CDC - DPDx - Malaria - Images

7/22/2019 CDC - DPDx - Malaria - Images

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DPDx - Laboratory Identification of Parasitic Diseases ofPublic Health Concern

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DPDx is an education resource designed for health !rofessionals and laboratory scientists" For ano#er#ie$ including !re#ention and control #isit $$$"cdc"go#%&alaria%"

'alaria

[Plasmodium falciparum] [Plasmodium knowlesi] [Plasmodium malariae] [Plasmodium ovale][Plasmodium vivax]

Parasite (iologyI&age )alleryLaboratory Diagnosisreat&ent Infor&ation

Clic* on a grou! of i&ages to see larger i&ages and &ore infor&ation"

Plasmodium falciparum

+ing- for& tr o!hooites of P. falc iparum in thic* and a t hin blood s&e ar"

+ing-for& tro!hooites rings. ofPlasmodium falciparumare often thin and delicate, &easuringon a#erage /%0 the dia&eter of the red blood cell" +ings &ay !ossess one or t$o chro&atin dots"

hey &ay be found on the !eri!hery of the +(C accol1, a!!liqu1. and &ulti!ly-infected +(Cs arnot unco&&on" +ing for&s &ay beco&e co&!act or !leo&or!hic de!ending on the quality of the

blood or if there is a delay in &a*ing s&ears" here is usually no enlarge&ent of infected +(Cs"


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Figu re A:+in gs ofP. falciparumin a thi c* blood s&ear"

Figu re B:+in gs ofP. falciparumin a thi c* blood s&ear"




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Figure C:+in gs ofP. falciparumin a thi c* blood s&ear"

Figure D:+in gs ofP. falciparumin a thi c* blood s&ear"




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Figure E:+in gs ofP. falciparumin a thi c* blood s&ear"

Figu re F:+in gs ofP. falciparumin a thi c* blood s&ear"




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Figu re G:+in gs ofP. falciparumin a thi n blood s&ear"

Figu re H:+in gs ofP. falciparumin a thi n blood s&ear"


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Figu re I:+in gs ofP. falciparumin a thi n blood s&ear"

Figu re J:+ing s ofP. falciparumin a thin blood s&ear"


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Colla!se his )rou!+ing- for& tr o!hooites of P. falc iparum in thin blood s&ears exhibiting 'aurer2sclefts"

'aurer2s clefts can be seen inP. falciparuminfections containing older ring-for& tro!hooites andasexual stages" 'aurer2s clefts rese&ble the 3ch4ffner2s dots seen inP. vivaxandP. ovale, but arusually larger and &ore coarse" 5isualiation of these structures is de!endent on the quality of thes&ear !re!aration and the !H of the )ie&sa stain" Li*e 3ch4ffner2s dots, 'aurer2s clefts a!!ear t!lay a role in the &etabolic !ath$ays of the infected +(Cs"

Figure K:+in gs ofP. falciparumin a thi n blood s&ear"

Figu re L:+in gs ofP. falciparumin a thi n blood s&ear" I&ag e courtesy of the Ari ona 3tate Publi c Health Laboratory"


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Figu re A:+i ng -for& tro!hooites ofP. falciparumin a thin blood s&ear, exhibiting 'aur er2s clefts"

Figu re B:+i ng -for& tro!hooites ofP. falciparumin a thin blood s&ear, exhibiting 'aur er2s clefts"




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Figure C:+i ng -for& tro!hooites ofP. falciparumin a thi n blood s&ear, exhibitin g 'aurer2s clefts"

Figure D:+i ng -for& tro!hooites ofP. falciparumin a thin blood s&ear, exhibiting 'aur er2s clefts"


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Colla!se his )rou!De#e lo!ing and older tro!hooites of P. falc iparumin thic* and a t hin blood s&ear"

De#elo!ing tro!hooites ofP. falciparumtend to re&ain in ring for&, but &ay beco&e thic*er an

&ore co&!act" he a&ount of !ig&ent and chro&atin &ay also increase" Co&!act or a&oeboidfor&s &ay be seen in s&ears $here there $as a delay in !rocessing the blood"

Figure E:+i ng -for& tro!hooites ofP. falciparumin a thi n blood s&ear, exhibitin g 'aurer2s clefts"

Figu re F:+i ng -for& tro!hooites ofP. falciparumin a thi n blood s&ear, exhibitin g 'aurer2s clefts"




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Figu re A:ro!hooites ofP. falciparumin a thi c* blood s&ear"

Figu re B:ro!hooite ofP. falciparumin a thi n blood s&ear"




