MALARIAL PARASITE

Phylum apicomplexa - “capable of penetrating RBC” *MAL – bad *ARIA – air

Plasmodium Plasmodium
PARASITE Plasmodium vivax Plasmodium ovale
falciparum malariae

Malignant Tertian Benign Tertian Benign Ovale Tertian

OTHER NAME Quartan Malaria
Malaria Malaria Malaria

TIME OF
PAROXYSMAL 36-48 hours 48 hours 72 hours 48 hours
ATTACK

Enlarged
SIZE OF RBC Normal Normal Slightly Enlarged
*vivax has larger
swollen RBC than ovale

TYPE OF RBC All types Young Old Young

Maurer’s / Stephen’s
Schuffner’s Ziemann’s James’
/ Christopher’s
STIPPLING’S
Vilma Santos Manila Zoo Orange Juice
Ferdinand Marcos

Single

Multiple

RING FORM Single Single Single

Double

Accole/Applique

Amoeboid (stretchy) Band Formation

GROWING Compact/coarse
Not found
TROPHOZOITE pigments

Rosette Formation
SCHIZONT 8-32 8-24 4-8
6-12
Microgametocyte
(Female – compact
nucleus)

GAMETOCYTE Round/Oval Round/Oval Round/Oval

Macrogametocyte
(Male – diffused
nucleus)

UNAY – 3AMT
Paroxysmal Attack: (Malarial Paroxysm)

 Chilling
 Fever
 Sweating (diaphoresis)

Mixed Infection – 1 RBC; more than 2 species of parasites

Multiple Infection – 1 RBC; more than 1 parasite

Stippling’s – produced when hemoglobin from RBC are metabolized

Hemoglobin – serves as nutrients for intracellular parasites

Ring Form – earliest form of malarial parasite in man

Final Host: Female Anopheles minimus flavirostris (Sexual stage: SPOROGONY)

Intermediate Host: Man (Asexual Stage: SCHIZOGONY)

*P. knowlesi – recently discovered and in Malaysia SIMILAR to P. malariae

UNAY – 3AMT
Laboratory Diagnosis:
Phylum: Apicomplexa
1. Gold Standard – uses microscopy Class: Sporozoa
Suborder: Haemosporina
Genus: Plasmodia
Specie: babesia, falciparum, ovale, vivax,
malariae, knowlesi

Top 2 most prevalent species in the Philippines

 Falciparum
Thick smear – to detect presence of malarial parasite  Vivax

*dehemoglobinization – lyses the blood to see the

malarial parasite MALARIA

- add diluted acid / distilled water Class: Plasmodium (blood-borne parasites)

- dipped in buffer solution 3 Constituents of Paroxysmal Attacks

- add Giemsa stain  Extensive Perspiration (diaphoresis)

 Chills
(ideal for looking for parasites in blood)  Fever

Thin smear – species identification *Shakey’s manager was a malaria victim from chills or
shaking effect of malaria hence the name of the restaurant
 Blood is collected DURING the occurrence of
malarial attack (high concentration of *Aedes aegypti has white bands on their legs
parasites in blood)
 Malaria q. 4 hours – indicator in a blood smear *Female Anopheles is a NIGHT biting mosquito
that determines the interval of collecting
blood sample of the patient
2 species that undergo DORMANT stage:
2. Other Tests
 Vivax
ELISA – enzyme-linked immunosorbent assay  Ovale
PCR – polymerase chain reaction
ICT – immunochromatographic test
 Para-Sight F Test (falciparum) Plasmodium malariae
*HRP-II --- histidine-rich protein II
responsible for production of P.
falciparum - Worldwide
 Optimal Assay (p-LDH) - used for - Quartan cycle
initial diagnosis - Can cause long lasting chronic infection
*plasmodium lactate - Nephrotic syndrome or renal failure
dehydrogenase *banding formation of trophozoite

