3 Malaria

Tropical diseases
Department of Parasitology
Qin Yuanhua
Ten major tropical diseases
• 1. Malaria
• 2. Tuberculosis
• 3. Leishmaniasis
• 4. Onchocerciasis
• 5. Lymphatic filariasis
• 6. Schistosomiasis
• 7. African Trypanosomosis
• 8. Chagas Disease
• 9. Leprosy
• 10. Dengue fever
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Tropical diseases：
1. Malaria
2. Tuberculosis Presented By: Qin Yuanhua
3. Leishmaniasis
4. Onchocerciasis
5. Lymphatic filariasis
Department of Parasitology
6. Schistosomiasis
7. African Trypanosomosis
8. Chagas Disease
9. Leprosy
10. Dengue fever
• 1. Malaria is one of the ten major
tropical diseases.
Each year, more than 1,000,000 children die of
malaria in Africa.
Tu Youyou jointly won the 2015 Nobel Prize for medicine for their work
against malaria. They discovered artemisinin , a drug that has significantly reduced
the mortality rates for patients suffering from malaria.
Tu Youyou (China Academy of Chinese Medical Sciences, Beijing)
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• 1.5 billion persons live in areas of the world where malaria
is an endemic disease
• the number of infected humans exceeds 500,000,000
• 1-2 million persons die each year.
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2.What is malaria?
Malaria is a serious and sometimes fatal

disease caused by a parasite. Patients with
malaria typically are very sick with high
fevers, shaking chills, and flu-like illness.
Four kinds of malaria parasites can infect
humans: Plasmodium falciparum, P. vivax,
P. ovale, and P. malariae.
3. Is malaria a common disease?
Yes. The World Health Organization

estimates that each year 300-500 million
cases of malaria occur and more than 1
million people die of malaria.
4. Is malaria a serious disease?
Yes. Malaria is a leading cause of death

and disease worldwide, especially in
developing countries.
Most deaths occur in young children. For
example, in Africa, a child dies from
malaria every 30 seconds.
Ⅱ Morphology
There are four stages visible in the peripheral blood.
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Ring stage of p. v.
nuclear
cytoplasm
Red nuclear chromatin; blue cytoplasm.

The rings are large and may contain one chromatin dots rather than
two.
The rings are in the center and occupy 1/3 the diameter of RBC
There is often one parasite per cell.
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Morphology
Ring form:
(Plasmodium vivax )
a ring of bluish
cytoplasm with
a dot-like nucleus
• Late ring in a RBC with
Schüffner's dots; 60 y.o.
man
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mature trophozoite of p. v.
malarial
pigment
cytoplasm
nucleus
Schüffner's
dots
One nucleus；
The ameboid cytoplasm: cytoplasm becomes abundant
and with irregular shape;
Brownish-black malarial pigment .
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Trophzoite of Plasmodium vivax
• irregular
cytoplasm and
enlarged
nucleus with
malarial
pigment
• ( hemozoin)
mature trophozoite of p. v.
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Young immature schizont with several chromatin masses.
Mature schizont, the cytoplasm is pink rather than blue
chromatin masses are visible: it has more than 12 merozoites.
malarial
pigment
merozoites
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Schizont of P.vivax
• multiple masses of
nuclear chromatin
Infected red blood cell and schizozoite
Infected red blood

cell
schizozoite
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Gametocytes of P.v.
（Giemsa’s stain ）
nucleus
Gametocytes
nucleus
Gametocytes
Gametocytes generally fill the enlarged red cells, as seen

here, and can be distinguished from trophozoites by their
more compact, homogeneous cytoplasm.
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female:
With a compact chromatin
mass located peripherally.
Pigment granules are not
readily apparent but the
Schuffner’s dot is distinct.
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Male
The chromatin material is diffuse
and located near the center of
parasite.
The cytoplasm is light blue and
the pigment is clearly visible.
Pigment is often heavier and more
prominent in gametocytes than in
trophozoites.
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Ⅲ Life cycle
• The malaria parasite life cycle involves two

hosts.
• During a blood meal, a malaria-infected

female Anopheles mosquito （按蚊）
inoculates sporozoites(子孢子) into the
human host
Ⅲ . Life cycle
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Vector mosquito: culex, anopheles
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In mosquito
1 Completion of
gametogony
（配子生殖）
2 Sporogony
（孢子生殖）
In mosquito
• The gametocytes（配子体）, male

