Plasmodium spp.

Parasitology Dept.

Plasmodiums
Terminology

Phylum Apicomplexa
Subphylum Sporozoa
Class Telosporea
Subclass Hmosporina
Family Plasmodiid
Vectored primarily by female Anopheles
mosquito

Plasmodiums
Distribution

Causes malaria disease

Four species of the genus Plasmodium: P. vivax, P.
ovale, P. malariae, and P. falciparum
P. vivax accounts for the vast majority of malarial
infection, because o/t wide distribution o/t parasite
P. vivax is the only one that extends through tropical,
subtropical, and temperate regions

Plasmodiums
Distribution

P. falciparum, which causes falciparum malaria,

is confined to the tropics and subtropics, and is
probably the most lethal form of malaria
Pockets of P. malariae infection are distributed
throughout the tropics and subtropics
P. ovale is primarily confined to tropical West
Africa, South America, and Asia

Plasmodiums
Life cycle

Complex life cycle, involving both sexual and

asexual phases
Asexual phase, called schizogony, occurs in
the vertebrate (which is intermediate host)
Sexual phase, called sporogony, occurs in the
insect, the definitive host

Life Cycle

Exoerytrocytic Cycle in Man

Anopheline mosquito injects infective

sporozoites into man
Migrate to liver parenchyma where schizogony
begins (called exoerythrocytic/ preerythrocytic
schizogony), produces exoerythrocytic schizonts
exoerythrocytic merozoits invade RBC
In P. vivax and P. ovale, dormant exoerythrocytic
schizonts (hipnozoits) occurs
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Life Cycle

Erythrocytic Cycle in Man

When exoerythrocytic merozoits invade RBC,

erytrocytic cycle begins
Merozoits ring form trophozoits mature
trophozoits schizonts erythrocytic
schozogony (erythrocytic) merozoits
gametocytogenesis gametocytes
(macrogametocytes & microgametocytes )

Life Cycle

Sexual Phase in Mosquito

After a mosquito has ingested gametocytes,

fertilization occurs zygotes ookinete
oocyst bursts out sporozoits reach
salivary glands
When the mosquito injects saliva while
obtaining a blood meal, it also injects
sporozoits into human host
Only female Anopheles take blood meals

Anopheles

Vector of Plasmodiums

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Blood Smear

Thick and thin blood smear

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Plasmodium vivax

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Plasmodium vivax
General

Synonims: Haemamoeba vivax, Plasmodium

malariae tertiana
Prepatent period: 8-17 days (depends on the
number of inoculated sporozoits and strain),
usually 14 days
Prepatent period is also called biological
incubation period: the period required since
sporozoits enter a human until it is demonstrated
in the blood stream
13

Plasmodium vivax

Morphology in Stained Preparation

Ring form : blue-stained

ring of cytoplasm with a
red chromatin dot
Late ring form: stippling
(Schuffners dots)
appear, no pigment yet

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Plasmodium vivax

Morphology in Stained Preparation

The early erythrocytic

trophozoit : bluestained cytoplasm with
a red chromatin dot,
stippling and pigments
appear, enlarged
infected RBC
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Plasmodium vivax

Morphology in Stained Preparation

Mature trophozoit: the

plasmodium enlarge, the
sitoplasm becomes
irregular and larger
(amoeboid), stippling
and pigments (+)
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Plasmodium vivax

Morphology in Stained Preparation

Schizont: progressive
steps in division
(presegmenting)

Mature schizont: consist

of 8-24 merozoits, usually
12-18

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Plasmodium vivax

Morphology in Stained Preparation

Macrogametocyte: female gametocyte,

stains deep blue, smaller nucleus,
chromatin is arranged in a compact mass
near the periphery
Microgametocyte: male gametocyte, stains
pale blue, larger nucleus, the chromatin is
irregularly situated within the cytoplasm
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Plasmodium vivax

Morphology of all stadiums

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P. vivax pd sediaan darah tipis

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P.vivax pd sediaan darah tipis

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P.vivax pd sediaan darah tebal

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Plasmodium ovale

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Plasmodium ovale
General

Synonims: Plasmodium vivax minutum

Prepatent period: minimal 8 days,

average 14-16 days

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Plasmodium ovale

Morphology in Stained Preparation

Ring form: resembles to that of P. vivax,

chromatin dot is larger
Late ring: James dots occasionally appear,
infected RBC is slightly enlarged

