CLINICAL PARASITOLOGY (LEC)

Our Lady of Fatima University Laguna| BSMLS| 3-YA-2

Topic: Sporozoa (Plasmodium spp. and Babesia spp.)
Classification of Protozoan
Phylum Apicomplexa
Babesia spp. Plasmodium spp.
→Cryptosporidium →Toxoplasma gondii
hominis
→Cyclospora
cayetanesis
→Isospora belli
Plasmodium spp.
→ Plasmodium falciparum
→ Plasmodium vivax
→ Plasmodium malariae
→ Plasmodium ovale
→ Plasmodium knowlesi
Babesia spp.
→ Babesia microti
→ Babesia divergens

Malaria
• from Italian word “mal’aria” which means “bad air” •
Considered to be the most important parasitic disease
affecting man (Belizario, 2004)

Vector: female Anopheles mosquito

1˚: Anopheles minimus var. flavirostris
Others: Anopheles litoralis
Anopheles maculates
Anopheles mangyamus

Final Host: female Anopheles mosquito

Intermediate Host: Man
Infective stages: sporozoites (man) gametocytes
(mosquito)
Source of Exposure to infection: Vectorborne
(Arthropodborne)

Other modes of transmission:

1. Transfusion malaria
2. Mainline malaria
3. Congenital malaria

Vector Biology: Anopheles flavirostris

Aquatic Habitat: slow flowing streams; shaded streams
Adult biting: Night biting (indoor and outdoor)
Adult resting: inside walls

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CLINICAL PARASITOLOGY (LEC)
Our Lady of Fatima University Laguna| BSMLS| 3-YA-2
Topic: Sporozoa (Plasmodium spp. and Babesia spp.)

Morphology
Paramet P. P. vivax P. P. ovale
er falciparu malaria
m e
1. Size of Normal Enlarged Norma Normal-
RBC or sl. sl.
smaller enlarged
2. Usually not Ameboid Band fimbriate
Trophozoit present form d
e
3. no. of 8-36 12-24 6-2 in 8
merozoite rosette
in schizont form
4. Maurers, Schuffner Ziemman Schuffner
Stipplings Stephens, ’s s ’s (James)
Christophe
r
5. Ring Single, single Single Single
forms multiple
6. Single, Single, Single Single
Chromatin double dense, big
dot
7. Present - - -
Applique
Intervals or accole
8. Macro- Large, Large, Large,
Species Prepatent Incubation
Gametocyt cresent round, round, round,
period period e Micro- oval oval oval
P. falciparum 11-14 days 8-15 days banana,
P. vivax 11-15 days 12-20 days sausage
P. malariae 3-4 weeks 18-40 days shape
P. ovale 14-26 days 11-16 days 9. Stages Ring forms all all all
in and
peripheral gametocyt
Periodicity/ Febrile Cycle blood es
Species Febrile cycle Interval Common
(hours) victims
P. falciparum * Malignant 36-48 All
tertian
P. vivax Benign tertian 48 Young
P. malariae Quartan 72 Adult
P. ovale Ovale tertian 48 Young

* Aestivoautumnal malaria – associated to P. falciparum

*Blackwater fever
– kidney infected with P. falciparum resulting to marked
hemoglobinuria
(acute renal failure, tubular necrosis, nephrotic
syndrome à DEATH)

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 CLINICAL PARASITOLOGY (LEC)
Our Lady of Fatima University Laguna| BSMLS| 3-YA-2
Topic: Sporozoa (Plasmodium spp. and Babesia spp.)
Diagnosis
1. Microscopy (Gold Standard) - “Thick and Thin Blood
Smear”
- stained with Giemsa or Wright’s stain
- perform multiple sets of blood films (blood
collected every 6 to 12 hours for up to 48 hours)

Manner of Reporting
A. Qualitative
• + = 1-10 parasite/100 thick field
• ++ = 11-100 parasite/100 thick field
• +++ = 1-10 parasite/thick field
• ++++ = more than 10/ thick field

