Plasmodium sp

Sitti Wahyuni, MD, PhD

Department of Parasitology
Medical Faculty, Hasanuddin University

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• A blood parasites
• Species (only in human)
– only in human
• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae
– Zoonotic (found in simian)
• P. knowlesi

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• Host:
– Definitive: Mosquito (Anopheles sp)
– Intermediate: Human
• Stage:
– Human:
• Sporozoites (ring)
• merozoites
• Schizont
• Trophozoites
• Gametocytes (microgametocytes & macrogametocytes)
– Mosquito
• Gametocytes (microgametocytes & macrogametocytes)
• Zygotes
• Ookinetes(invade the midgut wall)
• Oocysts
• Sporozoites (salivary glands)

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 Geographic distribution
• Present in areas where environmental conditions allow parasite
multiplication in the vector.
• Usually restricted to tropical -subtropical areas & altitudes < 1,500
m
• Plasmodium falciparum is the predominant species in the world.
• P. vivax and P. ovale: traditionally thought to occupy
complementary niches, with P. ovale predominating in Sub-Saharan
Africa and P. vivax in the other areas; but their geographical ranges
do overlap.
• P. malariae has wide global
• P. knowlesi is found in southeast Asia.

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World situation

http://www.cdc.gov/malaria/malaria_worldwide/impact.html

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 Indonesian situation
Year of No.
Islands sample No. sites exam No. Pf (%) No. P.v. (%) No. P.m. (%) No. P.o. (%)
Sumatra 1919–2009 676 239,109 8487 (3.5%) 7057 (2.9%) 494 (0.2%) –
Java/Bali 1900–2006 114 105,734 3387 (3.2%) 2773 (2.6%) 221 (0.2%) –
Kalimantan 1975–2005 17 7367 398 (5.4%) 248 (3.4%) 21 (0.3%) –
Sulawesi 1972–2006 55 11,530 482 (4.2%) 316 (2.7%) 8 (0.1%) –
13,198
Maluku 1997–2009 201 121,526 5311 (4.4%) (10.9%) 3 (0.002%) –
19,401
Lesser Sundas 1975–2009 609 383,950 23,502 (6.1%) (5.1%) 157 (0.04%) 11 (0.003%)
19,848
Papua 1929–2009 694 193,043 (10.3%) 9343 (4.8%) 1395 (0.7%) 40 (0.02%)
1,062,25 52,336
Indonesia 1900–2009 2366 9 61,415 (5.8%) (4.9%) 2299 (0.2%) 51 (0.005%)

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http://cmr.asm.org/content/24/2/377/F1.large.jpg
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 Ring
P.falciparum P.vivax P.ovale P.malariae

RBC: normal; multiple RBC: normal to 1.25×, RBC: normal to 1.25×, RBC: normal to 0.75×
infection of RBC more round; occasionally fine round to oval;
common than in other Schüffner's dots; multiple occasionally Schüffner's
species; Maurer's clefts infection of RBC not dots; occasionally
(under certain staining uncommon fimbriated; multiple
conditions) infection of RBC not
uncommon
Parasite: delicate Parasite: large cytoplasm Parasite: sturdy Parasite: sturdy
cytoplasm; 1 to 2 small with occasional cytoplasm; large cytoplasm; large
chromatin dots; pseudopods; large chromatin chromatin
occasional appliqué chromatin S.dot
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 Trophozoite
P.falciparum P.vivax P.ovale P.malariae

RBS: normal; rarely, RBC: enlarged 1.5 to 2×; RBC: normal to 1.25×; RBC: normal to 0.75×;
Maurer's clefts (under may be distorted; fine round to oval; some rarely, Ziemann's
certain staining Schüffner's dots fimbriated; Schüffner's stippling (under certain
conditions) dots staining conditions)
Parasite:seldom seen Parasite: large amoeboid Parasite: compact with Parasite: compact
in peripheral blood; cytoplasm; large large chromatin; dark- cytoplasm; large
compact cytoplasm; chromatin; fine, yellowish- brown pigment chromatin; occasional
dark pigment brown pigment band forms; coarse,
dark-brown pigment
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 Merozoite
P.falciparum P.vivax P.ovale P.malariae

RBC: normal; rarely, RBC: enlarged 1.5 to 2×; RBC: normal to 1.25×, RBC: normal to 0.75×;
Maurer's clefts (under may be distorted; fine round to oval, some rarely, Ziemann's
certain staining Schüffner's dots fimbriated, Schüffner's stippling (under certain
conditions) dots staining conditions)
Parasite: Parasite: large, may Parasite Parasite:
seldom seen almost fill RBC; mature :6-4 merozoites mature 6-12 merozoites
mature 8 -24 merozoites mature 12-24 merozoites with large nuclei, large nuclei, clustered
dark pigment, clumped in yellowish-brown, clustered around mass around mass of coarse,
one mass coalesced pigment of dark-brown pigment dark-brown pigment;
occasional rosettes
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 Gametocyt
P.falciparum P.vivax P.ovale P.malariae

RBC: distorted by parasite RBC: enlarged 1.5 to 2×; RBC: normal to 1.25×; RBC: normal to 0.75×; rarely,
may be distorted; fine round to oval, some Ziemann's stippling (under
Schüffner's dots fimbriated; Schüffner's dots certain staining conditions)

Parasite: crescent or Parasite:round to oval; Parasite: round to oval; Parasite: round to oval;
sausage shape; chromatin compact; may almost fill compact; may almost fill compact; may almost fill
in a single mass RBC; chromatin compact, RBC; chromatin compact, RBC; chromatin compact,
(macrogametocyte) or eccentric eccentric eccentric (macrogametocyte)
diffuse (microgametocyte); (macrogametocyte) or (macrogametocyte) or more or more diffuse
dark pigment mass diffuse (microgametocyte); diffuse (microgametocyte); (microgametocyte); scattered
scattered brown pigment scattered brown pigment brown pigment
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Morphology

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Morphology in thin blood smear

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 Patomechanisms
• Caused by the asexual erythrocytic (blood stage
parasites).
• Parasite develoment in erythrocyte
• substances such as hemozoin pigment and other
toxic factors accumulate in the infected red blood
cell
• Lysis erythrocyte
• release substances into the bloodstream
• The hemozoin and other toxic factors such as
glucose phosphate isomerase (GPI) stimulate
macrophages and other cells to produce cytokines
and other soluble factors
• Fever and others
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 Clinical features

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• Non endemic countries: these symptoms may
be attributed to influenza, a cold, or other
common infections, especially if malaria is not
suspected.
• Endemic countries: residents often recognize
the symptoms as malaria and treat themselves
without seeking diagnostic confirmation
("presumptive treatment").

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• The clinical presentation can vary depending on
– infecting species,
– level of parasitemia
– immune status of the patient
• Complication:
– P. falciparum: cerebral malaria, acute renal failure,
severe anemia, or adult respiratory distress
syndrome.
– P. vivax malaria: splenomegaly
– P. malariae;nephrotic syndrome.

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 Laboratory diagnosis

• Microscopy: Thin and thick blood smear

staining with giemsa see CSL manual
• Serology:
– Detection of Plasmodium antigen/antibody
response to Plasmodium antigen
– Detection of Plasmodium DNA in the blood

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