Sporozoa

(Plasmodium spp and Babesia spp)

 Classification of Protozoan Parasites
Phylum Sarcomastigophora
Subphylum Sarcodina
Acathamoeba Entamoeba dispar
Endolimax nana Entamoeba gingivalis
Entamoeba coli Entamoeba histolytica
Iodamoeba butschlii Naegleria fowleri
Subphylum Mastigophora
Chilomastix mesnili Dientamoeba fragilis Giardia
lamblia Trichomonas vaginalis Trichomonas hominis Trichomonas
tenax
Trichomonas vaginalis

Leishmania braziliensis Leishmania donovani

Leishmania tropica Trypanosoma cruzi
Trypanosoma brucei complex

Phylum Ciliophora Balantidium coli

 Classification of Protozoan Parasites

Phylum Apicomplexa Babesia spp.

Cryptosporidium hominis
Cyclospora cayetanesis
Isospora belli
Plasmodium spp.
Toxoplasma gondii

• Phylum Microspora Enterocytozon bineusi

Encephalitozoon spp.
Vittaforma cornea
Pleistophora spp.
Brachiola vesicularum
Microsporidium spp.
 Plasmodium spp.

Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi

Babesia spp
Babesia microti
 Malaria
• From Italian word “mal’aria” which means “bad air”
• Considered to be the most important parasitic disease affecting
man (Belizario, 2004)

Vector: female Anopheles mosquito

- Primary: Anopheles minimus var. Flavirostris
- Others: Anopheles litoralis
Anopheles maculates
Anopheles mangyamus

Final Host: female Anopheles mosquito

Intermediate Host: Man
Infective stages: Sporozoites (man)
Gametocytes (mosquito)
 Malaria
• Vector Biology :
— Anopheles flavirostris
• Aquatic Habitat:
— slow flowing streams; shaded streams
• Adult biting:
— Night biting (indoor and outdoor)
• Adult resting:
— inside walls
7
A. Pre-erythrocytic or Schizogony
exo-erythrocytic cycle
Sporozoite infect liver 8
parenchymal cells

Schizont

Liver cells rupture

releasing the
merozoites

B. Erythrocytic
cycle
B. Erythrocytic Cycle Schizogony
Merozoites invade RBC
9
Ring Form
(young trophozoite)

Mature Trophozoite

Schizont

Rupture of RBC releasing

the merozoites

Develop into a micro or

macrogamete
Microgamete Sporogony/Gametogony
+
Macrogamete 10

Zygote

Ookinete

Oocyst

Sporozoite
11
 Intervals

Species Prepatent period Incubation

period
P. falciparum 11-14 days 8-15 days
P. vivax 11-15 days 12-20 days
P. malariae 3-4 weeks 18-40 days
P. ovale 14-26 days 11-16 days
 Morphology
Parameter P. falciparum P. vivax P. malariae P. ovale
Size of RBC Normal Enlarged Normal or sl.
smaller 13
Normal - sl.
enlarged
Trophozoite Usually not present Ameboid Band form fimbriated
no. of 8-36 12-24 6-12 in 8
merozoite in rosette form
schizont
Stipplings Maurers, Stephens, Schuffers Ziemmans James
Christopher
Ring forms Single, multiple single Single Single
Chromatin dot Single, double Single, dense, Single single
big
Applique or Present - - -
accole
Gametocyte Macro-cresent, Micro- Large, round, Large, Large, round,
banana, sausage shape oval round, oval oval

Stages in Ring forms and all all all

peripheral blood gametocytes
 14

Trophozoite (ring form) Trophozoite (band form)

P. falciparum P. malariae

Macrogametocyte and
Mature schizont microgametocyte (P.
(P. falciparum) falciparum)
 15

Schizont (P. malariae)

 Pathology
CLASSICAL MALARIA PROXYSYMS
1. Cold stage
• sudden coldness and apprehension
• mild shivering turns to teeth chattering and shaking of the whole
body
• may last for 15 to 60 minutes

2. Hot stage/ flush phase : best stage to collect blood sample

• high temperature (40-41˚C), headache, palpitations, epigastric
discomfort, thirst, nausea and vomiting
• patient is confused and delirious
• may last for 2 to 6 hours

3. Sweating stage (Defervescence or Diaphoresis)

• profuse sweating, temperature lowers and symptoms diminishes
• may last for 2 to 4 hours
 Pathology

1. Recrudescence – renewal of parasitemia or its clinical

features arising from persistent undetectable asexual
parasitemia in the absence of exo-erythrocytic cycle
2. Relapse
- renewed asexual parasitemia following a period in
which the blood contains no detectable parasites.
- common to P. vivax and P. ovale infections, as
result from the reactivation of hypnozoite forms of the
parasite in the liver
3. Cerebral Malaria – diffuse symmetric encephalopathy,
retinal hemorrhages, bruxism, mild neck stiffness. If left
untreated may lead to coma and death.
 Periodicity/ Febrile Cycle

