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HUMAN MALARIA
HUMAN MALARIA ZOONOTIC MALARIA
Properties
PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM PLASMODIUM KNOWLESI
Malignant Tertian Malaria
Disease /
Benign Tertian Malaria Quartan Malaria Ovale Tertian Malaria Subtertian Malaria Pernicious Malaria Tropical Malaria NONE
Pathogenesis
Estivo-autumnal Malaria Blackwater Malaria
Common Name
MALARIA
(Disease)
● Predominant spp in the world
● Predominant in Sub-saharan Africa
Geographical Wide Global Distribution
but may overlap w/ P. ovale ● Prevailing species in most tropical regions, as well as sub-tropical regions Southeast Asia
Distribution (esp. in South America, Asia, Africa)
● Most common species in
temperate zone
AAA
In humans:
● Immature Trophozoite (Ring Stage)
● Immature Trophozoite (Ring Stage)
Diagnostic Stage ● Mature Trophozoite Rmt
● Mature Trophozoite
(Man) ● Schizont
SG ● Schizont
● Gametocyte
● Gametocyte
● Dengue fever
● Chikungunya
● Meningitis
Splenomegaly ● Pneumonia ● Most likely to progress to severe, potentially fatal forms with central
Nephrotic Syndrome nervous system involvement (cerebral malaria), acute renal failure, severe
Clinical (w/ rarely splenic rupture) ● Sepsis due to bacteremia anemia, or acute respiratory distress syndrome.
Presentation ● Typhoid fever
● Leptospirosis
● Viral hemorrhagic fever
The clinical presentation can vary substantially depending on the infecting species, the level of parasitemia, and the immune status of the patient.
● Hepatic Cells (starting point)
Habitat
● RBC (end point)
Mode of
Bite of Mosquitoes
Transmission
Definitive Female Anopheles Mosquito
Host (Sporogony)
Reservoir Host MAN
Intermediate
Man (Schizogony) Macaque Monkeys
Host
Infective Stage
infect to MAN Sporozoites
(Man)
Infective Stage
infect to MOSQUITO Gametocyte (diagnostic & infective)
(Mosquito)
Specimen
BLOOD
Source
Accompanied by: Other Clinical Features include:
● Headache ● Splenomegaly
● Myalgias ● Anemia
Manifestation Frequent Symptoms include: ● Arthralgias ● Thrombocytopenia
(Malaria) ● Fever and Chills
● Weakness ● Hypoglycemia
● Vomiting ● Pulmonary / Renal Dysfunction
● Diarrhea ● Neurologic Changes

● Ask Travel History

● Microscopic Examination of Blood Film
○ Peak Fever (best time to collect since parasites are most numerous around this time)
Lab ○ If only ring forms are seen, repeat examination after 6hrs
Identification ● Malaria Rapid Diagnostic Test (RDTs)
○ Immunochromatography to detect Plasmodium-specific antigens in a finger-prick blood sample (cartridge format)
○ Dipstick Test (Parasight F-Test)
● ELISA
● Fluorochrome & UV Microscope
 ○ To visualize parasite
● PCR
● Fluorescent In Situ Hybridization (FISH)
○ In vitro microscopic test for direct detection and differentiation of pathogens in clinical samples
Treatment CDC Malaria Information and Prophylaxis, by Country

INFECTED RED BLOOD CELL

Properties PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM PLASMODIUM KNOWLESI
Predilection
Young RBC Mature RBC Young RBC Indifferent to Cell Age
(preference of parasites)
No. of Parasites in Blood ≤ 25,000/cmm Less numerous More numerous; may reach up to 500,000/cmm
Appearance of RBC Enlarged & Pale Normal / Contracted in size Less enlarged & globular Normal / Contracted in size
Stipplings Ziemann’s Dots NONE
Schuffner’s Dots Schuffner’s Dots Maurer’s Dots (Clefts)
(eosinophilic granulations (smaller, more irregular and less prominent pink
(round, uniform pink; growing trophozoite stage) (James’ Dots) (star-shaped, few and purplish / reddish in color)
in inf. RBCs) granules)
Malarial Pigments Short, delicate rodlets irregularly scattered w/o More granular w/ early formation; plenty, coarse, Similar to P. vivax but somewhat coarser; Granular, dark brown or blackish w/ early
(in cytoplasm of parasite) much coalescence dark brown or blackish and peripherally scattered sometimes clumped or in lateral bands tendency to coalesce
 EARLY or RING TROPHOZOITE FORM
Properties PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM P. KNOWLESI

Image

Size ⅓ Red Cell Up to ⅓ ⅓ Red Cell ⅕ Red Cell

Cytoplasm Present Thicker than P. vivax Thin Ring
Delicate Ring Compact Ring Dense Ring Very Delicate Ring

NONE
Shape

Fine Dot One Mass Fine Dots Dense

Chromatin
(sometimes Two) (often inside ring) (frequently Two; headphone) (Well-defined Mass)
Accolé Forms Sometimes NONE Frequent
Vacuole PRESENT
Pigment NONE May be present NONE
When it's stated as "1/N Red Cell," it means that approximately one-third of the red blood cell is occupied by the ring-shaped Plasmodium parasite. This description indicates the extent of the infection within the cell. It implies that the parasite has invaded a
significant portion of the red blood cell, compromising its functionality.