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Figure C:ro!hooite ofP. falciparumin a thin blood s&ear"

Figure D:ro!hooite ofP. falciparumin a thi n blood s&ear" In this f igu re, a ga& etocyte can al so be seen in the u!!er ha lf of the i&a ge"




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Colla!se his )rou!)a&etocytes of P. falc iparum in thic* and a t hin blood s&ear"

)a&etocytes ofPlasmodium falciparumare crescent- or sausage-sha!ed, and are usually about

/"0 ti&es the dia&eter of an +(C in length" he cyto!las& of the &acroga&etocytes fe&ale. areusually a dar*er, dee!er blue6 the cyto!las& of the &icroga&etocytes &ale. is usually &ore !alehe red chro&atin and !ig&ent is &ore coarse and concentrated in the &acroga&etocytes thanthe &icroga&etocytes" 3o&eti&es in thin blood s&ears, the re&nants of the host +(C can be seenthis is often referred to as La#eran2s bib"

Figure E:ro!hooit es ofP. falciparumin a thi n blood s&ear"

Figu re F:ro!hooit es ofP. falciparumin a thi n blood s&ear"




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Figu re A:)a&etocyte ofP. falciparumin a th ic* bl ood s&ear" 7 ote also the !resence of & any ri ng-f or& tro!hooites"

Figu re B:)a&etocytes ofP. falciparumin a thi c* blood s&ear" 7 ote also the !resence of & an y ri ng -for& tro!hooites"




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Figure C:)a&etocytes ofP. falciparumin a thi c* blood s&ear"

Figure D:)a&etocyte ofP. falciparumin a thi n blood s&ear" Al so seen i n th is i &age ar e rin g-for& tro!hooites and an +(C exhi biting

ba so!h i l ic st i!!l ing u !!er left ."


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Figure E:)a&etocyte ofP. falciparumin a thi n blood s&ear" Al so seen in this i &ag e are ring -for& tro!hooites exhibitin g 'aurer2s clefts"

Figu re F:)a&etocyte ofP. falciparum in a thi n blood s&ear" In these s!eci& ens, La#eran 2s bibs can be seen"


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Figu re G:)a&etocytes ofP. falciparumin a th in blood s&ear" In these s!eci& ens, La#era n2s bibs can be seen"

Figu re H:)a&etocyte ofP. falciparumin a thi n blood s&ear, sho$ing La#eran2s bib" Also seen i n thi s i& age are ri ng-for& tro!hooites

exhibitin g 'aurer2s clefts"


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Colla!se his )rou!3chionts of P. falc iparumin a thin blood s&ear"

3chionts are rarely seen in !eri!heral blood ofPlasmodium falciparuminfections, exce!t inse#ere cases" 8hen seen, schionts contain any$here fro& 9-:; &erooites" A &ature schiontusually fills about :%< of the infected +(C"

Figu re I:)a&etocytes ofP. falciparumin a thi n blood s&ear" he ga& etocyte in the u !!er ri ght i s un dergoing exfl agellati on, a !rocess that

nor&all y occurs i n th e &id-gut of the &osqui to host" Ho$e#er, it & ay be obser#ed in hu& an blood s!eci&ens $h en there is a delay in

!rocessin g the bl ood"

Figu re A:3chi ont ofP. falciparumin a thin blood s&ear"




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Colla!se his )rou!

Plasmodium knowlesi

+ing- for& tr o!hooites of P. knowlesiin a thin blood s&ear"

=arly ring-for& tro!hooites rings. ofP. knowlesiare si&ilar toP. falciparum, as rings &ay sho$double chro&atin dots" A!!liqu1 for&s &ay a!!ear, as $ell as rectangular rings harboring one or&ore accessory chro&atin dots" +ed blood cells &ay also be &ulti!ly-infected" 8hen full-gro$n,non-a&oeboid rings &ay occu!y half or &ore of the host +(C"

Figu re B:3chi ont ofP. falciparumin a thin blood s&ear"

Figure C:3chi ont ofP. falciparumin a thi n blood s&ear" ro!hooites are al so seen in th is i &a ge"


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Figu re A:+i ng -for& tro!hooites ofP. knowle siin a )ie&sa-stained thin blood s&ear fro& a hu &an !atient that tra#eled to the Phil i!!ine

7ote a &ul ti!ly -inf ected +(C in th is i &a ge" I&age cour tesy of the 8ads$orth Center, 7e$ >or* 3tate De!art&ent of Health "

