Anti-Malaria Nightmare
 

My husband and I moved to South Korea last fall from the US. He accepted a teaching position here and I thought it would be the perfect opportunity for us to travel and see Asia. In January, we flew to Hong Kong and took a wonderful cruise which stopped in China, Vietnam,
Thailand and ended in Singapore. Afterwards, we flew back to Koh Samui, Thailand and stayed at the
Napasai Pansea (a beautiful resort) and then left there for Siem Reap and Angkor Wat. On the first day of our cruise, I became violently ill with what I thought was food poisoning. I had flu like symptoms and was in bed for two days. I was well again for the rest of the cruise, and on our last day in Koh Samui, I awoke with blurred vision in my right eye. I thought I had an infection. We flew to Siem Reap and our guide immediately met us and we checked into our hotel(De La Paix, wonderful)and set out to see the temples. My vision became progressively worse, and when I could barely see the sights, and while in a park couldn't see the adorable families of monkeys, I panicked. The guide took me to an eye doctor's office, which was in a house, and although he had a french diploma, had very limited equipment. He immediately diagnosed me as having a 60% detached retina and said I must leave the country for surgery immediately. I insisted that my husband go to the temples the next morning, while I stayed at our hotel, awaiting our flight. I thought maybe we'd never return there. He did go, and got some wonderful photos, while I pondered why this was happening to me. We left for an eye hospital in Bangkok where the dr. said I should return to Korea for the surgery, as the recovery period was very long. We went to Seoul and I endured two surgeries in two days, one with only a local anesthetic, and the pain was horrific.
There was virtually no English spoken, even though it was called an International Health Center. At the end of the week, we flew back to Busan, where we live, and I started to take the medications they gave me. After three days, I began to have seizures and was rushed by ambulance to a University hospital for treatment. Although, once again, English was barely spoken, the team of doctors saved my life. I was diagnosed as having hemolytic anemia, a condition where your immune system attacks itself.How could this have happened, when I was perfectly healthy before our trip? I was in the hospital for two weeks, and sent home two months ago on heavy steroids (prednisone) which is a nightmare in itself. The side effects are horrendous. I am gradually getting better, and once I'm weaned off the steroids, I hope I'll be myself again. Why did this happen? How did I get this condition? I have done much research, and it seems to point towards the anti-malarial medication our doctor in the U.S. prescribed for us before we left. I asked for it, as I thought we might need it in Vietnam or Cambodia.While my husband had no adverse reaction to it, I think that's what caused my illness. I discovered, upon doing research, that people who are of mediterranean descent (my family is originally from Italy) are lacking a certain enzyme, and should never take anti-malarial medication. They actually have a resistance to malaria. What can result from taking it? The first thing on the list was hemolytic anemia!
I have gradually gotten almost well, after nearly dying, and I will never know for sure if the melefoquine caused my trouble, but I want to caution people against taking anti malarial drugs unless it is absolutely
necessary. I was in a jungle for about an hour when we went to CuChi Tunnels in Vietnam, and hardly thinks that would be enough to take this medication. I regretfully wish I had gotten more information. I hope this might help someone else.

Thank you for your post. I have been to Asia many times. Under constant urging for others (You are going to take anti-malaria medication, aren't you?!?!?!?!)I started to take medication for my first trip to India. HUGE MISTAKE! I became so violently ill that my trip was a total disaster!!!!!!!!! After that experience, I decided never to take anti-malaria medication again unless I were going into the jungle for 5 months and sleeping in a tent.

On my last trip to India in 2001, many of my friends who were on anti-malaria medication became very sick, usually vomiting and diarrhea symptoms. They all could not believe I wasn't taking any medication. We were all travelling first class, staying in 5-star hotels, driving around in air conditioned mini-vans, etc. I really didn't see any risk. I wore long-sleeved shirts and pants, and applied mosquito repellent. That was good enough for travelling in mostly larger cities like Delhi, Agra, Jaipur, and Benares.

