1. Malaria
An Overview of
Life-cycle,
Morphology
and
Clinical Picture

2. Malaria Species Five species of malaria infect humans:
Plasmodium falciparum: malignant tertian malaria
Plasmodium vivax: benign tertian malaria
Plasmodium ovale : benign tertian malaria
Plasmodium malariae: quartan malaria
Plasmodium knowlesi (zoonotic)

4. Distribution of Plasmodium knowlesi
Plasmodium knowlesi infections reported in humans and macaques and limits of natural distribution of mosquito vectors and of macaques. The numbers in parentheses represent numbers of P. knowlesi cases reported for each Southeast Asian country or region in Malaysia.

5. Distribution of malaria in KSA

7. LIFE CYCLE OF MALARIA sporozoites Stomach Wall Pre-erythrocytic
Oocyst
Stomach Wall
Sporozoites
Salivary Gland
Zygote
Gametocytes
sporozoites
Pre-erythrocytic
(hepatic) cycle
Hypnozoites
Exo-erythrocytic
(hepatic) cycle
Erythrocytic
Cycle

8. Plasmodium vivax, Plasmodium ovale
Plasmodium falciparum::
Plasmodium vivax,
Plasmodium ovale
Plasmodium malariae\:

9. CLINICAL SIGNS & SYMPTOMS OF MALARIA
Fever
Chills
Sweating

10. feeling of intense cold vigorous shivering lasts 15-60 minutes
Malarial Paroxysm
cold stage
feeling of intense cold
vigorous shivering
lasts minutes
hot stage
intense heat
dry burning skin
throbbing headache
lasts 2-6 hours
  sweating stage
profuse sweating
declining temperature
exhausted and weak → sleep
lasts 2-4 hours

12. CLINICAL PICTURE Chronic Disease Acute Disease Infection During
Pregnancy
Non-severe
Acute Febrile
disease
Chronic
Asymptomatic
Infection
Placental
Malaria
Cerebral
Malaria
Anemia
Low
Birth weight
Developmental
Disorders;
Transfusions;
Death
Increased
Infant
Mortality
Death

13. Components of the Malaria Life Cycle
Sporogonic
cycle
Infective
Period
Mosquito bites
uninfected
person
Mosquito Vector
Parasites visible in blood
Human Host
Mosquito bites
gametocytemic
person
Symptom onset
Prepatent
Period
Recovery
Incubation Period
Clinical Illness

14. Definition
Severe malaria is defined as symptomatic malaria in a patient with P. falciparum asexual parasitaemia with one or more of the following complications:
Cerebral malaria (unrousable coma not attributable to other causes).
Generalised convulsions (> 2 episodes within 24 hours)
Severe normocytic anaemia (Ht<15% or Hb < 5 g/dl)
Hypoglycaemia (glood glucose < 2.2 mmol/l or 40 mg/dl )
Metabolic acidosis with respiratory distress (arterial pH < 7.35 or bicarbonate < 15 mmol/l)
Fluid and electrolyte disturbances
Acute renal failure (urine <400 ml/24 h in adults; 12 ml/kg/24 h in children)
Acute pulmonary oedema and adult respiratory distress syndrome
Abnormal bleeding
Jaundice
Haemoglobinuria
Circulatory collapse, shock, septicaema (algid malaria)
Hyperparasitaemia (>10% in non-immune; >20% in semi-immune)

15. Definition Uncomplicated malaria is defined as:
Symptomatic infection with malaria parasitemia without signs of severity and/or evidence of vital organ dysfunction.

16. Complications of malaria :
Cerebral malaria

17. Complications of malaria :
Pulmonary oedema

18. Complications of malaria :
anaemia
Child with severe malaria anaemia and no other malaria complication

19. Child with severe malaria anaemia in conjunction with acidosis and respiratory distress

20. Malarial haemoglobinuria
Clinical Picture :
Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency may develop intravascular haemolysis and haemoglobinuria precipitated by primaquine and other oxidant drugs, even in the absence of malaria. Haemoglobinuria associated with malaria (“blackwater fever”) is uncommon and malarial haemoglobinuria usually presents in adults as severe disease with anaemia and renal failure.

