Anti-Malaria medication puzzle

machadinha

I never knew you were active in the field, Overlander (I am not, btw). Good and straight advice, all of it. (btw Three in a thousand isn't much, but it's not nothing either, right? What warning would this result in on the medical instructions leaflet?)

And btw I consider "11.3% [who] had some kind of neuropsychiatric issue" not peanuts, and I suppose there are many who take some form of "recreational" drugs. That's by no means arguing for or against it though, let people make up their own minds.

pps I found a decent Indian vegetarian diet pretty balanced, but then I'm one of those who managed to gain weight there, unlike many others who report losing weight. It may help to know I've been a vegetarian for much of my life, and I prefer local Indian food over Western-style stuff cooked up there. I imagine subsisting on bad imitations of pancakes and pizzas and the likes might lead to some deficits in the long run. Some people take vitamin supplements, I guess if you're going way off the track and are stuck with little but rice and dhal this may be a good idea; I rarely found it a problem (except when going way off the track etc., indeed.)

So anyway the implication then is Lariam messes with your magnesium levels?

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Nick-H

Always good to hear from someone well-informed, but I wonder:
malarial encephalitis --- what is the risk in India?

Bear in mind, against the background of controversy, to take or not to take, that the British NHS advice for India is not to take prophylaxis: the emphasis is now on diagnosis and treatment.

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Just one member of the IndiaMike Mod Team

70s-80s overlander

You asked a good question: what IS the incidence of malarial encephalitis? This is mostly seen with p.falciparum rather than p.vivax, and p.falciparum is more common in the far eastern states of India -- BUT a somewhat scary April 2007 medical article from Orissa notes that of the 2994 adult patients seen with p.falciparum malaria 18% had encephalitis -- with 76% of the cases being male; 62% had severe pathology in other parts of the body, which led to a total case population death rate of 23%. [Ann Trop Med Parasitol. 2007 Apr;101(3):187-93]

Yes, Lariam is indicated for prevention of p.falciparum malaria as well as for prevention of p. vivax malaria. Yes, p.falciparum is the most likely type of malaria to kill you.

[So, the definitive study has not been done, but it sounds like Lariam neuropsychiatric side effects are more common in women (see earlier entry) while malarial neuropsychiatric effects are more common in men. While we're at it, let me note that children tend to come of out of malarial coma faster than adults.]

Current controversies concern using cheap/generic pentoxifylline with these cases and using cheap/over-the-counter L-arginine; the latter is even more interesting as it might both treat malaria brain/lung damage AND help to kill any mosquito that bites the person so treated. These controversies are 5-10 years old & still not resolved. Both pentoxifylline & L-arginine are rather benign -- so you can guess how I would vote [? should I add that both have at least minor effects on, ahem, sexual performance?]

Am I the only person who wrote down the names of major medical centers on my proposed path through India? [By the way, I am also a big proponent of carrying EXTRA Doxycycline -- as it not only has some antimalarial effect but, in substantial doses, hits cholera, typhus, etc, etc, etc -- while a small dose daily prevents skin infections from dust-infected knicks.]

machadinha

LOL yes that's nice. I got around without much of anything (well, except from the standard vaccinations, which I had looked into well, btw) So let me by no means suggest looking into it shouldn't be done, nor does it guarantee a thing, of course.

So what's with the magnesium?

Nick-H

70s... carrying that stuff around is fine if, as a professional, you know why, when and how much to take.

The rest of us are better off visiting a doctor.

70s-80s overlander

Nick -- Don't you find it curious that the British National Health Service recommends that British citizens DO NOT use British tax-payer funds to pay for malaria prophylaxis while the US Center for Disease Control recommends that US citizens DO use their private funds to pay for malaria prophylaxis? The British argument might be a "population-based" argument -- that it is cheaper to the British tax-payers as a group to let malaria victims get their treatment in India at Indian government or individual traveler expense, while the US argument might be an "individual-based" argument -- that it is cheaper and better for the individual US traveler who pays for his/her own medical care NOT to get malaria in the first place. Just asking & noting. The British NHS approach just happens to save money for the British government -- and possibly cost money for the Indian government, while the US CDC approach neither saves money nor costs money for the US government. [Oh, you do know, of course, that the US CDC maintains a program of on-site surveillance of disease in India.]

