Comparisons between Species

Table 1: Comparison of the Five Plasmodial Species Causing Human Malaria [1-4]

 

P. falciparum

P. vivax

P. ovale

P. malariae

P.  knowlesi

Worldwide Distribution

80-90% of cases in Africa, 40-50% of cases in western pacific and SE Asia, 4-30% in S Asia and S America and rest of tropics

70-90% of cses in most of Asia and S America, 50-60% of cases in SE Asia and western pacific,1-10% in Africa

8% of cases in parts of Africa, stray cases in Asia

2-3% in Africa, sporadic in Asia and S America

Reported from SE Asia; in some areas 70% of cases attributed to this

In India

30–90% of cases in Orissa, the north eastern states, Chattisgarh, Jharkhand, Madhyapradesh, Bihar, and Andamans; <10% of cases in other areas

Nearly 50% of total malaria burden; predominant species in most parts other than P. falciparum dominant areas.

Stray cases reported from Kolkata, Orissa, Delhi, Gujarat and Assam

3-16% reported from some tribal areas, particularly Orissa; prevalence may be higher than reported

Not reported

Pre-erythrocytic cycle (days)

5-6

8

9

13

8-9

Prepatent period (days)

9-10

11=13

10-14

15-16

9-12

Incubation period (days)

12 (9-14)

13 (12-17) or up to 6-12 months

17(16-18) or longer

28(18-40) or longer

12 (9-12)

Exo-erythrocytic cycle (hypnozoites)

Absent

Present

Present

Present in some strains?

Absent

Merozoites per tissue schizont

40,000

Over 10,000

15,000

2000

?

Erythrocyte preference

Young RBCs, but can infect all

Reticulo-cytes

Reticulo-cytes

Old RBCs

?

Erythrocytic cycle (hours)

48

48

49-50

72

24

Fever pattern

Tertian, sub tertian

Tertian

Tertian

Quartan

Quotidian

Febrile paroxysm (hours)

16-36 or longer

8-12

8-12

8-10

8-10 or longer

Average Parasitemia/µl

20,000-500,000

20,000

9000

6000

2500-5000

Maximum Parasitemia/µl

2,000,000

50,000

30,000

20,000

200000

Primary attack severity

Severe in non-immunes

Mild to severe

Mild

Mild

Moderate to severe

Severe malaria

6%

3%

Very rare

Very rare

6-10%

Case fatality

2%

0.8%

Very rare or none

Very rare or none

1-2%

Relapses/recrudescence

+

++

++

+++

Period of recurrence

Short

Long

Long

Very long

Duration of untreated infection (years)

1-2

1.5-4

1.5-4

3-50

2 weeks-?

 

Table 2: Comparison of Clinical Manifestations of P. falciparum and P. vivax malaria [5-14]

Symptom P. falciparum P. vivax
Season Post monsoon autumn (October-November) peak Summer (April-May) peak
Fever Tertian, subtertaian or quotidian; may be continuous initially; poorly delineated and extends for long duration, even 24-36 hours Tertian; intermittent, short and well delineated within 8 hours
Chills and Rigors Less common Common
Abdominal pain More common and more severe Can occur, but rare
Diarrhoea More common and more severe Can occur, but rare
Pallor More common Can occur, not uncommon
Jaundice More common and more severe, may be conjugated in a few Less common, only unconjugated
Malarial hepatopathy and hepatic encephalopathy Reported Not reported
Hepatomegaly More common Less common
Splenomegaly Common Common, splenic rupture more often reported
Cough Less common More common (>60% in some reports)
ARDS More common Can occur
Altered behaviour, psychosis More common Less common
Altered sensorium, convulsions, coma More common Can occur, but rare

Sources:

  1. Carter R, Mendis KN. Evolutionary and historical aspects of the burden of malaria. Clin Microb Rev 2002;15(4):564–594.
  2. Singh B, Sung LK, Radhakrishnan A, et al. A large focus of naturally acquired Plasmodium knowlesi infections in human beings. Lancet 2004;363(9414):1017–1024.
  3. Kumar A, Valecha N, Jain T, Dash AP. Burden of malaria in India: Retrospective and prospective view. Am Trop Med Hyg 2007;77(6 Suppl):69–78.
  4. Matteelli A, Castelli F, Caligaris S. Life cycle of malaria parasites. In: Carosi G, Castelli F, eds. Handbook of Malaria Infection in the Tropics. Associazione Italiana ‘Amici di R Follereau’ Organizzazione per la Cooperazione Sanitaria Internazionale. Bologna, 1997, pp. 17–23.
  5. Mühlberger N, Jelinek T, Gascon J, et al. Epidemiology and clinical features of vivax malaria imported to Europe: Sentinel surveillance data from TropNetEurop. Malaria J 2004;3:5. Available at http://www.malariajournal.com/content/pdf/1475-2875-3-5.pdf
  6. Jelinek T, Schulte C, Behrens R, et al. Imported Falciparum Malaria in Europe: Sentinel surveillance data from the European network on surveillance of imported infectious diseases. Clin Infect Dis 2002;34:572–576. Available at http://www.journals.uchicago.edu/doi/pdf/10.1086/338235
  7. Echeverri M, Tobón A, Álvarez G, et al. Clinical and laboratory findings of Plasmodium vivax malaria in Colombia, 2001 Rev Inst Med Trop S Paulo February, 2003;45(1):29–34. Available at http://www.scielo.br/pdf/rimtsp/v45n1/14944.pdf
  8. Gupta S, Gunter JT, Novak RJ, Regens JL. Patterns of Plasmodium vivax and Plasmodium falciparum malaria underscore importance of data collection from private health care facilities in India. Malaria J 2009;8:227. Available at http://www.malariajournal.com/content/pdf/1475-2875-8-227.pdf
  9. Singh N, Mishra SS, Singh MP, Sharma VP. Seasonality of Plasmodium vivax and P. falciparum in tribal villages in central India (1987–1995). Ann Trop Med Parasitol 2000;94(2):101–112.
  10. Ndyomugyenyi R, Magnussen P, Clarke S. Diagnosis and treatment of malaria in peripheral health facilities in Uganda: Findings from an area of low transmission in south-western Uganda. Malaria J 2007;6:39.
  11. Harris VK, Richard VS, Mathai E, et al. A study on clinical profile of falciparum malaria in a tertiary care hospital in south India. Indian J Malariol 2001;38(1–2):19–24.
  12. Nandi B, Nandi B. A clinical study of falciparum malaria – 302 cases. Med J Armed Forces India 1998;54(1):9–12.
  13. Singh N, Kataria O, Singh MP. The changing dynamics of Plasmodium vivax and P. falciparum in Central India: Trends over a 27-year period (1975–2002). Vector-Borne and Zoonotic Dis Fall 2004;4(3):239–248.
  14. Oh M-D Oh, Shin H, Shin D,Min-Ho Choi, Jong-Yil Chai, Kangwon Choe et al. Clinical features of vivax Malaria. Am J Trop Med Hyg 2001;65(2):143–146. Available at http://www.ajtmh.org/cgi/reprint/65/2/143.pdf

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