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Plasmodium sp

Sitti Wahyuni, MD, PhD

Department of Parasitology Medical Faculty, Hasanuddin University

3/17/2016

S. Wahyuni/Dept.Parasitology/Hasanuddin Univ.

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A blood parasites

Species (only in human)

only in human

Plasmodium falciparum

Plasmodium vivax

Plasmodium ovale

Plasmodium malariae

Zoonotic (found in simian)

P. knowlesi

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Host:

Definitive: Mosquito (Anopheles sp)

Intermediate: Human

Stage:

Human:

Sporozoites (ring)

merozoites

Schizont

Trophozoites

Gametocytes (microgametocytes & macrogametocytes)

Mosquito

Gametocytes (microgametocytes & macrogametocytes)

Zygotes

Ookinetes(invade the midgut wall)

Oocysts

Sporozoites (salivary glands)

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Geographic distribution

Present in areas where environmental conditions allow parasite multiplication in the vector.

Usually restricted to tropical -subtropical areas & altitudes < 1,500

m

Plasmodium falciparum is the predominant species in the world.

P. vivax and P. ovale: traditionally thought to occupy complementary niches, with P. ovale predominating in Sub-Saharan Africa and P. vivax in the other areas; but their geographical ranges do overlap.

P. malariae has wide global

P. knowlesi is found in southeast Asia.

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World situation

World situation http://www.cdc.gov/malaria/malaria_worldwide/impact.html 3/17/2016 S. Wahyuni/Dept.Parasitology/Hasanuddin

http://www.cdc.gov/malaria/malaria_worldwide/impact.html

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Indonesian situation

 

Year of

 

No.

       

Islands

sample

No. sites

exam

No. Pf (%)

No. P.v. (%)

No. P.m. (%)

No. P.o. (%)

Sumatra

1919–2009

676

239,109

8487 (3.5%)

7057

(2.9%)

494

(0.2%)

 

Java/Bali

1900–2006

114

105,734

3387 (3.2%)

2773

(2.6%)

221

(0.2%)

 

Kalimantan

1975–2005

17

7367

398 (5.4%)

248

(3.4%)

21 (0.3%)

 

Sulawesi

1972–2006

55

11,530

482 (4.2%)

316

(2.7%)

8 (0.1%)

 

           

13,198

   

Maluku

1997–2009

201

121,526

5311 (4.4%)

(10.9%)

3 (0.002%)

 

           

19,401

   

Lesser Sundas

1975–2009

609

383,950 23,502 (6.1%)

(5.1%)

157 (0.04%)

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(0.003%)

       

19,848

     

Papua

1929–2009

694

193,043

(10.3%)

9343

(4.8%)

1395

(0.7%)

40 (0.02%)

     

1,062,25

   

52,336

   

Indonesia

1900–2009

2366

9 61,415 (5.8%)

(4.9%)

2299

(0.2%)

51

(0.005%)

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http://cmr.asm.org/content/24/2/377/F1.large.jpg 3/17/2016 S. Wahyuni/Dept.Parasitology/Hasanuddin Univ. 7

http://cmr.asm.org/content/24/2/377/F1.large.jpg

3/17/2016

S. Wahyuni/Dept.Parasitology/Hasanuddin

Univ.

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Ring

P.falciparum P.vivax P.ovale P.malariae RBC: normal; multiple infection of RBC more common than in other
P.falciparum
P.vivax
P.ovale
P.malariae
RBC: normal; multiple
infection of RBC more
common than in other
species; Maurer's clefts
(under certain staining
conditions)
RBC: normal to 1.25×,
round; occasionally fine
Schüffner's dots; multiple
infection of RBC not
uncommon
RBC: normal to 1.25×,
round to oval;
occasionally Schüffner's
dots; occasionally
fimbriated; multiple
infection of RBC not
uncommon
RBC: normal to 0.75×
Parasite: delicate
cytoplasm; 1 to 2 small
chromatin dots;
occasional appliqué
Parasite: large cytoplasm
with occasional
pseudopods; large
chromatin dot
Parasite: sturdy
cytoplasm; large
chromatin
Parasite: sturdy
cytoplasm; large
chromatin
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(accolé) forms
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Univ.
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Trophozoite

