UDOM CHAITHONGPh.D. L’POOL

OBJECTIVES :OBJECTIVES :

TO STUDY TO STUDY MORPHOLOGY MORPHOLOGY

LIFE CYCLE LIFE CYCLE GEOGRAPHICAL DISTRIBUTION GEOGRAPHICAL DISTRIBUTION

EPIDE MIOLOGYPATHOGENICITY

DIAGNOSIS PREVENTION AND CONTROL

OBJECTIVE :

Human MalariaHuman MalariaPlasmodium malariaePlasmodium malariae (Laveran,1880) (Laveran,1880)

Plasmodium vivaxPlasmodium vivax (Grassi & (Grassi &

Feletti,1890)Feletti,1890)

Plasmodium falciparumPlasmodium falciparum (Welch,1897) (Welch,1897)

Plasmodium ovalePlasmodium ovale (Stephens,1922) (Stephens,1922)ZOONOSIS MALARIAPlasmodium knowlesi

Natural transmission of Plasmodium knowlesi to humansby Anopheles latens in Sarawak, Malaysia 2006

Geographical DistributionGeographical Distribution

HISTORY OF MALARIA

INDIA : AYURAVEDA AIR, FIRE , WATER

EARTH ,BREATHMASAGAH IS VECTOR

GREEK : ILIAD (HOMER) “PYRETOS” ANOPHELES (HARMFUL) IS THE VECTOR

CHINA: HUANG TI HEADACHE CHILL FEVER “ YAU MU” QINGHAUSU

THAILAND ‘KASAI” FEVER ,CHILL

EGYPT “ AATA”MOSQUITO IS VECTOR

MALARIA HISTORY

Geographical DistributionGeographical DistributionP. malariaeP. malariae & & P. vivaxP. vivax Tropical to Temperate Zone

P. falciparumP. falciparum Tropical & Subtropical Zone

P. ovale P. ovale Tropical Africa & Eastern Asia

ThailandThailandP. falciparum > P. vivax > P. malariae > P.ovale

MORPHOLOGYMORPHOLOGY Base on thin blood film

1. Trophozoite 1.1 Early, young, trophozoite (ring form) -Infected red cell - Enlarge -Multiple infected - Common -Trophozoite - Signet ring -Cytoplasm - Light blue -Chromatin - 1 red dot

Plasmodium vivax

1.2. Growing Trophozoite Form - Amoeboid Cytoplasm - Light blue Chromatin - Red dot or thread Stippling - Schuffner’s dot Pink dot on cytoplasm Pigment - Fine yellow brown rodlets

2. Schizont - Early - Chromatin 2 granules

- Growing - Chromatin 4 granules

- Mature- Chromatin12-24merozoites

- Schuffner’s dot - Pink dots

- Pigments - Fine yellow brown

rodlets eccentric mass

3. 3. GametocytesGametocytes 3.1. Young - Cytoplasm - Light blue with no vacuole - Chromatin - Large piece of red dot - Schuffner’s dot - Pink dots - Pigment - Fine granules yellow brown rodlets

3.2. 3.2. MicrogametocyteMicrogametocyte (Male gametocyte)Form - Spherical or ovalCytoplasm - Periphery pale blueChromatin - Abundant or diffused pale pinkPigment - Fine yellow brown rodlets

3.3.3.3.MacrogametocyteMacrogametocyte(Female gametocyte)Form - Spherical or ovalCytoplasm - Deep blueChromatin - Compact eccentric pinkPigment - Coarse yellow brownSchuffner’s dot - Pink dots

Ring formAmoeboid form

Mature Schizont

Female gametocyte

Male gametocyte

Growing Schizont

WBC

WBC

Plasmodium malariaePlasmodium malariae1.1.Trophozoite Trophozoite 1.1.1.1. Young , ring formYoung , ring form Infected red cellInfected red cell - Normal - Normal CytoplasmCytoplasm - - Deep blueDeep blue Chromatin Chromatin - Large - Large red red dot dot compact ringcompact ring

12. . Growi ngtrophozoi te 121. . - . Band form Cytoplasm - Deepblue band across the cell Chromatin - Red dot or thread

122. . - Compact form Cytoplasm - Deepblue compact ring Chromatin - Red dot Stippling Ziemann’s dot ( rare)

123. . Erregular form

2. Schizont 2. SchizontEarly - 2 red chromatin granules

Growing - 4 red chromatin granules

Late - - 6 1 2 merozoites(mature) ( rosset form ) Pigment Central blackbrownish mass

