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Chapter 7 : Malaria and Babesiosis

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Abstract:

Malaria is a very common disease in many parts of the world, particularly in tropical and subtropical areas. Of the four most common spp. that infect humans, and account for 95% of infections. Some estimates indicate that may account for 80% of the infections. is generally confined to the tropics, is sporadically distributed, and is confined mainly to central West Africa and some South Pacific islands. A number of recent studies have reported on the benefits of using PCR for detection of malaria; the high sensitivity, rapidity, and simplicity of some of the methods should be applicable to large-scale epidemiology studies, follow-up of drug treatment, and immunization trials. Antimalarial drugs are classified by the stage of malaria against which they are effective. With the use of genetic engineering techniques and serologic immunofluorescence tests and other, newer techniques, progress toward vaccine production may lead to effective protection against malarial infections. Development of multi-immune response vaccine is required to reduce significantly the increasing numbers of malaria infections and deaths seen each year. The chapter talks about Babesiosis. Often, babesiosis can be effectively managed with supportive care. Currently, the combination of clindamycin plus quinine has been recommended as the standard regimen for human babesial infection. The most common and accepted approach used to protect humans from infection involves methods to reduce the tick density.

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7

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Figures

Image of Figure 7.1
Figure 7.1

Life cycle of spp. (Illustration by Nobuko Kitamura; adapted from Wilcox, A., , U.S. Public Health Service bulletin 180, National Institutes of Health, Bethesda, Md., 1951.)

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.2
Figure 7.2

Life cycle of malaria.

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.3
Figure 7.3

Scanning electron micrograph of exflagellating male gametocyte. (Courtesy of Robert E. Sinden.)

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.4
Figure 7.4

Pathogenesis of malaria. (Adapted from E. K. Markell and M. Voge, , 5th ed., The W. B. Saunders Co., Philadelphia, Pa., 1981.)

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.5
Figure 7.5

-parasitized blood cells plugging the capillaries in brain tissue. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.6
Figure 7.6

(A) Scanning electron micrograph of a rosette consisting of a central parasitized RBC surrounded by several attached uninfected RBCs (original magnification, ×19,000; bar, 1 µm). (B) Scanning electron micrograph of the interaction of a parasitized RBC with an uninfected RBC that appears to be mediated by protrusion of knobs (original magnification, ×53,000; bar, 0.5 µm). (From reference with permission.)

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Algorithm 7.1
Algorithm 7.1

Malaria.

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.7
Figure 7.7

Morphology of malaria parasites. : ( ) early trophozoite (ring form); ( ) late trophozoite with Schüffner’s dots (note enlarged RBC); ( ) late trophozoite with ameboid cytoplasm (very typical of ); ( ) late trophozoite with ameboid cytoplasm; ( ) mature schizont with 18 merozoites and clumped pigment; ( ) microgametocyte with dispersed chromatin; ( ) macrogametocyte with compact chromatin. : ( ) early trophozoite (ring form); ( ) early trophozoite with thick cytoplasm; ( ) early trophozoite (band form); ( ) late trophozoite (band form) with heavy pigment; ( ) mature schizont with nine merozoites arranged in a rosette; ( ) microgametocyte with dispersed chromatin; ( ) macrogametocyte with compact chromatin. : ( ) early trophozoite (ring form) with Schüffner’s dots; ( ) early trophozoite (note enlarged RBC); ( ) late trophozoite in RBC with fimbriated edges; ( ) developing schizont with irregularly shaped RBC; ( ) mature schizont with eight merozoites arranged irregularly; ( ) microgametocyte with dispersed chromatin; ( ) macrogametocyte with compact chromatin. : ( ) early trophozoite (accolé or appliqué form); ( ) early trophozoite (one ring is in the headphone configuration with double chromatin dots); ( ) early trophozoite with Maurer’s dots; ( ) late trophozoite with larger ring and Maurer’s dots; ( ) mature schizont with 24 merozoites; ( ) microgametocyte with dispersed chromatin; ( ) macrogametocyte with compact chromatin. : Without the appliqué form, Schüffner’s dots, multiple rings per cell, and other developing stages, differentiation among the species can be very difficult. It is obvious that the early rings of all four species can mimic one another very easily.

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.8
Figure 7.8

(Top row) Ring forms (note that double rings are not limited to and that the RBC is beginning to enlarge as the rings grow). (Second row) Growing trophozoites (note the ameboid nature of the trophozoites and the presence of Schüffner’s dots). (Third row) Developing schizonts (note the number of merozoites). (Bottom row) Mature schizonts, female gametocytes, male gametocyte.

