Introduction and life

cycle of malarial
parasite

Aarti bhawariya
Roll no.2
MALARIA
●“Mal” means bad and “aria” means air ( false belief that disease
is spread by air pollution through stagnant water and marshy
lands)
●Malaria is a mosquito borne infectious disease affecting
humans and other animals
● caused by parasitic protozoans (a group of single-celled
microorganisms) belonging to the Plasmodium type.
AGENT
●human infection is mainly caused by five species of plasmodium.

○ P. vivax
○ P. falciparum
○ P. malariae
○ P. ovale
○ P. knowlesi
LIFE CYCLE

●Host: two hosts:

●1) definitive host- female Anopheles mosquito (sexual cycle
or sporogony takes place)
●2) intermediate host- human (asexual cycle or schizogony
takes place)
HUMAN CYCLE
●Mode of transmission and infective form
●Man acquires infection by the bite of female Anopheles
mosquito.
●Sporozoites (infective form) from the salivary gland of the
mosquito are directly introduced into the cutaneous venules and
enter the blood circulation
●Rarely, it can also be transmitted by blood transfusion or
transplacental transmission-here, trophozoites (or merozoites)
act as the infective form.
●In humans, the asexual cycle takes place through three
stages:
● (1) pre-erythrocytic schizogony
● (2) erythrocytic schizogony
● (3) gametogony
PRE-ERTHROCYTIC (HEPATIC) STAGE
●It is also called exoerythrocytic stage or intrahepatic or tissue stage.
● The motile sporozoites leave the circulation within 30 minutes and enter the
liver
●Attachment: The circumsporozoite proteins present on the surface of
sporozoites bind to the receptors present on the surface of hepatocytes
facilitating the entry of sporozoites
●Trophozoites: After entering into hepatocytes, the spindle shaped sporozoites
become rounded and transform into trophozoites
● Schizogony: Trophozoite is the feeding stage of the parasite which later on
undergoes several nuclear divisions and transforms into pre-erythrocytic
schizont
●Pre-erythrocytic schizont contains several merozoites; released outside on
rupture of hepatocyte.
●Merozoites then attack RBCs to initiate erythrocytic stage
●No liver injury: As only few hepatocytes are infected by Plasmodium, so hepatic
damage does not occur in malaria
●Duration of pre-erythrocytic schizogony varies from 5 days to 15 days
depending on the species
●Hypnozoites: Some sporozoites of P. vivax and P. ovale do not develop further and
may remain in liver as hypnozoites and cause relapse of malaria after many years
●Relapse should be differentiated from another phenomena seen in P. falciparum
and P. malariae called as recrudescence.
ERYTHROCYTIC SCHIZOGONY
●The hepatic merozoites after released from pre-erythrocytic
schizont, attack RBCs
○ Merozoites bind to the glycophorin receptors on RBC surface,
enter by endocytosis and are contained within a parasitophorous
vacuole inside the RBCs
○ Trophozoite: Soon the hepatic merozoites transform into
trophozoites
○ Early trophozoites are called as ring forms, which are an- nular or
signet ring in appearance containing a central vac- uole with a
peripheral thin rim of cytoplasm and a nucleus
○ Late trophozoite: Ring form enlarges and becomes more irregular
and transforms into late trophozoite or amoeboid form
● Malarial pigment: Plasmodium feeds on hemoglobin, releasing the undigested
products (hematin and iron porphyrin), which combine to form malarial pigment
(hemozoin pigment)
● Schizogony: Late trophozoite undergoes schizogony to produce 6-30 daughter
merozoites arranged in the form of rosette. This form is known as erythrocytic
schizont

●RBCs then rupture to release the daughter merozoites, malarial pigments and
toxins into the circulation which result in malarial paroxysm of fever at the end
of each erythrocytic cycle

●Each merozoite is potentially capable of invading a new RBC and repeating the
cycle. Intra-erythrocytic life cycle takes 48-72 hours depending upon species
GAMETOGONY
●After a series of erythrocytic cycles, some merozoites after entering
into RBCs, instead of developing into trophozoites, they transform into
sexual forms called as gametocytes.
●The gametocytes are usually round in shape, except in P. falciparum in
which they are crescent or banana-shaped
●They are of two types-
○ (1) male gametocyte (or micro- gametocyte)
○ (2) female gametocyte (or macro- gametocyte)
●Gametocytes are the infective form to mosquito.
MOSQUITO CYCLE

●A female Anopheles mosquito during the blood meal, takes both asexual and the
sexual forms. The asexual forms get digested whereas the sexual forms, the
gametocytes undergo further development.
●Each male gametocyte undergoes exflagellation and divides into eight flagellated
actively motile bodies called as male gamete or microgametes
●Female gametocyte does not undergo exflagellation but directly develop into one
female gamete or macrogamete
●Zygote: The male gamete fertilizes with the femalegamete to form zygote
●Ookinete: Zygote transforms into a motile elongated form called onkinete in
the midgut
●Oocyst: The ookinete penetrates the stomach wall of the mosquito and
becomes rounded, covered by a thin elastic membrane to form oocyst
●Sporozoites: Each oocyst undergoes sporogony (meiosis) to produce four
spindle-shaped sporozoites.
●On rupture of the mature oocyst, the sporozoites are released and migrate
to salivary gland and the cycle is repeated
●Extrinsic incubation period: Time required to complete the life cycle in
mosquito varies from 1 to 4 weeks, depending up on the species.
Plasmodium Knowlesi
● It is a malaria parasite of monkeys, but can also rarely affect humans.
● Anopheles leucosphyrus is the main vector.
● Epidemiology:

● The first human case was documented in 1965. However, cases in humans increasingly
being reported from Asia since 2008.
● World: Maximum cases have been reported from Malaysia (highest), Thailand and
Myanmar.
● The largest foci are located at Malaysian Borneo; 3,122 cases have been reported
between 2004-2015
● India: The only report of P. knowlesi infection has documented from Andamans. However,
India has all the potential of getting cases as the vector is found in the coastal region of
Kerala and Maharashtra.
CLINICAL FEATURES
●P. knowlesi produces an acute illness and relatively high parasitemia
●Paroxysms of fever occur daily (quotidian malaria) because of short RBC
cycle (24 hours)
●Clinically it resembles P. vivax, but severe malaria is seen more frequently
(7-10%), compared to 3% of P. vivax.
●However, it infects RBCs of all ages.
●Common complications seen are respiratory distress (most frequent) and
renal failure. No cerebral malaria has been reported so far..
LABORATORY DIAGNOSIS
●On blood smear examination, early trophozoite of P. knowlesi is
indistinguishable from P. falciparum, sometimes shows multiple ring forms,
accole forms and double dot ring forms
●The late trophozoites (with band forms), and round gametocytes are
morphologically similar to that of P. malariae
●Currently, no specific rapid diagnostic tests (RDTs) are available to
detect P. knowlesi
●P. knowlesi specific nested PCR assays are available using the primers
Pmk8 and Pmkr9 targeting small subunit rRNA.
TREATMENT

●It responds well to chloroquine or primaquine.

● As the disease rapidly progresses, treatment should be promptly
started.
THANK YOU