms may indicate that cultures need to be done.
Fever can also occur in the presence of inflammatory non infectious conditions and screening for these conditions can also be considered.

I hope this information is helpful to you, hope everything resolves soon
Above answer was peer-reviewed by
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