Malaria Flashcards
Mortality and morbidity
30-35%
Plasmodium vivas
Mortality
67-70%
Plasmodium falciparum
Benign
0.01-1%
Plasmodium malariae
Common in african countries
Plasmodium ovale
Palawan and mindanao
Plasmodium knowlesi
Population at risk for malaria
11,337,000
Incidence per 1000
0.48
Number of malaria deaths
536
Number of patient tested for malaria
444,668
Mother to fetus
Vertical transmission
Sexual contact
Horizontal transmission
Gold standard for diagnosis
Thick and thin smear
Not to be used in light infection
Thin smear
If degree of parasitemia is too low
Thick smear
Red staining substance
Chromatin dots
Bluish substance adjacent to red substance
Cytoplasm
Brown substance
Hemozoin
Stain used to identify malarian parasite.
Routine procedure
Wright and giemsa stain
Stain used to identify malarian parasite.
Mass staining
Field’s stain
Transfer stage
Infective stage
Produce tissue alteration, signs and symptoms
Pathogenic stage
Any stage seen by naked eye. Basis for diagnosis
Diagnostic stage
All stages seen in peripheral smear
Plasmodium vivaxl
Plasmodium vivax
Only strain that causes
Enlarged RBC
Plasmodium vivax
Ring form, no enlargement, 1chromatin dot
Young trophozoite
Plasmodium vivax
1/3 occupied by blue cytoplasm, irregular in shape
1 chromatin dot
There is RBC enlargement
Growing trophozoite
Plasmodium vivax
2/3 bluish cytoplasm occupied
1 chromatin dot
Mature trophozoite
Plasmodium vivax
2 chromatin dots
Young schizont
Plasmodium vivax
2-12 chromatin dots
Growing schizont
Plasmodium vivax
12-24 chromatin dots in cluster
Rupture in vivo
Release merozoites invading other RBC
Mature schizont
Plasmodium vivax
Being developed after several weeks
Infective stage
Gametocytes
Plasmodium vivax
In gametocytes, chromatin dots are now called
Chromatin granules
Female
Chromatin granules on periphery
Compacted edge
Macrogametocyte
Male
Chromatin granules at the center
Loose arrangement
Microgametocytes
Plasmodium vivax
The mosquito has to have both
Macro and micro gametocyte
All stages are also seen in peripheral smear
Plasmodium malariae
Plasmodium malariae
Size of RBC
Normal size
Plasmodium malariae
2-6 chromatin dots
Growing schizont
Plasmodium malariae
6-12 chromatin dots
Rosette arrangement/ daisy pattern
With brown substance
Mature schizont
Plasmodium malariae
Chromatin dots
Young schizont
Plasmodium malariae
Presence of band form
Growing trophozoite stage
Seen in 15 percent of parasite in growing trophozoite
Only ring form and gametocyte seen in peripheral smear
Plasmodium palcifarum
Plasmodium palcifarum
Size of RBC
Normal size
Plasmodium palcifarum
Ring form
How many parasite in a single indected RBC
More than 1 parasite
How many chromatin dots in ring form of Plasmodium palciparum
2 chromatin dots
Plasmodium palcifarum
Ring form
Asume any configuartion “ exclamation point” “ comma”
Pleomorphic
Plasmodium palcifarum
Mature schizont not usually seen in peripheral smear. If mature schizont seen leads to serious complication
Gametocyte
Plasmodium palcifarum
Presence of chromatin granules
Banana-shaped
Crescent shaped
How many chromatin dots in gametocyte?
18-24
Plasmodium palcifarum
More than 1 strain of parasite
Mixed infection
Plasmodium palcifarum
Period of height from 1 fever to next height of fever
Period of schizogony
Plasmodium palcifarum
Pathogenic stage of all plasmodium
After height of fever
Merozoite
Cytoplasmic destruction in RBC
Stipplings
Stippling found in P. Ovale
James Dot
Has a macerated area, “fimbriated” RBC
P. Ovale
Caused by p. Falciparum but also with mixed infection
Irregular paroxysm
Cold stage
Intense cold
Vigorous shivering
15-60 minutes
Hot stage
Intense heat Dry burning skin Throbbing headache Mid day 2-6 hours
Infective stage to man
Intermediate host
Sporozoite
Indective stage to mosquito
Definitive host
Gametocyte
Mosquito
Sexual
Sporogony
Sporozoite
Definitive host
Man
Asexual
Schizogony
Schixont
Intermediate host
Recrudiscence
Falciparum
Malariae
Ni hypnozoite
All schizonts rupture
Relapse
Ovale
Vivax
In relapse, sone of the sporozoites do not immediately undergo asexual reproduction but enter a dormant phase known as
Hypnozoite
Definitive diagnosis
Use of acridine orange
Quantitative buffy coat
More sensitive
Fluorescent Ab technique
Malarial strips
Rapid test but not reliable
Sensitivity only 30-65%
Immunochromatography
Used to those who already exposed
For centralized screening and antibody screening
ELISA
Best screening for volunteer donor
Serlogic: antigen and antibody screening
Best time to collect blood
Before height of temperature
If blood collected after height of fever
Ring forms only
If blood is collected at the height of fever
Rupture of schizont-> merozoites-> mistaken as platelets
Persons travelling to an endemic area
Non immune
Those who came in an endemic area but have been away for more than 5 years
Semi immune
Living in an endemic area for malaria
1st time pregnancy
Primigravid
Patients who should be hospitalized
Asexual stage of falciparum Life threatening malaria Children in the PBS Immunocompromised Pregnant women ( hypoglycemia )
Complicated malaria
Falciparum + drug resistance (R2 orR3)
Significant for Diagnosis of G6PD
Peripheral blood smear -> 20% heinz bodies
Destroys parasites in the liver, however it also triggers hemolysis in G6PD
Primaquine
Parasitemia documented within 7 days of life
Manifested observed several weeks after pre patent period
Congenital malaria
During active labor only
Parasitemia documented after 7 days but not more than 28 days of life
Conatal or Neonatal Malaria
Malaria in pregnancy
Avoid primaquine Palpate liver and spleen Paper white conjunctiva Yellow sclera Black urine