Malaria (Sporozoa Pt 1)

General Depiction of Sporozoa (4)(3)

1. Capable of reproducing sexually and asexually in alternate generations via spores

2. Apical complex in sporozoite

   1. Conoid (spiral-arranged microtubules)

   2. Rhoptries (secretory body)

   3. Polar rings

3. No flagella, cilia, pseudopods; most can “glide”

4. Phylum Apicomplexa; sporozoa “blood dwelling”

Plasmodium spp. Vector

Anopheles spp. mosquito

Geographic of Plasmodium vivax

• Highest in South America and Asia

Geographic of Plasmodium Falciparum

• Highest in Africa and Central America, Caribbean

Geographic of Plasmodium malariae

• Present in Africa and Asia

Geographic of Plasmodium ovale

• Present in Africa and Asia

Other means of Acquisition of Plasmodium spp. (2)

• Blood transfusion

• Vertical transmission

Plasmodium Fever cycle (6)

1. Shaking and chills

2. Fever (1-2 hours)

3. Sweating → normal temperature

4. Headach

5. Malaise

6. Myalgias

Fever Cycle P. falciparum (2)

• Every 36-48 hours

• quotidian fever

Fever Cycle P. vivax (2)

• Every 2 days

• Tertian fever

Fever Cycle P. malariae (2)

• Every 3 days

• Quartan fever

Other Plasmodium Symptoms (2)(6)

• Mild or asymptomatic disease in people with

  immunity

• Severe malaria (children, pregnant, non-immune)

  • Parasitemia (>5%); or

  • Acute respiratory distress syndrome; or

  • Renal failure; or

  • Jaundice; or

  • Severe anemia; or

  • Neurologic symptoms

P. Falciparum

• Endemic areas

• Incidence within endemic area

• Severity

• CNS involvement

• Relapse

• Stage of RBC infected

• Parasitemia

• Endemic areas - Large range; tropics, subtropics

• Incidence within endemic area - Extremely high

• Severity - moderate-severe; life threatening; BLACKWATER FEVER

• CNS involvement - COMMON

• Relapse - No

• Stage of RBC infected - All

• Parasitemia - High (>2%)

P. Vivax

• Endemic areas

• Incidence within endemic area

• Severity

• CNS involvement

• Relapse

• Stage of RBC infected

• Parasitemia

• Endemic areas - large range; tropics, subtropics, temperate; not in West Africa

• Incidence within endemic area - High

• Severity - moderate-severe; occasionally life threatening

• CNS involvement - Occasional

• Relapse - Yes

• Stage of RBC infected - Young

• Parasitemia - Low

P. ovale

• Endemic areas

• Incidence within endemic area

• Severity

• CNS involvement

• Relapse

• Stage of RBC infected

• Parasitemia

• Endemic areas - Tropics

• Incidence within endemic area - low

• Severity - mild

• CNS involvement - rare

• Relapse - Yes

• Stage of RBC infected - Young

• Parasitemia - Low

P. malarie

• Endemic areas

• Incidence within endemic area

• Severity

• CNS involvement

• Relapse

• Stage of RBC infected

• Parasitemia

• Endemic areas - Narrow range; tropics

• Incidence within endemic area - Rare

• Severity - Mild-moderate

• CNS involvement - Rare

• Relapse - No

• Stage of RBC infected - Old

• Parasitemia - Low

P. falciparum

• RBC Size

• Stages within peripheral blood

• Multiply-infected

• Early trophozoites

• Inclusions

• Schizont

• Gametocyte

• RBC Size - Normal

• Stages within peripheral blood - Trophozoites, gametocytes

• Multiply-infected - YES

• Early trophozoites - delicate, small rings; frequently with double chromatin dots (headphones); appliqué

• Inclusions - Occasional Maurer’s clefts

• Schizont - NOT TYPICALLY SEEN

• Gametocyte - banana-shaped; distort RBC

P. vivax

• RBC Size

• Stages within peripheral blood

• Multiply-infected

• Early trophozoites

• Inclusions

• Schizont

• Gametocyte

• RBC Size - enlarged; molding

• Stages within peripheral blood - All

• Multiply-infected - Rare

• Early trophozoites - larger rings; larger chromatin dot

• Inclusions - Schüffner’s dots (not on Wright’s)

• Schizont - 12-24 merozoites

• Gametocyte - round/oval; fill most of RBC

P. ovale

• RBC Size

• Stages within peripheral blood

• Multiply-infected

• Early trophozoites

• Inclusions

• Schizont

• Gametocyte

• RBC Size - Enlarged; oval

• Stages within peripheral blood - All

• Multiply-infected - Rare

• Early trophozoites - larger rings; larger chromatin dot

• Inclusions - Schüffner’s dots (only on Giemsa)

• Schizont - 10-16 merozoites

• Gametocyte - round/oval; fill most of RBC

P. malariae

• RBC Size

• Stages within peripheral blood

• Multiply-infected

• Early trophozoites

• Inclusions

• Schizont

• Gametocyte

• RBC Size - Smaller

• Stages within peripheral blood - All

• Multiply-infected - Rare

• Early trophozoites - small rings; chromatin dot unattached in center of ring (bird’s eye)

• Inclusions - rare Ziemann’s dots

• Schizont - 6-12 merozoites (rosette)

• Gametocyte - round/oval; fill most of RBC