Student guest post by Laura Vonnahme

As a part of traveling to a developing nation, we are often required to take medical precautions. This generally includes a line-up of shots for various diseases, a few other tests, and various regimens of prophylaxis for possible diseases. I have often left these doctors appointments with a line of band-aids on my arm, a handful of prescriptions and a little weakness in my knees. However, I will readily admit that my malaria prophylaxis is often pushed to the back burner; in fact the last time I went to a developing nation, I didn’t even get the malaria prophylaxis until I was in the country and I didn’t even bother taking it for the prescribed amount of time. However, as I readily admit my shortsightedness in the past, I have become more aware of the chronic conditions that can be caused by a single malaria infection.

Malaria is a mosquito-borne disease caused by a parasite, and there are four different species of parasites that cause malaria, Plasmodium falciparum (which is the most fatal), P. vivax, P. malariae, and P. ovale. When initially infected, parasites first enter the liver, then multiply quickly and enter the bloodstream, where they continue to multiply and rupture blood cells2. While P. falciparum causes the most severe symptoms, P. vivax and P. ovale can cause chronic malaria which is characterized by profound anemia, enlargement of the spleen, emaciation, mental depression, sallow complexion, edema of ankles, feeble digestion, and muscular weakness.

In addition, there is a more serious form of malaria caused by P. falciparum, called cerebral malaria, which can be deadly quickly if left untreated. However, a more controversial disease has been linked to malaria as of late. Recently there have been links to cerebral malaria, posttraumatic stress disorder (PTSD) and other psychological disorders in soldiers who have returned from service in areas where malaria is endemic. In particular several studies have been conducted on soldiers who had contracted malaria while in service during the Vietnam War. Dr. Nils R. Varney conducted one of these first studies here at the University of Iowa and reported that many cerebral malaria survivors from the Vietnam War have a number of neuropsychiatric symptoms that can persist for years after the acute illness has been treated. “Cerebral malaria does a number of different things to a patient’s brain that cause a variety of neurological problems,” Varney says. “…patients who survived the illness frequently developed depression, impaired memory loss, personality change and proneness to violence as long-term effects of the disease. These are symptoms that have been reported by many Vietnam veterans for years and are often treated strictly as PTSD.”

The journal article compared the neuropsychiatric status of 40 Vietnam combat veterans who contracted cerebral malaria between 1966-1969 with 40 Vietnam veterans with similar wartime experience who suffered gunshot or shrapnel wounds during the same period. The participants underwent numerous tests for sensory, cognitive and behavioral symptoms. Findings indicate that cerebral malaria results in multiple, major, substantially underappreciated neuropsychiatric symptoms in Vietnam veterans, including poor dichotic listening, “personality change,” depression, and, in some cases, partial seizure-like symptoms. Findings strongly suggest that history of malaria should be considered in any medical, psychological, or psychiatric workup of a Vietnam War veteran because a positive response could result in substantial changes in diagnosis and treatment. Interestingly, these results seen in Vietnam veterans are similar to those seen in British troops stationed in India during in the 19th century during the height of the British Empire. Nineteenth-century physicians documented these cases and considered malaria a leading cause of mental illness in British-occupied regions

Therefore, continued prophylaxis is extremely important for anyone traveling to an area where malaria is thought to be endemic. Thus, while you may think prophylaxis is a nuisance, the pills make you have weird dreams, you cant remember to take the pill every week or you just plain think your invincible, none of these are valid excuses for skipping a necessary malaria prophylaxis.

References

1. CDC – Malaria. (n.d.). Centers for Disease Control and Prevention. Retrieved April 11, 2010, from http://www.cdc.gov/malaria/

2. Malaria. (n.d.). Penn State Hershey. Retrieved April 11, 2010, from http://www.hmc.psu.edu/healthinfo/m/malaria.htm

3. UI/VAMC study says patient’s history of malaria may be a clue to many Vietnam vets’ psychological and other health problems. (n.d.). Retrieved April 11, 2010, from http://www.newswise.com/articles/uivamc-study-says-patients-history-of-malaria-may-be-a-clue-to-many-vietnam-vets-psychological-and-other-health-problems

4. Varney, N., Roberts, R., & Springer, J. (1997). Neuropsychiatric Sequelae of Cerebral Malaria in Vietnam Veterans. The Journal of Nervous & Mental Disease, 185(11), 695-703. Retrieved April 11, 2010, from http://journals.lww.com/jonmd/Abstract/1997/11000/Neuropsychiatric_Sequelae_of_Cerebral_Malaria_in.8.aspx

Comments

  1. #1 Leonard William Scheibel MD, Sc.D, FACP
    April 21, 2010

    Tara, That was a great article. After a career in malaria I was unaware of some of the NP effects mentioned by you and in refs 3 & 4. Bill Scheibel

  2. #2 Tara C. Smith
    April 22, 2010

    Thanks Bill–enjoyed your recent article with Phil as well! But I can’t take credit for this one–Laura, a student in my current course, wrote it.

