Malaria

parasite
2nd lecture

Plasmodium vivax
 Plasmodium vivax

 Malaria caused by plasmodium vivax is referred to as

vivax malaria

• Formerly known as benign tertian (BT)

• It is a relapsing species
 Distribution

• P. vivax is capable of developing in mosquitoes at lower

temperatures than p. falciparum and therefore has wider
distribution in temperatures and sub tropical areas.
• Mainly found in South America, Mexico, Middle East,
Northern Africa
• Rarely found in West Africa where the red cell of population
lack the Duffy blood group antigen.
 Transmission

• P. vivax is transmitted in the same way as P. falciparum.

• Congenital transmission, although rare, occurs more

frequently with P. vivax
 Life cycle

• Following injection of sporozoites by the Anopheles mosquito

• In the liver not all sporozoites develop directly into PE schizonts
• Recent researches has shown that the relapses which occur in vivax
malaria are caused by some of the sporozoites developing into
what are called hypnozoites.
• The mature PE schizonts and liver cells rupture releasing
merozoites into the blood stream.
 Life cycle
• Merozoites enter the RBCs (young RBCs) and become trophozoites and
develop into schizonts
• A mature P. vivax erythrocytic schizont contains up to 24 or more
merozoites and malaria pigment
• Merozoites release from the schizonts – invade new RBCs – develop into
schizonts – produce more merozoites
• After few erythrocytic cycles - some of the merozoites enter RBCs – develop
into Gametocytes
• life cycle is continued by anopheles vector ingesting gametocytes in a blood
meal
 Clinical features and pathology

• Infection is not usually severe and deaths from vivax malaria

are less common than from falciparum malaria.
• The temperature rise to 40.6 co
• The spleen enlarges and anemia may develop in children.
• Patient feels fever, cold and headache.
• Relapses are a feature of vivax malaria, they may occur 8-
10 weeks after previous attack (short term relapse)
• Or about 30-40 weeks later (long term relapses)
• Resistance to vivax malaria is naturally found in persons
whose red blood cell lack duffy antigens.
 Lab diagnosis

 P. vivax infection is confirmed by

– Examination of stained thick blood films
– Examination of stained thin blood films

 Rarely more than 2% of RBCs become infected. Young

cells are preferentially parasitized.
 Host red cell

• Becomes enlarged and irregular in shape

• schuffner’s dots are present
 Trophozoites

• Most are large and amoeboid . In thick films, the cytoplasm appear
fragmented
• Fine pigment granules may be seen in cytoplasm
P. Vivax in thin film
 Schizonts

• Large, round or irregular in form

• Mature schizonts contain 24 or more merozoites and small amount
of pigment.
 Gametocytes

• Contain scattered pigment granules

• Large, round or irregular in form
 Plasmodium malariae

 Referred to as malariae malaria

 Formerly known as quartan malaria

 Has a much lower prevalence than P.falciparum or P. vivax

and is able to persist in humans for many years
 Distribution

• In tropical Africa it accounts for up to 25% of

plasmodium infections.
 Transmission

• Transmitted in the same way as P. falciparum

• In tropical Africa; chimpanzee are naturally

infected with P. malariae and may serve as reservoir
hosts in some areas
 Summarized life cycle
• Sporozoite is injected by the anopheles mosquito – enter liver cells –
develop PE schizont (15,000 merozoites)
• PE schizont and liver cells rupture – release the merozoite in to the
blood stream.
• Merozoite invade RBCs (Older RBCs) – become trophozoite and
develop into schizont (10-12 merozoites) – produce merozoite.
• After several erythrocytic cycles – gametocytes are formed
• Life cycle is continued when the gametocyte are ingested by a
mosquito vector in a blood meal
 Clinical features
• Average incubation period is 18-40 days
• Severe P. malariae is rarely seen
• Only 1% of RBCs become parasitized
• Malarial attach occur regularly about every 72 hours
• The spleen become enlarged in the early stages of the infection
• A serious complication of infection with P. malariae is nephrotic
syndrome which may progress to renal failure
 Laboratory diagnosis

 Confirmation of P. malariae is by
– Stained thick film
– Stained thin film

• Note: careful and prolonged examination is required because

number of parasites are normally low
 Plasmodium malariae

• Rarely more than 1% or RBCs become infected ( examine films

carefully).
• Trophozoite, schizonts and gametocytes can be seen
Host red cell
• Not enlarged
• No schuffner’s dots or maurer’s dots
 Trophozoites
– Thick, compact and densely staining
– Band forms containing yellow-brown pigment can be seen in
thin films
– Bird’s eye form occasionally seen ( ring of cytoplasm surrounds
a centrally placed chromatin dot)
 Schizont
– Small and compact with neatly arranged merozoites and
abundant yellow-brown pigment
– Mature schizont contains up to 12 merozoites and little
cytoplasm
 Gametocytes

• Small, round or oval and compact. Difficult to distinguish

from mature trophozoites
• Nucleus usually lies to one side
• Yellow-brown pigment is easily seen.
 Plasmodium ovale

• Malaria caused by plasmodium ovale is referred to as

ovale malaria,

• Formerly known as ovale tertian malaria.

• Malaria is transmitted by Anopheles mosquito
• The life cycle of p. ovale resembles that of P. vivax
 Clinical features

• Incubation period is 16-18 days

• Less than of 2% of RBCs usually become infected
• Clinically resembles vivax malaria with attacks recurring
every 48-50 hours
• Mixed infection is common particularly in west Africa (P.
ovale with P. falciparum)
 Laboratory diagnosis
• Stained thick film and thin film
• Plasmodium ovale rarely more than 2% of red cell become infected
(young cells are preferentially parasitized)
• Trophozoite, schizont and gametocytes can be seen
Host red cell
– 20-30% of infected cells may become oval or irregular in shape with
ragged ends
– Schuffner’s (james’ dot) are present
• Trophozoites
– Small and compact, similar to p. malariae
– Less pigment than p. malariae
• Schizont
– Small and similar to p. malariae but with less pigment
– Mature schizont contain up to 10 merozoites
• Gametocytes
– Small and usually round. Difficult to distinguish from late stage
trophozoites
– Nucleus usually lies to one end