Figu re B:+i ng -for& tro!hooite ofP. knowle siin a )ie&sa-stained thin blood s&ear fro& a hu &an !atient that tra#eled to the Phil i!!ines

I&ag e cour tesy of the 8ads$orth Center, 7 e$ >or* 3tate De!art& ent of Health "




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Figure C:+i ng -for& tro!hooites ofP. knowle siin a )ie&sa-stain ed thin blood s&ear fro& a hu &an !atient that tra#eled to the Phil i!!ine


Figure D:+i ng -for& tro!hooites ofP. knowle siin a )ie&sa-stained thin blood s&ear fro& a hu &an !atient that tra#eled to the Phil i!!ine





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Colla!se his )rou!?lder, de#elo!ing tro!hooites of P. knowle si in a thin blood s&ear"

In de#elo!ing tro!hooites ofP. knowlesi, band for&s &ay a!!ear that are si&ilar in a!!earancetoP. malariae" As the #acuole is lost during &aturation of the tro!hooite stage, the !arasite

beco&es s&aller and &ore co&!act" he !ig&ent a!!ears as dar* grains and the red nucleusincreases in sie" 3ti!!ling a!!ears, often referred to as 23inton and 'ulligan2s2 sti!!ling, as it is noof the 3ch4ffner ty!e"

Figure E:+i ng -for& tro!hooites ofP. knowle siin a )ie&sa-stain ed thin blood s&ear fro& a hu &an !atient that tra#eled to the Phil i!!ine


Figu re F:+i ng -for& tro!hooites ofP. knowle siin a )ie&sa-stain ed thin blood s&ear fro& a hu &an !atient that tra#eled to the Phil i!!ine





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Colla!se his )rou!)a&etocytes of P. knowlesi in thin blood s&ears"

'ature &acroga&etocytes ofP. knowlesiare usually s!herical and fill the host +(C" hecyto!las& stains blue and the eccentric nucleus stains red" Pig&ent is coarse and blac*, and isscattered irregularly in the cyto!las&" he &icroga&etocyte is often, but not al$ays, s&aller thathe &acroga&etocyte" he cyto!las& usually stains a !ale !in*, $hile the nucleus stains a dar*erred" he nucleus &ay &a*e u! half the !arasite" he coarse, blac* !ig&ent is scattered irregularlthought the cyto!las&"

Figu re A:(a nd-for& tro!hooite ofP. knowle si in a )ie&sa-stain ed thin blood s&ear fro& a hu &an !atient that tra#eled to the Phil i!!ine


Figu re B:(and-for& u !!er. and ri ng -for& lo$er. tro!hooites ofP. knowle si, fro& the sa&e s!eci& en as Figure A"




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Colla!se his )rou!3chionts of P. knowle si in a thin blood s&ear"

In de#elo!ing schionts, 3inton and 'ulligan2s sti!!ling &ay be obser#ed" he nucleus continues tdi#ide until there are u! to /@ a#erage /. &erooites" As the schiont &atures, it fills the host+(C and the !ig&ent collects into one or a fe$ &asses" In the &ature schiont, the &erooites&ay a!!ear 2seg&ented2 and the !ig&ent has collected into a single &ass"

Figu re A:)a&etocyte ofP. kno wle siin a )ie&sa-stained thin blood s&ear fr o& a !atient tha t tra#eled to the Phi li!!ines" I&age courtesy of

the 8ads$orth Center, 7e$ > or* 3tate De!art&ent of Health "

Figu re B:)a&etocyte ofP. kno wle siin a )ie&sa-stained thin bl ood s&ear fro& a !atient tha t tra#eled to the Phil i!!ines" 7ote also a rin g-

for& tro!hooite in the lo$er left of thi s i& age" I&a ge cour tesy of the 8ads$orth Center, 7 e$ >or* 3tate De!art& ent of Health "




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Figu re A:'ature schiont in a )ie&sa-stained thin blood s&ear f ro& a !atient tha t tra#eled to the Phi li!!ines"I&ages courtesy of the

8ads$orth Cen ter , 7e$ > or* 3ta te De!ar t& ent of Heal th "

Figu re B:'ature schiont in a )ie&sa-stained thin blood s&ear f ro& a !atient tha t tra#eled to the Phi li!!ines" 7ote also a rin g-for&

tro!hooite to the ri gh t of the schi ont in th is f ig ur e" I&a ges cour tesy of the 8ads$orth Center, 7e$ > or* 3tate De!art&ent of Heal th"




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Figure C:De#elo!ing schiont in a )ie&sa-stained thin blood s&ear f ro& the sa&e !atient seen in Figu res A and B "

Figure D:'ature schiont in a )ie&sa-stained thin bl ood s&ear fro& the sa& e !atient seen in Figures A-C"


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Colla!se his )rou!

