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 |
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