P.falciparum P.vivax P.ovale P.malariae RBS: normal; rarely, Maurer's clefts (under certain staining
P.falciparum
P.vivax
P.ovale
P.malariae
RBS: normal; rarely,
Maurer's clefts (under
certain staining
conditions)
RBC: enlarged 1.5 to 2×;
may be distorted; fine
Schüffner's dots
RBC: normal to 1.25×;
round to oval; some
fimbriated; Schüffner's
dots
RBC: normal to 0.75×;
rarely, Ziemann's
stippling (under certain
staining conditions)
Parasite:seldom seen
in peripheral blood;
compact cytoplasm;
dark pigment
Parasite: large amoeboid
cytoplasm; large
chromatin; fine, yellowish-
brown pigment
Parasite: compact with
large chromatin; dark-
brown pigment
Parasite: compact
cytoplasm; large
chromatin; occasional
band forms; coarse,
dark-brown pigment

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Merozoite

P.falciparum

P.vivax

P.ovale

P.malariae

P.falciparum P.vivax P.ovale P.malariae RBC: normal; rarely, Maurer's clefts (under certain staining
P.falciparum P.vivax P.ovale P.malariae RBC: normal; rarely, Maurer's clefts (under certain staining
P.falciparum P.vivax P.ovale P.malariae RBC: normal; rarely, Maurer's clefts (under certain staining
P.falciparum P.vivax P.ovale P.malariae RBC: normal; rarely, Maurer's clefts (under certain staining

RBC: normal; rarely, Maurer's clefts (under certain staining conditions)

RBC: enlarged 1.5 to 2×; may be distorted; fine Schüffner's dots

RBC: normal to 1.25×, round to oval, some fimbriated, Schüffner's dots

RBC: normal to 0.75×; rarely, Ziemann's stippling (under certain staining conditions)

Parasite:

Parasite: large, may almost fill RBC; mature 12-24 merozoites yellowish-brown, coalesced pigment

Parasite mature :6-4 merozoites with large nuclei, clustered around mass of dark-brown pigment

Parasite:

seldom seen mature 8 -24 merozoites dark pigment, clumped in one mass

mature 6-12 merozoites large nuclei, clustered around mass of coarse, dark-brown pigment; occasional rosettes

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Gametocyt

P.falciparum P.vivax P.ovale P.malariae RBC: distorted by parasite RBC: enlarged 1.5 to 2×; may be
P.falciparum
P.vivax
P.ovale
P.malariae
RBC: distorted by parasite
RBC: enlarged 1.5 to 2×;
may be distorted; fine
Schüffner's dots
RBC: normal to 1.25×;
round to oval, some
fimbriated; Schüffner's dots
RBC: normal to 0.75×; rarely,
Ziemann's stippling (under
certain staining conditions)
Parasite: crescent or
sausage shape; chromatin
in a single mass
(macrogametocyte) or
diffuse (microgametocyte);
dark pigment mass
Parasite:round to oval;
compact; may almost fill
RBC; chromatin compact,
eccentric
(macrogametocyte) or
diffuse (microgametocyte);
scattered brown pigment
Parasite: round to oval;
compact; may almost fill
RBC; chromatin compact,
eccentric
(macrogametocyte) or more
diffuse (microgametocyte);
scattered brown pigment
Parasite: round to oval;
compact; may almost fill
RBC; chromatin compact,
eccentric (macrogametocyte)
or more diffuse
(microgametocyte); scattered
brown pigment

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Morphology

S. Wahyuni/Dept.Parasitology/Hasanuddin Univ.
S. Wahyuni/Dept.Parasitology/Hasanuddin
Univ.

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Morphology in thin blood smear

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Patomechanisms

Caused by the asexual erythrocytic (blood stage parasites).

Parasite develoment in erythrocyte

substances such as hemozoin pigment and other toxic factors accumulate in the infected red blood cell

Lysis erythrocyte

release substances into the bloodstream

The hemozoin and other toxic factors such as glucose phosphate isomerase (GPI) stimulate macrophages and other cells to produce cytokines and other soluble factors

Fever and others

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Univ.
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Clinical features

Clinical features 3 / 1 7 / 2 0 1 6 S. Wahyuni/Dept.Parasitology/Hasanuddin Univ. 17

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Non endemic countries: these symptoms may be attributed to influenza, a cold, or other common infections, especially if malaria is not suspected.

Endemic countries: residents often recognize the symptoms as malaria and treat themselves without seeking diagnostic confirmation ("presumptive treatment").

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The clinical presentation can vary depending on

infecting species,

level of parasitemia

immune status of the patient

Complication:

P. falciparum: cerebral malaria, acute renal failure, severe anemia, or adult respiratory distress syndrome.

P. vivax malaria: splenomegaly

P. malariae;nephrotic syndrome.

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Laboratory diagnosis

Microscopy: Thin and thick blood smear staining with giemsasee CSL manual

Serology:

Detection of Plasmodium antigen/antibody response to Plasmodium antigen

Detection of Plasmodium DNA in the blood

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