Nick-H

No, because I'm far from sure that is available on the NHS!

Certainly the now old-fashioned proguanil and cloroquine combination is an over-the-counter purchase at the chemist's shop. You do not get it on prescription.

Added to which, for most quick trips, the expense of the treatment is going to be back home, which ever country that is.

No... I don't think I'm that cynical, yet.

Of course, if you were to suggest that a recommendation to take a drug might have had some sort of, err... 'sponsorship'. I'd be cynical enough to believe that! Even British docs come under pressure from medical reps.

You know, despite the lobbies and the taxes received, and the fact that they'll never go quite so far as to outlaw it, the British government still advises people not to smoke!

70s-80s overlander

Magnesium is a natural anti-convulsant; that is, it "normalizes" nerve functioning; therefore it helps many varieties of insomnia, muscle tension, anxiety, irritability, negativity, etc; it also is a diuretic, pulling water out of nerve tissue as well as from other places. In regard to this Lariam/malaria question, magnesium is a bit of a "Catch 22":

if you are severely magnesium deficient before you contract malaria, you are likely to have a milder infection [however, those around you might dislike your baseline irritability]; malaria itself breaks red blood cells, dumping magnesium and other minerals into the blood stream -- giving falsely high values for these if someone happens to draw your blood;

if you load up on magnesium [but try to avoid producing loose bowels] after you contract malaria OR are experiencing Laram-related cerebral irritability, then your have a good chance of reducing the insomnia, dizziness, tremor, anxiety, etc.

[Interestingly enough, most of the early articles on this, from the 1970s, are written by Indian physicians; I am judging this by the titles of the articles as the abstracts are not yet available on the web; I say "not yet" as there is a project to get more of the older Indian literature available on the web.]

Given that spinach, lentils, and peanuts are each high in both magnesium and arginine -- and these nutrients are considered potentially helpful in reducing malarial side-effects -- I guess I would try to keep down a meal of these if I came down with malaria. I've never personally had malaria -- so I would be interested in hearing from those who have had it whether, after proper hydration, such a diet would be palatable and digestible. Apparently Ayurveda mentions the spinach part but not the lentil or peanut parts.

machadinha

I was just going over this site again: http://www.jetlagtravel.com/phaic_tan/health.htm

kristinm

I see by the smiley you realise that site is a spoof (I hope so anyway!)- the book is absolutely hilarious if you can get it outside Australia! A fantastic and wicked takeoff of adventure travel 'off the beaten track' guides to the fictional Phaic Tan (say it out loud). The same Aussie guys also made a fantastic film called The Castle.. if you ever see it on DVD grab it. They also did a great TV show which was a spoof current affairs show complete with blow waved brainless host and ego driven star reporter, bimbo and the office girl who did all the work! They are called 'working dog productions'.

machadinha

Oh yes, has been translated into numerous languages I believe, according to their site too. I know a guy who worked on a translation of their Molvanîa edition ("A land untouched by modern dentistry" ) -- funny guy to begin with, didn't surprise me

I'll be sure to check for that show.

Nick-H

Brilliant

kristinm

That's right - I was trying to think of the other one Molvania, it has a hideous photo of a toothless ancient man on the front.

edwardseco

OT: I have Molvania (in the US) and have seen another so it is available worldwide.

Back on track: I managed to hack a medical research site to look at the research done on malaria. It was astonishing how little and fragmentary it was. A disease that affects so many, but mostly poor, is not very fashionable. It was a depressing thought..

machadinha

It's rather ugly, yes, Ed. I used to have a link to some group who seemed to be in the know who addressed the industry's apparent lack to come up with a solution. I lost the link though, and googling for malaria just to retrieve it is no fun... As in there's just too much out there.

It seems to be highly multi-faceted though, a problem with malaria is that the parasites seem to quickly adapt to any prophylaxes. Which I think is one reason why many medical institutions worldwide have taken a step back in prescribing those prophylaxes in the first place.

But money and an attractive market sure seem to figure into it... Think of the AIDS situation, and for instance the fight South Africa put up to have medicines for it available at their actual cost.