SPOROZOA

Sierra Roma S. Hernandez, R.M.T., M.D., FPSP

Anatomic and Clinical Pathologist

SPOROZOA

Description.
Life cycle.
Clinical presentation.
Identification and comparison of the different species
Plasmodium spp.
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium knowlesi

Laboratory methods use in the identification of

malarial parasites.

Characteristics
obligate endoparasites

no apparent organelles of locomotion.

causes malaria

most species produce a spore form infective for the

DH after it is ingested or injected by a biting arthropod
vector.

Sporozoan parasites

All genera:
life cycle: reproduction
1. sexual phase
(gametocyte production & sporogony)
2. asexual phase
(schizogony)
Vector: infected Anopheles spp.
Sporozoites along w/ saliva are injected in the host
(infective stage to man)
Gametocytes: infective stage to mosquito

SPOROZOA
LIFE CYCLE:

bite of Anopheles (sporozoite in salivary gland)

after skin bite bloodstream 30 liver cells

asymptomatic patient (parasite not seen in blood)

from liver cells (count 6 days) converted into

merozoites paroxysm & prodrome RBC

destroyed release parasites invade another RBC
(with prodrome & paroxysm) after 2 to 3 cycles
transform into gametocytes (infective to mosquito)
ingested by mosquito count 14 days sporozoites
in salivary gland bite (<14 days cannot transmit
the disease)

Erythrocytic cycle
Merozoite enters RBC trophozoite schizont production
RBC rupture merozoites released to penetrate new
RBCs.
Each cycle induces a paroxysm when toxic materials are
released from the many ruptured RBCs.

Clinical Manifestations
Prodrome = sx of malarial infection prior to paroxysm
e.g.

lassitude, HA, anorexia, chilling sensation,

LGF

Paroxysm = periodic & sequential attacks

Paroxysm begins suddenly, characterized by a 10 to 15

minute (or longer) period of shaking chills, followed by high
fever lasting for 2 to 6 h or longer. The patient begins to
sweat profusely as the To returns to normal.

Terms to remember

INCUBATION PERIOD = time interval between infective

bite to occurrence of symptom
depends on: specie of parasite
intensity of infection
innate host resistance

PRE-PATENT PERIOD = time interval from the infective

bite of mosquito from the time it can be detected in
the blood
RELAPSE = due to activation of hypnozoites (stage
dormant within liver)
(P. vivax, P. malariae, P. ovale)

RECRUDESCENCE = recurrence of signs & symptoms in

P. falciparum
Parasite is still in the blood

Plasmodium falciparum

malignant tertian malaria

found worldwide in tropical and subtropical areas

estimate: approximately 1 million people per year are killed

(Africa)

can cause severe malaria multiplies rapidly in the blood

RBC rupture massive hemoglobinuria (blackwater fever)
the parasites can clog small blood vessels occurs in the
brain cerebral malaria fatal
PBS: multiple ring forms and crescents (gametocytes),
schizonts are rare

Rings of P. falciparum in a thick blood smear.

Trophozoites/ring forms

Gametocytes of P. falciparum in peripheral blood.

Female gametocyte appears to be blue, while the male gametocyte is more pink.

Plasmodium vivax
benign tertian malaria (paroxysms recur every 3rd day)

found mostly in Asia, Latin America, and in some parts

of Africa.
has dormant liver stages ("hypnozoites") that can
activate and invade the blood ("relapse") several
months or years after the infecting mosquito bite.
PBS: Schuffners granules, signet-ring
preferentially invade reticulocytes

Rings of P. vivax in a thick blood smear.

P. vivax in early trophozoite "ring" stage.

Trophozoites of P. vivax in
thin blood smears. Note
the amoeboid
appearance, Schffner's
dots and enlarged
infected RBCs.

Trophozoites of P. vivax. A band-like appearance of the trophozoite may be

mistaken for a band-form trophozoite of P. malariae.
Fine, light brown pigment is distributed throughout the cytoplasm (pigment in P.
malariae is usually darker and coarser and distributed on the periphery of the
cytoplasm). The infected RBCs are larger than the uninfected RBCs.

Schizont
of P.
vivax in a
thin blood
smear.

