Briton Dies Of Severe Malaria

[English Noodles]

http://www.thaivisa.com/forum/index.php?sh...6857&hl=malaria

http://www.thaivisa.com/forum/index.php?sh...6173&hl=malaria

http://www.thaivisa.com/forum/index.php?sh...5978&hl=malaria

http://www.thaivisa.com/forum/index.php?sh...3860&hl=malaria

http://www.thaivisa.com/forum/index.php?sh...2059&hl=malaria

[BritTim]

I wonder where he was in hospital. Many years ago, the brother of a Thai girlfriend contracted malaria while working in Cambodia. He ended up in hospital in Ubon, multiple times, blowing most of the family savings and nearly dying in the process. The doctors up country are often incompetent. Eventually, during a remission, I arranged to get him up to Bangkok. Two outpatient visits to Bumrungraad fixed him up.

If you want advice on Malaria in Thailand and Burma, get it in Bangkok. If you think you may have contracted malaria, get to Bangkok or Chiang Mai immediately and go to a top hospital. For the most serious forms of malaria, the best treatment is usually the Chinese drug Cotecxin. Western trained doctors, except the best in places like Thailand, will neither have access to it, nor use it.

Cotecxin can be used as a prophylaxis: get good advice on the appropriate dose. This is only indicated if you are planning to spend a lot of time in malaria infested jungles of Burma or the Thai-Burmese border areas.

Usually, malaria will NOT remain in your system if properly treated. Sometimes a different drug is required to totally eliminate the protozoa from the system than is used for initial treatment during an attack.

Edited May 24, 2006 by BritTim

[Patsycat]

How long does Malarone cover you after you have taken a course of it?

[Prakanong2005]

from www.malarone.com

"There are four types of malaria. MALARONE is approved for the treatment and prevention of Plasmodium falciparum malaria in adults and children weighing at least 25 lbs."

Metabolism:

In a study where 14C-labeled atovaquone was administered to healthy volunteers, greater than 94% of the dose was recovered as unchanged atovaquone in the feces over 21 days. There was little or no excretion of atovaquone in the urine (less than 0.6%). There is indirect evidence that atovaquone may undergo limited metabolism; however, a specific metabolite has not been identified. Between 40% to 60% of proguanil is excreted by the kidneys. Proguanil is metabolized to cycloguanil (primarily via CYP2C19) and 4-chlorophenylbiguanide. The main routes of elimination are hepatic biotransformation and renal excretion.

Elimination:

The elimination half-life of atovaquone is about 2 to 3 days in adult patients.

The elimination half-life of proguanil is 12 to 21 hours in both adult patients and pediatric patients, but may be longer in individuals who are slow metabolizers.

A population pharmacokinetic analysis in adult and pediatric patients showed that the apparent clearance (CL/F) of both atovaquone and proguanil are related to the body weight. The values CL/F for both atovaquone and proguanil in subjects with body weight ≥11 kg are shown in Table 1.

Table 1. Apparent Clearance for Atovaquone and Proguanil in Patients as a Function of Body Weight

See the site for the table as it does not paste well

[Chris Bussell]

The Great Adventure Of Life

When we are young we have oppertunity.

Bless this young man he took the oppertunity to study and travel, he did thank his perants for that special oppertunity. I feel sad to read of his death, he did nothing wrong and his family supported the spirit of adventure in life.

[nikster]

What would Garlic Capsules do???

Do you find that you "exude" a certain smell from sweating?

The only thing I am aware of that garlic helps is in metabolism and vampires.

Maybe it stops all blood sucking creatures...

Indeed. Mosquitos don't like to bite you if you have garlic in your blood. The more the better. The main reason I don't do it is that it repels girls just as well as it does mozzies

Doing a visa run to Burma today, I will be sure to apply Deet graciously. People say it's unhealthy but I find that it's the only thing that works if in areas with really heavy mosquito populations. At home, citronella oil based repellents are fine. In fact, I will try to get some garlic capsules as well just for the occasion.

Expensive anti-malarial drugs which have lots of side-effects and at the same time don't protect me from the most dangerous forms - no thanks. Most Doctors in Austria recommend against them and this story gives support to that.

RIP to the traveller, and my condolences.

[IMA_FARANG]

Well unless Jungle Trekking is in your plans I dont think anti-malaria tabs are necessary. Of course see it did this lad alot of good.

I understand a drug-resistant form of Malaria is known in provinces in Cambodia near the Thai border. Wonder if he was wandering about in that area?

[z21rhd]

Because the outcome of contracting Malaria can be very serious, a few facts regarding Malaria in Thailand are offered :-

1) 2 species of the protozoan pathogen Plasmodium are resident in Thailand, ie .. Plasmodium falciparum and Plasmodium vivax. (neither are viruses)

2) Plasmodium falciparum is the causative agent of the most pathogenic of the human malarias.

Untreated infections from this parasite may result in cerebral malaria or what is referred to as

severe malaria. Death can occur within 48 hours of initial infection.