  3. #3 becca
    April 22, 2010

    Great article!
    I’m really curious about the molecular mechanisms underpinning the psychological effects of the prophylaxis themselves, as well.

  4. #4 Bobby Love
    June 30, 2010

    Indeed it is a must for individuals who are living in a malaria prone area to take prophylactic medications. Just an effective way to prevent a serious problem.

  5. #5 dr. Ferenc Mélykuti
    August 3, 2010

    Dear. Dr. Smith,

    I have been desperatly searching for treatment methods for PMNS. I read the article on Newswise, and the abstract on LWW on Dr. Varney’s research but could not find any info on concrete treatment options for regenerative action to alleviate/cure psycholgical impact of PMNS (like sleeplessness or depression) Any help would be greatly appreciated in this regard!

    Sincerely,
    dr. Ferenc Mélykuti
    Pretoria

  6. #6 George Skypeck
    July 11, 2011

    Good article–thanks for the news on link to PTSD possible–how about to Agent Orange exposure in Vietnam? I was in Vietnam War 1967-end of 1971 in the Mekong Delta, got CM and Typhoid after Tet Offensive and still sufffer the effects and pain of these “bugs” long after the initial horrible effects…I was misdiagnosed by the army hospital in Saigon because they never knew about CB and I only found out this CB possibility because of the Army Nurse Captain who treated me at the time–our Army Docs were mostly anti-war hippies in uniforms and could have cared less about the combat soldier–they just wanted “out of the army and back home to make the bucks again.” And, in 1974, when I was thrown onto the VA rolls, the VA drs. knew nothing about tropical diseases unless they had been WW2 doctors in the Pacific#not many#. I didn’t see any mention of the massive amounts of big red bloodcllots that I vomited and deficated each time I had a drink of water while under this horrendous fever and halucinations from it. After the short stay in the Saigon hospital, I was sent back to my small team in the Delta to finish my tour. Terrible headaches still today….now with seizures again and recurring bouts like now and the past 8+weeks. But, I am still an artist…”De Oppresso Liber”

  7. #7 Jay
    Spark Nv
    July 11, 2012

    Had a real bad bout of malaria in 1968. Been diagnosied with spinal cerabela ataxia balance issue. Thanks Jay

  8. #8 William B. Gray
    Mission, Texas
    November 10, 2013

    While serving with the 51st. Infantry Long Range Patrol, I caught malaria in the first week of December 1967. It was diagnosed as falciparum. I was hospitalized at the 93rd evac center in Long Binh. I had very high temperatures during these bouts. The chills were such that it sometimes felt like my spine might snap. While my brain felt like it was boiling, I felt like I was freezing from the neck down.
    I was flown to Ft. Sam appx. 1 week later. During this time, I was prescribed Dapsem. I was sent home on R & R. At some point I had quit taking Dapsem.
    I came down with malaria-like symptoms within appx. 2 weeks. My father drove me back to Ft. Sam. They scolded me for not taking Dapsem.
    They tested my blood and said that I had Vivax. I told them that I had been diagnosed with falciparum. They argued and said that while testing my blood, their own diagnosis was that I had Vivax. Did I, in fact, have 2 different types of malaria or had there been a misdiagnosis?
    Lastly, I want to embarrassingly describe what I had experienced mentally. Although I had been in a lot of fire fights, I had weathered these remarkably well and felt no different mentally.
    I don’t know how to explain what happened next. It was as if my mind just changed. I didn’t tell anybody in the hospital about it. It was like I’m just lying on my back and then full reality of what I had experienced during those fire fights came crashing in mentally. The best way I can describe this is to say it felt very debilitating. I tried everything mentally to fight this off but really to no avail. As my physical body began to strengthen, my mind began to get a little better. And although I feel better than what I did while sickened with malaria, I have never quite gotten over the hump mentally.
    There may be so-called experts who might refute what I’m saying, but the fact remains that I DID experience what I’ve just described.
    I don’t believe for even a moment that I’m the only one who has experienced this.
    Do I believe that malaria brought this on? Absolutely!

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