I am submitting this on behalf of my husband. Approx four weeks after returning from Zim he began suffering acute symptoms of internal infection, i.e., high uncontrolled fever, body aches and chills/sweats. After a week of these symptoms we convinced him to go get tested for Malaria at local ER. He ended up hospitalized for seven days without a final diagnosis. Tests revealed high liver enzymes and signs of infection. His physicians (Inf Disease Specialist) ran over 25 cultures with no positive findings. They were in disagreement as to whether he was suffering from Malaria. The doctor who had the most experience (lived and practiced in a Malaria region of Pakistan) felt certain he had Malaria. He returned home with Malaria medication and a course of Doxy. He reached more or less full recovery after about three months. Tonight he is suffering from same symptoms after a bout with the 24 hour stomach flu. Anyone have similiar experience, resources or references? Thanks, his concerned Wife

I am sorry to hear about this, and hope your husband makes a quick recovery.

I wish your husband a speedy recovery!!!

This sure sounds like malaria to me.

I'm not sure where you are from.

But you need to get your huband to the best medical facility in your region for tests by a top infectious disease specialist.

If it's malaria, the right test will tell the story right away.

Best wishes,

Agreed. What you need, and are hard to find in the states, is a tropical medicine specialist. I have a friend who suffers from recurring malaria, although it is a Central American, not an African, strain.

Sorry to hear that. Would it have anything to do with his recent polar bear hunt? He's been into some extreme weather there and lots of traveling. I'm sure his immune system has been on a roller coaster of sorts.

Please tell Jeff that I said hello and to email me when he has time and feels better.

I am sorry to hear about your husband and hope he has a speedy recovery.

I have had a similar, milder, experience but can offer no meaningful advice. In April 2005, I returned from a field course in the Turks and Caicos with what looked for all the world like malaria. Every 3 1/2 weeks I'd get very short tempered for half a day, then get sick for 3 days with fever, chills/sweats and aches and pains. I'd spend a day in bed and by the 4th day it was like nothing had ever happenned. Repeated tests over the course of months found nothing even after my specialist got a university research group involved. A course of medication did nothing, but after about 4 bouts, the intensity of the episodes decreased and finally stopped entirely. With no apparent need and no new ideas, we gave up trying to find out what the cause had been. I suspect it was coincidence, but the symptoms first failed to appear on schedule while I was in Tanzania and taking malarone in Oct. 2005. Since then, I had no bouts until Feb. and March of this year when I had 2 very mild episodes.

All the best,
Dean

Agree with Mrlexma and Jetdrvr. Towards the end of our assignment in Zim, a friend's wife had very similar symptoms and experience. Tests were inconclusive, she didn't want to believe she had malaraia, but the doctor treated her for it - that's what it was.

As the others have said - getting him to a tropical med specialist is ideal. In the interim, probably a good idea to go with that
doc with the most experience

Hope your husband gets better...our prayers are with him.

My last trip I was sick on the trip with flu like symptoms for one week. Then I returned home and was in bed sleeping 22 hours a day for 10 days.

The local hospital, Scripps, did the full line of tests and all came back 100% normal, no elevated white cells, no decreased liver function....

It has been several weeks now, and I still get fatigued and need to sleep in the afternoons..

This is the most ill I have been in my adult life, and no one had any idea what it was, apart from a "bad virus".

Malaria can sometimes be a tricky thing to detect and it'll only show at certain times of it's cycle. So miltiple tests are usually needed to detect it - So the previous advice is very good.

Another thing it could be, although the symptoms sound a bit drastic for it is tick bite fever. The first bout from one tick and the second bout from another tick - probably a different type of tick. - If it is that, he'll feel like he's been hit by a train for a week or two and then slowly recover...... to make sure he doesn't have any more ticks, I'd suggest he takes a shower using dog tick and flea shampoo on every inch of himself. - Do it 2 or 3 times, to make sure......

Hope that helps and that he recovers quickly!

Never test just once for Malaria if the first test is negative, never. Test a few times. Try and test when he feels at his worst - at the point where he has very real large muscle pains, dry eyes, shivers, the sweats, feels like crap, looks like crap, feels like dying and very sorry for himself. That seems to work for me in terms of getting a more reliable test result. It is sometimes a real tricky disease to pinpoint – even for the labs over here in South Africa where they test for Malaria many times on a daily basis.

