MALARIA

Host, parasites and vectors

DEPT. PARASITOLOGY, SCHOOL OF MEDICINE
HASANUDDIN UNIVERSITY
MAKASSAR, INDONESIA
Sebaran Malaria di Indonesia
berdasarkan AMI
Malaria components

Host: Human
Parasit: Plasmodium spp.

Vector: Anopheles spp.

 Host – Parasit Relationship
>1 sequensial
Intermediate Host

IH1

1 intermediate host
DH No
intermediate host
Obligat Parasites

Self Free IH1

HD-A Incidental infection

Wrong host

IH2
Parasite Classification

ENDOPARASITE
ECOTPARASITE
6
 a mosquito-borne disease
developments
BITE 1 BITE 2 BITE 1’

Extrinsic Intrinsic
incubation incubation
1-2 weeks 1-2 weeks
SOURCE
OF
INFECTION
Infective
stage

SALI
VA

Infective
BLO stage
OD
MEN-DE-RI-
TA
Demam bersiklus pada malaria
Mekanisme penyebab
gejala malaria
 Gejala Tambahan
Lemah Gangguan
Kurang darah kesadaran
Kuning Sesak
Pembesaran Black water fever
limpa/hati Gagal ginjal, jantung,
Sakit perut otak
BBLR pada malaria Seperti gangguan
kehamilan jiwa
Kematian janin
 DIAGNOSIS
PENDERITA MALARIA
 Diagnosis Malaria
Riwayat dan Gejala Klinis
Apusan Darah:
Pewarnaan Giemsa
Pewarnaan Florescence
Direct Staining
QBC (Quantitative buffy coat method)
Serology
Qualitative: Rapid test (dipstik, lateral flow)
Quantitative: ELISA
Biomolecular:
PCR
Gene sequencing
 Riwayat dan gejala klinis
Demam bersiklus 48-72 jam (tergantung
jenis parasit)
Tanda hemolisis: anemi, ikterus, black water
fever, asfiksia
pembesaran limpa
Gangguan organ: malaria otak, gagal ginjal
Riwayat daerah
 Apusan darah tepi

Apusan tebal Apusan tipis

Sensitive Specifik
 Cara menghitung parasit
semikuantitatif
Negatif = 0 / 100 lpb
Positif
1+ = 1-10 / 100 lpb
2+ = 10-100 / 100 lpb = 1-10 / 10 lpb
3+ = 100-1000 / 100 lpb = 10-100 / 10 lpb = 1-
10 / 1 lpb
4+ = 1000-10000 / 100 lpb = 100-1000 / 10 lpb
= 10-100 / 1 lpb = >10/1 lpb
 Cara menghitung parasit per
microliter darah
Menggunakan Eritrosit
Menggunakan Leukosit (=500x leukosit)
Pada apusan tipis (blood smear)
Pada apusan tebal Normal: 3-5 juta/uL
(DDR) Rata-rata: 4 juta/uL
X= parasit / eritrosit x 4000
Normal: 5000- Dihitung dalam 1000 eritrosit
1000/uL X= 6/1000 x 100%
(ringan <0.2%; sedang 0.2-2%;
Rata-rata: 8000/uL berat >2%)

X= parasit/leukosit x
8000
 Serology
approach
Ag-Ab reaction
RDT (cepat dan
portable):
Penggunaan:
Daerah outbreak
Jika tidak ada
mikroskopis
Emergency Unit
Sebaiknya yang
multi plasmodium
PCR and DNA Sequencing
 Malaria components
Host: Human

Parasit: Plasmodium
Vector: Anopheles spp.
 3 teorema umum parasit
• Parasit menjadi parasit karena kehilangan 1
atau lebih fungsi vital untuk survive,
sehingga mencari fungsi tersebut di
organisme lain (HOST)
• Parasit hanya bisa menjadi dewasa dan
melanjutkan siklus hidupnya jika melewati
HD
• Parasit hanya bisa menjadi dewasa jika
memasuki HD dalam bentuk infektifnya
 Host – Parasit Relationship
>1 sequensial
Intermediate Host

IH1

1 intermediate host
DH No
intermediate host
Obligat Parasites

Self Free IH1

HD-A Incidental infection

Wrong host

IH2
Parasite Classification

ENDOPARASITE
ECOTPARASITE
 Human Parasites
Endoparasite
• Protozoa : Single cell animals
• Helminth : worms

Ektoparasite
• Arthropoda : Invertebrata with
body segment
 PROTOZOA
Rhizopoda /Amoeba Flagellata