Later, I saw a news programme--I think it was 60 MINUTES--that discussed how anti-malaris medication can cause dementia in certain people. I think people really have to look at the benefits and risks of ALL MEDICATION before use.

Cheers,
JG

I am very sorry you had such a terrible experience. You might be interested to know that according to the CDC web site, mefloquine is NOT recommended for many places in SE Asia, including the western provinces of Cambodia that border Thailand - I am not 100% sure but I think that would include Siem Reap.

I could not agree more!! I've made nine trips to Asia and have never taken meds before traveling there. I have reactions to some things, which became apparent after my one and only flu shot 40+ years ago. I was so sick I had to be hospitalized for several days after just one flu shot. NEVER AGAIN!!

I get very concerned about all the ads on TV about drugs for this and drugs for that. People don't really stop to think about putting something in their body. They are just looking for a fast cure... it's just part of our fast food culture. A quick fix for anything!! Don't get me started!!

Anyway, I would agree completely with the cautionary note about taking meds.

Carol

maybe i missed it but what medication did you take...that might be helpful for others...

have you considered flying home to usa to be fully evaluated? it seems that i would choose to do something like that at this point

Wow, what a nightmare! Really hope you are recovering ok, poor you.

Thanks for sharing. When I took anti - malarials a couple of years ago, it made the skin on my hands and wrist all bumpy. yuk.

The best thing of course is to avoid getting bitten in the first place. Anyhow, like I said, hope you are ok now.

Bob - the drug was mefloquine (sold under the brand name Larium). She doesn't mention name of the med until the very end of her post.

So does Malarone do bad things to you? I'm not sure if I believe the labels.

Lloyd

There have been several discussions on this site regarding Malerone. As far as I can tell, I am the one of the few that has had problems with it - it upset my stomach. My wife and I use doxycycline as an anti-malarial with no problems other than skin sensitivity to the sun.

Geez, what a nightmare. We have Malarone that we're supposed to start taking next week. I hope for no side effects!!!

Larium is known to have horrible side effects. The "experts" all say the risk is small but I would say that at least 25% of the people I know who have taken it have had awful side effects. I refused to take it after reading about it. I do take doxcy which if it does have side effects it's sun poisoning -- so I am very careful. But it doesn't cause the awful stuff that larium does. I have avoided melarone as I do all new drugs because they really don't know what the side effects are yet. I prefer tried and true to new unless I have no option. One thing I've heard about melarone is it can cause diarrhea -- something I really don't want when I go on vacation.

Korea Princess: What an awful situation! Though even before reading to the end of your post, I could have told you that this was most likely a reaction to Larium. My husband and I travel frequently to Africa and of course Malaria medication is almost non-negotiable. After going on line and reading the horrendous side effects of Larium (a medication BTW that they no longer prescribe in most of Europe) my husband andI opted for Malarone other then some bizarre dreams and a mild headache we have never had any horrible reactions we have been on it for weeks at a time. It is truly amazing that some doctors still prescribe Larium do a quick internet search and you will read stories that are chilling! Paralysis, dementia, blindness reallly horrible stuff! Actually, when I first went to my regular doctor for my pre-trip medicine, she started to prescrbe Larium (I think most regular GPs are maybe not quite as up to date on travel related illness as we would like to believe, certainly not tropical medicine advancements)luckilly I had done my research and requested Malarone again, we were most fortunate as this medicine worked fine for us.. Malaria is a real killer and one should take precautions if travelling to areas where it is prevalent; Again, I am sorry Korea princess and I hope you are feeling 100% soon.

I have taken Malarone for 3 trips to India..I don't think i had any reaction..I got sick with stomach pains and vomitting upon returning home, but don't know if it was related to Malarone or not..
I just finshed taking Malarone again for 3 weeks, and didn't have any side effects at all..

Make sure you take it with food or right after you eat..

That is a horrible story about Larium..I would never take Larium..

