Plasmodium SP: Sitti Wahyuni, MD, PHD

Plasmodium sp
Sitti Wahyuni, MD, PhD

Department of Parasitology
Medical Faculty, Hasanuddin University
S. Wahyuni/Dept.Parasitology/Hasanuddin
9/30/2019 1
Univ.
• A blood parasites
• Species (only in human)
– only in human
• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae
– Zoonotic (found in simian)
• P. knowlesi
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• Host:
– Definitive: Mosquito (Anopheles sp)
– Intermediate: Human
• Stage:
– Human:
• Sporozoites (ring)
• merozoites
• Schizont
• Trophozoites
• Gametocytes (microgametocytes & macrogametocytes)
– Mosquito
• Zygotes
• Ookinetes(invade the midgut wall)
• Oocysts
• Sporozoites (salivary glands)
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Geographic distribution
• Present in areas where the vector available
• MOstl in tropical -subtropical areas & altitudes < 1,500 m
• Plasmodium falciparum is the predominant species
• P. vivax and P. ovale:
– P. ovale predominating in Sub-Saharan Africa
– P. vivax in the other areas; but their geographical
ranges do overlap.
• P. malariae has wide global
• P. knowlesi is found in southeast Asia.
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World situation
http://www.cdc.gov/malaria/malaria_worldwide/impact.html
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Indonesian situation
Year of No.
Islands sample sites No. exam No. Pf (%) No. P.v. (%) No. P.m. (%) No. P.o. (%)
Sumatra 1919–2009 676 239,109 8487 (3.5) 7057 (2.9) 494 (0.2) –
Java/Bali 1900–2006 114 105,734 3387 (3.2) 2773 (2.6) 221 (0.2) –
Kalimantan 1975–2005 17 7367 398 (5.4) 248 (3.4) 21 (0.3) –
Sulawesi 1972–2006 55 11,530 482 (4.2) 316 (2.7) 8 (0.1) –
Maluku 1997–2009 201 121,526 5311 (4.4) 13,198 (10.9) 3 (0.002) –
Lesser Sundas 1975–2009 609 383,950 23,502 (6.1) 19,401 (5.1) 157 (0.04) 11 (0.003)
Papua 1929–2009 694 193,043 19,848 (10.3) 9343 (4.8) 1395 (0.7) 40 (0.02)
Indonesia 1900–2009 2366 1,062,259 61,415 (5.8) 52,336 (4.9) 2299 (0.2) 51 (0.005)
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http://cmr.asm.org/content/24/2/377/F1.large.jpg
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Univ.
Plasmodium sp
Sitti Wahyuni, MD, PhD