Ciliata Sporozoa
 Classification of Protozoan
Rhizopod Ciliata Flagellata Sporozoa
(Amoeboid) (Cilia +) (Flagel +) (Gamet +)

E. coli B. coli G. lamblia Isospora spp.

Intestine
E. Histollitica T. hominis Eimeria spp.
I. butchii
D. fragilis
E. ginggivalis T. tenax
Atrial
T. vaginalis
Leishmania Plasmodium
Blood spp. spp.
Trypanosoma
spp.
Naegleria Tx. gondii
Tissue fowleri Sc. lindemanii
Achantamoeba Pn. carini
spp.
Sporozoites in salivary glands of
mosquito injected into next host
 Sporozoites in liver cells undergo
schizogony to produce merozoites

28
Each merozoite produces
as many as 36 new
merozoites through
schizogony in RBCs

29
 Species parasit malaria
Plasmodium vivax (malaria tertiana)
Plasmodium falcifarum (malaria tropika)
Plasmodium ovale (malaria ovale)
Plasmodium malaria (malaria quartana)
New: Plasmodium knowlesi (malaria pada
kera)
Sporozoa: Plasmodium
Malaria components
Host: Human

Parasit: Plasmodium spp.

Vector: nyamuk
Anopheles
 Host – Parasit Relationship
>1 sequensial
Intermediate Host

IH1

1 intermediate host
DH No
intermediate host
Obligat Parasites

Self Free IH1

HD-A Incidental infection

Wrong host

IH2
Parasite Classification

ENDOPARASITE
ECOTPARASITE
 Ectoparasite
• Live/develop/procuring food on host
• Only procuring food on host
• Enter the skin and invasion to the host
tissue
• Mechanically / biologically transmits
infectious agents
• Poisonous stinging or biting
• Annoyance
 Characters of ectoparasites

• Segmented body
• Exoscleton
• Obligate or temporer parasitism
on host’s body surface
 Why they are a parasite
• Directly parasitic on man
• Causes physical Injurious (bite, sting)
• Poisonous
• As a biological vector for parasitic agents
• As a mecanical vector for parasitic agents
Peran arthropods dalam transmisi agent penyakit
dan sebagai parasit

Vector biologis / mechanic

Makan Injury / Annoy

 Arthropods as vector
• Nyamuk
Anopheles: Malaria (Plasmodium)
Aedes: DHF (Dengue virus)
Mansonia: Kaki gajah (W. bancrofti & B. malayi)
Culex: japanese encephalitis (virus)
• House fly (Musca domestica), cockroach (Blatta orientalis): Thypoid
(bakteri), Diare (bacteria & protozoan)
• Sand fly Phlebotomus spp. : Kala azar, oriental sore (Leishmania spp.)
• Black fly Simulium spp.: Nematod O. volvulus
• Biting midge Culicoides spp.: Nematod A. perstans, M. ozardi
• Horse fly Tabanidae: Leshmaniasis and Loa-loa
• Tsetse fly (Glossina spp.): Sleeping sickness (T. gambiense)
• Fly larvae: myasis
• Triatoma spp.: Chaga’s disease (Trypanosoma cruzi)
• Copepods (Cyclops & Diaptomus): Tape worm D. latum and Nematoda D.
medinenensis, G. spinigerum
• Kutu hewan (flea): Tape worm H. diminuta
• Crab, crayfish, lobster: Fluke P. westermani
 Arthropods as parasites
• Mosquitoes (Anopheles, Aedes, Mansonia,
Culex)
• Black flies (Simulium spp)
• Sandflies (Plebothomus, Lutzomyia)
• Louses (Pediculus humanus spp, Phtirus pubis)
• Flea (Ctenocephalides felis, C. canis,
nosopsyllus fasciatus, pulex iritans,xenophilla
ceopsis)
• Sarcoptes scabei
 Annoyance Arthropods
(Menyebabkan gangguan)

• Cimex lectularis (kutu busuk)

• Pediculus humanus (kutu badan)
• Pediculus capitis (kutu kepala)
• Phtiarisis pubis (kutu pubis)
• Ant (semut)
• Fly (Musca sp.)
• Wasp (rayap)
 Poisonous Arthropods
• Bee (lebah)
• Centipede (lipan)
• Caterpilar (ulat bulu)
• Millipede (kaki seribu)
• Scorpion (kalajengking)
• Spider (Laba-laba)
Arthropods
 Classification
of arthropods
INSECTA
flying
arthropods