3) Low level transmission areas of malaria are the western and northern borders of Thailand with

Burma, and the Thai borders with Cambodia.

4) In the early eighties resistance to antimalarials in Thailand became a problem and by the

nineties Thailand had the distinction of having one of the most multidrug resistant populations of

malaria in world. Which it still has !!

5) One of the most effective drugs for preventing malaria was Mefloquine (Larium) however, even

this antimalarial has now become partially resistant to P. falciparum in Thailand.

6) The "hill tribe" and displaced refugee villages in the provinces of Ranong, Chumpon, Prachuap

khiri khan, Petchburi, Rachaburi, Kanchanaburi have cycles of epedemics. While those in the

provinces of Tak, Mae Hong Son, Chiang Mai, Chiang Rai, Phayao are continously infected with

malaria (albeit in a low level of transmission)

7) In light of the above facts, any ideas that malaria is not a disease that one can be infected with

in Thailand are to be discarded as propaganda.

I discussed this case on the bus to work this morning with a Medical Writer working on our Malaria project who also did research into HIV in Thailand and had to go to malarial area's on the border for that research with Hill Tribes etc.

He said he thought there were now three types of Malaria in Thailand - the two you mention and another one that is very rare but is there?

Edit

Mmm - I did a google and one draft paper from Mahidol (who we work with) says 2 types but another paper from Penn State who are working with Mahidol say all 4 types are there???

"According to Liwang Cui, assistant professor of entomology at Penn State, malaria still is a major health problem in Thailand. While reported malaria cases have continued to decrease over the past two decades in Thailand, in rural areas people still remain at great risk.

"In Thailand, all four species of malaria occur, but the vast majority are caused by the Plasmodium falciparum and Plasmodium vivax infections," said Cui. "While major focus has been on P. falciparum, the most deadly of all malaria species, the burden of P. vivax has largely been neglected. In recent years, worldwide distribution of P. vivax has expanded significantly and the number of cases has been on the rise.""

http://live.psu.edu/story/16002

This WHO paper talks of only two types specifically but also talks of Falciparum "Mixed" but does not say mixed with what

http://www.rbm.who.int/wmr2005/profiles/thailand.pdf

I am now confused

To set the record straight :- Malaria occurs in most tropical regions of the world with P.falciparum predominating in Africa, New Guinea and Haiti. P.vivax is more common on the Indian sub-continent and Central America with the prevalence of these two infections roughly equal in Asia, Oceania and South America. P. malariae is found in most endemic areas especially sub-Saharan Africa but much less frequently. P. ovale is relatively unusual outside Africa although some cases are now being identified in other regions (eg. Southern States of India). It is also important to recognise that with the relative ease and speed of modern travel and migration, "imported" cases of malaria may present in any country. Additionally so called "airport malaria" has now been identified in a number of countries including the USA, UK, Belgium, and Switzerland. Airport malaria is particularly dangerous since Clinicians may have little reason to suspect it, if the patient has had no recent travel to areas where malaria is endemic. This may result in a delay before the correct diagnosis is made and which may lead to death before appropriate treatment can be initiated.

In Thailand , "mixed" means the patient has been infected by both species of Plasmodia ; ie .. falciparum and vivax. These are both resident species in Thailand - P. ovale and P. malariae are

only seen as imports. As previously indicated malaria in Thailand is essentially a border disease, especially prevalent in Hill tribe and displaced refugee villages.

For those wishing to travel to malarious areas - advice should be sought from competant authorities. Common sense determines that avoidance of being bitten by mosquitoes is the safest bet :- Repellants, indoors after dusk , spray rooms , log sleeves etc. Anyone feeling ill with a temp should seek early medical attention - making sure that the doctor knows that you have recently travelled.

[Namaste5]

Have not read all the blog, so maybe repeating this: vaccinations can intentionally or unintentionally bring on the disease they are trying to prevent. Also, you can get deodorized garlic, but better to take it raw with all its natural ingredients. Can take it raw, and then brush teeth and/or use a natural mouthwash.

[seonai]

From Green Wanderer - "Well, atleast he had a University degree...that will make a difference in...

...well it might have made a differnce in paying back mom and dad for dream trip.

sympathy goes out to the parents... who wants their son to leave this world before them ? Shocking...expecially since he was my age...

If I died today, I may not leave this world with riches and big life insurance policies, but nevertheless, wouldn't be in financial debt to anyone. Something to think about for those who have ever pondered death...

(no intent to offend anyone currently healing from this tragedy---things happen for reasons la ja)"

I thought this was one of the most insensitive posts I have ever read....... Seonai

[CSX]

An absolute tragedy.

To lose ones life when so young is terrible.

Especially he knew the risks and tried to minimize them by being prepared.

My thoughts and prayers are with his family.

God Bless all affected by the tragic lose.