<i>&quot;I discovered, upon doing research, that people who are of mediterranean descent (my family is originally from Italy) are lacking a certain enzyme, and should never take anti-malarial medication. They actually have a resistance to malaria. What can result from taking it? The first thing on the list was hemolytic anemia!&quot;</i>

Any reference?

And check http://linktrim.com/5e7

What sad story, Koreanprincess! As others have mentioned, Larium (mefloquine) is the anti-malarial that has the most side effects and the most severe side effects. It is also not recommended for the area you visited (Cambodia) as there is larium-resistant malaria in that part of SE Asia.

Just to note that larium is not the only anti-malarial available. Doxycycline and Malraone are both effective anti-malarials for which there is no known resistence anywhere in the world. Both have low incidence of side effects, and the side effects that people may have are quite mild (stomach upset for malarone and sun sensitivity for doxycycline) in comparison to some of the really serious side effects of larium. Nontheless, as other have mentioned, the majority of people taking larium do so without having serious side effects ( 25-30% of people have side effects from larium that are severe enough to discontinue the medication).

You make a number of excellent points. People should know, first of all, whether they are going to be traveling in malarial risk areas. For instance, someone on the board was prescribed an anti-malarial to visit Chaing Mai, which is not a malarial risk area. The area you visited that was the highest risk (as far as I can tell from your account) was Siem Reap, Camodia. One should always do their own research before a visit to a travel medicine or tropical medicine professional, so you can ask questions, and make sure you understand what you are taking, why and what the possible side effects are.

I wish you a smooth recovery.

I took Malarone for 6 weeks while in West Africa in 2004. Larium seemed risky, and I'm already very susceptible to the sun, so doxcy seemed like a bad idea too. Unfortunately I had a reaction to the Malarone. I think it was just because I took it for so long, but by the 5th week I couldn't hold much in after a meal (diarrhea), and I had some cramping. The last week (when you're home and you have to take it for another week) was awful. I would run to the bathroom after just having a drink of water. Two or three days after I stopped taking malarone I was able to eat as normal.
Nevertheless, I still think Malarone is a good anti-malarial, just perhaps for shorter time periods. I am traveling to Thailand this summer for a month, and am still considering taking malarone, but perhaps only for part of the trip when I would be at risk so as to reduce the amount of time I'm taking it. Doxcy still seems risky to me just because I am so susceptible to the sun at the best of times. Have people had much experience with doxcy and it's sun reaction?

Koreaprincess-
Best wishes for a continued recovery.

Regarding the use of doxycycline for malaria prevention, female travellers should note that as with other antibiotics, doxy can reduce the effectiveness of oral contraceptives.

http://www.hpa.org.uk/infections/top...oxycycline.pdf

Irish, note that most of Thailand is not considered a malraial risk area. Of the places listed in your other post, only Siem Reap and Luang Prabang are considered malarial risk.

Irish cheer-- I am highly allergic to the sun and have take doxcy for several trips without a problem.

I am certainly not knowledgable on this but have read many things about Larium. I last took any anti-Malaria medication probably 15 yerars back, no idea what it was but I felt unwell.
Unfortunately it isn't practical to take regular if you are living in regions as your home, experts might disagree, I simply have to do everything to avoid any 'bites', though it cannot be guarenteed it would be nice if anyone knows a site that expplains in 'very simple' terms the options open for anti-malarial (?)

Wow, what a horrible story! I hate to take even asprin. Would some of you please recommend trusted websites that list danger areas for Malaria and other risks? I'm planning a trip to Southern India and Northern Thailand next year and definitely want to avoid taking any unneaded meds. Thanks and I hope Koreanprincess a full recovery.

I always recommend the cdc website: www.cdc.gov/travel It has an excellent discussion of anti-malarials appropriate for each area, the advantages and disadvantages of each. Of course, you need to make a decision on anti-malarials in conjunction with a good travel med or tropical med doc.

The WHO site is good, but it's malarial risk data isn't updated very often, so follow the cdc guidelines in deciding which areas present risk.

