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Advanced Clinical Parasitology > Plasmodium and Babesia: Chapter 6 > Flashcards

Plasmodium and Babesia: Chapter 6 Flashcards

1
Q

Define the Following

  • Sporozoa
  • Macrogametocyte
  • Microgametocyte
  • Merzoite
A
  • Sporozoa: A group of protozoa that have no obvious means of locomotion
  • Macrogametocyte: Female sex cell of Plasmodium spp
  • Microgametocyte: Male sex cell of Plasmodium spp
  • Merozoite: Asexual sporoza trophozoite
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2
Q

Define

  • Ring form
  • Schizogony
  • Schizant
  • Sporogony
  • Sporozite
A
  • Ring form
    • Ringlike structure that appears initially after invasion of RBC by plasmodium spp
  • Schizogony
    • Asexual multiplication that occurs in humans prior to invasion of the RBCs
  • Schizant
    • Morphologic form responsible for the development and maturing of merozoites critical to parasite survival
  • Sporogony
    • Sexual multiplication that occurs in mosquitoes
  • Sporozite
    • Infective stage transferred by vector
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3
Q

Health & Economic Burden of Malaria

A
  • ~2.5 Billion (40% World’s Population) At Risk
  • 400-800 million febrile infections/year
  • 1 – 2 million deaths/year, >75% African children
    • ~4 die per minute
    • ~5000 die per day
    • ~35,000 die per week
  • <20% come to attention of the health system
  • Pregnant women at high risk of dying, low birth weight children
  • Children suffer cognitive damage and anemia
  • Families spend up to 25% of income on treatment – (regressive tax)
    • Major Impediment to Economic Growth and Development, as well as health
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4
Q

Life Cycle of Plasmodium

A
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5
Q

Occurence of Cyclic Paroxynsms (time required to burtst) in common plasmodium species

  • P. vivax
  • P. ovale
  • P. malariae
  • P. falciparum
A
  • P. vivax
    • Every 48hr
  • P. ovale
    • Every 48hr
  • P. malariae
    • Every 72 hr
  • P. falciparum
    • Every 36-48hr
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6
Q

Clinical disease

A
  • From the time of the original mosquito bite until a week or more later, the patient remains asymptomatic
  • During this time the organisms are undergoing multiplication in the liver. This is the pre-erythrocytic or exo-erythrocytic cycle
  • When the liver merozoites invade the RBCs, several broods begin to develop, however one will eventually dominate and suppress the other, thus beginning the process of periodicity
  • Once the cycle is synchronized, the simultaneous rupture of a large # of RBC and liberation of metabolic waste byproducts into blood streams precipitate the paroxysms of malaria
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7
Q

Clinical symptoms include

A
  • Anemia
  • Splenomegaly
  • Classic paroxysms (with cold stage-fever-and sweats)

These symptoms are nonspecific and a diagnosis of malaria should always be considered in a patient with a travel history to an edemic area

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8
Q

Paroxysms in cold stage

A
  • Typical paroxysms begins with a cold stage and rigors lasting 1-2 hours. During the next few hours the patient will spike a fever that is high and will last for several hours marked by sweating and a subsequent drop in body temperatuer to normal or subnormal. Patients are usually exhausted and collaspse to sleep afterward
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9
Q

Causes of Anemia in Malaria

A
  • Direct RBC lysis as a function of the parasites lifecycle
  • Splenic clearance of both infected and uninfected RBCs (coated with immune complexes)
  • Automine lysis of coated infected and uninfected RBCs
  • Decreased incorporation of iron into heme
  • Increased fragility of RBCs
  • Decreased RBC production from bone marrow suppression
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10
Q

Host defenses against malaria

A
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11
Q

Pathogenesis and Clincal Symptoms

A
  • Paroxysms
    • Periodicity varies by Plasmodium species
    • Chacterized by chills
      • Chills
      • Fever
      • Sweating
      • Fatigue
    • Relapses possible with P. vivax and P.ovale
  • Additional possible symptoms:
    • Ischemia-insufficient supply of blood to organ
    • Anemia-decrease in RBC (healthy or unhealthy)
    • CNS-involvement-can cause strokes
    • Nephrotic syndrome-due to toxic degrad products
  • Natural resistance due to some erythrocyte structural abnormalilites, certain hemoglobinopathies, and certain blood groups
    • Example: individuals who are Duffy group negative showe greater resistance
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12
Q

