P. falciparum P. vivax P. ovale P. malariae P.

knowlesi
Prepatent period 11 to 14 days 11 to 15 days 14 to 26 days 3 to 4 weeks
Incubation period Ave. of 8 to 15 days 12 to 20 days 11 to 16 days 18 to 40 days
(bet. sporozoite
infection &
appearance of s/sx)
Interval between 48 hours Paroxysms occur on Paroxysms occur on Every 72 hours, Due to lack of
attacks alternate days alternate days causing paroxysms on exoerythrocytic
days 1 and 4 [quartan stage, fever follows
malaria] a quotidian pattern
(noted to be non-
relapsing)
Age of infected May infect RBCs of all Infect only young Infect only young Infect only aging cells May infect RBCs of
erythrocytes ages RBCs RBCs all ages

Clinical features of malaria: regular paroxysms of fever with assoc. asymptomatic intervals

Prodromal symptoms:

 Feeling of weakness and exhaustion

 Desire to stretch and yawn
 Aching bones, limbs, and back
 Loss of appetite
 Nausea vomiting
 Sense of chilling

Onset:

 Malaise
 Backache
 Diarrhea
  Epigastric discomfort

Classical malaria paroxysms have 3 stages

1. Cold stage
-starts with a sudden inappropriate feeling of coldness and apprehension
-mild shivering quickly turn to violent teeth chattering and shaking of the entire body
-although the core temperature is high or may be rising quickly, there is intense peripheral vasoconstriction
-patient may vomit and febrile convulsions may ensue at this stage in young children
-rigors last for 15-60 minutes after which the shivering ceases, and the hot stage or flush phase begins

2. Hot stage
-patient becomes hot and manifests with headache, palpitations, tachypnea, epigastric discomfort, thirst, nausea, and vomiting
-temperature may reach a peak of 41C or even more
-patient may become confused or delirious
-skin may be notably flushed and hot
-phase lasts from 2-6 hours

3. Sweating stage
-defervescence and diaphoresis or profuse sweating ensues
-temperature lowers over the next 2 to 4 hours
-symptoms diminish accordingly

The total duration of a typical attack is 8 to 12 hours.