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.9
Figure 7.9

(Top row and second row) Band form developing trophozoites (note that the RBC is normal or slightly smaller than normal). (Third row) Developing schizonts (note the small number of merozoites). (Bottom row) Mature schizonts in a thick blood film.

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.10
Figure 7.10

(Top three rows) Developing trophozoites (note the nonameboid trophozoites, presence of Schüffner’s dots, oval RBCs, and fimbriated edges of infected red cells). (Bottom row) Developing schizonts and gametocytes.

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.11
Figure 7.11

and spp. (Top row) ring forms (note the double rings per cell, appliqué or accolé form, and headphone appearance of some rings). (Second row) Ring forms and gametocyte (note Maurer’s clefts and crescent-shaped gametocyte). (Third row) Gametocyte, exflagellation of male gametocyte, and developing ookinete. (Bottom row) spp. (note the Maltese cross configuration of rings; these are not seen in every species of ).

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.12
Figure 7.12

Intracytoplasmic malaria pigment seen within a polymorphonuclear leukocyte in a specimen from a patient with malaria. (Courtesy of Loyda Oduber, Jaime LaRoche, Pitágoras Ureña, and Cinthia Batista, Clinical Hospital San Fernando, Panama.)

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.13
Figure 7.13

ParaSight-F test kit showing a negative test strip with a reagent control mark (A) and a positive test strip with a reagent control mark above the positive test result (B).

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.14
Figure 7.14

Bed nets used in malaria prevention. (A) Nets being dipped in a suspension of insecticide following purchase. For people to appreciate the value of the insecticide treatment, it is important for them to see the process. The nets are wrung out, placed in a plastic bag, and returned to the owner. Later, in the house, the net is laid directly on the bed and allowed to dry out. This must be done indoors to avoid direct exposure to the sun, which degrades the insecticide. (B) Net in place in the home. The occupant of the house in the Bagamoyo BedNet Project, Tanzania, is preparing for rest. The net is a rectangular design, which provides a better ventilating effect than the conical variety. (C) Rectangular bed net being set up outdoors to enable the collection of mosquitoes by the Centers for Disease Control and Prevention Light Trap suspended on the left. Nets for this use are not treated with insecticide. Mosquitoes attracted to the person sleeping under the net are attracted to the light and enter the trap. In the morning, the trap is removed and the collection will indicate which mosquito species are hunting outdoors for blood meals. Similar collections can be made indoors. (Courtesy of Clive Shiff, Johns Hopkins University, with permission.)

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.15
Figure 7.15

Life cycle of spp. (Illustration by Gwen Gloege.)

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Image of Figure 7.16
Figure 7.16

Six examples of blood films containing the ringlike forms of spp. (A) Thick blood film containing numerous rings; (B to F) various ring forms, multiple rings per cell, some rings present outside of the red blood cells, and the typical image of the “Maltese cross” configuration of the four rings.

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Tables

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Table 7.1

Countries reported by the Centers for Disease Control and Prevention to have areas of endemic malaria

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.2

spp.: clinical characteristics of the four infections

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.3

Malaria pathophysiology

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.4

pathogenesis and sequelae

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.5

Immunopathology of malaria

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.6

Parasitemia determined from conventional light microscopy: clinical correlation

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.7

Malaria characteristics

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.8

Plasmodia in Giemsa-stained thin blood films

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.9

Alternative approaches to malaria diagnosis

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.10

Antimalarial drugs and their actions

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.11

drugs and therapeutic use

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.12

Antimalarial drugs and associated problems

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.13

Malaria resistance

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.14

Areas with reported chloroquine-resistant

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.15

Drugs available in the United States for treatment of malaria

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
TABLE 7.16

Drugs used for the prevention of malaria

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.17

Current issues related to maternal malaria, transmission, pathogenesis, and therapy options

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.18

Malaria epidemics in recent years: climatic change, population displacement, control policy failures, drug resistance

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.19

Host genetic factors in resistance to malaria

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
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Table 7.20

Epidemiology of malaria

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.21

Relevant concepts for the control of mosquito transmission of human malaria parasites

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.22

Global strategy for malaria control: constraints

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7
Generic image for table
Table 7.23

Similarities and differences in spp.

Citation: Garcia L. 2007. Malaria and Babesiosis, p 142-189. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch7

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