Plasmodium - Revision history

Aidan at 16:33, 23 March 2026

2026-03-23T16:33:49Z

← Older revision		Revision as of 16:33, 23 March 2026
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	==Background==		==Background==

	* ~~Mosquito~~-borne protozoon that causes '''malaria'''		* Genus of single-celled mosquito-borne protozoon parasite that causes '''malaria'''

	===Microbiology===		===Microbiology===

	*Intracellular protozoal parasite of red blood cells		*Intracellular protozoal parasite of red blood cells within the family [[Family::Plasmodiidae]]
	*Species that cause human disease are: ''P. falciparum'', ''P. vivax'', ''P. ovale'', ''P. malariae'', and ''P. knowlesi'' (from the macaque monkey)		*Species that cause human disease are: ''P. falciparum'', ''P. vivax'', ''P. ovale'', ''P. malariae'', and ''P. knowlesi'' (from the macaque monkey)
	**Most common cause of disease in humans is ''Plasmodium falciparum''		**Most common cause of disease in humans is ''Plasmodium falciparum''
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	==Diagnosis==		==Diagnosis==

			* Typically done with a "malaria screen" that combines a rapid diagnostic test followed by confirmatory microscopy at the public health laboratory
			** Should be repeated every 12 to 24 hours up to 3 times

	===Thick and Thin Peripheral Blood Films===		===Thick and Thin Peripheral Blood Films===

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	**Alternative: [[Is treated by::quinine]] 542 mg base (650 mg salt) PO q8h for 3 to 7 days, plus [[Is treated by::doxycycline]] 100 mg PO bid for 7 days		**Alternative: [[Is treated by::quinine]] 542 mg base (650 mg salt) PO q8h for 3 to 7 days, plus [[Is treated by::doxycycline]] 100 mg PO bid for 7 days
	*Prevention of relapsing ''P. vivax'' and ''P. ovale'' with radical cure		*Prevention of relapsing ''P. vivax'' and ''P. ovale'' with radical cure
		⚫	**[[Is treated by::Primaquine]] 30 mg base daily for 14 days started after fevers resolve but before the completion of the primary treatment ([[chloroquine]] or other)
	**Indicated for patients with prolonged exposure
⚫	**[[Is treated by::Primaquine]] 30 mg base daily for 14 days started ~~concurrent~~ ~~with~~ or ~~following~~ [[chloroquine]]
	***First rule out [[G6PD deficiency]] and [[pregnancy]]		***First rule out [[G6PD deficiency]] and [[pregnancy]]
	**If pregnant, just treat intermittently until after delivery with once-weekly [[chloroquine]]		**If pregnant, just treat intermittently until after delivery with once-weekly [[chloroquine]]

Aidan: /* Clinical Manifestations */

2026-01-29T16:24:39Z

Clinical Manifestations

← Older revision		Revision as of 16:24, 29 January 2026
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	**q72h (quartan): ''P. malariae''		**q72h (quartan): ''P. malariae''
	**May vary by timepoint in infection, with early infection having daily or more frequent fevers from shedding from the liver stage		**May vary by timepoint in infection, with early infection having daily or more frequent fevers from shedding from the liver stage
	*Bloodwork may show anemia, neutropenia, and thrombocytopenia[[CiteRef::elkhalifa2021he]]		*Bloodwork may show anemia, neutropenia, and thrombocytopenia[[CiteRef::elkhalifa2021he]][[CiteRef::zniber2025ha]]
	*May have concurrent bacterial or other infections		*May have concurrent bacterial or other infections

Aidan: /* Clinical Manifestations */

2026-01-29T16:23:26Z

Clinical Manifestations

← Older revision		Revision as of 16:23, 29 January 2026
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	**q72h (quartan): ''P. malariae''		**q72h (quartan): ''P. malariae''
	**May vary by timepoint in infection, with early infection having daily or more frequent fevers from shedding from the liver stage		**May vary by timepoint in infection, with early infection having daily or more frequent fevers from shedding from the liver stage
			*Bloodwork may show anemia, neutropenia, and thrombocytopenia[[CiteRef::elkhalifa2021he]]
	*Leukopenia more common
	*May have concurrent bacterial or other infections		*May have concurrent bacterial or other infections

Aidan at 02:02, 5 August 2025

2025-08-05T02:02:46Z

← Older revision		Revision as of 02:02, 5 August 2025
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⚫	*Mosquito-borne protozoon that causes '''malaria'''

