PLASMODIUM

DISEASE

• Plasmodim Vivax (widely distributed)

• Plasmodium Falciparum (serious disease)
• Plasmodium Ovale
• Plasmodium Malarie

• Plasmodium Knowlesi (Southeast Asia)

 I M P O RTA N T P R O P E RT I E S

• Definitive host & Vector: Female Anopheles Mosquito;

Sexual cycleSporogony
• Intermediate host: Human; Asexual cycleSchizogony
 LIFE CYCLE IN HUMANS

• Saliva of the Biting mosquito

• Sporozoites in blood
•Hepatocytes(within 30 min.)
•Exoerythrocytic phase sporozoites cell
multiplication and differentiation into
merozoites
•P.vivax & P.ovale produces Latent form
Hypnozoite
 LIFE CYCLE IN HUMANS

• Merozoites released from liver cells

and infect Rbcs
• Erythrocytic phase: Merozoitering
shaped Trophozoiteameboid
formSchizont filled with merozoites
• Merozoites releaseinfect other
erythrocytes
 THE SEXUAL CYCLE “IS
INITIATED IN HUMANS”

• Some Merozoites develop in male and

others into female Gametocytes
• Gametocyte containing RBCs ingested
by Female Anopheles Mosquito
 THE SEXUAL CYCLE “IS
COMPLETED IN MOSQUITO”

• Gut of female Anopheles mosquito

• Female gametocyte macrogamete
• Male gametocyte8 microgamete
• Fertilization diploid zygotemotile
ookinete(burrows into the gut
wall)oocyst(within which many
haploid sporozoites are produced)
• Sporozoites release and migrate to the
Salivary gland
• Ready to complete the cycle when
mosquito takes her next blood meal
 PATHOGENESIS AND EPIDEMIOLOGY

• Pathological findings: most result from destruction of

RBCs
• RBCs destroyed: 1) release of the merozoites 2) Spleen
(sequester and lyse)
• ENLARGED SPLEEN (congestion of sinusoids with
erythrocytes+ hyplerplasia of lymphocytes and
macrophages)
 PATHOGENESIS AND EPIDEMIOLOGY

• Malaria caused by P.FALCIPARUM is more severe

• Infection of more RBCs
• Occlusion of the capillaries
• Leads to the Hemorrhage and Necrosis particularly in the Brain (Cerebral malaria)
• Extensive hemolysis and Kidney damage Hemoglobiuruia
• The dark color of the patient’s urine has given rise to the term “blackwater fever”
• P.falciparum causes a high level of parasitemia because it can infect rbcs of all ages
; in contrast P.vivax: reticulocytes ; P.malariae: mature red cells
MORE THAN 200 PEOPLE WORLDWIDE
HAVE MALARIA, AND MORE THAN 1
MILLION PEOPLE DIE OF IT EACH YEAR
 CLINICAL FINDINGS

• Malaria presents with abrupt onset of fever & chills

accompanied by headache, myalgias & athralgias about 2
weeks after mosquito bite
• Splenomegaly; hepatomegaly 1/3rd
• Anemia prominent
 LABORATORY DIAGNOSIS

• Microscopic examination of Blood

• Thick & Thin Giemsa-stained smears
• Thick smear: presence of organism
• Thin smear: species identification
 LABORATORY DIAGNOSIS

The gametocytes of P.falciparum are

crescent-shaped (“banana-shaped”)
whereas those of the other plasmodia are
spherical
 LABORATORY DIAGNOSIS

•If more than 5% of RBCs are

parasitized, the diagnosis is usually
P.falciparum malaria
•Note in the picture very high
percantage of red cells containing
ring forms, this indicates infection
by P.falciparum
 LABORATORY DIAGNOSIS

FIGURE 1: A red blood cell showing the

Schuffner's dots characteristic of cells
infected by Plasmodium
vivax and Plasmodium ovale.
FIGURE 2 PLASMODIUM VIVAX A TO
E: A) signet ring trophizoite within RBC
B) Ameboid trophozoite within RBC
showing schuffner’s dots
C) Schizont with merozoites inside
D) Microgametocyte E) Macrogametocyte
PLASMODIUM FALCIPARUM F)
banana-shaped gametocyte
 LABORATORT DIAGNOSIS

IF STILL diagnosis is not revealed then PCR-based test

OR ELISA can be useful
 TREATMENT

Species Drug(s) Comments

Chloroquine-sensitive Chloroquine
P.falciparum & P.malariae
Chloroquine-sensitive Chloroquine+Primaquine Primaquine b/z
P.vivax & P.ovale hypnozoites of P.vivax
and ovale are not killed by
choloroquine
Do not use Primaquine if
G6PD deficient
Chloroquine-resistant Coartem or Malarone
P.falciparum;
uncomplicated infection
Chloroquine-resistant Artesunate or quinidine
P.falciparum; severe
complicated infection
 PREVENTION

• There is no vaccine
• Preventive measures: moquito netting, protective clothing,
insect repellents ; Drainage of stagnant water
• Chemoprophylaxis:
• Travelers to chloroquine resistant p.falciparum
areamefloquine or doxycycline; malarone can also be used
• Travelers to choloroquine sensitive p.falciparum area:
Chloroquine
• Travelers to area other 3 plasmodia: Choroquine followed by
primaquine