Malaria classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Yazan Daaboul, Serge Korjian, Alison Leibowitz [2], Marjan Khan M.B.B.S.[3]

Overview

The classification of malaria can be established according to the strains of Plasmodium species. There are five common Plasmodium species that infect humans: P. falciparum, P. ovale, P. vivax, P. malariae, and P. knowlesi. Malaria can also be classified according to severity of infection: uncomplicated vs. severe.[1][2]

Classification

Classification by Plasmodium Strain

The following Plasmodium strains are the most common strains implicated in human malarial infection.[1][3]

Comparison of Plasmodium Species Implicated in Human Malaria [4]
Strain Appearance of Erythrocyte (RBC) Appearance of Parasite Clinical Significance
P. falciparum
  • Normal appearance with Maurer's clefts: Ring, trophozoite, and schizont forms.
  • Distorted appearance: Gametocyte form
  • Chromatin dots and "appliqué" (accolé): Ring form
  • Clump of mass and dark pigment: Trophozoite and schizont forms
  • Crescent or sausage shape: Gametocyte form
Tertian/subtertian fever (every 48 hours), causes severe malaria in up to 24% of cases, and is frequently drug resistant.
P. vivax
  • Normal with fine Schüffner dots: Ring form
  • Enlarged with fine Schüffner dots: Trophozoite, schizont, and gametocyte forms
  • Large cytoplasm with pseudopods: Ring form
  • Large ameboid cytoplasm with yellow-brown pigment: Trophozite form
  • Large mass that fills RBC with yellow-brown coalescent pigment: Schizont form
  • Large mass that fills RBC with scattered brown pigment: Gametocyte form

Tertian fever (every 48 hours), results in severe malaria in up to 22% of cases, and is frequently drug resistant. Relapse is common due to the dormant liver phase.

P. ovale Normal with fine Schüffner dots
  • Sturdy cytoplasm and large chromatin: Ring form
  • Compact cytoplasm with dark-brown pigment: Trophozoite form
  • Large nuclei clustered around mass of dark-brown pigment: Schizont form
  • Round to oval form that fills RBC with scattered brown pigment: Gametocyte form
Tertian fever (every 48 hours), rarely causes severe malaria or drug resistance. Relapse is common due to dormant liver phase.
P. malariae Normal with Ziemann's stippling
  • Sturdy cytoplasm and large chromatin: Ring form
  • Compact cytoplasm with occasional band forms and coarse dark-brown pigment: Trophozoite form
  • Large nuclei clustered around a mass of coarse, dark-brown pigment and occasional rosettes: Schizont form
  • Round to oval form that fills RBC with scattered brown pigment: Gametocyte form
Quartan fever (every 72 hrs), rarely results in severe malaria or drug resistance. Although dormant liver phase is uncommon, infection persistence is frequently demonstrated.
P. knowlesi Normal with Sinton and Mulligan stippling
  • Delicate cytoplasm with appliqué (accolé) forms: Ring form
  • Compact cytoplasm and large chromatin with band forms and dark-brown pigment: Trophozoite form
  • Segmentation with large nuclei around a mass of coarse brown pigment and occasional rosettes: Schizont form
  • Round to oval form that fills RBC with scattered brown pigment: Gametocyte form
Daily fevers, may result in severe malaria in up to 10% of cases, although resistance is rare.
Adapted from Center for Disease Control and Prevention (CDC) - Malaria

Classification by Severity of Infection

The following table classifies malarial infections by severity.

Comparison of Malaria Infections According to Severity[5]
Severity Clinical Significance
Uncomplicated

Attack lasts 6-10 hours consisting of 3 stages:


Non-specific symptoms:


Physical findings:

Severe

Malaria is complicated by organ damage and is considered a medical emergency that requires prompt hospitalization.

Adapted from Center for Disease Control and Prevention (CDC) - Malaria

References

  1. 1.0 1.1 Long CA, Zavala F (2017). "Immune Responses in Malaria". Cold Spring Harb Perspect Med. doi:10.1101/cshperspect.a025577. PMID 28389518.
  2. Srisutham S, Saralamba N, Malleret B, Rénia L, Dondorp AM, Imwong M (2017). "Four human Plasmodium species quantification using droplet digital PCR". PLoS One. 12 (4): e0175771. doi:10.1371/journal.pone.0175771. PMID 28423028.
  3. Rath A, Prusty MR, Barik SK, Das M, Tripathy HK, Mahapatra N; et al. (2017). "Development, standardization and validation of molecular techniques for malaria vector species identification, trophic preferences, and detection of Plasmodium falciparum". J Vector Borne Dis. 54 (1): 25–34. PMID 28352043.
  4. ("Malaria". Center for Disease Control and Prevention. Center for Disease Control and Prevention (CDC). Nov. 29 2013. Retrieved Jul 24 2014. Check date values in: |accessdate=, |date= (help)
  5. "Malaria". Center for Disease Control and Prevention. Center for Disease Control and Prevention (CDC). Nov. Feb 8 2010. Retrieved Jul 24 2014. Check date values in: |accessdate=, |date= (help)



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