Ruptured
schizont
of P.
vivax in a
thin blood
smear,
showing
free
merozoites
and
pigment.

Macrogametocyte of P. vivax. Note

the enlargement of the gametocytes
compared to uninfected RBCs.

Microgametocyte of P. vivax in thin blood.

Plasmodium ovale
benign tertian malaria

found mostly in Africa (especially West Africa) and the islands of

the western Pacific.
biologically and morphologically very similar to P. vivax.

can infect individuals who are negative for the Duffy blood
group.
explains the greater prevalence of P. ovale (rather than P.
vivax ) in most of Africa.

Plasmodium malariae

Quartan malaria (3-day cycle)

found worldwide

the three other species have a tertian, two-day cycle.

If untreated, causes a long-lasting, chronic infection that in

some cases can last a lifetime.
In some chronically infected patients can cause
serious complications such as nephrotic syndrome.
PBS:

bar and band forms with rosette schizonts

parasitizes old RBC (normal size)

Plasmodium malariae in thick smear. (schizonts)

Ring-form (and developing

trophozoites of P.
malariae.
"Birds-eye" trophozoite of P.
malariae.

Band-form
trophozoites of
P. malariae in thin
blood smears.

Basket-form trophozoites of P. malariae in a thin blood smear.

Schizonts are compact, with 6-12 merozoites arranged in a

rosette-like fashion around the central pigmented area.
(immature schizonts)

Gametocytes of P.
malariae.

Plasmodium knowlesi
Quotidian malaria

Cyclic paroxysms every 24 h

shown to be a significant cause of zoonotic malaria in Malaysia

Found in forests of SE Asia esp. Malaysian Borneo

found throughout Southeast Asia as a natural pathogen of longtailed and pig-tailed macaques.

Morphology: resembles P. malariae and P. falciparum (ring forms)

has a 24-hour replication cycle can rapidly progress from an
uncomplicated to a severe infection; fatal
cases have been
reported.

Plasmodium knowlesi
Rapid diagnostic assays

Cannot distinguish this from other species

Final diagnosis relies on careful observation of blood

smears
Correct ID is important

P. malariae generally produces mild or benign disease

P. knowlesi produce very high parasitemias leading to severe or

fatal pulmonary and hepatorenal symptoms.

Ring-form
trophozoites
of P.
knowlesi fro
m a human
patient that
traveled to
the
Philippines.
Note a
multiplyinfected
RBC.

Band-form and ring-form trophozoites of P. knowlesi,

Gametocytes of P. knowlesi

Developing schizont of P. knowlesi

Mature schizonts.
A ring-form trophozoite to the right of the schizont is also seen.

CHARACTERISTICS of Plasmodium spp.

Differentiating
points

P. falciparum

P. vivax

Common
Name

Malignant tertian Benign tertian

(36 to 48 H)
(48H)

RBC infected

Young & old

Young

Size of
infected RBC

Normal

Pigment

Maurers dots

P. malariae
Quartan
malaria
(72H)

P. ovale
Ovale malaria
(48H)

Old

Young

Enlarged

Normal or
smaller

Enlarged

Schuffners dots

Ziemanns
dots

Schuffners
dots

Method of Diagnosis

demonstrate and ID trophozoites, schizonts or gametocytes in peripheral

blood.
Draw blood; initial test must be considered a stat request. Subsequent
specimens drawn at 6 to 12 h intervals.
Both thick and thin smears done.

Negative morning and afternoon thick-stained smears for 3 consecutive days

during symptoms absence of infection.

application of PCR:

for epidemiological surveys

in screening of infected donors in blood banks

in the ID of asymptomatic carriers of malaria
in the monitoring therapeutic response

Treatment
Sporonticides (sporogony)

primaquine, pyrimethamine, proquanil

Schizonticide

chloroquine, quinine, quinidin

pyrimethamine, halopanthrene
Primaquine = anti-relapse

can also kill gametocytes

Febrile diseases mistaken for malaria

Typhoid fever

Acute respiratory infection

Meningitis

Encephalitis

Influenza
UTI

Septicemia

Ear infection

Tuberculosis

Acute hepatitis

Systemic viral illness

THANK
YOU!