Number of Species of Malaria

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QUESTION

I recently read an ISOS world malaria day poster saying 5 species of plasmodium cause malaria. I think that is confusing as we always talked about 4, ovale, vivax, falciparum and malaria….are they referring to the way we now split ovale into 2 sub species? or is this a typo on their part?

ANSWER

That is a really interesting question, and a good observation on your part! I imagine the fifth species they are referring to is Plasmodium knowlesi, which is found in parts of south-east Asia, with the majority of cases being reported from Borneo. Originally known only from macaque monkeys, it appears to be occurring more frequently in humans. However, it is not known whether this is a new host switch, or whether it is simply a matter of better detection methods—the morphology of P. knowlesi closely resembles that of P. falciparum in its early trophozoite stages, and P. malariae in later trophozoite and other life stage forms. Moreover, some molecular-based tests for P. knowlesi cross-react with other forms of malaria, such as P. vivax, leading to greater diagnostic confusion.

There is also a hypothesis that changes in land use in tropical forests may be resulting in greater human exposure to the vectors which carry P. knowlesi, which accounts for its increased recent prevalence in humans. P. knowlesi is the only known malaria in humans (and indeed, in all primates) with a 24-hour reproductive cycle, which means that without treatment, high levels of parasitaemia can accumulate rapidly in the blood, and lead to severe clinical symptoms. This makes its apparent emergence of great public health concern in south-east Asia. Luckily, at this point, P. knowlesi is completely susceptible to chloroquine treatment and other medications, and so is easily controlled once diagnosed.

One of our contributors, Christina Faust, wrote a blog post last year on P. knowlesi entitled Of Macaques and Men. More information on recent research about P. knowlesi can be found in the article, Monkeys Provide Malaria Reservoir for Human Disease in South-East Asia.

What is “Pf” and “Pv” in relation to malaria?

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QUESTION:

What is pf and pv?

ANSWER:

“Pf” stands for Plasmodium falciparum and “Pv” stands for Plasmodium vivax. These are two different species of the parasite that causes malaria in humans. Pf causes the most acute, severe form of the disease, which can have a cerebral manifestation (“cerebral malaria”) and causes the most deaths worldwide. Pv is still a serious disease, but usually less severe. If diagnosed early, both forms are easily treated and completely curable.

What are the strains of malaria?

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QUESTION:

What are the different strains of malaria?

ANSWER:

Malaria is caused by small, single-celled parasites called protozoans, and specifically ones of the genus Plasmodium. There are many, many species of Plasmodium, which infect a wide variety of different species, from lizards and birds to rodents, bats and primates. Of all the species of malaria, four main ones infect humans – these are P. falciparum, P. vivax, P. ovale and P. malariae. A fifth species, P. knowlesi, usually infects macaque monkeys in South East Asia but has been known to cross over to humans. Each of these species causes slightly different manifestations of the disease in humans, and even within the species, there are regional strains and variations. Probably the most distinct internal division within a malaria species is within P. ovale, where two sub-species are currently recognised: P. ovale curtisi and P. ovale wallikeri. These two forms are identical morphologically (that is, in the way they look under the microscope) but can be differentiated genetically.

Causes of Malaria

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QUESTION:

What causes malaria?

ANSWER:

Malaria is a disease caused by a parasitic single-celled animal known as Plasmodium. There are different species of Plasmodium, which cause different kinds of malaria. The main types which infect humans are P. falciparum, P. vivax, P. ovale and P. malariae. The parasite is transmitted by certain species of mosquito; the parasite lives in the human blood stream and so goes in to the mosquito when the insect feeds. When the same individual mosquito then feeds on another person, it transmits parasites into a new host.

The symptoms of malaria are caused by the actions that the parasite undertakes while in the human host. For example, part of its reproductive cycle involves invading and then multiplying inside red blood cells. Once several cycles of reproduction have occurred, the new parasites burst out of the red blood cell, destroying it. The cycles are times so that all the new parasites burst out of the red blood cells at the same time; this coordinated destruction of the red blood cells, either every 24, 48 or 72 hours, depending on the malaria species, causes the one day, two day or three day cycles of fevers and chills that characterise malaria infection episodes.

How Many Types of Human Malaria?

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QUESTION:

How many types of malaria infect humans?

ANSWER:

There are four main types of malaria which infect humans: Plasmodium falciparum, P. vivax, P. malariae and P. ovale. P. ovale additionally can be split into two sympatric sub-species, P. o. curtisi and P. o. wallikeri. Each of these five kinds has a subtly different life cycle which results in slight variations in symptoms and also in treatment. For more information on this, check out the Q&As on malaria symptoms and malaria treatment; CDC is also a site worth checking out.

Additionally to the four species above, there are observations of a number of other Plasmodium species being able to infect humans, although much less frequently. The most reported of these is P. knowlesi, found in SE Asia, which usually infects macaque monkeys but is capable of crossing over into humans and causing severe quotidien malaria, and may even result in death. The number of cases of P. knowlesi appears to be on the rise in some regions, although the cause of this is not quite clear. For an introduction to P. knowlesi, you should read Christina Faust’s blog.

The list of other species of Plasmodium that have been reported to infect humans (sometimes only experimentally in the lab) includes P. brasilianum, P. cynomolgi, P. eylesi, P. inui, P. rhodiani, P. schwetzi, P. semiovale, P. simium and P. tenue.