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Abstract:

The genus includes at least 172 named species of intraerythrocytic parasites infecting a wide range of mammals, birds, reptiles, and amphibians. Malaria imposes an enormous burden of illness and substantial mortality on the tropical world and in many subtropical regions. There are an estimated 515 (95% confidence interval, 330 to 660) million clinical episodes of malaria due to , the most common cause of malaria, and 1.5 million to 2.7 million deaths due to malaria each year. Gastrointestinal complaints, nausea, vomiting, and diarrhea, which may be bloody, are also not uncommon and should not distract the clinician from the diagnosis of malaria. In the face of rapidly developing drug resistance, development of new antimalarial drugs and, ultimately, an effective malaria vaccine are high priorities. The genus includes approximately 100 species that are transmitted by ticks of the genus and infect a variety of wild and domestic animals. The diagnosis of babesiosis should be considered for a patient with the appropriate clinical symptoms and a history of travel to areas where the disease is endemic, exposure to ticks, or recent blood transfusion. Examination of Giemsastained thin blood smears is the most direct approach to diagnosis.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133

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Human Lyme Disease
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Parasitic Diseases
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Malaria Life Cycle
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Human Granulocytic Ehrlichiosis
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Blood Infections
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Infectious Diseases
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Image of FIGURE 1
FIGURE 1

Life cycle of the malaria parasite. (Reproduced with permission from reference .)

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 2
FIGURE 2

: morphology of successive developmental stages in Giemsa-stained thin blood smears. Rings and gametocytes will be found in peripheral blood smears; other stages occur in infected erythrocytes but are sequestered in the capillaries and venules of the internal organs and are rarely found in the periphery. Films: 1, normal erythrocyte; 2, young rings; 3, rings with appliqué form; 4, appliqué ring with Maurer's dots; 5, late ring; 6 and 7, mature trophozoites; 8, late trophozoite; 9, young schizont; 10 and 11, mature schizonts; 12, gravid schizont; 13, immature gametocyte; 14, mature microgametocyte; 15 and 16, mature macrogametocytes.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 3
FIGURE 3

: morphology of successive developmental stages in Giemsa-stained thick blood smears. Films: 1, leukocyte nuclei and erythrocyte stroma, no parasites; 2 to 4, rings; 5 to 7, trophozoites; 8, mature trophozoite; 9, young schizont; 10 and 11, mature schizonts; 12, gravid schizont; 13, immature gametocyte; 14, immature and mature gametocytes; 15 and 16, mature macrogametocytes (above) and microgametocytes (below).

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 4
FIGURE 4

: morphology of successive developmental stages in Giemsa-stained thin blood smears. Films: 1, normal erythrocytes; 2 to 4, rings; 5 to 7, growing trophozoites; 8, mature trophozoite; 9 and 10, immature schizonts; 11 and 12, mature schizonts; 13, immature gametocyte; 14, mature microgametocyte; 15, mature macrogametocyte; 16, mature microgametocyte.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 5
FIGURE 5

: morphology of successive developmental stages in Giemsa-stained thick blood smears. Films: 1, leukocyte nuclei and erythrocyte stroma, no parasites; 2 to 4, rings; 5 to 7, growing trophozoites; 8, mature trophozoite; 9 and 10, immature schizonts; 11, mature schizont; 12, gravid schizont; 13, immature gametocyte; 14, mature gametocyte, sex undetermined; 15, mature microgametocyte; 16, mature macrogametocyte.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 6
FIGURE 6

: morphology of successive developmental stages in Giemsa-stained thin blood smears. Films: 1, normal erythrocytes; 2 to 4, rings; 5, young trophozoite; 6 and 7, trophozoites; 8, mature trophozoite; 9 and 10, immature schizonts; 11 and 12, mature schizonts; 13, immature gametocyte; 14 and 15, mature microgametocytes; 16, mature macrogametocyte.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 7
FIGURE 7

: morphology of successive developmental stages in Giemsa-stained thick blood smears. Films: 1, leukocyte nuclei and erythrocyte stroma, no parasites; 2 to 4, rings; 5 to 7, growing trophozoites; 8, mature trophozoite; 9 and 10, immature schizonts; 11, mature schizont; 12, gravid schizont; 13 and 14, immature gametocytes; 15, mature macrogametocyte; 16, mature microgametocyte.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 8
FIGURE 8

: morphology of successive developmental stages in Giemsa-stained thin blood smears. Films: 1, normal erythrocyte; 2 and 3, rings; 4 and 5, growing trophozoites; 6, mature trophozoite; 7, band form trophozoite; 8 and 9, immature schizonts; 10, schizont; 11 and 12, “daisy head” schizonts; 13, immature gametocyte; 14 and 15, mature macrogametocytes; 16, mature microgametocyte.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 9
FIGURE 9

: morphology of successive developmental stages in Giemsa-stained thick blood smears. Films: 1, leukocyte nucleus and erythrocyte stroma, no parasites; 2 to 4, rings; 5 to 8, trophozoites; 9, young schizonts; 10, schizont; 11, “daisy head” schizont; 12, gravid schizont; 13, immature gametocyte; 14, mature gametocyte, sex undetermined; 15, mature microgametocyte; 16, mature macrogametocyte.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 10
FIGURE 10

: morphology of successive developmental stages in Giemsa-stained thin blood smears. Films: 1 to 4, rings; 5 to 7, growing trophozoites; 8, mature trophozoite; 9 and 10, immature schizonts; 11, mature schizont; 12, mature schizont containing 16 merozoites; 13, immature gametocyte; 14, mature microgametocyte; 15, mature macrogametocyte; 16, mature microgametocyte. (Images reproduced from figures in reference with permission.)

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 11
FIGURE 11

Life cycle of . Events in the tick begin with the parasites still visible in consumed erythrocytes. Some are beginning to develop Strahlenkörper forms (specialized apical organelles) (A). The released gametes begin to fuse (B). The zygote then goes on to infect and move through other tissues within the tick (C) to the salivary glands. Once a parasite has infected the salivary acini, a multinucleate but undifferentiated sporoblast is formed (D). After the tick begins to feed, the specialized organelles of the future sporozoites form (E). Finally, mature sporozoites bud off the sporoblast (F). As the tick feeds on its vertebrate host, these sporozoites are inoculated into the host (G). Sporozoites (or merozoites) contact a host erythrocyte and begin the process of infection by invagination (H). The parasites become trophozoites and can divide by binary fission within the host erythrocyte, creating the various ring forms and crosses seen on stained blood smears (I). Illustrations are not to scale. (Reproduced with permission from reference .)

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Image of FIGURE 12
FIGURE 12

spp. in thin blood films. (Left) in human blood: parasites in erythrocytes and extracellular parasites; (right) sp. in classic Maltese cross (tetrad) configuration, a form diagnostic for babesiosis but rare in slides from humans infected with .

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
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Tables

Generic image for table
TABLE 1

Classification of severe malaria

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
Generic image for table
TABLE 2

Comparative morphology of spp. in Giemsa-stained thin smears

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
Generic image for table
TABLE 3

Alternative methods for diagnosis of malaria

QBC, quantitative buffy coat technique.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133
Generic image for table
TABLE 4

Distribution of drug-resistant

Based on information from the World Health Organization Roll Back Malaria Department (http://apps.who.int/malaria/ resistancefalciparum.html) as of 10 July 2009.

Citation: Rogers W. 2011. and , p 2091-2112. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch133

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