ALIZA B.

CASTRO, RN, LPT

DR. ALLAN B. CASTRO, MD, LPT MESED

MALARIAL MICROBIOLOGY

PARASITES PCC-CON
BIOLOGY AND Lorem ipsum dolor sit

LIFE CYCLE amet, consectetur

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PLASMODIUM

• Blood parasites
• 156 named species which infect various species of vertebrates
• Four species are considered true parasites of humans (natural intermediate host)
• P. falciparum
• The predominant species in the Philippines and in the world
• P. vivax
• Also found in the Philippines
• Same niche with P. ovale
• P. ovale
• Subsaharan Africa
• P. malariae
• Wide global distribution

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LIFE CYCLE

• 3 stages
• Mosquito Stage (Sporogonic Cycle)
• Human Liver Stage (Exo-erythrocytic Cycle)
• Human Blood Stage (Erythrocytic Cycle)
• Vector: Female Anopheles

• Infective Stage
• To humans: Sporozoites
• To mosquito: Gametocytes
• Diagnostic Stage
• Immature trophozoite, Mature trophozoite
• Schizont, Gametocytes
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LIFE CYCLE
EXO-ERYTHROCYTIC CYCLE
Human Liver Stage
• Mosquito takes a blood meal and injects
sporozoites
• Sporozoites lodge in and infect liver cells
• Sporozoites mature into schizonts, which rupture
the liver cell to release merozoites into the blood
stream
• Hypnozoites
• Special form of P. ovale and P. vivax which
become dormant in liver cells
• Can be activated years after initial infection

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LIFE CYCLE
ERYTHROCYTIC CYCLE
Human Blood Stage
• Cycle of asexual reproduction
• Blood stage parasites are responsible for clinical
manifestations

• Merozoites released from liver cells enter the

blood stream and infect RBCs
• Merozoites become trophozoites (ring stage)
• Immature trophozoite can either become:
• Mature trophozoite
• Schizont
• Schizont multiply and rupture RBCs releasing
merozoites that will again infect other RBCs
• Mature trophozoite develop into gametocytes
• Male: micorgametes
• Female: macrogametocytes
• Gametocytes are then ingested by mosquito during
blood meal
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LIFE CYCLE
SPOROGONIC CYCLE
Mosquito Stage
• Cycle of sexual reproduction

• In the stomach, microgametes enter

macrogametocytes generating zygotes
• Zygotes become ookinetes which are motile and
elongated becoming able to move into the midgut
wall
• Ookinetes encyst to become oocyst
• Ruptured oocyst will release sporozoites which
make their way to the salivary glands

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INCLUSION BODIES

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CLINICAL DISEASE:
MALARIA
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MALARIA

• Incubation period (Liver Stage)

• P. falciparum: 7-14 days
• P. vivax: 12-17 days (relapse up to 3 years)
• P. ovale: 9-18 days (relapse up to 20 years)
• P. malariae: 13-40 days
• Uncomplicated malaria: symptoms can be rather non-specific
• Untreated malaria: can progress to severe forms that may be rapidly (<24 hours) fatal,
• Should always be considered in those with history of exposure
• Signs and Symptoms
• Most frequent:
• Fever and chills
• Headache, myalgias, arthralgias, weakness
• Vomiting, and diarrhea
• Others:
• Splenomegaly, anemia, thrombocytopenia, hypoglycemia
• Pulmonary or renal dysfunction, and neurologic changes
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MALARIA

• Clinical presentation can vary substantially depending on:

• Infecting species
• Level of parasitemia
• Immune status of the patient
• P. falciparum
• Most likely to progress to severe, potentially fatal forms
• With central nervous system involvement (cerebral malaria)
• Acute renal failure, severe anemia, or acute respiratory distress syndrome
• P. vivax
• Complications include splenomegaly (with, rarely, splenic rupture)
• P. malariae
• Nephrotic syndrome

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MALARIA
Stages of Malaria
• Prodromal Stage
• End of incubation period
• 2 -3 days before 1st paroxysm
• S/S
• Malaise, fatigue, lassitude, headache, muscle pain, nausea,
anorexia (i. e. , flu-like symptoms)
• Can range from none to mild to severe
• Febrile Attack (Malarial Paroxysm)
• Periodic febrile episodes alternating with symptom-free periods
• Initially fever may be irregular before developing periodicity
• May be accompanied by splenomegaly, hepatomegaly (slight
jaundice), anemia
• 3 phases
• Cold Stage
• Hot Stage
• Sweating Stage

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MALARIA
Stages of Malaria
• Prodromal Stage
• Febrile Attack (Malarial Paroxysm)
• Cold Stage
• Hot Stage
• Sweating Stage

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MALARIA
Periodicity of Febrile Episodes

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MALARIA
DIAGNOSIS
• Microscopy
• “gold standard” for malaria diagnosis
• Visualized on both thick and thin blood smears
• Stains: Giemsa, Wright, or Wright-Giemsa stains
• Giemsa is the preferred stain
• Allows for detection of certain morphologic features (e.g. Schüffner’s dots, Maurer’s clefts, etc.)
• Thick smears : detect the presence of parasites
• Thin smears : species-level identification
• Quantification may be done on both thick and thin smears
• Molecular Detection
• Antibody and Antigen Detection

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SUMMARY

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SUMMARY

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TREATMENT
Species Areas w/o resistance to Areas w/ resistance to Areas w/ resistance to
chloroquine chloroquine mefloquine
UNCOMPLICATED
P. falciparum, unknown Chloroquine or Artemether-lumefantrine Artemether-lumefantrine
Hydroxychloroquine (preferred) or Atovaquone- (preferred) or Atovaquone-
proguanil or Quinine plus proguanil or Quinine plus
tetracycline or doxycycline or tetracycline or doxycycline or
clindamycin or, if no other clindamycin
options, Mefloquine
P. malariae Chloroquine or
Hydroxychloroquine
P. ovale Chloroquine or
Hydroxychloroquine
P. vivax Chloroquine or Artemether-lumefantrine or
Hydroxychloroquine Atovaquone-proguanil or
Quinine plus tetracycline or
doxycycline or clindamycin or,
if no other options,
Mefloquine
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TREATMENT

• P. vivax and P. ovale

• If not G6PD deficient by quantitative testing:
• Primaquine (any prior regimen for acute infection)
• Tafenoquine (only if chloroquine used for acute infection; not for children <16 y/o)

• COMPLICATED
• Regardless of species
• Intravenous artesunate
• If needed, interim treatment:
• Artemether-lumefantrine
• Atovaquone-proguanil
• Quinine
• If no other options, Mefloquine

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THANK YOU!

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