JamesA, you are quite right, if you are living in a malarial area, your best bet is careful avoidance of bites and quick testing any time you run a signifigant fever.

To: RHKK, The medication I took was called melefoquine, sometimes called larium.

Thanks to all of you who wish me well. I will be off the prednisone the dr. prescribed for the hemolytic anemia within two weeks. Hopefully, my blurred vision will get better and I'll return to my normal energetic self. I am going back to LA to be completely checked out at the end of May. I sure learned a horrible lesson regarding mefloquine (dr. didn't have updated info). Jed, to answer your question about the enzyme deficiency I mentioned, go to Medline Plus website and search &quot;Glucose-6-phosphate dehydrogenase deficiency&quot;. I hope to be well enough to do some travelling this summer, but it will be in Europe, not any jungles!

The obvious conclusion that anyone reading this forum topic should come away with is: GET INFORMED FIRST.

Another reader was right-on in recommending the CDC and WHO websites. There is an excellent chart which lists all current anti-malarial treatments, and there are many more than are discussed here. You should also get the facts on which countries have reported resistance to particular anti-malarial treatments; that will influence which treatment you choose. And you should find out what the rated risk is for the country you're visiting; for example for &quot;Type I&quot; countries that have very limited risk, the only prevention recommended is bug spray to prevent bites.

No method is 100% preventative; write down what anti-malaria preventative you took, because if you are hit with malaria, the chosen treatment depends completely on what prevention you used. All that info is on the websites mentioned.

I'm leaving tomorrow for South Korea and Vietnam; printed out the chart and brought it to my doctor's office; she went over it with me and we decided that chloroquine was the best bet. She herself had taken it for a trip 3 years earlier with no problem. The list of potential side effects is small. So far I've only had one dose but noticed no effects.

rabbitlady, did you and your doctor read the cdc information on malarial prevention in South East Asia? The malaria in SE Asia has been resistant to chlorquinine for decades. There are only very limited areas where chlorquinine is still effective, mostly in central and south America.

Lived with a family of two + two very small children for five years in malaria prone areas of Southern Africa. Some time ago. We all took some sort of medication for longer periods. Ask a doctor what is appropriate where. Malaria has different forms. Also consider -what many people do not do- that you have to continue taking most of this medication for a few weeks after you return home, because you have to cover an incubation period. Of all remedies, we have a light net hanging from the ceiling over your bed as the the best. Keep the d.... mosquitoes away from you at night. If you are really concerned and you are staying for several days in the same hotel and the hotel room does not have those nets (which you can easily ask before), nothing prohibits you from taking such a large (but not bulky nor heavy) net in your luggage and hang it from a self attaching plastic hook you attach to the ceiling and take away again each morning or before you vacate the room.

I realise that the query by Irishcheer above is old but I can help as to the sun sensitvity with doxycycline. We were prescribed this for Cambodia in April. For general day to day exposure to the sun it was not a problem . However we spent two nights in a resort in Sihanoukville and the day in between by the pool. My husband and myself (under an umbrella when not swimming )suffered bad sunburn and my husband became ill that night.We were mystified as to how it had happened until we remembered the warning on the doxicycline box. On the other hand our two daughters did not suffer, one of whom had been out there by then for 6 weeks.
Apart from that though the only side effect I suffered was raging indigestion in bed but I then switched to taking the medication at lunchtime and all was well.

Any med can make you very sick. I took Bactrim (and my DH worked for company that makes it) when we went to Mexico just to prevent tummy problems...turns out I am allergic to sulfa. Boy, I was sick...fingers turned blue to second knuckle. Lesson...don't take what you absolutely don't need. We do not take malaria meds for our trips to Asia.