3. Gametocyte3. Gametocyte

3.1. Microgametocyte Cytoplasm - Pale blue Chromatin - Abundant or diffused pinkish Pigment - Scattered coarse blackbrownish granules

3.2. Macrogametocyte

Cytoplasm - Deep blue

Chromatin - Compact or eccentric pink

Pigment - Coarse blackbrownish granules are crealy defined

Ring form

Band form

Compact form

Mature Schizont

Female gametocyte

Male gametocyte

Female gametocyte

Plasmodium falciparumPlasmodium falciparum1. Trophozoite Infected red cell - Normal red cell Multiple infected - Very common Cytoplasm - Medium blue Chromatin - Red dot Frequently 2 signet rings 2 chromatins in one ring

1.2. Growing trophozoite Cytoplasm - Medium blue Chromatin - Red dot Stippling - Maurer’s dot Pigment - Fine black granules

2. Schizont

Early - 2 red dots chromatin Growing - 4 red dots chromatin Mature - 16-24 merozoites Pigment - Central or eccentric solid fused dark

brownish mass Early ,growing and mature are rarely seen in peripheral blood

3. GametocyteGametocyte3.1.Microgametocyte Form - Crescent, sausage or banana round end in shape Cytoplasm - Pale blue Chromatin - Central diffused pink Pigment - Dark brownish rodlets

32. . MacrogametocyteMacrogametocyte

- Form - Form Crescent , sausage banana Crescent , sausage banana pointed end pointed end - Cytoplasm - Cytoplasm Deep blue Deep blue - Chromatin - Chromatin Compact eccentric Compact eccentric red dot red dot - Pigment - Pigment scattered coarse granules scattered coarse granules are clearly defined in dark are clearly defined in dark blackbrownish rodlets blackbrownish rodlets

Ring form

Female gametocyte

Mature SchizontMale gametocyte

Double chromatins

Plasmodium ovale

1. Trophozoite Infected red cell -Enlarge oval red blood cell 1.1. Early , ring Multiple infected - Rare Cytoplasm - Deep blue Chromatin - Large red dot

12. . Growing Trophozoite

- Cytoplasm Elongate or oval deep blue - Chromatin Red dot or thread - Pigment Fine greenish brown granule - Stippling Schuffner’s dot - Pale bluish dots

2. Schizont

Early - 2 red dots Growing - 4 red dots Mature - - 612merozoites - Pigment Central or eccentric greenish brown mass

3.Gametocyte 31. . Microgametocyte

- Form Oval or Tear dorp - Cytoplasm Pale blue - Chromatin Abundant diffuse pinkish - Pigment Fine greenish brown -Schuffner’s dot violet blueish dots

3 .2 . Macrogametocyte

- Form Oval or Tear dorp - Cytoplasm Deep blue - Chromatin Compact or eccentric red dot - Pigment Greenish brown granules

- Schuffner’s dot violet blueish dots

Ring form

Female gametocyteMature Schizont

Male gametocyte

Growing Schizont

Young gametocyte

Plasmodium knowlesi is a primate malaria parasite commonly found in Southeast Asia. It causes malaria in long-tailed macaques (Macaca fascicularis),

and pig-tailed (M.nemestrina) macaques

but it may also infect humans, either naturally or artificially.

Plasmodium knowlesi is the fifth major human malaria parasite. It may cause severe malaria as indicated by its asexual erythrocytic cycle of about 24 hrs

The known vectors belong to the genus Anopheles

An. latensAn. leucosphyrusAn. hackeriare believed to be the main vector of P. knowlesi

P . knowlesi in human infection could not easily differentiate with other Plasmodium species, especially for atypical form of P . falciparum and P . malariae .Symptoms typically begin approximately 11 daysafter an infected mosquito has bitten a person andthe parasites can be seen in the blood between 10 – 12 days after infection. The parasite may multiply rapidly resulting in very high parasite densities that may be fatal.