Morphologic Forms: Ring Forms (early trophozoites)

A
  • Ringlike structure of parasite that develops after invasion of RBC
  • Appears as blue cytoplasmic circle with red chromatin dot(s) on Giemsa stain
  • Area within ring known as vacuole
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13
Q

Mrophologic Forms: Developing trophozoites

A
  • Appearance varies by Plasmodium species
  • Ring form is much more pleomorphic and ameboid
  • Circle of ring and chromatin dot(s) may still be present
  • Brown pigment may be present
  • Infected young, pliable RBCs are usually larege due to growing parasite
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14
Q

Define of Schizant: Contrast immature & Matuer schizants

A
  • Definition-A cell formed from a trophozoite during asexual stage of the life cycle of sporozoan protozoans, such as the malaria parasite.
  • Immature schizants-
    • Growing chromatin and cytoplasmic material
    • Brown pigment granules may be present
    • Parasite occupies more space within the RBC
  • Mature schizants
    • Mature and contains many merozoites (the maxiumum for that species before releasing into the blood stream
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15
Q
A

Immature Schizonts

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16
Q

Morphologic Forms: Mature schizants

A
  • Fully developed merozoites emerge (asexual sporozoa trophozoites)
  • Number and arrangement of merozoites vary with the malarial species
  • Cytoplasmic material is presumed to be absent except with Plasmodium vivax
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17
Q

Identify this: (Notice merozites in cells that vary in quanity according to species)

A

Mature Schizont

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18
Q

Morphologic Forms: Microgametocytes

A
  • Male sex cell
  • Diffuse chromatin mass that stains pink-purple and surrounded by cytoplasmic material
  • pigment may be present
  • Plasmodium falciparum
    • Crescent-shaped
  • Other Plasmodium species
    • Round-oval
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19
Q

Morphologic Forms: Macrogametocytes

A
  • Female sex cell
  • Compact chromatin material surrounded by cytoplasmic material
  • pigment possibly present
  • plasmodium falciparum
    • Crescent-shaped
  • Other plasmodium species
    • Round to oval
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20
Q

Identify

A

Plasmodium vivax

(notice the tiny granules)

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21
Q

Identify

A

Plasmodium malariae

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22
Q

Identify this

A

Plasmodium falciparum

(irregular to comma-shaped cytoplasmic dots seen in P. falciparum)

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23
Q

Laboratory Diagnosis & perfered specimen

A
  • Stained smear is still considered gold standard
  • specimen of choice is mulitple sets of Giemsa-stained peripheral blood smears
    • Thick smear for screening
    • Thin smear for differentiation/morphology of Plasmodium species
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24
Q

Laboratory Diagnosis: Timing of blood collection, & RDT

A
  • Timing of blood collection
    • Optimal time is between characterisitic cycles of fever and chills known as paroxysms
    • Paroxysms vary by Plasmodium species
  • RDT
    • (Rapid Diagnostic Tests) such as plasmodium glutamate dehydrogenase testing; HRP II testing (Histidine rich protein) seen in P. falciparum; P.falciparum lactate dehydrogenase (pLDH); etc… are used in the field where expensive high technical testing like PCR and or microscopic detection by trained personnel are not practical.
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25
Q

Prevention of Malaria is based on using three types of drugs working together

A
  • Chemoprophylaxis with the use of schizonticides against tissue schizonts
  • Chemoprophylaxis with the use of a schizonticide directed to blood schizonts
  • Chemoprophylaxis directed to the gametocyte stage of the plasmodium,
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26
Q

Plasmodium vivax (benign tertian malaria): Lab diagnosis, life cycle notes, and epidemiology