Department of Parasitology
Medical Faculty, Hasanuddin University
9/30/2019 8
Univ.
• A blood parasites
• Species (only in human)
– only in human
• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae
– Zoonotic (found in simian)
• P. knowlesi
9/30/2019 9
Univ.
• Host:
– Definitive: Mosquito (Anopheles sp)
– Intermediate: Human
• Stage:
– Human:
• Sporozoites (ring)
• merozoites
• Schizont
• Trophozoites
– Mosquito
• Zygotes
• Ookinetes(invade the midgut wall)
• Oocysts
• Sporozoites (salivary glands)
9/30/2019 10
Univ.
Geographic distribution
• Present in areas where the vector available
• MOstl in tropical -subtropical areas & altitudes < 1,500 m
• Plasmodium falciparum is the predominant species
• P. vivax and P. ovale:
– P. ovale predominating in Sub-Saharan Africa
– P. vivax in the other areas; but their geographical
ranges do overlap.
• P. malariae has wide global
• P. knowlesi is found in southeast Asia.
9/30/2019 11
Univ.
World situation
http://www.cdc.gov/malaria/malaria_worldwide/impact.html
9/30/2019 12
Univ.
Indonesian situation
Year of No.
Islands sample sites No. exam No. Pf (%) No. P.v. (%) No. P.m. (%) No. P.o. (%)
Sumatra 1919–2009 676 239,109 8487 (3.5) 7057 (2.9) 494 (0.2) –
Java/Bali 1900–2006 114 105,734 3387 (3.2) 2773 (2.6) 221 (0.2) –
Kalimantan 1975–2005 17 7367 398 (5.4) 248 (3.4) 21 (0.3) –
Sulawesi 1972–2006 55 11,530 482 (4.2) 316 (2.7) 8 (0.1) –
Maluku 1997–2009 201 121,526 5311 (4.4) 13,198 (10.9) 3 (0.002) –
Lesser Sundas 1975–2009 609 383,950 23,502 (6.1) 19,401 (5.1) 157 (0.04) 11 (0.003)
Papua 1929–2009 694 193,043 19,848 (10.3) 9343 (4.8) 1395 (0.7) 40 (0.02)
Indonesia 1900–2009 2366 1,062,259 61,415 (5.8) 52,336 (4.9) 2299 (0.2) 51 (0.005)
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http://cmr.asm.org/content/24/2/377/F1.large.jpg
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Ring
P.falciparum P.vivax P.ovale P.malariae
RBC: normal; multiple RBC: normal to 1.25×, RBC: normal to 1.25×, RBC: normal to 0.75×
infection of RBC more round; occasionally fine round to oval;
common than in other Schüffner's dots; multiple occasionally Schüffner's
species; Maurer's clefts infection of RBC not dots; occasionally
(under certain staining uncommon fimbriated; multiple
conditions) infection of RBC not
uncommon
Parasite: delicate Parasite: large cytoplasm Parasite: sturdy Parasite: sturdy
cytoplasm; 1 to 2 small with occasional cytoplasm; large cytoplasm; large
chromatin dots; pseudopods; large chromatin dots chromatin dots
occasional appliqué chromatin S.dots
Wahyuni/Dept.Parasitology/Hasanuddin
9/30/2019 15
(accolé) forms Univ.
Trophozoite
RBS: normal; rarely, RBC: enlarged 1.5 to 2×; RBC: normal to 1.25×; RBC: normal to 0.75×;
Maurer's clefts (under may be distorted; fine round to oval; some rarely, Ziemann's
certain staining Schüffner's dots fimbriated; Schüffner's stippling (under certain
conditions) dots staining conditions)
Parasite:seldom seen Parasite: large amoeboid Parasite: compact with Parasite: compact
in peripheral blood; cytoplasm; large large chromatin; dark- cytoplasm; large
compact cytoplasm; chromatin; fine, yellowish- brown pigment chromatin; occasional
dark pigment brown pigment band forms; coarse,
dark-brown pigment
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Univ.
Merozoite
RBC: normal; rarely, RBC: enlarged 1.5 to 2×; RBC: normal to 1.25×, RBC: normal to 0.75×;
Maurer's clefts (under may be distorted; fine round to oval, some rarely, Ziemann's
certain staining Schüffner's dots fimbriated, Schüffner's stippling (under certain
conditions) dots staining conditions)
Parasite: Parasite: Parasite Parasite:
seldom seen large, may almost fill mature :6-4 merozoites mature 6-12 merozoites
mature 8 -24 merozoites RBC; with large nuclei, large nuclei, clustered
dark pigment, clumped in mature 12-24 merozoites clustered around mass around mass of coarse,
one mass yellowish-brown, of dark-brown pigment dark-brown pigment;
coalesced pigment occasional rosettes
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Gametocyt
RBC: distorted by parasite RBC: enlarged 1.5 to 2×; RBC: normal to 1.25×; RBC: normal to 0.75×; rarely,
may be distorted; fine round to oval, some Ziemann's stippling (under
Schüffner's dots fimbriated; Schüffner's dots certain staining conditions)
Parasite: crescent or Parasite:round to oval; Parasite: round to oval; Parasite: round to oval;
sausage shape; chromatin compact; may almost fill compact; may almost fill compact; may almost fill
in a single mass RBC; chromatin compact, RBC; chromatin compact, RBC; chromatin compact,
(macrogametocyte) or eccentric eccentric eccentric (macrogametocyte)
diffuse (microgametocyte); (macrogametocyte) or (macrogametocyte) or more or more diffuse
dark pigment mass diffuse (microgametocyte); diffuse (microgametocyte); (microgametocyte); scattered
scattered brown pigment scattered brown pigment brown pigment
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Morphology
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Morphology in thin blood smear
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Pathomechanisms
• Caused by the asexual erythrocytic (blood stage
parasites).
• Parasite development in erythrocyte
• Hemozoin pigment and other toxic factors
accumulate in the red blood cell
• Lysis erythrocyte
• Release substances into the bloodstream
• Hemozoin and other toxic factors such as glucose
phosphate isomerase (GPI) stimulate macrophages
and other cells to produce cytokines and other
soluble factors
• Fever and others
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Clinical features
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• Non endemic countries: these symptoms may
be attributed to influenza, a cold, or other
common infections, especially if malaria is not
suspected.
• Endemic countries: residents often recognize
the symptoms as malaria and treat themselves
without seeking diagnostic confirmation
("presumptive treatment").
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• The clinical presentation can vary depending on
– infecting species
– level of parasitemia
– immune status of the patient
• Complication:
– P. falciparum: cerebral malaria, acute renal failure,
severe anemia, or adult respiratory distress
syndrome.
– P. vivax: splenomegaly
– P. malariae: nephrotic syndrome.
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Laboratory diagnosis
• Microscopy: Thin and thick blood smear

staining with giemsa see CSL manual
• Serology/ biomolecular:
– Detection of Plasmodium antigen/antibody
response to Plasmodium antigen
– Detection of Plasmodium DNA in the blood
9/30/2019 29
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Plasmodium SP: Sitti Wahyuni, MD, PHD

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Plasmodium SP: Sitti Wahyuni, MD, PHD

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Plasmodium sp

Sitti Wahyuni, MD, PhD

Maluku 1997–2009 201 121,526 5311 (4.4) 13,198 (10.9) 3 (0.002) –

Sitti Wahyuni, MD, PhD

Maluku 1997–2009 201 121,526 5311 (4.4) 13,198 (10.9) 3 (0.002) –

• Microscopy: Thin and thick blood smear

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