[percy2]

Beer and Bread are good sources of Vit. B

G&T for your quinine

Who said avoiding malaria couldn't be fun

Going to Ranong for a visa trip may be dangerous but don't fly the terrorrists may get you

Phuket , Samui , Samet and Chang all have malaria so don't go on holiday

Whats the link for the blog , or have I misinterpreted?

Careful with deet it melts plastics.

Cheers

[Bates]

Hmm, this topic has scared me off a bit... I'm leaving on 30/6 for a year stay at Mae Sot (Tak Province)...

The article said... he was trekking in the jungle... How about the city of Mae Sot? Is it any saver? I'm not going to take any malaria pills...If anyone could provide me any info, greatly appreciate it.

Thnx

Bates

[Jamesthai]

Sad news to hear-My condolences to his family.

I contracted malaria p.falciparum in southern Thailand about 3 years ago and it nearly killed me. I had what people are referring to as the mixed type as I also contracted p.vivax about 6 weeks after recovering from the main event.

With falciparum you go from flu like symptoms to ICU in a few days-Its very rapid. It simple terms it messes with your blood, poisons it and shuts down your organs resulting in muti-organ failure and often death. So if you feel ill get a blood test-it could be dengue, malaria etc or just the flu.-but it may save your life.

I was living on an island down south nowhere near a border and had been there for about 6 months without leaving. I was among 3 farangs who I know got it on this small island at that time and I was the only one to survive. Doctors in Bangkok told me it was actually quite common throughout Thailand and in the month or so I was in hospital they told me of outbreaks in Chang Mai, Samui and Phuket regions as well as more border areas.

The govermnent health department just denied all claims of any outbreak as my doctors says they always do "because malaria does not exist in Thailand". Truth is it does (And its drug resitant) they just dont want to harm tourism. My Dr. did say it was still a 10m to one shot of getting it. Also any preventative medicine would not work.

In short the chances are you wont get malaria, but just in case get as blood test if you feel bad-they normally check for everything as most Thai medical staff know it exists even if some officials choose to deny it.

J

[the gent]

Well, atleast he had a University degree...that will make a difference in...

...well it might have made a differnce in paying back mom and dad for dream trip.

sympathy goes out to the parents... who wants their son to leave this world before them ? Shocking...expecially since he was my age...

If I died today, I may not leave this world with riches and big life insurance policies, but nevertheless, wouldn't be in financial debt to anyone. Something to think about for those who have ever pondered death...

(no intent to offend anyone currently healing from this tragedy---things happen for reasons la ja)

Generally speaking, we Irish have a saying that only the good die young, the rest of us labour on in a stumbling blindness. But on reading your post I have to venture the opinion that your brand of stupidity seems so profound as to elevate you into another category beyond comprehension.

Perhaps your time may come soon.......

[elkangorito]

Start taking your Vitamin B tablets people! It is the only time I don't get touched by mosquitos.

My condonlences to the family.

In 1982 (when I was 21), I went to Papua New Guinea to walk the Kokoda Track. After doing this, I ended up staying there for quite some time.

Prior to 'walking the track', I had read somewhere that Vitamin B will help ward off mosquito attacks. This advice was quite specific as it recommended taking high doses (100mg per day) of 'B Forte' for at least 2 weeks prior to entering the mosquito zone then reducing to 10-25mg per day. (This was a long time ago...I hope I've got my figures right).

I followed these instructions & after 3 months (before going to PNG), I noticed that people were commenting upon my 'unusual' body odour & skin colour (slightly yellowed).

Whilst 'walking the track' (dense jungle), I was the only person who was not attacked by mosquitoes. As a matter of fact, I can't recall one occassion where I was bitten by anything, although my companions were always commenting about my strange body odour.

I must also say that I had previously taken a course of Maloprim...BUT I WAS NEVER BITTEN BY ANYTHING. The flies even kept away. I must have really smelt strange.

Edited June 1, 2006 by elkangorito

[elkangorito]

Well, atleast he had a University degree...that will make a difference in...

...well it might have made a differnce in paying back mom and dad for dream trip.

sympathy goes out to the parents... who wants their son to leave this world before them ? Shocking...expecially since he was my age...

If I died today, I may not leave this world with riches and big life insurance policies, but nevertheless, wouldn't be in financial debt to anyone. Something to think about for those who have ever pondered death...

(no intent to offend anyone currently healing from this tragedy---things happen for reasons la ja)

Generally speaking, we Irish have a saying that only the good die young, the rest of us labour on in a stumbling blindness. But on reading your post I have to venture the opinion that your brand of stupidity seems so profound as to elevate you into another category beyond comprehension.

Perhaps your time may come soon.......

My grandad was Irish & he was one bloody great guy...had a similar attitude. I have decided to think like him. All this talk about 'paying your bills before/when you die' is crap!! When you're dead, you're dead...& I personally won't be in any position to give a toss for the living, when I die. Besides, nobody can tell when they are going to die so money never comes into the equation...unless you're the 'guilty' type.