	==Background==		==Background==

		⚫	* Mosquito-borne protozoon that causes '''malaria'''

	===Microbiology===		===Microbiology===

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	*Prevention of relapsing ''P. vivax'' and ''P. ovale'' with radical cure		*Prevention of relapsing ''P. vivax'' and ''P. ovale'' with radical cure
	**Indicated for patients with prolonged exposure		**Indicated for patients with prolonged exposure
	**[[Is treated by::Primaquine]] 30 mg base daily for 14 days started concurrent with [[chloroquine]]		**[[Is treated by::Primaquine]] 30 mg base daily for 14 days started concurrent with or following [[chloroquine]]
	***First rule out [[G6PD deficiency]] and [[pregnancy]]		***First rule out [[G6PD deficiency]] and [[pregnancy]]
	**If pregnant, just treat intermittently until after delivery with once-weekly [[chloroquine]]		**If pregnant, just treat intermittently until after delivery with once-weekly [[chloroquine]]
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	***Parasitemia and clinical status should both improve by 48 to 72 hours		***Parasitemia and clinical status should both improve by 48 to 72 hours
	*Antimalarials		*Antimalarials
	**[[Is treated by::Artesunate]] 2.4 mg/kg IV bolus over 1-2 minutes at 0, 12, 24, and 48 hours		**First-line is [[Is treated by::Artesunate]] 2.4 mg/kg IV bolus over 1-2 minutes at 0, 12, 24, and 48 hours
	***[[Artesunate]] is held in specific centres in Canada		***[[Artesunate]] is held in specific centres in Canada
	***Should be followed by weekly CBC x4 to monitor for post-artesunate delayed hemolysis		***Should be followed by weekly CBC x4 to monitor for post-artesunate delayed hemolysis
			***If tolerating oral medications at the 24 hour mark, can transition to oral follow-on therapy; otherwise, complete the fourth dose at 48 hours
	***Four hours after the last dose, add one of the following:		***Four hours after the last dose, add one of the following:
			****If all four doses of artesunate were received:
⚫	****[[Is treated by::Atovaquone-proguanil]] 1000 mg/400 mg PO daily for 3 days
	****[[Is treated by::~~Doxycycline~~]] ~~100~~ mg PO ~~bid~~ for 7 days		*****[[Is treated by::Atovaquone-proguanil]] 1000 mg/400 mg PO daily for 3 days
	****[[Is treated by::~~Clindamycin~~]] 10 mg~~/kg~~ IV ~~followed by 5 mg/kg IV q8h~~ for 7 days		*****[[Is treated by::Doxycycline]] 100 mg PO bid for 7 days
			*****[[Is treated by::Clindamycin]] 10 mg/kg IV followed by 5 mg/kg IV q8h for 7 days
			****If fewer than four doses of artesunate were received:
		⚫	*****[[Is treated by::Atovaquone-proguanil]] 1000 mg/400 mg PO daily for 3 days
			*****Oral quinine + doxycycline/clindamycin for 7 days
	***If unable to switch to oral therapy, then continue [[artesunate]] IV daily for total of 7 days		***If unable to switch to oral therapy, then continue [[artesunate]] IV daily for total of 7 days
	**[[Is treated by::Quinine]] 5.8 mg/kg IV loading dose over 30 min followed by 8.3 mg/kg IV infused over 4 hours q8h for 7 days		**[[Is treated by::Quinine]] 5.8 mg/kg IV loading dose over 30 min followed by 8.3 mg/kg IV infused over 4 hours q8h for 7 days

Aidan at 17:21, 16 June 2025

2025-06-16T17:21:07Z

← Older revision		Revision as of 17:21, 16 June 2025
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	****[[Is treated by::Doxycycline]] 100 mg PO bid for 7 days		****[[Is treated by::Doxycycline]] 100 mg PO bid for 7 days
	****[[Is treated by::Clindamycin]] 10 mg/kg IV followed by 5 mg/kg IV q8h for 7 days		****[[Is treated by::Clindamycin]] 10 mg/kg IV followed by 5 mg/kg IV q8h for 7 days
			***If unable to switch to oral therapy, then continue [[artesunate]] IV daily for total of 7 days
	**[[Is treated by::Quinine]] 5.8 mg/kg IV loading dose over 30 min followed by 8.3 mg/kg IV infused over 4 hours q8h for 7 days		**[[Is treated by::Quinine]] 5.8 mg/kg IV loading dose over 30 min followed by 8.3 mg/kg IV infused over 4 hours q8h for 7 days
	***Dose of quinine dihydrochloride would be 7 mg/kg and 10 mg/kg		***Dose of quinine dihydrochloride would be 7 mg/kg and 10 mg/kg