Plasmodium malariae

+ing- for& tr o!hooites of P. malariae in thic* and thin* blood s&ear s"

+ing-for& tro!hooites ha#e one rarely t$o. chro&atin dots and a cyto!las& ring that tends tobe thic*er thanP. falciparum" 2(ird2s-eye2 for&s &ay a!!ear" here is no enlarge&ent of infected+(Cs"

Figure E:De#elo!ing schiont in a )ie&sa-stained thin blood s&ear f ro& the sa&e !atient as Figures A-D"

Figu re A:+in g-for& lo$er rig ht. an d de#elo!ing u !!er l eft. tro!hooites ofP. malariae in a thi c* blood s&ear"


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Figu re B:B(irds -eyeB tro!hooite ofP. malariae in a thi n blood s&ear"

Figure C:+i ng -for& tro!hooite ofP. malariae in a thi n blood s&ear"




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Colla!se his )rou!ro!hooites of P. malariae in a thic* blood s&ear "

In de#elo!ing tro!hooites ofP. malariae, chro&atin is rounded or strea*y and the cyto!las& isusually co&!act $ith no #acuole" Pig&ent &ay be coarse and !eri!heral" As the tro!hooites&ature, the cyto!las& &ay elongate across the host +(C, for&ing a 2band-for&2, or &ay be o#al

$ith a #acuole for&ing a 2bas*et- for&2" Chro&atin is usually in a single &ass, less definite inoutline" Pig&ent granules beco&e larger and tend to ha#e a &ore !eri!heral arrange&ent"

Figure D:+i ng -for& tro!hooite ofP. malariae in a thin blood s&ear"

Figu re A:ro!hooite ofP. malariae in a thi c* blood s&ear"


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Colla!se his )rou!(and-for& t ro!hooites of P" &a lariae in a thin blood s&ear "

In de#elo!ing tro!hooites ofP. malariae, chro&atin is rounded or strea*y and the cyto!las& isusually co&!act $ith no #acuole" Pig&ent &ay be coarse and !eri!heral" As the tro!hooites&ature, the cyto!las& &ay elongate across the host +(C, for&ing a 2band-for&2, or &ay be o#al

$ith a #acuole for&ing a 2bas*et- for&2" Chro&atin is usually in a single &ass, less definite inoutline" Pig&ent granules beco&e larger and tend to ha#e a &ore !eri!heral arrange&ent"

Figu re B:ro!hooite ofP. malariae in a thi c* blood s&ear"

Figu re A:(a nd-for& tro!hooite ofP. malariae in a thin blood s&ear"




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Figu re B:(a nd-for& tro!hooite ofP. malariae in a thin blood s&ear"

Figure C:(a nd-for& tro!hooite ofP. malariae in a thin blood s&ear"




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Colla!se his )rou!(as*et-for& tro!hooites of P. malariae in a thin blood s&ear"

In de#elo!ing tro!hooites ofP. malariae, chro&atin is rounded or strea*y and the cyto!las& is

usually co&!act $ith no #acuole" Pig&ent &ay be coarse and !eri!heral" As the tro!hooites&ature, the cyto!las& &ay elongate across the host +(C, for&ing a 2band-for&2, or &ay be o#al$ith a #acuole for&ing a 2bas*et- for&2" Chro&atin is usually in a single &ass, less definite inoutline" Pig&ent granules beco&e larger and tend to ha#e a &ore !eri!heral arrange&ent"

Figure D:(a nd-for& tro!hooite ofP. malariae in a thin blood s&ear"

Figure E:(a nd-for& tro!hooite ofP. malariae in a thin blood s&ear"




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Figu re A:(as*et-for& tro!hooite ofP. malariae in a thi n blood s&ear"

Figu re B:(as*et-for& tro!hooite of P" &a lar ia e in a thi n blood s&ear"




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Colla!se his )rou!b)a&etocytes of P. malariae in thic* and a thin blood s&ear "

)a&etocytes ofP. malariaeare co&!act and tend to fill the host +(C" here is no enlarge&ent ofthe infected +(C and so&eti&es there is a reduction in sie" he cyto!las& stains blue and thechro&atin !in* to red" Abundant dar* !ig&ent &ay be scattered throughout the cyto!las&"

Colla!se his )rou!3chionts of P. malariae in thic* and a thin blood s&ear "