Koreaprincess I do hope and pray you will fully recover.
In 2004 my son was on an extensive backpacking trip through India and met the whole family for a reunion in Goa. Because of a malaria scare he took Larium. It started off with nightmares and severe headache but soon progressed to a high fever. He was lucky to get on a plane back to China where he teaches. He saw an American doctor who thought it might be malaria or dengue fever. Long story short, it attacked his immune system and he now has RA. It has not stopped us travelling but no Larium or anything else for that matter, just a good insect repellant. So far so good. Got back from China and Thailand in April - no problem.

Malarone affects different people differently. When we took it to go to Siem Reap, I had no problems with it, except instead of diarrhea I had constipation. But it made my husband very sick--nauseous and dizzy--so he quit taking it and just covered himself with Deet. In South Africa he took doxycycline and had no problem with it. We would never consider Lariam. But here's the question: Do we need anti-malarials in Vietnam in December? The CDC site says no risk except in &quot;rural areas.&quot; What does that mean? Mekong Delta? Traveling through farmland?

The Mekong Delta certainly qualifies as rural. One of the questions to ask yourself is whether you will be staying in rural areas. If you are simply driving through rural areas during the daytime, you are at low risk and may simply want to use repellant. If you will be staying over night in rural areas, you may wish to take an anti-malarial. Mosquitos that carry malaria are active from dusk to dawn and are most active at dusk and dawn.

If you are just going to cities (Hanoi, HCMC, Hue, etc.) you are not considered at risk.

Discuss this with a good travel med doc.

I think the key here is to check with a doctor who is very familiar with travel meds and issues, and then to actually try out your medicine in advance if at all possible. No one medication is perfect for everyone.

I did not take Larium (and actually would have to check which I did take) in India. My daughter and her 20 classmates all took Larium. I insisted my daughter start while still at home after hearing the horror stories.

She had no problems, and in fact her entire group took their pills together on &quot;Malaria Mondays&quot;. That way they could all look out for each other, and more importantly, plan for longer breakfasts, where they would trade details of their Larium dreams.

Again, people can have amazingly bad reactions to even the simplest of medications. Get good medical advice, and don't try new drugs for the first time when you're out in the middle of nowhere.

I've been on Malarone twice...2003/2004 and 2004/2005 on trips to Ghana. I didn't want to take it, but went on and took it. I never felt my normal self. Stomach problems that landed me in bed about a half a day and just an out of body-ness. I took it for three weeks. I kept on going though...mind over matter.
I personally would NEVER take Larium. That can be a really bad one...that's why many folks have switched to Malarone. If a country recommends only Larium then I just won't go...or else I'd possibly go without taking anything. I'd have to really sleep on that one.
One of my best friends was on his meds regularly...in Senegal...and the second year there got cerebral malaria and nearly died. He was found passed out in his house and was airplaned to a hospital in a two-seater plane. The doctors were great and knew how to handle it and thank God was brought back to life. But, he had the affects of the malaria for years to come. Happy Travels!

Just a few notes about recommended anti-malarials. Note that there are only two anti-malarials that are effective against malarial world-wide: malarone and doxycycline. (So don't worry, Guenmai, there is no place in the world where only larium is recommended!)

There are pockets of larium resistant malaria in SE Asia. Most of Asia has chlorquinine-resistant malaria, as does Africa. Indeed, there are only a few places in South America where the malaria responds to chlorquinine.

As several of us have mentioned, do see a good travel med doc. Always do your research first so you can discuss the issues intelligently.

jane---there will be a GTG on oct 7 in cambridge...any interest in joining us...??

if so let me know:
[email protected]

Kathie...I remember when I was doing my African research that some places recommended Larium and not to take Malarone. I can't remember which countries as it's been 3 years since I did the research. I just remember that I had noted back then to mark a few places off of my list. Maybe I can find the list at home somewhere. Happy Travels!

Oh, from what I remember someplace(s) that I read about did only list Larium. I wish I could find that list. Happy Travels!

Guenmai, some older recommendations may only have listed larium as recommended, but malarone and doxy both work everywhere that larium works and they both work in places where larium doesn't.

Kathie...Great to know Kathie. I guess I can add some countries back on my list. Smiles. Happy Travels!