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dear dr. i have malaria from last 4 months.problem is that its not curing (even after 3 times treatment)and 2nd rare thing is that my temp. never gone upto 99f in this 4 months.when last yr when i was typhiod then also my temperature not higher than 98-99f .but it was cured by cefruxime very easily. now i did typhiod s all tests this time its negetive. i have 24 hours fever ,(without temp),mostly in afternoon and evening pain,headache,poor appetite. in the beggening of this problem,doctor found malaria positive (p f).then he gave me lariago 500mg tablets then i feel better after take it.my body pain and fever became less.but then he start malarid 150 mg tablets,my symptoms came back again and after 1 month its became positive again (in card and slide ,both).then i changed the doctor he gave me lumarax80 tabs but not permanently gone.can blood culture solve my problem?if yes then when should i do,now or wait for untill its positive.any other test u want to suggest? thanks
- muhammad ( India ) Dec 17,2015 1:46 AM

Answer

Dec 25,2015 9:13 PM
Dear Muhammad,

Based on the history that you narrated, you were initially treated for vivax malaria with chloroquine and primaquine. Afterwards , you were treated for falciparum malaria with artemether and lumefentarine (80/480). Investigations alone are not the criteria for suspecting malaria in a patient. Contributing evidence such as prevalent specie in the area, presence of thrombocytopenia (low platelets on blood counts) with splenomegaly (enlarged spleen on ultrasound ) and classical high grade fever should be taken into consideration when deciding on the treatment. 


Empiric treatment with antibiotics is also now considered in addition to the antimalarial therapy as it can reduce the burden of possible sepsis as a complication. The fever now is low grade and you have been treated twice for malaria. Most likely the malaria is cured. 


Blood culture will not give any info with respect to malaria. If there is bacterial involvement then blood cultures can be of use in this situation especially if the fever is not subsiding. Document the temperature for 24 to 48 hours. If there is a spike despite taking the above treatment then IV artesunate for malaria if suspected , blood cultures and further workup can be planned. If you remain afebrile then there is no need for extensive workup.


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