Plasmodium ovale

+ing- for& tr o!hooites of P" o#ale in thic* and a t hin blood s&ear "

+ing-for& tro!hooites usually contain a single chro&atin dot, but &ay contain double-chro&atindots" 'ulti!ly-infected +(Cs &ay be seen, &a*ing the rings difficult to differentiate fro&P.alciparum" he sing rings &ay be difficult to differentiate fro&P. vivax, as the cyto!las& is

usually thic* $ith a large chro&atin dot" As the tro!hooites &ature, they are less a&oeboid thanP. vivaxand &ay exhibit fi&briation and 3ch4ffner2s dots" Infected +(Cs are not usually enlarged

Figure C:(as*et-for& tro!hooite ofP. malariae in a thin blood s&ear"

Figu re A:)a&etocyte ofP. malariae in a thi c* blood s&ear"

Figu re B:)a&etocyte ofP. malariae in a thi c* blood s&ear"

Figure C:)a&etocyte ofP. malariae in a thi n blood s&ear"

Figure D:)a&etocyte ofP. malariae in a thi n blood s&ear"

Figure E:De#elo!ing ga& etocyte ofP. malariae in a thi n blood s&ear"

Figu re F:De#elo!ing ga& etocyte ofP. malariae in a thi n blood s&ear"




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as inP. vivaxinfections"

Colla!se his )rou!ro!hooites of P. ovale in thic* and t hin blood s&e ars"

)a&etocytes of P. ovale in thic* and t hin blood s&e ars"

3chionts of P. ovale in thic* and thin blood s&ear s"

Plasmodium vivax

+ing- for& tr o!hooites of P. vivaxin thic* and t hin blood s&ears"

ro!hooites of P. vivaxin thic* and t hin blood s&e ars"

De#elo!ing tro!hooites ofP. vivaxbeco&e increasingly a&oeboid, $ith tenuous !seudo!odial!rocesses and large #acuoles" 3ch4ffner2s dots are #isible $ith !ro!er staining" Pig&ent tends to

be fine and bro$n" Infected +(Cs are usually noticeably larger than uninfected +(Cs"

Colla!se his )rou!)a&etocytes of P. vivaxin thic* and t hin blood s&e ars"

Figu re A:+i ng -for& tro!hooite ofP. ovale in a thi c* blood s&ear"

Figu re B:+i ng -for& tro!hooite ofP. ovale in a thi c* blood s&ear"

Figure C:+i ng -for& tro!hooites ofP. ovale in a thi n blood s&ear" 7ote the &ulti!ly -infected +(C in thi s i& age"

Figure D:+i ng -for& tro!hooites ofP. ovale in a thin blood s&ear"

Figure E:+i ng -for& tro!hooites ofP. ovale in a thi n blood s&ear" 7ote the &ulti!ly -infected +(C in thi s i& age"

Figu re A:ro!hooite ofP. vivaxin a thi c* blood s&ear"

Figu re B:ro!hooite ofP. vivaxin a th in blood s&ear" 7 ote the a&oeboid a!!earan ce, 3ch4 ffn er2s dots an d enlar ged inf ected +(Cs"

Figure C:ro!hooit es ofP. vivaxin a thi n bl ood s&ear" 7 ote the a&oeboid a!!earan ce, 3ch4 ffn er2s dots an d enlar ged inf ected +(Cs"

Figure D:ro!hooite ofP. vivaxin a th in blood s&ear" 7 ote the a&oeboid a!!earan ce, 3ch4 ffn er2s dots an d enlar ged inf ected +(Cs"

Figure E:ro!hooite ofP. vivaxin a thi n bl ood s&ear" 7 ote the a&oeboid a!!eara nce, 3ch4f fner2s dots an d enlar ged inf ected +(Cs"

Figu re F:ro!hooite ofP. vivaxin a thi n bl ood s&ear" he infected +(Cs are a lso noticeably l arger th an the un infected +(Cs"

Figu re G:ro!hooite ofP. vivaxin a th in blood s&ear" 7 ote the band-li*e a!!earance of the tro!hooite in this figu re that & ay be &ista*en

for a band-for& tro!hooite ofP. malariae " 7ote, ho$e#er, the fine, lig ht bro$n !ig&ent th at is distributed through out the cyto!las&

!ig&ent i nP. malariae is usua ll y dar*er a nd coarser an d distributed on the !eri!hery of the cyto!las& ." he in fected +(Cs are a lso

noticeably lar ger than the uni nfected +(Cs"




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