Plasmodium falciparum

By : Tharsini a/p Salyam

Mengetahui morfologi parasit Plasmodium falciparum dalam filem darah tebal dan filem darah nipis Mengenal pasti dan melukis morfologi parasit Plasmodium falciparum Mengetahui perubahan ke atas sel perumah sel darah merah dari segi saiz , bentuk dan kehadiran bintik bintik untuk parasit Plasmodium falciparum

INTRODUCTION
Total known species 5 : P.falciparum P.ovale P.malariae P.vivax P.knowlesi Transmission : mosquito , blood tranfusion, placenta and lab accidents

Malaria Diagnosis

B.F.F.M.=Blood Film For Malaria

Blood Smear Prepare smears as soon as possible after collecting venous blood to avoid any
Changes in parasite morphology.

the gold standard for diagnosis of malaria..

Reporting of Blood film

Look for the different morphological forms of parasite in blood smear:
1. Trophozoites / ring forms 2. Schizont 3. Gametocytes

Identify species differences in the characteristics of morphological forms in different species

Recognizing Malaria Parasites

Inside a red blood cell

Blue cytoplasm

One or more red chromatin dots

Recognizing Erythrocytic Stages:

Schematic Morphology
Blue Cytoplasm RING Red Chromatin Brown Pigment TROPHOZOITE

SCHIZONT

GAMETOCYTE

Recognizing Erythrocytic Stages:

RBC CHARACTERISTICS
Size Color

Plasmodium falciparum
Mature RBC Normal

Shape
Cytoplasmic inclusion

Round . Maybe crenated

Maurers cleft maybe present in late trophozoite

7 3

THICK BLOOD SMEAR

6 2

4 1 6 2

8 1

1 1

1 1: Small trophozoites.
2: Gametocytes normal. 3: Slightly distorted gametocyte. 4: Rounded-up gametocyte. 5: Disintegrated gametocyte. 6: Nucleus of leucocyte. 7: Blood platelets. 8: Cellular remains of young erythrocyte.

Ring form Early trophozoites

TROFOZOIT MUDA : PARASIT Sitoplasma dan kromatin halus 1@ 2 double chromatin Terdapat juga marginal (accolle form) bentuk tepian 1 atau lebih parasit dalam 1SDM (multiple infection) Tidak terdapat pigmen TROFOZOIT MUDA : PERUMAH Saiz tidak berubah Tiada stippling

Thin Blood Film

Thick Blood Film

Trofozoit Matang
PARASIT Bentuk cincin yang lebih besar dan irregular Saiz lebih kecil daripada spesies lain Kromatin lebih besar Sitoplasma padat Kadang kadang terdapat pigmen kasar berwarna perang kehitaman
PERUMAH Terdapat Maurers spot SDM mungkin kecut dan crenated

Plasmodium falciparum - Ring

Skizon Muda dan Matang

MUDA Bentuk padat dan hampir memenuhi SDM Pigmen berselerakan Kromatin irregular MATANG Hampir memenuhi SDM Merozoit semakin kecil Pigmen berwarna kuning coklat (tengah)

Dilapor berada dalam infeksi yang serius / dikultur Jika ada , pesakit mungkin sudah meninggal Boleh dijumpai dalam saluran darah di dalam organ
Developing Schizont Mature Schizont

Mature schizont in a thin blood smear.

Ruptured schizont in a thin blood smear.

Another schizont in a thin blood smear.

GAMETOSIT BETINA
BETINA Bentuk cresent/ bulan sabit dengan hujung yang lebih tajam Saiz lebih besar daripada SDM Warna sitoplasma : biru gelap Kromatin : padat berkumpul di tengah Pigmen : rice grain mengelilingi kromatin

GAMETOSIT JANTAN
JANTAN Bentuk cresent/sabit/pisang dengan hujung lebih tumpul Saiz lebih besar daripada SDM Warna sitoplasma : Biru pucat Nukleus : besar dan tidak padat, dark pink Kromatin : berselerakan Pigmen : granul warna keemasan yang berselerakan (rice grain)

Two gametocytes in a thin smear.

Gametocyte in a thin smear showing the membrane of the rbc.

Gametocytes in a thick smear

Gametocytes in a thick smear

Plasmodium falciparum
Infected erythrocytes: ***normal size (Maurers dots)

4
2
1

Gametocytes: mature (2)and

Rings: double chromatin dots

multiple infections in same red cell

immature (1) forms (1is rarely seen in peripheral blood)

2
Trophozoites: compact
*(rarely seen in peripheral blood)

Schizonts: 8-24 merozoites

*(rarely seen in peripheral blood)

Species Differentiation on Thin Films

Feature Enlarged infected RBC Infected RBC shape Stippling infected RBC Trophozoite shape Chromatin dot Mature schizont Gametocyte round Mauer clefts small ring, appliqu often double rare, 12-30 merozoites crescent shape P. falciparum P. vivax + round, distorted Schuffner spots P. ovale + oval, fimbriated Schuffner spots round none small ring, compact single 6-12 merzoites compact, round P. malariae

large ring, large ring, amoeboid compact single large

12-24 4-12 merozoites merozoites large, round large, round