Plasmodium Report
Plasmodium Report
Group 1
Plasmodium
The Plasmodiidae family has a single genus, Plasmodium, which includes those parasites that undergo exoerythrocytic and pigmentproducing erythrocytic schizogony in vertabrates and a sexual stage followed by sporogony in mosquitoes. (Faust, 1974)
Plasmodium
The sporozoan protozoa of the genus Plasmodium are pigment- producing ameboid intracellular parasites of vertebrates with one habitat in red cells and another in cells of other tissues. The definitive hosts are various species of mosquitoes of the genus Anopheles.
Plasmodium
The malaria parasite exhibits a complex life cycle involving an insect vector (mosquito) and a vertebrate host (human). Four Plasmodium species infect humans: P. falciparum, P. vivax, P. ovaleand P. malariae. All four species exhibit a similar life cycle with only minor variations.
Extrinsic Phase in Anopheles: also called as Definitve phase in which sexual reproduction occurs (2) Intrinsic Phase in man: also called Intermediate phase in which asexual reproduction occurs.
The malaria parasite is a multi-stage protozoan with a complex life cycle requiring an insect vector and a human host. There are three stages in its life cycle: the preerythrocitic cycle, the erythrocytic cycle, and the sporogonic cycle. (CDC)
(video presentation)
P. vivax
Early Relatively large; trophozoite usually one or ring prominent chromatin dot, sometimes two, often two rings or more in one cell
P. malariae
Compact; one chromatin dot; double infection is rare
P. falciparum
P. ovale
Compact; one chromatin dot; double infection uncommon
Small, delicate; sometimes two chromatin dots; multiple red cell infection common; appliqu forms frequent Large Large; markedly Smaller than Medium size; trophozoite ameboid; vivax; compact; usually abundant often band compact, rarely chromatin; shaped; not ameboid; prominent vacuole; ameboid; vacuole pigment in fine vacuole inconspicuous; rodlets inconspicuous; rare in pigment is peripheral coarse blood after half grown; pigment granular Mature Large Small Small schizont or segmenter
Medium
P. vivax
P. malariae
P. falciparum
P. ovale
Number of merozites Microgametocy tes and Macrogametoc ytes Alterations in infected red cell
12-24
Spherical
6-12
8-26
6-12
Spherical but smaller than vivax Enlarged; decolorized; prominent Schuffners dots, appear early; infected cells may be oval-shaped with fimbriated ends
Spherical but Crescent smaller and less shaped numerous Cell may seem smaller; fine stippling (Ziemanns dots) occasionally seen Normal size but may have brassy appearance; Maurers dots common; Garnhams bodies occasionally seen.
P. vivax Length of 48 hours asexual phase Parasitized Enlarged. red cells Fine stippling (Schuffners dots). Primarily invades reticulocytes, young red cells Level of usual 8 000- 20 maximum 000/cu mm of parasitemia blood Distribution All forms in peripheral blood.
P. malariae 72 hours Not enlarged. No stippling (except with special stains) Primarily invades older red cells
P. falciparum 36-48 hours Not enlarged. Coarse stippling (Maurers clefts). Invades all red cells regardless of age. 1. 500 000/cu mm Only rings and crescents (gametocytes) in peripheral blood
P. ovale 49-50 hours Enlarged. Fine stippling. Cells often oval or fimbriated.
< 10 000/cu mm
< 10 000/cu mm
PATHOGENESIS
Table of Pathogenesis
Mode of transmission
CLINICAL MANIFESTATIONS
There are no absolute diagnostic clinical features of malaria except fro the regular paroxysms of fever with asymptomatic intervals. Prodromal symptoms include: feeling of weakness and exhaustion, desire to stretch and yawn, aching bones, limbs and back, nausea, vomiting, and sense of chillness.
Cold Stage
feeling of cold, apprehension, mild shivering quickly turns into violent teeth chattering and shaking of the whole body. The patient may vomit and febrile convulsions for young children.Lasts for 15 to 60 min.
Hot stage
patients becomes hot and manifests with headache, palpitations, tachypnea, epigastric discomfort, thirst, nausea and vomiting. The temp ,ay reach up to 40 to 41 C. The patient may become confused and delirious. The skin is flushed and hot. Lasts from 2 to 6 hours.
Sweating Stage
Defervescence or diaphoresis ensue with the patient manifesting with profuse sweating. The temperature lowers and symptoms diminish.
Take Note!
P.vivax, P. malariae, and P. ovale parasitimias is low grade , primarily because the parasites favor either young or old RBC but not both. P. falciparum invades RBC of all ages and parasitemia is very high. P. falciparum also causes the parasitized red cells to agglutinate and adhere to capillary walls , with resulting obstruction, thrombosis, and local ischemia P. falciparum also causes severe or fatal complications such as cerebral malaria, malarial hyperpyrexia, gastrointestinal disorders and algid malaria
Take Note!
P. malariae has been implicated in a nephritic syndrome in children quartan nephrosiswith peak incidence at about age of 5. It is characterized by generalized edema, oliguria, massive proteinuria and hypoproteinemia. There are also presence glomerular lesions which include basement membrane thickening and sometimes fibrosis.
DIAGNOSIS
CLINICAL DIAGNOSIS
stain Quantitative buffy coat( QBC) ParaSight F test Indirect hemagglutination(IHA) Indirect luorescent antibody test( IFAT) ELISA
THIN-FILM PREPARATIONS
Plasmodium vivax
Plasmodium ovale
Plasmodium falciparum
Plasmodium malariae
THICK-FILM PREPARATIONS
Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
LABORATORY FINDINGS
LABORATORY FINDINGS
Normocytic anemia of variable severity, with poikilocytosis and anisocytosis During paroxysms there may be transient leukocytosis. Leukopenia develops with a relative increase in large mononuclear cells. Presence of casts and protein in the urine of children with P. malariae is suggestive of quartan nephrosis. Severe P. falciparum infection , renal damage may cause oliguria and appearance of casts, protein, and RBSs.
TREATMENT
Treatment
Chloroquine is the drug of choice Pyrimethamine/ sulfadoxine or quinine is used in areas where there is higher levels of resistance to chloroquinine
Elimination of mosquito breeding places or vector control Protection against mosquitoes such as screens, and mosquito repellants Suppressive drug therapy for exposed persons Use of flying insect spray containing pyrethrum
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