Aidan: /* Clinical Manifestations */

2025-04-22T14:22:48Z

Clinical Manifestations

← Older revision		Revision as of 14:22, 22 April 2025
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	*Non-specific [[Fever in cancer patients\|febrile illness]] with [[headache]], [[myalgias]], and [[malaise]]		*Non-specific [[Fever in cancer patients\|febrile illness]] with [[headache]], [[myalgias]], and [[malaise]]
	*Incubation period can vary, but is generally 9 to 14 days for ''P. falciparum'', 12 to 18 days ''P. vivax'' and ''P. ovale'', and longer for others		*Incubation period can vary, but is generally 9 to 14 days for ''P. falciparum'', 12 to 18 days ''P. vivax'' and ''P. ovale'', and longer for others
	*Fevers are often periodic, appearing based on rupture of schizonts ~~(tertian and quartan fever)~~		*Fevers are often periodic, appearing based on rupture of schizonts
	**q24h: ''P. falciparum'', but wide variation		**q24h (quotidian): ''P. falciparum'', but wide variation
	**q48h: ''P. vivax'' or ''P. ovale''		**q48h (tertian): ''P. vivax'' or ''P. ovale''
	**q72h: ''P. malariae''		**q72h (quartan): ''P. malariae''
	**May vary by timepoint in infection, with early infection having daily or more frequent fevers from shedding from the liver stage		**May vary by timepoint in infection, with early infection having daily or more frequent fevers from shedding from the liver stage
	*Leukopenia more common		*Leukopenia more common

Aidan at 17:17, 27 September 2024

2024-09-27T17:17:14Z

← Older revision		Revision as of 17:17, 27 September 2024
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	**Aldolase less sensitive for ''P. ovale'' and ''P. malariae'' and depends on parasitemia		**Aldolase less sensitive for ''P. ovale'' and ''P. malariae'' and depends on parasitemia
	**Both may cross-react with ANA and RF, and with [[dengue]], [[hepatitis C]], [[leishmaniasis]], [[trypanosomiasis]], [[schistosomiasis]], [[tuberculosis]], and [[toxoplasmosis]]		**Both may cross-react with ANA and RF, and with [[dengue]], [[hepatitis C]], [[leishmaniasis]], [[trypanosomiasis]], [[schistosomiasis]], [[tuberculosis]], and [[toxoplasmosis]]
	**Increasing pfhrp2/3 mutations leading to false negatives (higher in South America and Africa)~~<ref>Jejaw Zeleke, A., Hailu, A., Bayih, A.G. ''et al.'' ''Plasmodium falciparum'' histidine-rich protein 2 and 3 genes deletion in global settings (2010–2021)~~: ~~a systematic review and meta-analysis. ''Malar J'' '''21''', 26 (2022). https://doi.org/10.1186/s12936-022-04051-7</ref>~~		**Increasing pfhrp2/3 mutations leading to false negatives (higher in South America and Africa)[[CiteRef::jejaw zeleke2022pl]]
	*BinaxNOW is the only test in Canada		*BinaxNOW is the only test in Canada
	**3 bands		**3 bands

Aidan at 13:26, 27 June 2024

2024-06-27T13:26:40Z

← Older revision		Revision as of 13:26, 27 June 2024
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	*Mostly caused by ''P. falciparum'', though can also be caused by ''P. vivax''		*Mostly caused by ''P. falciparum'', though can also be caused by ''P. vivax''