Terresterial
animal

ARACHINDA

Near water
terresterial animal

MYRIAPODA

Aquatic animal
CRUSTACEA
 Classification

– INSECTA (serangga)
– ARACHNIDA (Laba-laba & Kalajengking)
– CRUSTACEA (Cyclops, Kepiting & Udang)
– MYRIAPODA (Lipan & Kaki seribu)
– ONYCHOPORA (Not injurious to human)
 Class Crustacea
• Aquatic animals
• Head + Thoracic segments Cephalothorac
• 2 Orders:
– Copepoda (microscopic): Cyclops & Diaptomus
(host of D. latum, D. medinensis, G. spinigerum)
– Decapoda (macroscopic / 5 pair legs): Shrimps,
lobster, crabs, crayfish are intermediate host of
Paragonimus westermani
CYCLOPS
Ciclops
 Class Myriapoda
• Terresterial animals
• Segmented and elongated body
• A pair of legs on each segment
• 2 Order:
– Ordo Diplopoda: Millipedes (Kaki seribu,
Fontaria sp.) host of Hymenolepis diminuta
– Ordo Chilopoda: Centipedes (Lipan) are
poisonous (Scolopendra sp.)
Centipede
 Class Arachnida
• Terrestrial animals
• Some poisonous and painful biting
• Vector of viral diseases
• 4 order:
– Scorpionida (Kalajengking, Buthus sp.)--beracun
– Aranea (Laba-laba beracun, Lactrodectus sp.)--beracun
– Ixodoidea (Tick=sengkenit, Ixodes sp.)-- paralisis motorik
– Sarcoptoidea (Tungau: Tanah, debu, kudis Sarcoptes
scabei)-- asthma (alergi), kudis
 Scorpionida

Aranea

Sarcoptoidea
 Class Insecta (Serangga)
• Body: Head, thorax, abdomen
• 3 pair of legs on thorax
• Important order:
– Diptera (Lalat & Nyamuk)
– Siphonaptera (kutu binatang)
– Anoplura (Kutu manusia =Pediculidae)
– Hemiptera (Kutu busuk)
– Orthoptera (Kecoa)
– Lepidoptera (Gol. Kupu-kupu & Moth)
– Coleoptera (Gol. Kumbang)
– Hymenoptera (Gol. Lebah & Rayap)
 Diptera

• Head, Thorax, Abdomen

• 2 pair of wings (fungsional + halter)
• Three pairs of leg
Medical important member:

Culicidae (Mosquitoes, Nyamuk)

Simulidae (Simulium, blackfly)
Psychodidae (Phlebotomus, sandfly)
Ceratopogonidae (Culicoides, Gnats, Biting
midge)
Tabanidae (Tabanus, lalat kerbau)
Muscidae (Musca sp, Glossina sp., Lalat
rumah & lalat tsetse)
 Mosquitoes
• Long proboscis
• Specific wing venation
• Male do not suck blood
• Female mostly need blood meal for egg,
except autogenous female, such as
Toxorhynchites spp.
Schematic Mosquito
 Classification of mosquitoes

Culidae

Anophelinae Culicinae Toxorhynchitinae

Anopheles Culex Aedes Mansonia Toxorhynchites

Anopheles Aedes Mansonia

Culex

Important Toxorhynchites
genera
Life cycles
 Culicidae (mosquito)
Anopheles Aedes Culex Mansonia
Disease Malaria DHF, Chikunguya Japanese encephalitis Filariasis (elephantiasis)
Agent Plasmodium spp. Dengue virus, JE virus W. Bancrofti
Chikunguya virus B. malayi
Resting Make angle to Paralel to wall Paralel to wall Paralel to wall
position wall