The treatment is fortunately easy and cheap, so when in doubt - we simply take a course! In Mozambique we buy Ariplus (trade name) over the counter for about $7.50. It is a three day course with 9 tablets - and it works. We cannot test for Malaria in camp as we are very far from any labs and sophisticated testing facilities. So we just take a course of Ariplus. Extremely unsophisticated approach, but it works.

It also seems not to have any major side-effects that I could pick up off the pamphlet in the box.

For what it is worth! I hope your husband wins the fight soon ...

another disease to suspect is dengue fever; akin to malaria, carried by mosquito's common to the tropics.

there are a lot of illnesses from the 3rd world..It sounds like Malaria or a form of tick fever, symptons are about the same and both come from Africa...

But I think you had better leave your husbands diagnosis to the professionals, not a bunch of hunters and shooters like ourselves..

I would however seek a specialist or two, preferably one with a lot of experience with the country wherein he contacted the problem. I know for a fact that many local doctors have no clue when it comes to Malaria and tick fever.

I would check the blood for borreliose (Lyme desease) bacteria antibody in a specialised institute. This is a dangerous form of tick fever and found more and more on infected hunters.

Heavy Giadia infection?? Several of my mates have had nasty infections with flu like sympoms

2) Malaria- almost never shows possitive on a blood test taken during daylight hours untill the disease is well advanced. Must take a blood sample at a peak in the fever or between 11PM and 4 am when parrasites are released from the liver.

3) If you strongly suspect malaria I left some co-artem in the USA in January and could esily write up a script and send you a course. The only things that work on the malaria cases I have seen comming out of the Zambezi Valley are co-artem and Quinine/doxy combination

4) Sleeping sickness is back with a vengence- Where was he hunting?

5) We now have seven identified stains of tick fever and tick bite fever, and I came down with "an African form of Lymes disease" two years ago- I invariably catch every interesting disease going...

7) Heavy Bilhazia or fluke infection can produce the same symptoms. S. Rhodesiensis lays its eggs in the intestines rather than the bladder so there is no blood in the Urine to serve as a warning... I can send Biltricide if needed.

Lastly- there are several standard cures for African Diseases that are not available in the USA - like co-artem and Biltricide. Have been checking up on this with a US Tropical diseases doc, but I gather at this stage if a Doctor from here prescribes the drugs and sends them you may recive them and take them under the direction of your local specialist.

Hi there, I think there are something like 6 or so different types of malaria, with some strains worse than others, some, eg cerebral malaria are really serious and can kill you before you know it. If ever you get flu-like symptoms within 14 days of being in a malarial zone, get to your GP ASAP. There are also some nasty tick-bite fevers, such as the 'rocky-mountain' strain which can make you extremely sick too and are about 20% lethal if untreated. Doxycline usually gives it a knock for six. If, as Bahati said you give your body a good once-over you should be able to detect if you have had a tick-bite. Often the tick leaves a bit of a nasty scab and welt where it was sucking on you! Do not leave the head and hair out too, they can get up there un-detected!

Sleeping sickness can not be completely ruled out, as Ganyana said, if you have been bitten by tsetsies, don't forget they can also carry trypanosoma which would also cause similar symptoms. You will know if you have been bitten by a tsetsi fly, they often sneak up the back of your shirt and bite you around your back and sides like little fire-demons. You swat them, and they fly off as if nothing has happened, tough little sodds!

If you have been in contact with water of any sort, especially stagnant water, get checked for bilharzia. If you sleep 12 hours each day, get up and are still tired for the rest of the day, and have dark urine, you may have these nasty little worms in you. Biltricide and the generic horse-tablets often get it sorted out most of the time, but you may have to have a follow-up course of medicine. There are also other simailar diseases, such as Chaga's disease, which is spread by blood-sucking assassin bugs in South America. Chagas can inflict a large percentage of the population in some areas, and not sure how curable it is. Lyme disease, also caused by ticks is a North American disease I think, could also produce similar symptoms. I wish you all the best and hope that the correct diagnosis is made quickly. It is important to recall where you have been to start doing some of the eliminations.

From the symptoms described, I would think that a relapse of malaria would be my first guess of the cause of your husband's fever to be honest. Some of the strains can be quite resistant to quinine, might be best to get one of the most recent anti-malarials on the market. Best of luck, Nzou.

/.

