Malaria And Babesia

Front 1

Vector for malaria

Back 1

arthropod vector: Female Anopheles Mosquito

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Cases of Malaria reported in the US

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1,500 annually

53 locally transmitted; not endemic

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Number of cases of transfusion-transmitted mosquito-borne malaria in the US

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1963-2011: 97 cases

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What type of protozoa is malaria considered?

Back 4

Flagellate

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Percentage of world population endemic

Back 5

41%

Front 6

How many cases a year?

Back 6

300-500 million cases each year

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What is the typical geographical location Blood protozoa are found in?

Back 7

Equator area

Front 8

Where are high risk areas

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• Africa
• Asia
• Middle East
• Central
• South America
• Hispaniola
• Oceania

Front 9

Modes of transmission of blood parasites?

Back 9

• Mosquito
• Blood/Blood products
• Congential
• Shared Needles

Front 10

A parasite similar to Malaria

Back 10

Babesia microti

Front 11

When do the clinical manifestations of malaria typically appear?

Back 11

8-30 days after exposure

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Common Clinical manifestations of Malaria

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• Fever: irregular for the first week or more
• Anemia; lyses RBCs
• Splenomegaly
• Mild jaundice

Front 13

Jaundice can be sever in?

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P. falciparium infection

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Malaria and pregnancy

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• Susceptibilty to P. falciparum
• P. falciparum contributes to 8-14% of low birth weight

Front 15

Tercian Malaria

Back 15

48 hours between fevers

P. vivax

P. ovale

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Quartan Malaria

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72 hours between fevers

P. malariae

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Malaria tropica

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Irregular fever

P. falciparum

Front 18

Infected RBC

<N, N:

Back 18

P. malariae

Front 19

Infected RBCs

N:

Back 19

P. falciparum

Front 20

Infected RBCs

>N:

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P. ovale

Front 21

Infected RBCs

>>N:

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P. vivax

Front 22

Infected RBCs

Schuffner's Dots:

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P. vivax

P. ovale

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Infected RBCs

Crescent shape

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P. falciparum

Front 24

Infected RBCs

Ameboid

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P. vivax

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Infected RBCs

Fimbriation

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P. ovale

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Infected RBCs

Elongated

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P. ovale

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Circulating blood

Rings only

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P. falciparum

Front 28

Numerous Rings

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P. falciparum

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Multiply infected RBCs (Rings)

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P. falciparum

Front 30

Accessory Chromatin dots (Rings)

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P. falciparum

Front 31

Delicate Rings

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P. falciparum

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Ameboid Trophozoites

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P. vivax

Front 33

Compact Trophozoite

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P. ovale

P. malariae

P. falciparum (rare)

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Band form (Trophozoites)

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P. malariae

Front 35

6-12 nuclei (schizonts)

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P. malariae

Front 36

6-14 nuclei (schizonts)

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P. ovale

Front 37

12-24 (schizonts)

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P. vivax

Front 38

8-24 (schizonts)

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P. falciparumm (rarely seen)

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Rosettes (schizonts)

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P. malariae

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Crescent (Gametocytes)

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P. falciparum

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Round (Gametocytes)

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P. ovale

P. vivax

P. malariae

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What Plasmodium spp. doesn't enlarge RBC

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P. falciparum

P. malariae

Front 43

What plasmodium spp. enlarges RBCs

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P. vivax

P. ovale

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Geographical location of P. falciparum

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• Africa
• Asia
• Central and South America
• Haiti
• India
• Oceania

Front 45

Geographical location of P. malariae

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• Most endemic areas
• Common in Sub-Saharan Africa

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Geographical location of P. vivax

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• Asia
• Africa
• Central and South America
• Haiti
• India
• Oceania
• More common than P. falciparum in India and Central America

Front 47

Geographical location of P. ovale

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• Rare outside of Africa
• Southern India

Front 48

What Plasmodium spp attacks all stages of RBCs

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Plasmodium falciparum

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Parasitemia

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# of RBC with parasites in them

Front 50

How many RBCs can P. falciparum infect

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up to 48%

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Acute course of P. falciparum

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• Cause abortions, still births and death in pregnant women
• Blackwater fever
• Cerebral malaria

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What stage of RBCs does P. malariae infect

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Mature

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What % does P. malariae infect

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~0.2%

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What stage of development are P. malariae at?

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Typically at 1 stage of development

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Illness associated with P. malariae

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Typically benign

Chronic infections in children lead to nephrotic syndrome

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Blackwater fever

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• Many RBCs are lysed during a paroxysm (fever, chills, followed by fever)
• Enlarged spleen and liver
• Renal failure due to renal anoxia
• Black= hemoglobin in urine

Front 57

Cerebral Malaria

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• Blood vessels in brain become infected
• May lead to coma and death
• No parasites in CSF

Front 58

What type of RBCs does P. ovale target?

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Mature RBC

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Incubation of P. ovale

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10-17 days

Periodicity: 48 hours

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P. ovale milder fever

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Complication rare usually due to debility or preexisting disease

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P. vivax parasitizes what RBCs?