Species Febrile cycle Interval Common

(hours) victims
P. falciparum Malignant tertian 36-48 All
P. vivax Benign tertian 48 Young
P. malariae Quartan 72 Adult
P. ovale Ovale tertian 48 Young
 Diagnosis
1. Microscopy (Gold Standard) - “Thick and Thin Blood Smear”
- stained with Giemsa or Wright’s stain

Manner of Reporting
A. Qualitative
+ = 1-10 parasite/100 thick field
++ = 11-100 parasite/100 thick field
+++ = 1-10 parasite/thick field
++++ = more than 10/ thick field

B. Quantitative

Malaria parasite/ uL = no. of parasites x 8, 000

200 WBC
 Diagnosis
2. Rapid Diagnostic Test (RDT)
• Detects Plasmodium-specific antigens in finger prick
sample
A. Histidine-rich protein II (HRP II)
- Water soluble CHON produced by trophozoites
and young gametocytes
- e.g., Paracheck Pf test, ParaHIT f test
B. Plasmodium LDH
- Produced by both sexual and asexual stages
and can distinguish between P. falciparum
and non-P. falciparum
- eg. Diamed Optimat IT
 Diagnosis

3. Quantitative Buffy Coat (QBC)

• uses a special capillary tube
with acridine orange
• (+) bright green and yellow
under fluorescent microscope

4. Serologic Tests (IHA, IFAT,

ELISA)

5. Molecular Methods through PCR

(low cases and mixed infection)
 Treatment
1. Protective (Prophylactic)
2. Curative (Therapeutic)
3. Preventive
• Arthemether-Lumefantrine (Coartem TM)
- first line drug for confirmed P. falciparum cases.
- Not recommended in pregnancy, lactation & infants
• Quinine (plus Tetracycline or Doxycycline)
- second line drug for confirmed P. falciparum cases which AL fail
or not available
• Quinine IV drip
- drug of choice for complicated or severe P. falciparum malaria
• In addition to AL and Q+T,D, Primaquine is given on the 4th day as
single dose to prevent transmission
Chemoprophylaxis: Mefloquine & Doxycyline
 Prevention
1. Use of mosquito repellant
2. Use of Insecticide treated nets (ITN)
3. Take Prophylactic medication

Control
4. Environmental cleanliness
- (stream cleaning to speed up water flow and exposing to
sunlight)
5. Indoor residual spraying
6. Zooprophylaxis – use of carabao to deviate mosquitoes
7. Use of biologic control methods
a. Bacillus thuringiensis – larvicidal
b. Larviparous fishes (e.g., Oreochromis niloticus)
 Resistance to Malaria
1. Most Africans and American Blacks
- Duffy antigen negative: Fy(a-b-)  Resistant
to P.vivax and P. knowlesi
2. Those with Sickle Cell Anemia
3. G6PD deficient individuals
 Plasmodium knowlesi

• A primate malarial parasite common in SEA

• Causes malaria in long tailed macaques (Macaca
fascicularis)
• May also infect humans
• The appearance of P. knowlesi is similar to that
of P. malariae.
• PCR assay and molecular characterization are
the most reliable methods for detecting and
diagnosing P. knowlesi infection
 Babesia spp.
(Babesia microti)
Blood parasites that cause malaria-like infections
- “Babesiosis” – pathology due to B. microti
- Parasites divide through binary fission or budding
- Cycle in the tick is still uncertain

Vector: Ticks (Ixodes scapularis)

Infective Stage: sporozoites

Diagnostic stage:
- “Maltese cross” arrangement of the
merozoites and ring-form trophozoite
27
 Pathology

• Associated with excessive pro-inflammatory

cytokines such as the tumor necrosis factor
(TNF)
• Most cases are subclinical and may occur as self-
limiting
• Headache, high-grade fever, chills, vomiting,
myalgia, DIC, hypotension, respiratory distress
and renal insufficiency.
 Diagnosis

1. Microscopy of the Giemsa-stained peripheral

blood smear
A. Merozoites in Maltese cross arrangement
B. Ring form
- most frequent intraerthrocytic form

2. PCR (gold standard)

3. Immunofluorescent assays
30
Treatment
Clindamycin – Drug of choice
Chloroquine – former drug of choice

In the Philippines: human babesiosis is not yet reported

however, it could be present in dogs. (B. canis)

Prevention and Control

- Avoidance of places where ticks are usually found
- wearing of light-colored pants tucked into one’s socks
- Tick check (especially for children)