(microgametocytes) and female
(macrogametocytes), are ingested by an
Anopheles mosquito during a blood meal
In huaman
• Blood stage parasites are responsible

for the clinical manifestations of the
disease.
Key points of life cycle
• Host: intermediate host : human
definitive host : mosquito
• Infective stage : sporozoite
• route of infection : mosquito bite skin of
human
• Inhabit of Parasite : liver and red blood cells
• Transmitted stage : gametocytes
• Sporozoite : tachysporozoite and
bradysporozoite
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•Schizogonic cycle in red cells :
48 hrs/P.v；
36-48 hrs/P. f
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2. Characteristic
(1). periodic
(2). repeated
(3). regular
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(1)Parasitized erythrocytes are destroyed directly
by the plasmodium.
(2)Depression of marrow function
(3)Hypersplenism
(4) Immune hemolysis
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4. Splenomegaly
• Tropical splenomegaly
syndrome. This young
Malaysian girl had a
protuberant abdomen due
to a large spleen extending
to the pelvis. She showed
high antibody levels to P.
falciparum and raised Ig M.
It is believed that the
condition results from
repeated infection with
malarial parasite along with
an abnormal immunological
response.
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• Spleen from a case of
P. falciparum
infection. The
deposition of malarial
pigment makes it
almost black in colour.
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symptoms
P.f: schizogony takes place in the capillaries of the
internal organs, the infected red cells tend to adhere
to one other and the small vessels may become
plugged. This may produce several fatal results:
Cerebral malaria
Renal failure
Serious anemia
Acute respiratory distress syndrome ARDS
Shock
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A. Clinical symptoms and history
B. Microscopic examination of blood.
1. Thin and thick smears (Giemsa's stain)
To master the morphology of parasites and
changes of infected red cells
2. P.f.: Only Ring forms and gametocytes can
be found in blood film.
C. Other methods:
Immunologic/Biochemical/Molecular diagnosis.
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Thin film
Thick film
Question: Which stages are
there in the blood film of P.v.
or P.f. ?
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Ⅵ Malaria Vaccines
1 Anti-sporozoite vaccines
2 Anti-asexual blood stage vaccines
3 Transmission-blocking vaccines
Vaccines are being developed and tried but
none is available yet for routine use .
Vaccine
Since October 2021, WHO has recommended broad use of the

RTS,S/AS01 malaria vaccine among children living in regions
with moderate to high P. falciparum malaria transmission. The
vaccine has been shown to significantly reduce malaria, and deadly
severe malaria, among young children. In October 2023, WHO
recommended a second safe and effective malaria vaccine,
R21/Matrix-M. The availability of two malaria vaccines is
expected to make broad-scale deployment across Africa possible.
Ⅶ Control and treatment
Treatment:
1 Cloroquine, Qinghaosu, etc. (blood
cycle)
2 Primaquine, Pyrimethamine,etc.(liver
stage)
3 Primaquine.(Gametocytes)
Mosquito control
Malaria supervision
• The end
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Tropical diseases

Tu Youyou (China Academy of Chinese Medical Sciences, Beijing)

Malaria is a serious and sometimes fatal

Yes. The World Health Organization

Yes. Malaria is a leading cause of death

There are four stages visible in the peripheral blood.

Red nuclear chromatin; blue cytoplasm.

Infected red blood

Gametocytes generally fill the enlarged red cells, as seen

• The malaria parasite life cycle involves two

• During a blood meal, a malaria-infected

• The gametocytes（配子体）, male

• Blood stage parasites are responsible

Since October 2021, WHO has recommended broad use of the

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