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a b

DISTRICT LABORATORY PRACTICE

IN

TROPICAL COUNTRIES

Plasmodium falciparum Widespread in tropics. Often high parasitaemia. Only trophozoites and gametocytes usually seen.

Trophozoites Small rings, occasionally larger rings in heavy infections.* Often with double chromatin dot. May lie on red cell membrane (accol forms).

* Parasites are difcult to recognize if patient has taken antimalarials. Trophozoites of resistant strains can appear thick and distorted.

Schizonts Only seen occasionally in severe infections. Usually with 2 or 4 merozoites and pigment. Gametocytes Banana shaped. Rounded forms may be seen if lm dries slowly. Host cell Often contains several parasites. Irregular mauve-red Maurers dots (clefts) seen in cells with mature rings.

Plate 5.43 P.falciparum. a Trophozoites and gametocytes in thin lm. b Young schizont (rare), and trophozoites. c Many trophozoites, gametocyte, and white cells containing pigment in Fields stained thick lm. d Thick lm from patient with sickle cell disease and falciparum malaria. Note, blue stippling in background (reticulocytosis) and nucleated red cell nucleus (above trophozoite).

Plasmodium malariae Low prevalence in tropics and subtropics. Rarely more than 1% of cells infected (easily missed). Trophozoites, schizonts and gametocytes usually seen. Trophozoites Thick, neat, densely stained. Yellow-brown pigment in late trophozoites. Band forms can be seen in thin lms. Occasionally birds-eye ring form may be seen. Schizonts Small with neatly arranged (up to 12) merozoites. Yellow-brown pigment. Gametocytes Small, round or oval (can be difcult to differentiate from late trophozoites). Yellow-brown pigment. Host cell No changes. Older cells parasitized.

Plate 5.46 P.malariae. a Trophozoites (Birds eye and band forms, gametocyte, and schizont in thin lm. b Schizont, trophozoite, and gametocyte in thin lm. c Trophozoites, schizonts, and gametocyte in Fields stained thick lm.

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PARASITOLOGICAL TESTS
a b
Plasmodium vivax Widespread in tropics and temperate areas. Rarely more than 2% of cells infected. Trophozoites, schizonts and gametocytes, usually seen.

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Trophozoites Large and amoeboid. Cytoplasm fragmented in thick lms. Fine pigment. Schizonts Large, round or irregular in form. Contain up to 24 or more merozoites and ne pigment. Gametocytes Large, round or irregular in form (small forms also). Scattered pigment. Host cell Enlarged, irregular in shape, pale staining. Schuffners dots present (pH 7.1). Seen indistinctly around parasites in thick lms. Several parasites in a cell with some strains.

Plate 5.44 P.vivax. a Trophozoites, gametocytes, and schizonts in thin lm. b Schizont (mature), gametocyte, and trophozoite in thin lm. c Trophozoites in Fields stained thick lm.

Plasmodium ovale Low prevalence, mainly in West Africa (also elsewhere). Rarely more than 2% of cells infected (young cells preferentially parasitized). Trophozoites, schizonts and gametocytes usually seen. Trophozoites Small and compact (can resemble P. malariae in thick lms). Small amount of pigment. Schizonts Small and compact. Contain up to 12 merozoites. Gametocytes Small and round. Difcult to differentiate from late trophozoites. Host cell About 2030% of cells may become oval with mbriated (ragged) ends. Schuffners dots are prominent (pH 7.1). Seen indistinctly around parasites in thick lm.

Plate 5.45 P.ovale. a Trophozoite, schizont, and gametocyte in thin lm. b Trophozoite, schizont, and gametocyte in thin lm. c Trophozoite, gametocyte, and schizont in Fields stained thick lm.

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