Trophozoites of Plasmodium Vivax

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QUESTION

What should I take in this condition? After treatment I came to know that Rechocin should be taken for 6 months 2  weekly.

ANSWER

I am not sure I understand your question, but if you have been diagnosed with trophozoites of Plasmodium vivax in your blood, then you can be treated with normal anti-malarials (the World Health Organization recommends artemisinin-based combination therapies for first line treatment of uncomplicated malaria, but depending where you are, you might even just be able to take chloroquine), as these kill the blood stages of malaria. To prevent relapse, caused by hypnozoites dormant in the liver, you should talk to your doctor about the possibility of also taking a course of primaquine, which usually lasts 14 days. This drug is not suitable for people with G6DP deficiency, however, so you may need a test for this condition before you can take the treatment.

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.

Transmission of Malaria

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QUESTION

Why can the malaria parasite be transmitted from mosquito to human, but not from human to human (via blood)?

ANSWER

This is a very good question, and actually, malaria can be transmitted via human blood directly to another person, but this occurs relatively rarely!

It has to do with the life cycle of the malaria parasite. When a mosquito bites a human host, it injects sporozoites from its salivary glands into the blood. This life stage first migrates to the liver, where it undergoes a cycle of multiplication, before entering the blood stream. Here, in the so-called “erythrocytic” portion of the life cycle, the parasite reproduces a series of times in red blood blood, before finally forming gametocytes, which are required to be ingested by a mosquito vector during another blood meal for the life cycle to be continued. As such, when blood is passed between people, they would have to pass infected red blood cells, and not gametocytes (which are not infective to humans, only to mosquitoes) in order for the other person to become infected.

As such, when a person who is infected with malaria donates blood, there is a chance that they might pass on some red blood cells which are infected with mature trophozoites or schizonts; these could then go on to infect more red blood cells in the person who received the blood. However, in most countries, blood is screened for malaria, and in fact, in many places, people who might have been exposed to malaria are not allowed to donate whole blood, only plasma (in which the red blood cells have been removed, and therefore there is no risk of transmission). Given the high levels of malaria prevalence in some endemic countries, however, preventing people from donating blood who are positive for malaria may result in too little blood being collected; in these cases, other strategies, such as treating donors or closely monitoring patients post-transfusion, may prove to be a better strategy.

malaria life cycle schematic CDC

Schematic of the malaria life cycle, courtesy of CDC (www.cdc.gov)