B. Quantitative
Pathology Malaria parasite/ uL = no. of parasites x 8, 000
CLASSICAL MALARIA PAROXYSMS 200 WBC
1. Cold stage
- sudden coldness and apprehension
- mild shivering turns to teeth chattering and
shaking of the whole body
- may last for 50 to 60 minutes
2. Hot stage/ flush phase: best stage to collect blood
sample
- high temperature (40-41˚C), headache,
palpitations, epigastric discomfort, thirst,
nausea and vomiting
- patient is confused and delirious - may last 2. Quantitative Buffy Coat (QBC) – uses a special
for 2 to 6 hours capillary tube with acridine orange (+) bright green and
3. Sweating stage (Defervescence or Diaphoresis) yellow under fluorescent microscope
- profuse sweating, temperature lowers and
symptoms diminishes 3. Rapid Diagnostic Test (RDT) – detects Plasmodium-
- may last for 2 to 4 hours specific antigens in finger prick sample
A. Histidine-rich protein II (HRP II) – water
1. Recrudence – renewal of parasitemia or its clinical soluble CHON produced by trophozoites and
features arising from persistent undetectable asexual young gametocytes (e.g., Paracheck Pf test,
parasitemia in the absence of exo-erythrocytic cycle ParaHIT f test)
B. Plasmodium LDH – produced by both sexual
2. Relapse – renewed asexual parasitemia following a and asexual stages and can distinguish
period in which the blood contains no detectable between P. falciparum and non-P. falciparum
parasites. (Diamed Optimat IT)
- common to P. vivax and P. ovale infections, as result
from the reactivation of hypnozoite forms of the parasite 4. Serologic Tests (IHA, IFAT, ELISA)
in the liver
5. Molecular Methods through PCR (low cases and mixed
3. Cerebral Malaria – diffuse symmetric encephalopathy, infection)
retinal hemorrhages, bruxism, mild neck stiffness. If left
untreated may lead to coma and death.

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 CLINICAL PARASITOLOGY (LEC)
Our Lady of Fatima University Laguna| BSMLS| 3-YA-2
Topic: Sporozoa (Plasmodium spp. and Babesia spp.)
Treatment
1. Protective (Prophylactic)
2. Curative (Therapeutic)
3. Preventive
• Arthemether-Lumefantrine (Coartem TM) – first
line drug for confirmed P. falciparum cases. Not
recommended in pregnancy, lactation & infants
• Quinine (plus Tetracycline or Doxycycline) – second
line drug for confirmed P. falciparum cases which
AL fail or not available
• Quinine IV drip – drug of choice for complicated or
severe P. falciparum malaria
• In addition to AL and Q+T,D, Primaquine is given on
the 4th day as single dose to prevent transmission
- PCR assay and molecular characterization are the
most reliable methods for detecting and diagnosing P.
knowlesi infection
*however, P. vivax appears to interfere PCR
testing (cross-reactivity)
Babesia spp.
(Babesia microti & Babesia divergens)
- First described to cause “Texas cattle fever or red
water feverӈ B. divergens
- Blood parasites that cause malaria-like infections
- “Babesiosis” – pathology due to Babesia spp.
- Parasites divide through binary fission or budding
- Cycle in the tick is still uncertain

Chemoprophylaxis: Mefloquine & Doxycyline

Prevention
1. Use of mosquito repellant
2. Use of Insecticide treated nets (ITN)
3. Take Prophylactic medication
Vector: Ticks (Ixodes scapularis)
Control
1. Environmental cleanliness Infective Stage: sporozoites
(stream cleaning to speed up water flow and exposing to Diagnostic stage: “Maltese cross” arrangement of the
sunlight) merozoites and ring-form trophozoite
2. Indoor residual spraying
3. Zooprophylaxis – use of carabao to deviate
mosquitoes
4. Use of biologic control methods
a. Bacillus thuringiensis – larvicidal
b. Larviparous fishes (e.g., Oreochromis
niloticus)

Resistance to Malaria
1. Most Africans and American Blacks
(Duffy antigen negative)à Fy(a-b-) à Resistant to P. vivax
and P. knowlesi
2. Those with Hemoglobinopathies (S, C, E and
thallasemia)
3. G6PD deficient individuals

Pathology
- Associated with excessive pro-inflammatory cytokines
such as the tumor necrosis factor (TNF)
- Most cases are subclinical and may occur as self-
limiting
- Headache, high-grade fever, chills, vomiting, myalgia,
Plasmodium knowlesi DIC, hypotension, respiratory distress and renal
- A primate malarial parasite common in SEA insufficiency.
- Causes malaria in long tailed macaques (Macaca
fascicularis) Diagnosis
- May also infect humans 1. Microscopy of the Giemsa-stained peripheral blood
- The appearance of P. knowlesi is similar to that of P. smear
malariae. A. Merozoites in Maltese cross arrangement

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CLINICAL PARASITOLOGY (LEC)
Our Lady of Fatima University Laguna| BSMLS| 3-YA-2
Topic: Sporozoa (Plasmodium spp. and Babesia spp.)
B. Ring form à most frequent intraerthrocytic
form found
2. PCR (gold standard)
3. Immunofluorescent assays

Treatment Clindamycin
Clindamycin– Drug of choice
Chloroquine – former drug of choice (it only improve
thesymptoms but not the degree of the parasitemia)

In the Philippines: human babesiosis is not yet reported

however, it could be present in dogs. (B. canis)

Prevention and Control

- Avoidance of places where ticks are usually found
- wearing of light-colored pants tucked into one’s socks
- Tick check (especially for children)

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