Back from the dead so to speak. I greatly appreciate some of the very knowledgeable answers and advice provided. I didn't ask my wife to post this, I just asked her to look up something I had seen on tick bite fever. Lest you question my mental competence, I put an entire infectious disease/tropical medicine group in Florida on its ear. After untold tests etc and a week in the hospital, no diagnosis. I was treated with quinine and doxy. But no one ever told me what I had. Alf six seperate occult smears for malaria were negative as was every other test. What I am going to do is print off this info you guys have provided and go point by point through my records and see what might have been missed. A bad stomach virus stressed me out appartenly and caused a relapse. I pounded it with Doxy and am on the mend rather quickly. I have been blessed with Lymes disease in the US and now this. Ganyana, I was around Gonerezhou in September. I really want to study on this along with your helpful answers. Bryan, I have been going kind of hard but I dont think my trip to the arctic set this off. I also owe you some photos. Also suffice to say I had a couple of conversations with your boss while I was rolled in 4 blankets and pouring sweat. I will keep you posted, but I fear only appropriate and further testing in the face of a properly timed relapse will give me the answers. Thanks again for the replies and for the concern. Doctors don't know everything. Ask me how I know.

Jeff

Keep your head up Jeff. You can beat this junk. Keep us posted...and yes, I am waiting to see your hunt photos.

Consider work up for schistosomiasis.

It's endemic to Africa, and I've seen a few similar cases while I was in medical school in Miami.

Hopefully your husband is in the hands of a good Infectious Disease specialist at this point.

Good luck,

Garrett

quote:

Originally posted by Bwana Bunduki:
Doctors don't know everything. Ask me how I know.

Jeff

I am guessing that YOU and or YOUR WIFE are/is
a medical doctor with that pair of sentences.

Bwana Jeff,

I am glad that you are recovering from your illness.

From your clinical signs I am able to narrow the etiology of your illness as either:

1. acute peridontitis

2. If you could provide me with additional information as to any activity involving fornication with the natives I will be able to give a definitive diagnosis. I do not want to discuss the details as your wife visits AR. I suggest you call my office and arrange a complete work up. call me asap.


dale

I went through a similar experience as a result of a spider bite.

I thought I was going to die.

I hope you are better Jeff.

quote:

Originally posted by larryshores:
I went through a similar experience as a result of a spider bite.

I thought I was going to die.

I hope you are better Jeff.

You also can have what they call Tickfever, after a bite from the pepper tick.

This is the opinion of a layman, but a PH who has had malaria many many many times.

It is my understanding that malaria in its gametocyte form can lie dormant in the liver if unsuccesfully treated. It is my oft repeated experience that should the sufferer get tired or run down, these ganetocytes come out of the liver and mutate into the next (I forget the name) form of the malaria parasite, which brings on the symptoms you describe and which has for many years been called recurring malaria.

It was explained to me by a top doc in Zim that actually no malaria is essentially recurring, it can only recur if it has not been entirely killed in the first place. If you treat it successfully you can only get it again if bitten again.

As with Bahati above I deal with this often, and have found that when in doubt, a course of coartem which is a cocktail of lumefantrine and arthemeter will cure the malaria - and have little or no side effects if it was mis-diagnosed.

If the patient is over 80kgs or 175 odd lbs then a time and a half dose should be taken, i.e instead of four tablets per dose take 6. This should ensure that the malaria is indeed cured once and for all, and will not recur.

Again and with all due respect to the fine medical profession of the States, it has also been my experience that very very few doctors in the States are anywhere close to up to date on malaria and its cures. The very fact that you recovered for the most part without medication the first time supports my case here and the doxy will also push the malaria back down but will be unlikely to cure it completely.

My advice is get some Coartem down your throat asap, it will do you no harm if you are not malarial, but malaria really gets serious when untreated or half treated as seems to be your present case.

Hope this made sense, and I also agree with Ganyana and Bahati. Again with all due respect we have dealt with malaria hundreds of times more than any normal US physician and are in a position to comment constructively.

While the countries most experienced in malaria treatment have accepted Coartem and most literature reenforces its use in drug resistant falciparium treatment, neither Coartem nor Riamet (another brand name) are available in the US. Probably because of lack of demand and no return on the years of testing and millions of dollars required for FDA approval.

