Malaria: The dangers of not taking anti-malaria tablets

[Terpe]

Mandy had stopped taking anti-malarial tablets while working in Haiti

Last Christmas saw Mandy George in a coma in a Dominican Republic hospital.

Her mum and brother had flown to her bedside, and were praying she would fight off the malaria parasite that was attacking her organs and sending her body into septic shock.

"Everything that could go wrong in my body went wrong," she says.

After living and working in Haiti for more than two years, she had stopped taking anti-malarial medication.


Recovering in hospital with some of her medical team

No one else she knew there was taking it and she had heard people say that the medication was harmful when taken long-term.

That information was wrong, and the decision nearly cost Mandy her life.

It was while on holiday in the Virgin Islands, just a week earlier, that 33-year-old Mandy started to feel unwell with a fever and some very intense headaches.

Instead of getting medical advice there, Mandy waited until she returned home to Haiti a few days later, and by then she "felt horrific".

"I collapsed. I begged a friend to take me to hospital, where I spent the night, and then in the morning I started to have liver failure and got pneumonia," she says.

'A swollen carrot'

Doctors in Haiti realised treatment in the nearby Dominican Republic was the best option and she was flown straight to an intensive care bed.

By this time her liver and kidneys had failed, she had swelled up to twice her normal size. Her skin had also turned a yellowish-orange colour, making her resemble "a swollen carrot".

She also needed blood transfusions and dialysis.

The worst part for Mandy, however, was the sensation of drowning caused by her lungs filling up with fluid.

"I was gasping for air even though there was air all around me. They were trying everything to make it better.

"I had all sorts of contraptions on my face, medication to inhale, balloons of air pumped into me. But nothing worked."

It was then that doctors decided to induce a coma. Mandy doesn't remember much of this time, although some images do stand out.

"I was so ill I didn't have the energy to be afraid. I felt quite calm, although I kept telling them I couldn't breathe.

"I saw my friend with tears in her eyes and the doctor standing with his arms crossed staring at my monitor.

"I remember thinking - 'I could die here'."

Deaths

Mandy wouldn't have been the first UK national to die from malaria.

In 2010, more than 1,700 travellers were diagnosed with malaria after returning to the UK and seven of them died. In 2012, two people died of the disease in the UK.

Last month a woman from Lancashire died after contracting malaria on holiday in the west African country of The Gambia. She had not taken anti-malaria tablets either.

Mandy says she survived thanks to the fantastic care of the medical staff in the Santo Domingo hospital - and one particular doctor who made it her mission to make sure she beat malaria.


Mandy visited San Francisco with her family after her health improved

In the end, she spent one month in intensive care and several more weeks in a wheelchair while urging her weak legs to walk again.

After several weeks of communicating by writing notes, because a tracheostomy tube had been inserted in her windpipe to help her breathe, she was finally able to talk again too.

It was fully six months before she returned to normal, and by that time she had returned to the UK and was recuperating at her parents' home in Lincolnshire.

"I was very lucky", she says. Doctors are always telling me, 'Wow it's amazing you are still alive!'. I feel very grateful and fortunate to be here now," she says.

The fact she was young, fit and healthy was probably a factor in her recovery, but she is still very aware of how close she came to succumbing to the parasite.

Mandy also has some important advice for others before they go abroad.

"Don't travel anywhere if you think you have something seriously wrong with you, get tested immediately you think there's a problem, and low risk doesn't mean no risk.

"I'm an intelligent person - but I had no idea how serious malaria could be."

Source:-
http://www.bbc.co.uk/news/health-25265531

[les_taxi]

Big perils in taking them too - I would not touch them with a bargepole

[Michael Parnham]

Mandy had stopped taking anti-malarial tablets while working in Haiti

Last Christmas saw Mandy George in a coma in a Dominican Republic hospital.

Her mum and brother had flown to her bedside, and were praying she would fight off the malaria parasite that was attacking her organs and sending her body into septic shock.

"Everything that could go wrong in my body went wrong," she says.

After living and working in Haiti for more than two years, she had stopped taking anti-malarial medication.


Recovering in hospital with some of her medical team

No one else she knew there was taking it and she had heard people say that the medication was harmful when taken long-term.

That information was wrong, and the decision nearly cost Mandy her life.

It was while on holiday in the Virgin Islands, just a week earlier, that 33-year-old Mandy started to feel unwell with a fever and some very intense headaches.

Instead of getting medical advice there, Mandy waited until she returned home to Haiti a few days later, and by then she "felt horrific".

"I collapsed. I begged a friend to take me to hospital, where I spent the night, and then in the morning I started to have liver failure and got pneumonia," she says.

'A swollen carrot'

Doctors in Haiti realised treatment in the nearby Dominican Republic was the best option and she was flown straight to an intensive care bed.

By this time her liver and kidneys had failed, she had swelled up to twice her normal size. Her skin had also turned a yellowish-orange colour, making her resemble "a swollen carrot".

She also needed blood transfusions and dialysis.

The worst part for Mandy, however, was the sensation of drowning caused by her lungs filling up with fluid.

"I was gasping for air even though there was air all around me. They were trying everything to make it better.

"I had all sorts of contraptions on my face, medication to inhale, balloons of air pumped into me. But nothing worked."

It was then that doctors decided to induce a coma. Mandy doesn't remember much of this time, although some images do stand out.

"I was so ill I didn't have the energy to be afraid. I felt quite calm, although I kept telling them I couldn't breathe.