A
  • Laboratory diagnosis
    • All stages can be present in the blood film
  • Life cycle notes
    • Tends to invade young, pliable RBCs-results in distorted cells that are enlarged
  • Epidemiology
    • Most widley distributed of the Plasmodium species and found in tropical, subtropical, and temperate regions (C. &S America, India and S.E Asia)
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27
Q

Plasmodium vivax: Clincial symptoms, Treatment, & Preventaion

A
  • Clincial symptoms: Benign tertian malaria
    • Paroxysms occur every 48 hours
    • Replase possible due to reactivation of dormant infected liver cells (hyponozoites)
  • Treatment
    • Numberous drugs available but resistance can exist
  • Preventation and control
    • Personal protection
    • Prophylaxis
    • Mosquito Control
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28
Q

Identify this

A

P. vivax ring trophs

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29
Q

Identify this

A

P. vivax ring troph

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30
Q

Identify this

A

P. vivax schizonts

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31
Q

Identify this

A

P. vivax schizonts

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32
Q

Identify

A

Plmasodium vivax

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33
Q

Identify this

A

Plasmodium Vivax gametocytes

34
Q

Identify this

A

Plasmodium vivax gametocytes

35
Q

Plasmodium ovale: little overview

A
  • P. ovale and P. vivax infections are very similar yet P. ovale is less severe, tends to replase less frequently, and usually ends with spontaneous recovery, often with less than 6-10 paroxyms.
  • Like P. vivax it infects only young cells (reticulocytes) and the parasitemia is generally limited to around 2-5% of available RBCs. Thus RBCs’ tend to be enlarged.
36
Q

Plasmodium ovale: Epidemiology & Clincial symptoms

A
  • Epidemiology:
    • Found primarly in tropical africa as well as Asia and S. America
  • Clinical symptoms: Benign teritan malaria:
    • ​48-hour paroxyms
    • Replase possible due to reactivation of hypnozoites
    • Without treatment, infection often lasts for only one year without treatment then spontaneous recovery compared to years with P. vivax
37
Q

Plasmodium Ovale: Lab diagnosis & Life cycle notes

A
  • Diagnosis
    • All stages can be observed in blood firm
    • Ring forms, microgametoctyes, and macrogametocytes are diffcult to distinguish from those P.vivax
    • Mature schizants with an average of 8 merozites differentiate it from P. vivax with an avg of 16 merozoites
  • Life cycle notes
    • Targets and infects young, pliable red blood cells resulting in distorted cells with ragged cell walls.
38
Q

Identifty this

A

Plasmodium ovale ring troph

39
Q

Identify this

A

Plasmodium ovale ring troph

40
Q

Identify this

A

Plasmodium ovale Schizonts

Note the oval shape and rough edges that the shape takes

41
Q

Identify this

A

P. ovale microgametocyte

42
Q

Identify this

A

P. ovale microgametocyte

43
Q

Identify this

A

P. ovale microgametocyte

44
Q

Plasmodium ovale: characterisictis of infected RBC and appearnce of RBCS

A
45
Q

Table 6-3 tyical characterstics of P. Ovale

A

review table

46
Q

Plasmodium malariae: Clinical symptoms, treatment, prevention and control

A
  • Clincial symptoms: quartan malaria
    • Paroxyms occur every 72 hours
    • Spontaenous recovery can occur
    • There are no known relapses
  • Treatment
    • Same as for P. vivax
  • Prevention and control
    • Similar to those for P. vivax
47
Q

Plasmodium malariae: Overview

A
  • P. malariae invades primarily the older RBCs so the number of infected cells are somewhat limited
  • Incubation period between infection and symptoms may be much longer than that seen with P. vivax & ovale, raning from about 27-40 days.
  • Parasites can be found in the bloodstream several days before the initial attack. the prodromal symptoms may resemble those of P. vivax. A regular periodicity is seen from the beginning with a more severe parosxysm including a longer cold stage and more severe symptoms during the hot stage. collapse during the sweating stage is common
48
Q

