Plasmodium Vivax- Malaria

 

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Plasmodium Vivax- Malaria

Introduction

Plasmodium Vivax is a human pathogen from the group of micro organisms called the protozoa. It is the causative agent of the recurring malaria. The parasite is carried by the female Anopheles Mosquito. Plasmodium Vivax is one of the four parasites that causes mosquito. It is a unicellular parasite. It causes malaria when an Anopheles mosquito takes a blood meal and the parasite infects the red blood cells.P. vivax is a common parasite in America. It is found mainly in the United States of America. It is also found in large numbers in Latin America. In addition, the parasite is common in parts of Africa. It is reported to cause about 65 percent of malaria cases found in South America and in in Asia. Malaria is a tropical disease and is found in tropical as well as in non tropical areas of the Asian region.The main reason that makes the parasite so prevalent in Asia is due to the dense population of the nation.In fact, the oldest history of P. vivaxis for Asia. The parasite is said to have first been found in Asia.About 80% of the global incidences of P. vivax is concentrated in the Asian region. Globally, about 2.85 billion people are said to be at a risk of being infected by P. vivax. Actually, the regional incidence of the parasite is said to be increasing globally as that of P. falciparum is decreasing (Arnott, Barry, and Reeder, 2012).As a result, the disease has become an important disease among the human and is has raised a lot of concern globally.There are certain factors which favor the transmission of P. vivaxparasite. Some of these factors are; as globalization continues to grow, international travels haveincreased. This has caused wide spread of the Anopheles mosquito. In addition, the population is growing at a high rate especially in the Asian parts of the world. Towns become congested and the environmental conditions deteriorate. The conditions favor the breeding of mosquito and subsequently the malaria transmission. In fact, malaria transmission has been increasing even in non- endemic areas. The image of the parasite can be observed as follows under a microscope;

Mechanism of pathogenesis

  1. vivax is one of the four microorganisms that cause malaria. It causes a type of malaria known as benign tertian. The disease is not very fatal. However it is the most difficult type of malaria to cure.The symptoms of this type of malaria are not different from the other malaria symptoms. They include; fever, headache and diarrhea. Vomiting is also common. The patient feels weak and chills can also be experienced. However, the disease has one major complication which is the enlargement of the spleen.The parasites become dominant in the liver. As a result, the disease keeps on recurring after months or after some years (WHO, 2012).

The dominant parasites can however be killed but only under special medication. The microorganism is introduced in the body by the Anopheles mosquito. Plasmodium sporozoites pass through the salivary glands of the mosquito and into the blood stream of the human being.Once it gets into the body, it invades the liver cells.In the liver, they invade the hepatocytes. Most of them divide and form schizonts. This might take 1 to 2 weeks after which they rapture to formlarge numbers of merozoites. The merozoites then move out of the liver and invade the red blood cells.This stage is referred to as the erythrocytic stage. The merozoites are produced at a very high rate. They are usually in ring forms. They mature from this form to form tropozytes and then form red cell schizonts which cause malaria symptoms (WHO, 2012).

In fact, after 48 hours, enough of them are already produced to cause symptoms on the patient. It is important to note that the sporozoites that are found in the liver stage are not ones that cause malaria. Rather, the merozoitesforms in the erythrocytic stage are the ones that cause malaria. The parasites digest the red cells proteins which are the hemoglobin. The parasites release toxic substances into the body. The toxics they cause arereferred to as hemozoin. It is this toxins that cause high fever in the individual.Heme is a non protein form of hemoglobin that is formed after the blood has been digested by the malaria parasites or by any other blood feeding parasites. Free heme is usually toxic to the cells and is converted into hemozoin by the parasites. The hemozoin can also be referred to as the malaria pigment. It is important to note that this toxin is the one that enhances survival of the malaria parasite. Therefore it is important when developing drugs for malaria cure. The other toxin that the parasite P. vivax can cause is the glycosylphosphatidylinositol (GPI). This toxin makes the macrophages as well as the endothelial cells to become active and consequently produce cytokines. Generally, there is limited knowledge regarding to virulence mechanisms of the malaria causing organisms. The virulence knowledge that can be identified on the P. vivax is that it infects young RBCs as opposed to P. falciparum that affects RBCs at all stages (The Rockefeller University Press, 2012).