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Younger RBCs

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Incubation and Periodicity P. vivax

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10-17 days

48 hours

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What stage are P. vivax at

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Typically one stage of development

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Who is at less of a risk of parasite infection of P. vivax

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West Africans aren't infected due to lack of Duffy antigen on RBCs

Front 65

What is the infective stage of Plasmodium spp.

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bite from female mosquito with sporozoites

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What stage of Plasmodium infects liver cells

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sporozoites (exoerthrocytic stage)

Front 67

What life stage invades RBCs

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merozoites

erythrocytic stage

Front 68

Life stages following merozoite stage

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Forms trophozoite-->schizont--> ruptures and enters new RBCs

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What is the final stage in humans

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Micro and macrogametes

Misquito bites human

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Thick smear

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No. parasites *(8000/No. WBCs counted)= No. of parasites in blood

RBC lysed

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Thin smear

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(No. infected RBCs/Total No. RBCs counted)*100= % of infected RBCs

Minimum of 500 RBCs should be counted

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Positive thick film

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0.0001-.0004% (5-20/uL)

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Naive patients may be symptomatic below this level

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0.0002% (100/uL)

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Maximum Parasitemia of P. vivax, P. ovale

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2% (100,000/uL)

Young RBCs only

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Hyperparasitemia severe mortality

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2-5% (100,000-250,000/uL)

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Exchange tranfusion, high mortality

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10%

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What is rarely seen in a P. falciparum smear?

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Trophs (more dense than younger rings)

Schizonts (8-24 small merozoites)

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"Basket form" is seen in

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P. malariae

Rosettes schizonts also seen

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Schuffner's dot is seen with

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P. vivax

P. ovale

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Slight deformation of the RBC

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P. ovale

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Host of Babesia

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White-tail deer

White-footed mice

Cattle

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Vector of Babesia

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Deer tick Ixodes scapularis or I. dammini

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Where does B. microti live and reproduces

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within RBCs

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What does B. microti mimic

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P. falciparum

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What geographical location does Babesia sp occur

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Norhteast: Mass, NY, New Jersey, New England

Upper Midwest: Wisconsin and Minnesota

West Coast: Ca, Wa

Europe: B. divergens

Peak during warm months

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Clinical manifestation of Babesia

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May be asymptomatic

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Signature of B. microti

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Four merozoites- "Maltese Cross"

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Babesia sexual reproduction takes place in

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Tick

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Babesia zygote migrate to

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salivary gland of tick

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What is the infective stage of Babesia

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sporozoite form and enter during blood meal

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What happens when babesia infects human RBC

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become trophozoites and divide by asexual reproduction

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What are released from RBCs in Babesia

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Merozoites; infect additional cells

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What cycle does Babesia lack in humans

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exoerythorocytic cycle

Merozoites can become gametes

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transovarian transmission

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occurs in the tick allowing the life cycle to continue without an intermediate host

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Intermediate host in Babesia

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Human

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Geographic distribution P. knowlesi

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Southeast Asia

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What is P. knowlesi transmitted from?

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long-tailed

pig-tailed macaques

considered zoonotic

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What does P. knowlesi look like?

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P. malariae but can also look similar to ring trophozoite in P. falciparum

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Giemsa Stain of P. knowlesi

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Troph can have Sinton and Mulligan stippling

A band resembling P. malariae

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A blood film request is always...

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A STAT

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Automation can cause

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false negative

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Parasites can continue to grow in

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EDTA tubes

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Problems encountered with Malaria patient

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• Vague symptoms poor travel history
• Self-medicate
• Malaria not considered
• Automated exam
• low parasitemia (<0.1% to 0.0001%), Immunologically naive

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What group is babesia microti life threatening to?

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• Young, elderly, and immunosuppressed patients
• symptoms 1-6 weeks
• Malaria like
• Hemolytic anemia
• respiratory, liver, or renal failure, or disseminated intravascular coagulation

Front 105

When can you lose parasites

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>4 to 6 hours delay in smear preparation

distortion in >1 to 2 hours

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Poor adhesion to slide

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If ratio of EDTA/blood too high or blood held in EDTA too long

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Blood stain of choice

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Giemsa

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EDTA P. falciparum

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gametocytes round up confusing morphology

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EDTA P. vivax

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ameboid trophs no Schuffners dots

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Plasmodium spp. EDTA

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male gametocytes exflagellate resemble Borrelia: related to pH, pCO2 (room temp cap off)

Front 111

Temperature effects

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• P. falciparum: at warm temp rings will grow mimic malariae
• P. falciparum: gametocytes will round up; mimic P. malariae
• Plasmodium spp.- all rings will develop at a faster rate
• All round up in refrigerator temps

Front 112

What is the QC organism

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PMNs

Front 113

Advantages of Thin blood film

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• RBC morphology visible
• Compare size of RBCs infected to uninfected RBC
• Easier to ID to species level
• Calc parasitemia

Front 114

Disadvantage of Thin blood film

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• Lower sensitivity
• Low parasitemia may be missed

Front 115

Advantages of Thick blood film

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• Examining greater volume of blood
• See malaria pigment within WBCs
• May see schuffner's dots

Front 116

Disadvantages of thick blood film

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• Can't compare sizes of infected and uninfected RBCs
• Organism distortion hard to recognize
• Species level is more difficult to id