Subphylum Apicomplexa: Plasmodiumspp.

Important Properties and Life Cycle

Malaria is caused by five plasmodiaspecies: Plasmodium vivax, Plasmodium malariae,
Plasmodium ovale, Plasmodium knowlesi, and Plasmodium falciparum. The vector and
definitive host is the female Anopheles mosquito. The sexual cycle (sporogony) occurs primarily
in mosquitoes, and the asexual cycle (schizogony)occursin humans (intermediate hosts).
The infective stage is the sporozoite from the saliva of the biting mosquito, which is taken up by
the liver cells. This is called the exoerythrocytic phase. Multiplication and differentiation of
sporozoites into merozoites occur during this stage. P. vivax and P. ovale produce a latent form
(called hypnozoite or sleeping form) in the liver, which is the cause of the relapse or
recrudescence seen in vivax and ovale malaria.
Merozoites (pathogenic stage) are released from liver cells and infect the red blood cells.
The parasite’s life cycle now enters the erythrocytic phase. These merozoites multiply and are
eventually released to infect other red blood cells. The periodic release of merozoites causes the
typical recurrent symptom seen in malaria patients. Some merozoites then develop into
microgametocytes (male gametocytes) and macrogametocytes (female gametocytes).The
gametocyte containing red blood cells are ingested by the mosquito during feeding. Sexual
reproduction then ensues.
Epidemiology and Pathogenesis
Infection with plasmodia occurs worldwide. It occurs primarily in tropical and subtropical areas,
especially in Asia, Africa, and Central and South America. Sixty nine percent (69%) of cases in
the Philippines are due to Plasmodium falciparum while the remaining 31% are due to
Plasmodium vivax (World Malaria Report 2013). The primary vector is Anopheles flavirostris,
which breeds in clear, slow flowing streams near foothills and forests. In the 2014 Asia Pacific
Malaria Elimination Network (APMEN) VI held in Makati City, Philippines, then Secretary of
Health Doctor Enrique Ona reported an 83% reduction in malaria casesfrom2005 to 2013, with a
92% decrease in malarial deaths. Secretary Ona also reported that of 53 known provinces that are
endemic for the disease, 27 have already been declared malaria free, which are: Cavite,
Batangas,Marinduque,Catanduanes, Albay, Masbate, Sorsogon,Camarines Sur, Iloilo, Aklan,
Capiz, Guimaras,Bohol,Cebu, Siquijor, Western Samar, Eastern Samar, Northern Samar,
Northern Leyte, Southern Leyte, Biliran, Camiguin,Surigao del Norte, Benguet, Romblon,
Batanes, and Dinagat Islands. The main mode of transmissionof malaria is the bite of the female
mosquito vector. However, the parasite can also be transmitted through blood transfusion
(transfusionmalaria), intravenous drug abuse with sharing of IV needles (“main line malaria”),
and transplacental transmission(congenitalmalaria). Most of the pathologic findingsresult
fromthe destruction of red blood cells. P. falciparumand P. knowlesi can infect both young and
old red blood cells leading to high levels of parasitemia.P. vivax and P. ovale mainly infects
young red blood cells, while P. malariae infects old red blood cells. Plasmodiumknowlesi is a
natural parasite of macaque monkeys throughout the Southeast Asia region. Cases of infection
have been noted in Thailand, Singapore,Brunei, Indonesia, Myanmar, Vietnam, and the
Philippines(Murray, 2014). The red blood cells infected by P. knowlesi has normal morphology.
All developmental stages of the parasite may be seen in the peripheral blood.