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Plasmodium ovale

Morphology in Stained Preparation

Trophozoit: non-amoeboid, infected RBC is

oval in shape with fimbriation (comet-like),
stippling and pigments (+)

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Plasmodium ovale

Morphology in Stained Preparation

Mature schizont:
contains 6-12 merozoits,
usually 8

Gametocyte: similar to P.
vivax
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Plasmodium ovale

Morphology of all stadiums

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Plasmodium malariae

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Plasmodium malariae
General

Synonims: Plasmodium malariae

quartana, Plasmodium quartana

Prepatent period: minimal 14 days,

average 28-37 days

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Plasmodium malariae

Morphology in Stained Preparation

Ring form: compact cytoplasm

Late ring: infected RBC is not enlarged,

stippling (Ziemanns dots) never seen

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Plasmodium malariae

Morphology in Stained Preparation

Mature trophozoit: band

form
Schizont: contains 6-12
merozoits, usually 8,
arranged in a rossette
formation
Gametocyte: resembles to
those of P. vivax
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Plasmodium malariae
Morphology of all stadiums

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Plasmodium
falciparum

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Plasmodium falciparum
General

Synonims: Plasmodium tropica

Prepatent period: minimal 5 days,

average 8-12 days

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Plasmodium falciparum

Morphology in Stained Preparation

Ring form: vary in

shape; double
chromatin, multiple
infection, accole,
blister, flame

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Plasmodium falciparum

Morphology in Stained Preparation

Trophozoit: rare in
peripheral blood after
half grown, infected RBC
is normal sized, stippled
(Maurers dots) and
pigmented
Note at the Maurers dots
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Plasmodium falciparum

Morphology in Stained Preparation

Schizont: consist of 8-26 merozoits,

usually 8-18, rare in peripheral blood

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Plasmodium falciparum

Morphology in Stained Preparation

Microgametocyte: sausage shape, chromatin diffuse, large nucleus

Macrogametocyte: longer and more slender, central chromatin,
pigment and nucleus more compact

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Plasmodium falciparum

Morphology in Stained Preparation

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P. falciparum pd sediaan darah tipis

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P. falciparum pd sediaan darah tebal

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43

Plasmodium falciparum
Morphology of all stadiums

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Pemeriksaan laboratorium
I.

II.

III.

Pemeriksaan dgn mikroskop

SD tebal dan tipis utk menentukan :
1. positif atau negatif
2. spesies dan stadium plasmodium
3. kepadatan parasit
Tes diagnostik lain :
Deteksi Antigen/Antibody plasmodium
- QBC
- ELISA
- Dipstick
Molekuler : PCR

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Rapid Diagnostic Test

Tes Diagnostik Cepat ( Rapid Diagnostik Test)
1. Deteksi 1 Antigen ( Pf test, ICT test,
Paracheck yg mengandung Ab
monoklonal thd HRP II)
2. Deteksi 2 Antigen ( P.f, dan P.v)
3. Deteksi 4 Antigen ( PAN MALARIA )

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Rapid Diagnostic Test

Kelemahan :
1. Mahal
2. Kepekaan tgtg kepadatan parasit.
3. Tdk dpt hitung kepadatan parasit
4. Tdk dpt mengetahui stadium parasit
5. Positif/negatif semu
6. Spesies tgt Ag-nya
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Diagnostik Parasitologis Malaria

Idealnya darah diambil akhir stadium

demam, memasuki stad berkeringat.

Sediaan darah tebal : 10 l darah (3 tts)
Sediaan darah tipis : 2 l (1 tts)

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Kepadatan Parasit
1.
2.

Semi kuantitatif
Kuantitatif
Kepadatan parasit dihitung pd SD tebal per
200 lekosit atau SD per 1000 eritrosit
Pisahkan jlh parasit aseksual dgn sexual
(gametosit)

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Kepadatan parasit

Contoh :
1500 parasit/200 lekosit
kepadatan parasit :
8000 x 1500 = 60000 parasit/l
200
50 parasit/1000 eritrosit = 5 %
kepadatan parasit :
5.000.000 x 50 = 250.000 parasit/l
1000
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Kepadatan parasit

Hiperparasitemia
Bila > 5 % eritrosit terisi parasit
> 250.000/l
Penderita tersangka malaria :
pemeriksaan SD negative, ulang setiap 6 jam
sampai 3 hr berturut-turut

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Epidemiologi Malaria
Penularan

malaria > 100 negara didunia.