Treatment for severe malaria will therefore require a combination of available meds and in severe cases IV drugs. The US CDC posts information for both the public and practitioners on treatment. See this link for clincian guidelines.

CDC Treatment of Malaria

Look on the bright side, Gronarezhou rules out sleeping sickness. (and half a dozen other really nasty diseases which are endemic to the Zambezi Valley)

Tick Bite fever causes a distinct rash on the chest and palms of the hand. Easiest seen when lying in the bath. Two days after the rash comes a headache from hell.

Tick fever is less distinct and not as easy to diagnose. The standard test we use in Zim for "riketsia" comes up negative and blood samples have to be sent to the University and that takes a week- or longer.

Only thing I left of is Anthrax...don't often see it in humans here, but have opened more than one animal that was infected, nearly wet myself and gone running for the cipro. I expect a renewed outbreak down in the south east, but this seems a bit early. NB- You can catch anthrax from walking under vulture roosts when they have been feeding off an infected carcas or opening an infectednimal once you have shot it!

In September of 2007 my wife and I got dange fever. We got it while on vacation in Cancun Mexico. We were down there 4 days and returned back to Houston, TX on a Tuesday, both of us felt fine. On Friday evening (3 days after we returned) we both felt a little ache. Saturday we woke up with a 102 degree fever and by Sunday our fever had gone over 104 degrees. We both went to the doctor on Monday and they immediately sent us to a Tropical Disease specialist. He was 90% sure we had dange fever, but he couldn't rule out malria, so everyday our fever was over 100 degrees we had to go in and have our blood tested for the malria virus.......did this for 4 days. Needless to say we both felt like shit. Our fevers finally went away after nine days and a week later all our blood tests came back negative for malria.

Dange fever is also spread by mosquitos.

Denge is only occasionally found in the Zambezi Valley-and all the way north. None as far south as Gonarezhou

Ganyana, Oday and JT,

Thanks again for the info. I am strongly considering a course of Coartem. Ganyana I may impose on your kind offer. The relapse scared me. But I never felt quite right prior to that. Yea I know how could you tell. Anyway, to be honest the arrogance of my specialty group has had them all disagreeing so once I felt better I just gave up. I can also see where Doxy would drive this back down. The initial attack and hosptial stay I was treated with Quinine, Rocefin, Doxy and something else I can't recall for sure. With this relapse, The Doxy knocked it down quickly but I am not up to full speed. Thanks again for your input.

Dale,

Thanks...I think...

Jeff

I don't have any medical advice, Bwana. Just hope you get to feeling better.

Jeff, I am sorry that you have gone through so much hassle and pain with this illness. I am just a layman too, but I would think that a good, full coarse of Doxy should have stopped it for good 9 times out of 10 if it was a tick-bite fever. I do not think that it is schistosomiasis/bilharzia, as it would probably only have responded to bilricide I would have thought, but may be wrong.

I have had bilharzia at least 3 times, and any fisherman in Africa will be familiar with it. The test is a simple blood and urine test which shows up eggs in the urine. You usually know when you have it, because your energy becomes completely sapped and you become pretty useless until you get it treated. Although you can have fever with it, the tiredness is more of an indicator than fever I would have thought and sometimes blood in the urine.

Malaria still rings out to me, and as already mentioned, it can come back if you are run down and it has not been completely blasted in the first place. With malaria, I think vicious headaches and excruciating aches, pains, cold sweats and fever, especially at night are often a give-away. Most people I know who have had it said that they felt they were going to die it was so bad.

It will probably not do you any harm to get a full dose of good anti-malarials, but check with your doc on this first. This will at least mean that you can exclude malaria from your list. I hope that all the blood-tests show something soon. What ever it is, it should eventually be found in the blood tests. I find it interesting that malaria has come back negative 6 times, but have also heard it does not always come back positive. Six negative tests is a lot though! I hope this helps if at all. Hang in there, drink lots of fluids,
kind regards,
Nzou.

I am sure you have read the CDC site but if not here is a link..

http://www.cdc.gov/malaria/disease.htm

"Malaria Relapses
In P. vivax and P. ovale infections, patients having recovered from the first episode of illness may suffer several additional attacks ("relapses") after months or even years without symptoms. Relapses occur because P. vivax and P. ovale have dormant liver stage parasites ("hypnozoites") that may reactivate. Treatment to reduce the chance of such relapses is available and should follow treatment of the first attack."