Mechanisms of growth in the Lab

Study of P. vivax micro organism in the laboratory is usually very difficult. In fact, the microorganism cannot be grown in a defined medium. The main reason as to why it is not easy to study it in the lab is due to the fact that the microorganism grows in immature red blood cells. The immature red blood cells can only be derived from the haemopoetic stem cells. The concentration of these cells is usually very low such that it cannot be sufficient for the researchers to grow cells infected by P. vivax in the laboratory. It therefore becomes difficult for the researchers to perform in vitro experiments which are crucial for further discovery on drug development. However, there have been recent advances in the study.In these studies, researchers will be seeking to produce a constant supply of immature red blood cells from the stem cells. The cells will then be infected by P. vivax which will be obtained directly from the patients. A continuous supply of the infected cells will be ensured. This is seen as an alternative to help in studying the microorganism in the laboratory (Tres Cantos Open Lab Foundation, 2011).The parasites grow in the blood cells outside the human body only in the presence of Locke’s solution and should be free of calcium chlorid. Ascetic fluid can also be present (The Rockefeller University Press, 2012).

The microorganism can be detected in a patient through lab tests. This is the best way to confirm the diagnosis of the disease in addition to the symptoms manifested. The diagnosis of malaria in the laboratory involves blood tests. It involves identifying the parasite in the blood of the patient. Identification of its antigens in the blood can also be a confirmatory test for malaria. Microscopy is regarded as the best for laboratory confirmatory test for malaria. The technique is simple and most lab technicians can apply it with o much problems. To carry out the test, a drop of blood from the patient is collected. Blood collection can be through a finger prick. It can also be collected froma large vein such as at the arm.

After the blood has been collected, a blood smear is made on glass slide. It is then dipped in a reagent that stains the parasite. The reagent commonly used is the Giemsa stain. Once this has been done, you can now examine the smear under a microscope. A magnification of ×1000 can be used to clearly observe the parasites. On observation under the microscope, the parasites are identified by their physical appearance. Alternatively, presence of the parasite can be noted as a result of the appearance of the red blood cells that they have infected.For perfect diagnosis of malaria, it is important to understand various morphological features presented by various blood stages of the parasites. One should not rely on a single image to confirm the test. You should identify various morphological characteristics before drawing your conclusion (Antimicrobial Resistance Network, 2009). The morphological features at different stages are described as follows; at the trophozoites stage, the parasite is usually polymorphus in shape. The shapes range from large ring forms to amoeboid mass which occupy the whole of red blood cells. In a thin smear they appear as in the digram;

(CDC, n.d)

At the schizonts stage, large bodies containingmerozoites are observed. Golden brown pigmentation is also observed. This stage is present in the peripheral blood. They appear as in the following diagram in a thin smear.

(CDC, n.d)

The structures observable at the gametocytes are large bodies which have a voluminous nucleus and a red/ purple color in females or pink color in males.The appear as in the diagrambelow;

(CDC, n.d).

At the parasitic stage the parasites can be easily observed in large numbers (Antimicrobial Resistance Network, 2009).

Other laboratory tests that can be used to detect the disease include; antigenic detection, serological tests as well as indirect fluorescent antibody test.

Disease Treatment/ Prevention

The best recommended treatment for p. vivax is use of chloroquine and primaquine. The later is best effective at the liver stage. It helps in decreasing the risk of relapse. However, resistance of the parasite to these drugs is increasing over the recent years (Filho et al, 2007). Scientists therefore have been given a wake up call to do more research so as to discover new drugs which are not resistance. One of the drugs that have been developed to overcome the resistance is the artesunate. The drug is however not used in the U. S. A. the drug is used in combination with primaquine for effective cure to be achieved. Another drug that can be used as an alternative to treat P. vivax is mefloquine. The drug is readily available in many countries.Atovaquone- proguanil is also effective especially for patients who have developed a resistance to chloroquine. Despite the fact that quinine is not so effective, it can also be used to treat P. vivax malaria. If radical treatment is not offered to the patients, there are high chances that the disease is going to relapse after some time. In fact, the relapse can be as high as 100 percent of the cases. Therefore, the best way to avoid the occurrence of a relapse is to give radical treatment. Eradication of the disease at the liver stage by use ofprimaquine is usually effective in avoiding a relapse.

Prevention

All forms of malaria can be prevented. The spread of malaria is mostly associated with travellers. Therefore, one the efforts that can be used to prevent malaria are to seek advice from a travel clinician when travelling so as to get the advice on the best malaria protection mechanism that you can adapt. The main reason as to why it is advisable to seek medical advice before travelling is because the effectiveness of the various drugs is not the same in all regions and may also vary with time. In taking the prevention measures, one should evaluate the risk of infection. Then prevention of mosquito bites is also effective which can be achieved by controlling the mosquitoes. Chemoprophylaxis can also be taken as a preventive medication (WHO, 2012).

Conclusion

Plasmodium vivaxis just one of the four species of plasmodium that causes mosquito. The form of malaria caused by this microorganism is not fatal. It is however recurring. The recurrence can however be avoided through radical treatment.P. vivax is most common in the Asian countries. As a result of its increasing epidemiology, it has raised so much concern worldwide. Research is still being done to find a solution on its control and how it can be reduced. With observation of the correct measures, the disease can be controlled.

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