"I saw my friend with tears in her eyes and the doctor standing with his arms crossed staring at my monitor.

"I remember thinking - 'I could die here'."

Deaths

Mandy wouldn't have been the first UK national to die from malaria.

In 2010, more than 1,700 travellers were diagnosed with malaria after returning to the UK and seven of them died. In 2012, two people died of the disease in the UK.

Last month a woman from Lancashire died after contracting malaria on holiday in the west African country of The Gambia. She had not taken anti-malaria tablets either.

Mandy says she survived thanks to the fantastic care of the medical staff in the Santo Domingo hospital - and one particular doctor who made it her mission to make sure she beat malaria.


Mandy visited San Francisco with her family after her health improved

In the end, she spent one month in intensive care and several more weeks in a wheelchair while urging her weak legs to walk again.

After several weeks of communicating by writing notes, because a tracheostomy tube had been inserted in her windpipe to help her breathe, she was finally able to talk again too.

It was fully six months before she returned to normal, and by that time she had returned to the UK and was recuperating at her parents' home in Lincolnshire.

"I was very lucky", she says. Doctors are always telling me, 'Wow it's amazing you are still alive!'. I feel very grateful and fortunate to be here now," she says.

The fact she was young, fit and healthy was probably a factor in her recovery, but she is still very aware of how close she came to succumbing to the parasite.

Mandy also has some important advice for others before they go abroad.

"Don't travel anywhere if you think you have something seriously wrong with you, get tested immediately you think there's a problem, and low risk doesn't mean no risk.

"I'm an intelligent person - but I had no idea how serious malaria could be."

Source:-
http://www.bbc.co.uk/news/health-25265531

Another good and also useful article Peter!

[Doc Alan]

Haiti is one of the central, South American and Caribbean countries described as “ variable to low risk “ for malaria, but data on actual numbers for this country are inconsistent.


Global malaria death rates have fallen by about half since 2000. There were still over 200 million cases and over 600,000 deaths in 2012. Most are in sub-Saharan Africa ( in November a woman from UK died from malaria after a holiday in The Gambia ). The local population may have some natural immunity, but too many get malaria who might not have done, if they had insecticide-treated bednets and the right drugs. An estimated million lives have been saved in Africa by such measures in the past decade.


Almost ALL drugs have more than one action – either good and / or unwanted “ side effects “. Added to this with antimalarials are :- parasite resistance ; and fake drugs – so if the wrong drugs are used for a given part of the world they may be worse than useless.


Even genuine anti-malarials CAN have side effects, but they are nowhere near as common as many people think.


Five issues should be considered by individuals and their pharmacists / doctors :-


• Risk of exposure to malaria

• Extent of drug resistance

• Efficacy ( how good ? ) of recommended drugs

• Side effects

• Individual factors ( age, pregnancy, other illness such as kidney / liver disease ).



If you decide to take antimalarials, but worry about side effects then you could start a few weeks before your trip, so any problems become obvious before leaving the UK. If you DO develop side-effects while abroad, try to continue prevention by obtaining a reliable alternative from a pharmacist or doctor.



Antimalarial drugs need to be paid for in the UK. However, if malaria is diagnosed on your return ( in most cases it’s a straightforward diagnosis ), then treatment is FREE on the NHS. 30 -50 cases a week may be treated by the NHS ; it reflects well on the success of treatment that only 2 – 16 deaths have occurred in this country each year over the past two decades.


As for the Philippines, there is already a “ sticky “ thread on malaria and dengue ( http://filipinaroses.com/showthread....ngue-Fever-Map ) . Malaria cases have decreased by ¾ since 2000 ( now less than 10,000 ) ; deaths by almost 100% ( from about 750 to a dozen ) ; and the national goal is to eliminate it by 2020 .



It’s a matter for individual judgement ( and the five issues above ) whether to take antimalarials. The most highly endemic provinces are now Apayao and Quirino in Luzon, Sul and Tawi-Tawi in Mindanao.



If anyone DOES consider they need antimalarials for the Philippines, the recommended drugs are EITHER doxocycline 10 mg daily ( 1 – 2 days before travelling ; daily in the malarious area ; for 28 days after leaving ) OR mefloquine ( 250 mg weekly ; starting 1 – 3 weeks before trip ; every week in malarious area ; for four weeks after leaving ).



My own choice ? I have never taken antimalarials during work in Malaysia or visits to the Philippines in the past 4 decades .



http://globalhealthsciences.ucsf.edu...pines_2013.pdf

[malditako]

What about antimalaria shots and antimalaria for kids? What are the common side effects?

[Doc Alan]

There are currently NO licensed vaccines against malaria, or any other human parasite. The final results of an African clinical trial on a research vaccine should be known by late 2014, and hopefully it could be available by late 2015.


Antimalarials for children may be different in terms of drug type and dosage – weight is a better guide than age, and ( for example ) doxocycline is NOT recommended under the age of 12. Always check with your pharmacist, doctor and / or nurse. There is also advice available on various websites ( www.fitfortravel.nhs.uk ; www.who.int/ith ; www.nathnac.org/travel/index.htm ).




As for POSSIBLE side effects, they are too numerous to list on this Forum. For doxocycline and mefloquine they are most commonly “ non specific “ - like headache, abdominal pain, nausea, diarrhoea, vomiting, loss of appetite. These of course are far less serious than malaria. As my update has hopefully made clear, however, reported malaria cases have declined dramatically in the Philippines and most visitors choose not to take antimalarials .