Dear Doctor,

I recently recovered from malaria and typhoid. I am completely done with my medication and the pain is all gone and I am now back at work. However, I am confused about the sudden and constant fatigue that I feel even when I have not done anything, especially in the afternoon.

I struggle to keep my eyes open especially and I feel like I cannot even walk for a short distance. I have been keeping hydrated; drinking lots of water but I don’t see a big difference. What can I do to get back to normal?

Josiane

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Dear Josiane,

It is good to know that you have recovered from malaria and typhoid, two common but potentially fatal infectious illnesses if left untreated. Weakness after recovering from any infectious illness depends on how long the infection lasted and how many days after sickness treatment was started. After starting suitable antibiotics, it takes a minimum 24 to 72 hours for effect of antibiotics to become apparent.

Age of the person, the amount and quality of food intake before becoming sick, nutritional status before sickness, are other factors which determine speed of recovery after an infection. For example, a person with good nutritional status who has been diagnosed and treated early has a much greater chance of recovering back to normal early. A weak individual or for whom the definitive diagnosis and therefore curative treatment has been delayed can recover slowly and take more time.

Also at extremes of age like in very small children or very old people, recovery is slow as compared to young adults. Other factors which hamper early recovery are presence of immune depressed conditions like HIV infection, diabetes, and long term intake of drugs like corticoids or immune suppressants, malnutrition, smoking and or alcoholism.

Typhoid is a bacterial infection of the intestines, where the affected part of the intestine is inflamed. This causes abdominal pain along with high grade fever, nausea and or vomiting. Cure occurs after taking complete course of an appropriate antibiotic. One’s food intake may be impaired during the period of sickness due to loss of appetite, which may take some time to recover. There may be persistent abdominal pain, even though mild, along with a sensation to vomit as a sequel even after fever subsides. This may prevent intake of adequate amount of food and also nutrients, making a person feel weak.

Malaria is also an infectious illness which causes fever. There may be associated nausea and or vomiting. This impairs food intake of the individual. Nausea may persist after recovery as a sequel. Anti-malarial drugs also cause nausea and vomiting as adverse effect. These factors add up to cause loss of appetite and weakness. Malaria can also cause anaemia due to break down of red blood corpuscles by the causative parasite. This causes anaemia (deficiency of hemoglobin), which if not corrected can a sense of weakness.

Rarely weakness may not be directly due to these infections but some other cause like diabetes, hypothyroidism, associated worm infestation, chronic anaemia, and etcetera.

It is important to take small frequent meals, even if there is no appetite. There is no restriction on food, but food consumed should include essential nutrients. This can be provided by fresh green vegetables, fruits, whole grains, nuts and healthy meat and milk products. Avoid alcohol and sodas. Adequate relaxation and light exercises would be beneficial.