EARLY or RING TROPHOZOITE FORM (IMAGES)

SMEAR PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM P. KNOWLESI

THICK
SMEAR
 DEVELOPING TROPHOZOITE FORM
Properties PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM PLASMODIUM KNOWLESI

Image

Rarely seen in Peripheral Blood

Size Large SMALL
Stipplings PRESENT
Malarial Pigment PRESENT
Irregular
Cytoplasm Found in the Middle of the Band BECOMES THICKER
(amoeboid-like) NONE
Compact
Shape Very irregular COMPACT
(often band forms)
Vacuole Prominent INCONSPICUOUS
Chromatin DOTS OR THREADS Large Irregular Clumps Dots or Threads
Texture
Fine COARSE
(pigment)
Color
Yellow Brown Dark Brown Dark Yellow Brown Black
(pigment)
Quantity
Medium Abundant MEDIUM
(pigment)
Distribution
Scattered Fine Particles Scattered Clumps and Rods Scattered Coarse Particles Aggregated in Two Clumps
(pigment)

DEVELOPING TROPHOZOITE FORM (IMAGES)

SMEAR PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM P. KNOWLESI

THICK
SMEAR
 IMMATURE SCHIZONT FORM
Properties PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM PLASMODIUM KNOWLESI

Image

NONE

Size ALMOST FILLS RED CELLS

Shape Somewhat Amoeboid COMPACT
Chromatin Numerous Irregular Masses FEW IRREGULAR MASSES Numerous Irregular Masses
Pigment SCATTERED
Division of Cytoplasm NONE
 MATURE SCHIZONT FORM
Properties PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM PLASMODIUM KNOWLESI

Image

Size Fills Red Cell Nearly Fills Red Cell ¾ of Red Cell Nearly Fills Red Cell
Segmented
Shape SEGMENTED SEGMENTED
(Daisy Head)
6 - 12 NONE
Merozoites (range) 18 / 24 / 32 or 8 - 32
12/14 - 24 (schizonts symmetrically arranged; rosette, daisy 6 - 12
Released (no particular arrangement)
head, marguerite)
Mean
16 8 24
(Merozoites)
Size
Medium LARGE Small
(Merozoites)
Yellow Brown Dark Brown Dark Yellow Brown Black
Pigment
(Aggregated in Center) (Aggregated in Center) (Aggregated in Center) (Aggregated in Center)
 MICROGAMETOCYTES
Properties PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM PLASMODIUM KNOWLESI

Image

Time of Appearance 3 - 5 Days 7 - 14 Days 12 -14 Days 7 - 12 Days NONE

No. in Blood Stream Many SCANTY Many
Size Fills Enlarged Red Cell Smaller than Red Cell Size of Red Cell Larger than Red Cell
Shape Round or Oval Compact ROUND COMPACT Kidney-shaped (bluntly round ends)
Cytoplasm PALE BLUE Reddish Blue
Fibrils in Skein Fine Granules
Chromatin AS for P. vivax
(w/ surrounding unstained area) (scattered throughout)
Pigment Abundant Brown Granules througout AS for P. vivax Dark Granules througout
 MACROGAMETOCYTES
Properties PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM PLASMODIUM KNOWLESI

Image

NONE

Time of Appearance 3 - 5 Days 7 - 14 Days 12 -14 Days 7 - 12 Days

No. in Blood Stream Many SCANTY Many
Size Fills Enlarged Red Cell Smaller than Red Cell Size of Red Cell Larger than Red Cell
Shape Round or Oval Compact ROUND COMPACT Crescentic-sharply Rounded or Pointed Ends
Cytoplasm DARK BLUE
Chromatin Compact Peripheral Mass AS for P. vivax Compact Masses (Near Center)
Pigment Small Masses Round Periphery AS for P. vivax Black Granules; Round Nucleus
 LIFE CYCLE
SCHIZOGONY

1 SPOROZOITES are inoculated into bloodstream via infected female Anopheles Mosquito
2 Stays in blood circulation (30 - 60 minutes)
3 Inside liver cells, the sporozoites become TROPHOZOITES
4 They become HEPATIC SCHIZONTS inside liver cells
Once the liver cell undergoes pre-erythrocytic schizogony or primary exoerythrocytic schizogony, they become This is the cycle that occurs before the invasion of RBC and they are still in the liver. It takes about 7 - 21 days. And some of
5
HEPATIC MEROZOITES. these hepatic merozoites become HYPNOZOITES.
Hepatic Merozoites can either:
1. Invade other liver cells (trophozoites > schizonts > merozoites via para-erythrocytic schizogony or secondary exoerythrocytic schizogony)
6
2. Invade RBC (trophozoites > schizonts > merozoites > release via *erythrocytic schizogony)
3. Ingested by Phagocytes (merozoites from erythrocytic schizogony may be ingested)
Merozoites from RBCs can either:
1. Invade other RBCs and repeat erythrocytic cycle
7
2. Phagocytosed
3. Invade other RBC and transform into GAMETOCYTES (after 2 - 3 erythrocytic generations)
*erythrocytic schizogony - lasts for 36 - 72 hours depending on the species (see table below)

TEMPLATE
Properties PLASMODIUM VIVAX PLASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM FALCIPARUM PLASMODIUM KNOWLESI

NONE

TAXONOMIC RANK AND CLASSIFICATION

TAXONOMIC APICOMPLEXA CILIOPHORA
RANK CONOIDASIDA ACONOIDASIDA CILIOPHORA
Class Conoidasida Aconoidasida
NONE
Sub-Class Coccidiasina NONE
Order Eucoccidiro Haemosporida Piroplasmorida Vestibuliferida
Family Eimeriidae Sarcocystidae Cryptosporidiidae Plasmodiidae Babesidae Balantidiidae
Genus Eimeria Cytoisospora (Isospora) Toxoplasma Sarcocystis Cryptosporidium Plasmodium Babesia Theileria Balantidium