Pathology

1. Infected mosquito injects sporozoites

2. Sporozoites migrate to the liver, where they form merozoites

3. Merozoites are released and invade red blood cells

4. In the red blood cell, the merozoite becomes a trophozoite

5. In the red blood cell, the trophozoites multiply, producing new merozoites. These are released when the red blood cell ruptures and can infect other red blood cells

6. Some merozoites become gametocytes

7. The female mosquito picks up gametocytes from an infected human. The sexual cycle occurs in the mosquito, where sporozoites are formed

(Microbiology 3th book by Richard A. Harvey)

• P. falciparum - Termed malignant because the disease may deteriorate rapidly from mild symptoms to coma and death

• P. vivax - Termed benign because the clinical course was generally mild compared to falciparum malaria

• Tertian malaria - Time between paroxysms (short burst), which occur every 48 hours. Quartan malaria -  72 hours cycle of paroxysms

Cold stage 15 minutes to 1 hour (sensation of cold and shivering)

Hot stage 2 to 6 hours (fever, headache, vomiting and seizures in young children)

Sweating stage 2 to 4 hours (sweat, return to normal temperature and tiredness) 

The patient may sleep for 8 to 12 hours and feel well until the next paroxysm

(Metta, 2014) 

1. Bite from an infected mosquito injects sporozoites

2. Sporozoites migrate to the liver and reproduce to form merozoites. Some remain dormant for years before becoming activated

3. Merozoites are released and invade red blood cells

4. In the red blood cell, the merozoite becomes a trophozoite

5. In the red blood cell, the trophozoites multiply, producing new merozoites. These are released when the red blood cell ruptures and can infect other red blood cells

6. Cycle of the red blood cell infection and destruction causing shaking, chills, and fever

7. Large numbers of infected red blood cells, thereby causing hemolytic anaemia

8. Ruptured red blood cells released hematin (brown malaria pigment derived from haemoglobin) that produces discoloration of the spleen, liver, lymph nodes, and bone marrow

9. Activation of the defence mechanism leads to marked hyperplasia (increase in cell number) of mononuclear phagocytes (immune system), producing massive splenomegaly (enlarged spleen) and occasional hepatomegaly (enlarged liver)