3. Quantitative Buffy Coat (QBC) Technique Trophozoite: ring forms and red cells are smaller

- utilizes dye and UV light Gametocyte: round shape and fine granular
- Capillary tube with acrylein orange or any appearance
other fluorescence stain
- Normal RBCs resist absorbance of the dye
*infected blood is less dense than normal
UNAY – 3AMT
Plasmodium falciparum
- Common to all ages
- RBCs appear normal even when infected but
the color is slightly FAINTED (due to parasites
feeding on hemoglobin)
Ring Form:
- Thin and delicate
- 1/5 the diameter of RBC
- One or two chromatin dots
- May be found on peripheral (accole and
appliqué) and multiple-infected RBCs
Developing trophozoite:
- Tend to remain in ring form but may be
thicker and more compact
- Amount of pigment may increase
- Compact or amoeboid forms may be seen in
places where there is a delay in processing the
blood
- Mature forms found only in severe infections
Gametocyte:
- Infected RBCs are enlarged
- Stippling – Schuffner’s Dot
Trophozoite
- “amoeboid”
- Large chromatin
- May contain Schuffner’s dots
- Occasionally cells contain more than one
parasite
Immature Schizont
- Multiple chromatin bodies
- Brown pigment
Mature Schizont
- 8 to 24 merozoites
- Merozoites surrounded by cytoplasmic
material
- Brown pigment may be present
*due to hemoglobin degradation
Malarial HEMOZOIN pigments – found in brain cells
in case of cerebral involvement

Microgametocyte Gametocyte:
- Sausage or banana-shaped - pink to purple
- Male - Chromatin bodies (colourless)
- Dispersed central chromatin with nearly black - Brown pigment
pigments visible (light pink)
-
Macrogametocyte Plasmodium ovale
- Crescent-shaped
- Female Ring form
- Compact chromatin - thick and amoeboid appearance
- Black pigment visible (pale blue)
Developing trophozoite
- becoming ring-like in appearance
Immature Schizont
- Multiple chromatin bodies surrounded by Immature Schizont
cytoplasm - progressively dividing chromatin
- Detected in severe infection
Mature Schizont
Mature Schizont - 8 merozoites in a cluster arrangement
- 8 to 32 merozoites (average 24) in cluster
arrangement Microgametocytes and macrogametocytes
- Not found in blood smears - round to oval cytoplasm smaller than vivax

Plasmodium vivax
PATHOGENESIS
Ring Form:
- Single form Malarial attack – 6 to 10 hours
- Contains the LARGEST CHROMATIN DOT 1. Cold Stage – 15 to 60 mins
among all the species
UNAY – 3AMT
 2. Hot Stage – 2 to 6 hours (fever headache Citronella: added to mosquito repellant
seizures)
3. Sweating Stage – 8 to 12 hours (sweats, ITN – insecticide treated set
returns to normal temperature, tiredness)

Invasive Merozoites
- Severe inducing chemicals
- Metabolized glucose faster
- Cytoadherence factor (infected RBCs become
sticky)
- Surface protein glucosylphosphatidyl inositol
[GPI] (causes fever)
- Matabolic Acidosis

*7.35 to 7.45 normal pH of the body

Severe Malaria
- Cerebral malaria
- Severe anemia
*due to RBC lysis upon release of merozoites
and blood becomes described as brown-
colored urine
- Acute respiratory distress syndrome (ARDS)
- acute kidney failure
- Hyperparasitemia
- Matabolic acidosis
- Hypoglycemia

RESISTANCE
1. Sickle Cell Anemia – Hgb S present but lacks
hemoglobin
2. G6PD deficiency
3. Negative for Duffy antigen Fy (a-b-)

a-b-
 resistance to P. vivax
 no expressions of Duffy

a+b-
 Resistance to P. falciparum

Treatment:
 Protective (prophylactic) = schizonticidal –
taken 1 week before and after exposure to
endemic areas
 Curative (therapeutic) = schizonticidal –
WORST TREATMENT
 Preventive = gametocytocidal

- Chloroquine Quinine
- Qoxycycline Clindamycin
- Mosquito nets, repellants
UNAY – 3AMT