1.Double chromatine in red cell ( PF)2.Mature shizonts have 8-16 merozoites (PM)3.Band form (PM)

LIFE CYCLELIFE CYCLE1. EXOGENOUS PHASEEXOGENOUS PHASE OR MOSQUITO PHASE SEXUAL CYCLE OR SPOROGONY ANOPHELES MOSQUITOESANOPHELES MOSQUITOES2. ENDOGENOUS PHASEENDOGENOUS PHASE OR HUMAN PHASE ASEXUAL PHASE OR SCHIZOGONY -A. EXO-ERYTHROCYTIC SCHIZOGONY

-B. ERYTHROCYTIC SCHIZOGONY

ENDOGENOUS PHASEENDOGENOUS PHASEA. EXOERYTHROCYTIC A. EXOERYTHROCYTIC SCHIZOGONYSCHIZOGONY SPOROZOITES

BLOOD CERCULATION

PARENCHYMAL CELL

EXOERTHROCYTIC SCHIZOGONY HYPNOZOITES OR DORMOZOITES(TISSUE SCHIZOGONY)

EXOERYTHROCYTIC MEROZOITES

BLOOD CERCULATION

B. ERYTHROCYTIC SCHIZOGONYB. ERYTHROCYTIC SCHIZOGONYEXOERYTHROCYTIC MEROZOITES

RED BLOOD CELL

TROPHPZOITES

TROPHOZOITE

SCHIZONT

ERYTHROCYTICMEROZOITES

ASEXUAL CYCLE

YOUNG GAMETOCYTE

GAMETOCYTE

MICROGAMETOCYTEMACROGAMETOCYTE

SEXUAL CYCLE

EXOGENOUSEXOGENOUS PHASEPHASEMACROGAMETOCYTE MICROGAMETOCYTE

MACROGAMETE MICROGAMETE

ZYGOTE( EXFLAGELATION )

OOKINETEPENETRATE TO MIDGUT WALL

OOCYST

SPOROZOITES

SPOROZOITES IN SALIVARY GLANDS

HUMAN

Exogenous phase

Endogenous phase

Mosquito phase

Human phase

2 อาทิ�ตย์ ทิ� 25o C ต��า กว่�า 16o C จะไม่�เก�ด

Sporogony ในม่าลาเรีย์ ทิ�กชน�ด

Incubation period

PV 13 ( 12-17 )PO 17 ( 16-18 )PF 12 ( 9-14 )PM 28 ( 18-40 )

CLINICAL FEATURES AND PATHOLOGYTHE CHARACTERISTIC FEATURE

OF MALARIA IS FEVERIT USUALLY OCCURS IN THREE STAGE

AS FOLLOWS:1. COLD STAGE ; 15 - 60 Min.2. HOT STAGE ; 2 - 6 Hrs.3. SWEATING STAGE

1. Cold stage : characterized by

- Rigor and headache

- Patients feel cold and shiver even

though their temperature are rising

- The skin pale and cyanotic

- Take 15 -60 Min.

2. Hot stage.

The temperature rise to its maximum.

Severe frontal headache

Often vomiting and diarrhea

The skin becomes flushed

Take 2 - 6 Hrs.

3. Sweating stage

The patient starts to sweat profusely and

usually begins to fell better.

Weak and exhausted and tend to asleep

The temperature is normal, headache and

other pains are relive until the next rigor

Plasmodium vivax

P. ovale

Benign tertian malaria

Ovale tertian malaria

PERIODICITYPERIODICITYP. vivax 48 Hrs.P. falciparum 36-48 Hrs.P. ovale 48 Hrs.P. malariae 72 Hrs.

Plasmodium malrariaeQuartian

malarai

..P. vivax 48 Hrs.P. falciparum 36-48 Hrs. P. ovale 48 Hrs.P. malariae 72 Hrs..

Plasmodium falciparumMalignant tertian malaria

P. vivax 4 8 Hrs.

P. falciparum- 3648 Hrs.

P. ovale 48 Hrs.

P. malariae 7 2 Hrs.

P.knowlesi 24 Hrs.

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A. เช(*อรีะย์ะ TrophozoitesB. เช(*อรีะย์ะ gametesC. เช(*อรีะย์ะ schizontsD. เช(*อรีะย์ะ merozoitesE. เช(*อรีะย์ะ sporozoites

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A. Plasmodium falciparumB. Plasmodium ovaleC. Plasmodium vivaxD. Plasmodium malariaeE. Plasmodium vivax และ P malariae

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ว่�น�จฉั%ย์ผู้,$ปี#ว่ย์เปี/นม่าลาเรีย์ชน�ดใด 1.Plasmodium malariae2.Plasmodium falciparum3.Plasmodium knowlesi4.Plasmodium ovale5.Plasmodium vivax