Plasmodium malariae: Symptoms and Geopgrahic distribution

A
  • Nephrotic syndrome is common
  • CNS involvement is rare
  • Anemia is mild to moderate
  • Duration of untreated disease may be over 20 years
  • Symptom periodicty is 72 hrs
  • Initial fever patterns are regular whereas in vivax and ovale it is irregular
  • 18-40 day incubation period
  • Geographic distrubition
    • Tropical and subtropical areas of C & S. America, Africa and S.E Asia
49
Q

Plasmodium malariae: Lab diagnosis, Life cycle notes and Epidemiology

A
  • Lab diagnosis
    • Rings seen less often
    • Developing trophozites and immature and mature schizants are more common
  • Life cycle notes
    • ​Infects mature red blood cells
    • Little red blood cell enlargment or distortion
    • Noted for forming bands
  • Epidemiology
    • Found in subtropic and tropic regions
50
Q

Identifty this (illustration)

A

Plasmodium malariae

51
Q

Identify this

A

P. malariae

(notice the Band and Basket shapes)

52
Q

Whats this? (Graphic)

A

Plasmodium Malariae

(note that there are 6-12 merozoites)

53
Q

Identify this

A

Plasmodium malariae schizont forms

54
Q

Plasmodium falciparum: Life cycle notes & Epidemiology

A
  • Life cycle notes
    • Invades up to 50% of red blood cells of any age
    • Infections-in late summer and early fall
  • Epidemiology
    • Limited to tropical and subtropical regions (Tropical and Subtropical areas of C & S. America, Africa amd S.E Asia)
55
Q

Plasmodium falciparum: Important points

A
  • Nephrotic syndrome is rafe
  • CNS involvement is very common (80% of fatal cases)
  • Anemia is severe
  • Parasitemia of all RBC regardless of age
  • Duration of untreated infection is 6-17 months
  • Symptoms are very severe
  • Paroxysm is every 36-48 hours
  • Incubation period is 8-11 days
  • Relapses from the liver or recrudescences are rare
  • Schizogony occurs in the internal organs (spleen, liver, bone marrow, etc) rather than circulating blood.
  • Ischemia caused by plugging of vessels within these organs by masses of parasitized RBCs produces symptoms variying with the organ affected
56
Q

Plasmodium falciparum: Clincial symptoms

A
  • Symptoms: lack water fever, maligant tertian malaria
    • Flu-like symptom early in infection
    • 36-48 hr paroxyms
    • Deadlist form of malaria
      • ​Large amount of toxic cellular debris
      • May enter kidneys, brain, and liver
      • May result in coma and death ( causes widespread ischemia due to capillary blockages) Stick to sides of capiliary
57
Q

Plasmodium faliciparum: Lab diagnosis

A
  • Typically only ring forms and gametocytes in blood firm
  • Multiple infections can occur
  • Red blood cells are neither enlarged nor distorted
  • Other stages develop in capillaries of the viscera
  • Relapses do not occur but infection can silenty persist and resurge
58
Q

Identify this

A

Plasmodium falciparum

(Note the presence of mulitple rings and also the characteristic ear phone-ring form)

59
Q

Identify these cells

A

Plasmodium falciparum

A. Ring form with double chromatin B, ring form. (a), schizont (b), and stain precipitate (c).

60
Q

Identify this

A

Plasmodium falciparum ring forms

(noticed mulitply infected cells)

61
Q

Identify this graphic

A

P. falciparum

(Notes-The most merozoites contained in a mature schizont of any other plasmodium schizont but can overlap with P. vivax to cause confusion)

62
Q

Identify this

A

Plasmodium falciparum schizont

63
Q

Identify this

A

Plasmodium falciparum schizont

64
Q

Identify this

A

Plasmodium falciparum schizont

65
Q

Identify this graphic

A

Plasmodium falciparum micro and macrogametocyte

(The very unique bana or crescent shapes gametocyte of plasmodium falciparum)

66
Q

Identify this

Specifically (E) & (D)

A

E-Mature macrogametocyte

D-developing gametocyte.

67
Q

Babesia life cycle

A
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Advanced Clinical Parasitology (5 decks)

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