Merupakan yang ketiga pada kasus
penyakit menular di dunia.
Malaria dijumpai pada : 60L.U - 32L.S
Tertinggi : 266 m diatas permukaan laut
Terendah : 433 m dibawah perm. Laut.
Di luar daerah tersebut : bebas malaria
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Efektifitas Vektor

1.
2.
3.
4.

Ditentukan oleh:
Kepadatan vektor dekat pemukiman
manusia
Kesukaan menghisap darah manusia
(antroopofilia)
Frekuensi menghisap darah
Lamanya sporogoni
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Berdasarkan kebiasaan makan &

istirahat anopheles terbagi:
Endofili

: suka tinggal dalam rumah

Eksofili
: suka tinggal diluar rumah
Endofagi
: menggigit dalam rumah
Eksofagi
: menggigit diluar rumah
Antropofili : suka menggigit manusia
Zoofili
: suka menggigit
binatang

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Faktor yang mempengaruhi

epidemiologi :
1.
2.
3.
4.

Lingkungan
Manusia
Vektor
Parasit
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Ad.1. : Lingkungan
Ditentukan oleh :
Suhu ; Suhu yang optimum 2030C. Makin tinggi suhu (s/d batas
tertentu) makin pendek masa inkubasi
ekstrinsik (sporogoni) dan sebaliknya.
Kelembaban ; tingkat kelembaban
60% merupakan batas paling rendah
untuk hidup nyamuk
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Ad.a : Lingkungan Fisik

Hujan

; hujan yang diselingi panas akan

memperbesar kemungkinan berkembang
biak nyamuk anopheles.
Ketinggian : Secara umum malaria
berkurang pada ketinggian yang semakin
bertambah, tetapi bida berubah bila
terjadi pemanasan bumi dan El- Nino

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Parameter pada survei

malaria :
1.
2.
3.

Parasite Rate (PR)

Spleen Rate (SR)
Average Enlarged Spleen
(AES)
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Ad.1 : Parasite Rate (PR)

Defenisinya

adalah :
persentase penduduk yang
darahnya mengandung
parasit malaria pada saat
tertentu.
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Ad.2 : Spleen Rate (SR)

SR = jlh anak yg besar limpanya x 100

jlh anak yg diperiksa limpanya

Anak umur 2-9 tahun

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Ad.3: Average Enlarged Spleen

(AES)
Adalah

rata-rata pembesaran
limpanya dapat diraba.
AES ini bermanfaat untuk
mengukur keberhasilan suatu
program pemberantasan.
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Endemisitas malaria :

1.
2.
3.
4.

Berdasarkan SR pada kelompok 2-9

tahun diklasifikasikan sbb:
Hipoendemik : SR 10%
Mesoendemik : SR 11-50%
Hiperendemik : SR 50%
Holoendemik : SR 75%
(dewasa : 25 %)
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Parameter Malaria
Annual Parasite Incidence (API)
API = Jlh penderita SD positif dlm 1 thn x 100%
Jlh penduduk daerah tersebut

Annual Blood Examination Rate (ABER)

ABER =Jlh sediaan darah yg diperiksa 1 tahun x 100%
jumlah Penduduk tahun tsb

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Parasite Rate (PR)

PR =
jumlah SD yg positif
x 100%
Jumlah seluruh SD yang diperiksa

Malaria Morbidity
Jumlah kasus malaria per 1000 penduduk (pada
penyakit lain per 100.000 penduduk)

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Pemberantasan Malaria di
Indonesia
1.
2.
3.
4.
5.

Parasit kontrol : pengobatan orang sakit

Vektor kontrol :
Penyemprotan dengan insektisida
Membasmi larva nyamuk
Biologik kontrol
Peran masyarakat
Imunisasi / vaksinasi
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Malaria

References

Heelan, J. S., Ingersoll, F. W.: Blood and Tissue Sporozoa in

Essentials of Human Parasitology, Delmar Thomson
Learning, US, 2002
Beaver, P. C., Jung, R. C., Cupp, E. W.: Malaria Parasites and
Piroplasm in Clinical Parasitology, 9th ed., Lea & Febiger,
Philadelphia, 1984
Peters, W., Pasvol, G.: Arthropod-borne Infections in
Tropical Medicine and Parasitology, 5th ed., Mosby,
London, 2001
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Thank You
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