Palpi:
Male Long, tip enlarge Long as proboscis Longer than proboscis Long as proboscis
Female Long Short Short
Larva No siphon Short, tick siphon Long, slender siphon Short, piercing type
Paralel to surface Angle to surface Angle to surface On water plan
Pupa Short trumpet Medium trumpet Long trumpet Piercing trumpet
Water surface Water surface Water surface On water plan
Egg Water surface Container wall Water surface On water plan
arrangement Soliter Soliter Raft Rosette
ANOPHELES
Female anopheles
Male anopheles
Female anopheles
Eggs of Anopheles
Pupa of anopheles
CULEX
Male Culex
Female Culex
Eggs of culex
Larva of Culex
Siphon of Culex
Pupa of Culex
AEDES
Male Aedes
Female Aedes
Eggs of Aedes
Larva of Aedes
Siphon of Aedes
Comb of Aedes aegypti
MANSONIA
Male mansonia
Eggs of Mansonia
CULICOIDES
 Simulidae (Black flies)
• Only 3 genera in the world, only one
genus in Southeast Asia: Simulium spp.
• Small stout bodied, humped back, short
legs, conspicuous eyes (holoptic in male
and dichoptic in females)
• Lay eggs at / just below water level in a
non pollutant running water (stream, water
falls, river)
• Vectors of Onchocerca spp. in man and
animal
Adults, egg, larva & pupa of
Simulium sp.
 Psychodidae (Sand-flies)
• The blood sucking member is Phlebotomus sp.
• Breeding sites are never aquatiq
• Lay eggs on moist and dark crack & crevices
(shady side at the base of a building)
• Small size adults and can pass mosquito net
• Mouthparts like in mosquitoes but shorter
• Cause diseases: Sand-fly fever (virus),
Bartonellosis (bacteria: Bartonella bacilliformis),
Leishmaniasis (parasites: Leishmania spp.)
Adults, egg, larva & pupa of
Plebotomus sp.
 Ceratopogonidae
(Gnats, Biting Midges)
• Only Culicoides sp. is medically important
• Smal dark flies, long 15-jointed pilose antena in
both males and females
• Spotted wings
• Lay a single row of eggs in water (crab holes,
tree holes, decaying vegetation, aquatic plants,
etc.)
• Vector of filarial worms: Achantocheilonema
perstans and Mansonella ozzardi
Adult and larva Culicoides sp.
Chironomidae
-Mosquito-like insect
-Non biting diptera
-Adult, larval and
pupal stages almost
similar to those of
mosquitoes
Tabanus spp.
Musca domestica
Glossina sp. (Tsetse fly)
 Importance of tsetse fly:

• Vectors of African Sleeping Sickness

(Trypanosomiasis)
• Parasites: Tr. gambiense, Tr. rhodesiense
CIMEX LECTULARIS
 Hemiptera
(Kutu busuk, Bugs)
Cimex Reduvius Triatoma Rhodnius
lectularis personatus infestans prolixus
(Bed bug) (Kissing bug)
Disease No Chagas’ Chagas’ Chagas’
disease disease disease

Vector of Trypanosoma Trypanosoma Trypanosoma

cruzi cruzi cruzi

Biting Pruritus No pain, but No pain, but Painful and

urticaria Swelling Swelling swelling

Wing No Present Present Present

Male

Female
Male

Genital like a claw

Female
With
recaptaculum
seminalis
PINJAL (KUTU BINATANG)
 Siphonaptera
(kutu binatang, flea, pinjal)
Host Disease Vector of Comb : Thickening line
Prothoracix (sisir) (penebalan) on
Genal (gigi) mesopleuron

Pulex irritans Human Pes (Sampar) No No

Helminthiasis D. caninum No
Xenopsylla Rat Pes (Sampar) No Yes
cheopsis Helminthiasis H. diminuta No
Nosopsyllus Rat, Pes (Sampar) No Yes
fasciatus rodent Helminthiasis H. diminuta Genal comb +
Ctenocephalides Cat Helminthiasis D. caninum Prothoracic comb + Yes
felis Genal comb +
(gigi I & II sama)
Ctenocephalides Dog Helminthiasis D. Caninum Prothoracic comb + Yes
canis H. nana Genal comb +
(gigi I & II tdk sama)
 Prothorasic comb

Genal
comb

Mesopleuron’s
Tickening line
Females’
recaptaculum
seminalis
Male’s
Genital claw
Genital claw
Seperti W terbalik
Recptaculum
seminalis
ANOPLURA (KUTU MANUSIA)
 Anoplura
(Kutu Manusia, Louse=Lice)
Thorax + Abdomen fused --- thoracoabdominal

Pediculus Pediculus Phtirus pubis

humanus humanus
capitis corporis
Synonyms Head louse Body louse Crab louse
Site Head Body Pubis
Body Large Medium Small
Ovale & plat Ovale & plat Crab-like
dorsoventral dorsoventral
Pediculus humanus capitis
Pediculus humanus corporis
(LARGER)
Engorged female
Phtirus pubis
SARCOPTES SCABEI
MITE
MITE (KUTU DEBU)
TICK
Arthropods-borne diseases
MANAGEMENT
The transmission of parasitic diseases
involves 3 factors:

( 1) INFECTION SOURCES
(2) MODE OF TRANSMISSION
(3) SUSCEPTIBLE HOST
 Hygiene
Diagnosis/
Vaccination
Treatment

Vector
control

Blocking Out: Blocking In:

Isolation Vector Control Quarantine
Personal protection Personal protection

Managemen of Arthropode-borne diseases:

A,diagnosis & treatment; B,isolation; C,blocking out flowing injection; D,detection of carriers and missed cases;
E,immunization; F,cleanliness & hygiene; G,isolation & screening; H, quarantine