Case
A 25-year old male photographer went on an adventure trip to the forest of Palawan to take pictures of exotic
birds and plants. Eleven days after his trip, he developed headache, muscle aches and pains, nausea and vomiting.
He had shaking chills which lasted for 10 minutes followed by fever and sweating. Paroxysms of chills, high grade
fever, and sweating would occur within 24 hours. His urine was dark red and had hemoglobin in the urine. He also
developed anemia.
Malaria: "bad air"
Infective stage: gametocytes
Falciparum: recrudescence, walang pinipili and high something ng parasitemia
Vivax: most common worldwide
Ovale: wala sa pinas ( james’ dots or james’ stippling)
Maltese cross - babesia parasite
Differentials: typhoid(no urinary findings), dengue, HUS E. Coli 0157:H7, leptospirosis, hepa ( no jaundice) , lyme
disease,
night: anopheles, kissing bug(trypomastigote, bite in mucosa)
morning: aedes(dengue, chikungunya, yellow fever)
Questions:
1. What is the etiologic agent of the disease? Explain.
● Plasmodium falciparum
- The incubation period for malaria for P. falciparum is usually 10–15 days, but it may also be weeks or
months.
- Periodic paroxysms of malaria are closely related to events in the bloodstream. An initial chill, lasting from
15 minutes to 1 hour, begins as a synchronously dividing generation of parasites rupture their host red
cells and escape into the blood. Nausea, vomiting, and headache are common at this time.
- P falciparum pyrexia may last 8 hours or longer and may exceed 41°C.
- In severe P falciparum infections, renal damage may cause oliguria and the appearance of casts, protein,
and red cells in the urine.
2. Discuss the laboratory examination that you will request to establish your diagnosis?
● Complete blood count
○ In the event that the person does have a positive malaria test, these additional tests will be
useful in determining whether the patient has uncomplicated or severe manifestations of the
malaria infection.
○ Specifically, these tests can detect severe anemia, hypoglycemia, renal failure,
hyperbilirubinemia, and acid-base disturbances.
● Thick and thin blood smears
○ Gold standard
○ A blood specimen collected from the patient is spread as a thick or thin blood smear, stained
with a Romanovsky stain (most often Giemsa), and examined with a 100X oil immersion
objective.
○ Visual criteria are used to detect malaria parasites and to differentiate (when possible) the
various species.
○ Wright’s stain, which is commonly used in hospital laboratories for examining blood (called a
CBC with manual differential), can be used if Giemsa stain is not available.
○ If negative use RDT
● Rapid Diagnostic Test (RDT)
○ When microscopy is not readily available, rapid diagnostic tests may be used instead of blood
smears.
○ These tests detect malaria antigens (proteins) in a sample of a person's blood (usually taken with
a fingerstick) and indicate a positive result by a color change on the testing strip.
A 25-year old male photographer went on an adventure trip to the forest of Palawan to take pictures of exotic
birds and plants. Eleven days after his trip, he developed headache, muscle aches and pains, nausea and vomiting.
He had shaking chills which lasted for 10 minutes followed by fever and sweating. Paroxysms of chills, high grade
fever, and sweating would occur within 24 hours. His urine was dark red and had hemoglobin in the urine. He also
developed anemia.
Malaria: "bad air"
Infective stage: gametocytes
Falciparum: recrudescence, walang pinipili and high something ng parasitemia
Vivax: most common worldwide
Ovale: wala sa pinas ( james’ dots or james’ stippling)
Maltese cross - babesia parasite
Differentials: typhoid(no urinary findings), dengue, HUS E. Coli 0157:H7, leptospirosis, hepa ( no jaundice) , lyme
disease,
night: anopheles, kissing bug(trypomastigote, bite in mucosa)
morning: aedes(dengue, chikungunya, yellow fever)
Questions:
1. What is the etiologic agent of the disease? Explain.
● Plasmodium falciparum
- The incubation period for malaria for P. falciparum is usually 10–15 days, but it may also be weeks or
months.
- Periodic paroxysms of malaria are closely related to events in the bloodstream. An initial chill, lasting from
15 minutes to 1 hour, begins as a synchronously dividing generation of parasites rupture their host red
cells and escape into the blood. Nausea, vomiting, and headache are common at this time.
- P falciparum pyrexia may last 8 hours or longer and may exceed 41°C.
- In severe P falciparum infections, renal damage may cause oliguria and the appearance of casts, protein,
and red cells in the urine.
2. Discuss the laboratory examination that you will request to establish your diagnosis?
● Complete blood count
○ In the event that the person does have a positive malaria test, these additional tests will be
useful in determining whether the patient has uncomplicated or severe manifestations of the
malaria infection.
○ Specifically, these tests can detect severe anemia, hypoglycemia, renal failure,
hyperbilirubinemia, and acid-base disturbances.
● Thick and thin blood smears
○ Gold standard
○ A blood specimen collected from the patient is spread as a thick or thin blood smear, stained
with a Romanovsky stain (most often Giemsa), and examined with a 100X oil immersion
objective.
○ Visual criteria are used to detect malaria parasites and to differentiate (when possible) the
various species.
○ Wright’s stain, which is commonly used in hospital laboratories for examining blood (called a
CBC with manual differential), can be used if Giemsa stain is not available.
○ If negative use RDT
● Rapid Diagnostic Test (RDT)
○ When microscopy is not readily available, rapid diagnostic tests may be used instead of blood
smears.
○ These tests detect malaria antigens (proteins) in a sample of a person's blood (usually taken with
a fingerstick) and indicate a positive result by a color change on the testing strip.