21. Common methods for parasitological diagnosis of malaria
The two methods common in use :
1: Light microscopy
2: Rapid diagnostic tests (RDTs).

22. Microscopy is the gold standard for diagnosis of malaria
Parasite density
Species diagnosis
Monitoring response to treatment

23. Wellcome Trust (Modified)
ACTION OF ANTIMALARIAL DRUG IN THE DIFFERENT LIFE STAGES OF THE MALARIA PARASITE
Sporontocides
Primaquine
Pyrimethamine
Proguanil
Tissue Schizontocides
Primaquine
Pyrimethamine
Tetracycline
Proguanil
Gametocyide
Primaquine
Anti-relapse (P.vivax)
primaquine
Blood Schizontocides
Chloroquine
Sulfadoxine/Pyrimethamine
Quinine
Quinidine
Artemisinins
Wellcome Trust (Modified)

24. Practical

25. PRACTICAL ON BLOOD PARASITES

26. Common methods for parasitological diagnosis of malaria
The two methods common in use :
1: Light microscopy
2: Rapid diagnostic tests (RDTs).

27. Laboratory diagnosis of malaria
Rapid diagnostic tests detect malaria antigens

29. RDT procedure

30. Laboratory diagnosis of malaria
Light microscopy:1: Preparing blood film

31. Laboratory diagnosis of malaria
Light microscopy:1: Preparing blood film

32. Laboratory diagnosis of malaria
Light microscopy: Thick and thin films

33. Plasmodium falciparum (trophozoite stage in thick smear)
Laboratory diagnosis of malaria
Plasmodium falciparum (trophozoite stage in thin smear)
Plasmodium falciparum (trophozoite stage in thick smear)
CCMOVBD

34. The Malaria Parasite 34 Morphology of Malaria Three developmental
CCMOVBD
Trophozoites
Three developmental
stages seen in blood
films:
Trophozoite
Schizont
CCMOVBD
CCMOVBD
Gametocyte
2. Schizont
3. Gametocyte

35. 35 Morphology of Malaria
CCMOVBD
Plasmodium vivax
Species of malaria is identified by its chracteristic microscopic appearance:
CCMOVBD
Plasmodium malariae
Malaria Tutorials, Wellcome Trust
Plasmodium ovale

36. Plasmodium falciparum (trophozoite stage in thin smear)
36 Morphology of Malaria
Plasmodium falciparum (trophozoite stage in thin smear)
CCMOVBD

37. Plasmodium falciparum (trophozoite stage in thick smear)
37 Morphology of Malaria
Plasmodium falciparum (trophozoite stage in thick smear)
CCMOVBD

38. Plasmodium falciparum
38 Morphology of Malaria
Plasmodium falciparum
(characteristic banana-shaped or crescent –shaped gametocyte stage in thin smear)
CCMOVBD

39. Diagnosis: malaria or Plasmodium vivax
A 25 year-old male from India, who came 3 months ago was admitted in KKUH with a history of severe anaemia and intermittent high grade fever for the last two months not responding to antibiotics.
WHAT IS THE DIAGNOSIS?
Diagnosis: malaria or Plasmodium vivax

40. Diagnosis: malaria or Plasmodium vivax
A businessman who makes frequent trips to Thailand , presents with intermittent fever .
WHAT IS THE DIAGNOSIS?
Diagnosis: malaria or Plasmodium vivax

41. Diagnosis: malaria or Plasmodium falciparum
A student in KSU who returned three weeks from vacation in Africa , he developed intermittent fever last week and lost consciousness a short time ago.
WHAT IS THE DIAGNOSIS?
Diagnosis: malaria or Plasmodium falciparum

42. Plasmodium flaciparum , gametocyte stage
The patient was then treated with schizontocidal antimalarial drugs, a follow-up blood film is shown .
ARE THERE ANY PARASITES? WHAT STAGE ?
Plasmodium flaciparum , gametocyte stage

43. Bone marrow aspiration
Bone marrow amastigotes

44. Leishmania , amastigote stage
A 7 year old child presented with anemia , hepatospenomegaly and fever .Not responding to antimalarials and antibiotics . Bone marrow smear is shown
ARE THERE ANY PARASITES? WHAT STAGE ?
Leishmania , amastigote stage