	====~~CATMAT~~ Criteria (~~2019~~)====		====Criteria (CATMAT and WHO)====

	*Severe disease is defined as the presence of any one of criteria below		*Severe disease is defined as the presence of any one of criteria below
	*Clinical		*Clinical
	**Prostration (unable to walk to sit up without assistance) or impaired consciousness		**Prostration (unable to walk to sit up without assistance) or impaired consciousness (GCS less than 11 in adults)
			**Pulmonary edema (radiologically confirmed, or oxygen saturation <92% with respiratory rate >30/min)
	**Respiratory distress
	**Multiple convulsions (>2 in 24 hours), which can be from cerebral malaria, hypoglycemia, severe metabolic acidosis, ~~etc~~		**Multiple convulsions (>2 in 24 hours), which can be from cerebral malaria, hypoglycemia, severe metabolic acidosis, or other
	**Circulatory collapse (SBP <80 in adults, <50 in children)		**Circulatory collapse (SBP <80 in adults, <50 in children, or capillary refill ≥ 3 s)
			**Abnormal significant bleeding (including prolonged bleeding from nose, gums, venepuncture sites)
	**Pulmonary edema
		⚫	**Jaundice (clinical, or total bilirubin >50)
	**Abnormal bleeding
⚫	**Jaundice (clinical or total bilirubin >25)
	**Hemoglobinuria (macroscopic)		**Hemoglobinuria (macroscopic)
	*Laboratory		*Laboratory
	**Severe anemia (Hb ≤70 or Hct <20%)		**Severe anemia (Hb ≤70 or Hct <20%)
	**Hypoglycemia (<2.2)		**Hypoglycemia (<2.2)
	**Acidosis (pH <7.25 or bicarb <15)		**Acidosis (pH <7.25 or bicarb <15 or base deficit >8)
	**Renal impairment (creatinine >265)		**Renal impairment (creatinine >265 or urea >20)
	**Hyperlactatemia (>5 mmol/L)		**Hyperlactatemia (≥5 mmol/L)
	**Hyperparasitemia		**Hyperparasitemia
	***≥2% for children <5 years		***≥2% for children <5 years
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	*Boggild A, ''et al''. [https://www.canada.ca/en/public-health/services/catmat/canadian-recommendations-prevention-treatment-malaria.html Canadian recommendations for the prevention and treatment of malaria: Statements from the Committee to Advise on Tropical Medicine and Travel (CATMAT)].		*Boggild A, ''et al''. [https://www.canada.ca/en/public-health/services/catmat/canadian-recommendations-prevention-treatment-malaria.html Canadian recommendations for the prevention and treatment of malaria: Statements from the Committee to Advise on Tropical Medicine and Travel (CATMAT)].
	*[https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html CDC Treatment of Malaria: Guidelines For Clinicians (United States)]		*[https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html CDC Treatment of Malaria: Guidelines For Clinicians (United States)]
			*[https://www.who.int/teams/global-malaria-programme/guidelines-for-malaria WHO Guidelines for Malaria]

	{{DISPLAYTITLE:''Plasmodium''}}		{{DISPLAYTITLE:''Plasmodium''}}

Aidan: /* Further Reading */

2024-05-19T12:41:21Z

Aidan at 02:00, 2 April 2023

2023-04-02T02:00:51Z

← Older revision		Revision as of 02:00, 2 April 2023
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	===Molecular Testing===		===Molecular Testing===

	*PCR is available		*PCR and LAMP are available
	*~~Done~~ reflexively in Ontario to confirm species and detect a mixed infection		*PCR is done reflexively in Ontario to confirm species and detect a mixed infection
			*LAMP may need to replace RDT due to increasing falciparum false-negatives

	==Management==		==Management==

← Older revision		Revision as of 12:41, 19 May 2024
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	==Further Reading==		==Further Reading==

	*Boggild A, ''et al''. [https://www.canada.ca/en/public-health/services/~~reports-publications~~/~~canada~~-~~communicable~~-~~disease~~-~~report~~-~~ccdr/monthly-issue/2014-40/ccdr-volume-40-7-april-3-2014/ccdr-volume-40-7-april-3-2014~~.html ~~Summary of~~ recommendations for the ~~diagnosis~~ and treatment of malaria by the Committee to Advise on Tropical Medicine and Travel (CATMAT)]~~. ''CCDR'' 2014;40(7)~~.		*Boggild A, ''et al''. [https://www.canada.ca/en/public-health/services/catmat/canadian-recommendations-prevention-treatment-malaria.html Canadian recommendations for the prevention and treatment of malaria: Statements from the Committee to Advise on Tropical Medicine and Travel (CATMAT)].
	**A continuously-updated version is maintained [https://www.canada.ca/en/public-health/services/catmat/canadian-recommendations-prevention-treatment-malaria.html online].
	*[https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html CDC Treatment of Malaria: Guidelines For Clinicians (United States)]		*[https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html CDC Treatment of Malaria: Guidelines For Clinicians (United States)]