Comparison of the Plasmodium Species

Which Cause Human Malaria

Plasmodium Stages found Appearance of Erythrocyte
species in blood (RBC) Appearance of Parasite

normal; multiple infection of RBC more delicate cytoplasm; 1-2 small chromatin
Ring common than in other species dots; occasional appliqu (accoll) forms
P. falciparum

normal; rarely, Maurers clefts seldom seen in peripheral blood; compact

Trophozoite (under certain staining conditions)
normal; rarely, Maurers clefts
Schizont
(under certain staining conditions)
cytoplasm; dark pigment
seldom seen in peripheral blood; mature
= 8-24 small merozoites; dark pigment,
clumped in one mass

crescent or sausage shape; chromatin in a

Gametocyte distorted by parasite single mass (macrogametocyte) or diffuse
(microgametocyte); dark pigment mass

normal to 1-1/4 X, round; occasionally fine large cytoplasm with occasional

Ring Schffners dots; multiple infection of RBC pseudopods; large chromatin dot
not uncommon
enlarged 1-1/22 X; may be distorted; fine large ameboid cytoplasm; large chromatin;
Trophozoite Schffners dots fine, yellowish-brown pigment
P. vivax

large, may almost fill RBC; mature = 12-24

enlarged 1-1/22 X; may be distorted; fine
Schizont merozoites; yellowish-brown, coalesced
Schffners dots pigment

round to oval; compact; may almost fill

enlarged 1-1/22 X; may be distorted; fine RBC; chromatin compact, eccentric
Gametocyte Schffners dots (macrogametocyte) or diffuse (micro-
gametocyte); scattered brown pigment

normal to 1-1/4 X, round to oval; occasionally

Ring Schffners dots; occasionally fimbriated;
multiple infection of RBC not uncommon
normal to 1-1/4 X; round to oval; some
Trophozoite fimbriated; Schffners dots
P. ovale
sturdy cytoplasm; large chromatin
compact with large chromatin;
dark-brown pigment

mature = 6-14 merozoites with large

normal to 1-1/4 X; round to oval; some
Schizont nuclei, clustered around mass of
fimbriated; Schffners dots dark-brown pigment

round to oval; compact; may almost fill

normal to 1-1/4 X; round to oval; some RBC; chromatin compact, eccentric
Gametocyte fimbriated; Schffners dots (macrogametocyte) or more diffuse (micro-
gametocyte); scattered brown pigment

Ring normal to 3/4 X sturdy cytoplasm; large chromatin

compact cytoplasm; large chromatin;

normal to 3/4 X; rarely, Ziemanns stippling
Trophozoite occasional band forms; coarse, dark-brown
P. malariae

(under certain staining conditions) pigment

mature = 6-12 merozoites with large

normal to 3/4 X; rarely, Ziemanns stippling
Schizont nuclei, clustered around mass of coarse,
(under certain staining conditions) dark-brown pigment; occasional rosettes

round to oval; compact; may almost fill

normal to 3/4 X; rarely, Ziemanns stippling RBC; chromatin compact, eccentric
Gametocyte (under certain staining conditions) (macrogametocyte) or more diffuse (micro-
gametocyte); scattered brown pigment
Keypoints for Plasmodium Species
Which Cause Human Malaria

Infected RBCs

Size Shape Schffners Dots

<N, N: PM Crescent: PF (gametocytes) PV, PO

N: PF Ameboid: PV
>N: PO Fimbriation: PO
> >N: PV Elongated: PO

Parasites Found In Circulating Blood

Rings Trophozoites Schizonts (mature) Gametocytes

Rings only Ameboid: PV 6-12 nuclei: PM Crescent: PF

(gametocytes): PF
Compact: PO 6-14 nuclei: PO Round: PV
Numerous: PF PM PO
PF (rarely seen) 12-24: PV PM
Multiply infected 8-24: PF (rarely seen)
RBCs: PF Band form: PM
Rosettes: PM
Accessory
chromatin dots: PF
Delicate: PF

Certain morphologic key characteristics of the infected erythrocytes and parasites Legend
can be used to orient the diagnosis towards one of the four Plasmodium species
that infect humans, as shown above.These characteristics are by no means absolute, PF: P. falciparum
however.The final diagnosis should be based on the combined findings for the various
characteristics: what is the most probable species, based on the available findings. PV: P. vivax
PO: P. ovale
PM: P. malariae