PLASMODIUM SPP.

Plasmodium is a genus of parasitic protozoa, many of which cause malaria in their

hosts
The parasite always has two hosts in its life cycle: a Dipteran insect host and a
vertebrate host.
Sexual reproduction always occurs in the insect, making it the definitive host
Plasmodium is a member of the family Plasmodiidae, order Haemosporidia and
phylum Apicomplexa which, along with dinoflagellates and ciliates, make up the
taxonomic group Alveolata.
EPIDEMIOLOGY
In the Philippines, in order of frequency:

Plasmodium falciparum Malignant tertian or subtertian malaria

Falciparum malaria

Plasmodium vivax Benign tertian malaria

Vivax malaria

Plasmodium malariae Quartan malaria

Malariae malaria

Plasmodium ovale Benign tertian malaria

Ovale malaria
EPIDEMIOLOGY
 Principal malaria vector is Anopheles minismus var flavirostris
night biter
Transmitted by the BITE of a Plasmodium- infected female Anopheles mosquito
Malaria can also be transmitted through blood transfusion from infected
donors and by contaminated needles and syringes
In congenital malaria, infected mothers transmit parasites to their child before
or during birth
9th leading cause of morbidity in the Philippines
58 out of 81 provinces are malaria-endemic
Parameter P. falciparum P. vivax P. ovale P. malariae

Infected RBC Size is not enlarged Size is enlarged with pale color Larger than normal, often Same with P.vivax
with fringed or irregular
Color is normal shape

Round shaped, sometimes Round shaped, sometimes fimbriated

crenated and adopt bizarre shapes due to
spreading Basophilic Stippling:
Basophilic Stippling ZIEMANNS DOTS
Basophilic Stippling: SCHUFFNERS DOTS
Basophilic stippling: SCHUFFNERS DOTS
MAURERS DOTS (very fine reddish granules)

Small trophozoite Same as P. vivax but with small
(early rings) threadlike blue cytolasmic circle with
1 or 2 small red chromatin dots;
double chromatin common; marginal
forms are common
Signet-ring form with heavy red dot (nucleus)
and blue cytoplasmic ring
Small, darker in color, and
generally more solid than those of
P. falciparum; Schuffners dots
regularly present in almost 100%
of infected cells
Same as P. vivax but with blue
cytoplasmic circle, smaller,
thicker and heavier
Parameter P. falciparum
Trophozoite Remains in ring form but grows resembling
small trophozoite of P. vivax in size;
usually the oldest asexual stage seen in
peripheral blood
Gametocytes Present in peripheral blood stream; similar
to P. vivax crescent or sausage shape
P. vivax
Like small trophozoite, with increased
cytoplasm and ameboid activity; small
yellowish brown pigment granules in
cytoplasm, increasing with age of parasite
Microgametocyte
light red to pink chromatin, light to blue
cytolasm, yellowish brown pigment, usually
round resembling RBC
Macrogametocyte
small, compact, dark red eccentric chromatin,
cytoplasm dark blue, no vacuoles, abundant
dark brown pigment scattered throughout the
cytoplasm
P. ovale
Resembles closely same stage of
P. malariae but is considerably
larger; pigment is lighter and
less conspicuous
larger, round or oval bodies and
occupy the whole of the
enlarged infected RBC
P. malariae
Chromatin rounded or elongated;
cytoplasm compact or in narrow
band across cell; dark brown
granules may have peripheral
arrangement
round, occupies the whole RBC
Paramete P. falciparum P. vivax P. ovale P. malariae
r
Stages in Ring forms and All stages are All stages are present All stages are present
Peripheral gametocyte; other present
blood stages are rare

Length of 48 hours or less 48 hours 48 hours 72 hours

asexual cycle
Disease -black water fever intermittent fever intermittent fever every intermittent fever every 72
- intermittent fever every 48 hours 48 hours hours
every 36-48 hours

RBC affected All Stages of RBC Young RBC Young RBC Aging RBC
Life cycle

The life-cycles of Plasmodium species involve several different stages both in the insect
and the vertebrate host.
These stages include sporozoites, which are injected by the insect vector into the
vertebrate host's blood. Sporozoites infect the host liver, giving rise to merozoites and (in
some species) hypnozoites.
These move into the blood where they infect red blood cells. In the red blood cells, the
parasites can either form more merozoites to infect more red blood cells, or produce
gametocytes which are taken up by insects which feed on the vertebrate host. In the
insect host, gametocytes merge to sexually reproduce.
After sexual reproduction, parasites grow into new sporozoites, which move to the
insect's salivary glands, from which they can infect a vertebrate host bitten by the insect.
SYMPTOMS
The first symptoms of malaria are nonspecific and similar to the symptoms of a
minor systemic viral illness: headache, lassitude, fatigue, abdominal discomfort,
and muscle and joint aches, usually followed by fever, chills, perspiration, anorexia,
vomiting and worsening malaise
Feature Vivax Ovale Malariae Falciparum
Incubation Period 10-17 days 10-17 days 18-40 days 8-11 days

Prodromal Symptoms May be influenza-like in all four types

HA, photophobia, muscle aches & pains, anorexia, N/V

Severity ++ + ++ +
Initial Fever Pattern Irregular to Usually regular Continuous,
quotidian every 72hrs remittent or
quotidian
Periodicity 44-48 hrs 48-50 hrs 72 hrs 36-48 hrs
Anemia ++ + ++ ++++
CNS involvement +/- +/- +/- ++++
Nephrotic Syndrome +/- - +++ +
MANAGEMENT
Antimalarial combination therapy is the simultaneous use of two or more blood
schizontocidal medicines with independent modes of action and, thus, different
biochemical targets in the parasite.
Treatment of uncomplicated P. falciparum
Artemisinin-based combination therapies (ACTs) are the recommended treatments for
uncomplicated P. falciparum malaria.
Pregnancy
First trimester:
quinine plus clindamycin to be given for 7 days (artesunate plus clindamycin
for 7 days is indicated if this treatment fails);
an ACT is indicated only if this is the only treatment immediately available, or
if treatment with 7-day quinine plus clindamycin fails or uncertainty of
compliance with a 7-day treatment.
 Treatment of Severe Malaria
Severe malaria is a medical emergency. After rapid clinical assessment and
confirmation of the diagnosis, full doses of parenteral antimalarial treatment should
be started without delay with whichever effective antimalarial is first available
For adults, artesunate IV or IM:
artemether or quinine is an acceptable alternative if parenteral artesunate is not
available.
Intravenous (IV) artesunate should be used in preference to quinine for the
treatment of severe P. falciparum malaria in adults.
 Treatment of uncomplicated P. vivax malaria
Chloroquine combined with primaquine is the treatment of choice for chloroquine-
sensitive infections
In areas with chloroquine resistant P. vivax, artemisinin-based combination
therapies are recommended for the treatment of P. vivax malaria.
PHARMACOLOGY OF ANTIMALARIAL MEDICINES
CHLOROQUINE, AMODIAQUINE, SULFADOXINE, PYRIMETHAMINE, MEFLOQUINE,
ARTEMISININ AND ITS DERIVATIVES,PRIMAQUINE