Plasmodium vivax
Plasmodium vivax | |
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Mature P. vivax trophozoite | |
Scientific classification | |
Domain: | Eukaryota |
Clade: | Diaphoretickes |
Clade: | SAR |
Clade: | Alveolata |
Phylum: | Apicomplexa |
Class: | Aconoidasida |
Order: | Haemospororida |
Family: | Plasmodiidae |
Genus: | Plasmodium |
Species: | P. vivax
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Binomial name | |
Plasmodium vivax | |
Synonyms[1] | |
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Plasmodium vivax is a
Health
Epidemiology
Plasmodium vivax is found mainly in Asia, Latin America, and in some parts of Africa.[7][8] P. vivax is believed to have originated in Asia, but recent studies have shown that wild chimpanzees and gorillas throughout central Africa are endemically infected with parasites that are closely related to human P. vivax. These findings indicate that human P. vivax is of African origin.[9] Plasmodium vivax accounts for 65% of malaria cases in Asia and South America.[10] Unlike Plasmodium falciparum, Plasmodium vivax is capable of undergoing sporogonic development[11] in the mosquito at lower temperatures.[12] It has been estimated that 2.5 billion people are at risk of infection with this organism.[13]
Although the Americas contribute 22% of the global area at risk, high endemic areas are generally sparsely populated and the region contributes only 6% to the total population at risk. In Africa, the widespread lack of the
P. vivax is carried by at least 71 mosquito species. Many vivax vectors thrive in
Clinical presentation
Pathogenesis results from rupture of infected red blood cells, leading to fever. Infected red blood cells may also stick to each other and to walls of capillaries. Vessels plug up and deprive tissues of oxygen. Infection may also cause the spleen to enlarge.[15][self-published source?]
Unlike P. falciparum, P. vivax can populate the
Plasmodium vivax can cause a more unusual form of malaria with atypical
The parasite can lie dormant in the liver for days to years, causing no symptoms and remaining undetectable in blood tests. They form
A single infectious bite can trigger six or more relapses a year, leaving patients more vulnerable to other diseases. Other infectious diseases, including falciparum malaria, appear to trigger relapses.[10]
Serious complications
Serious complications for malaria are dormant liver stage parasites,
Prevention
The main way to prevent malaria is through vector control. There are mostly three main forms that the vector can be controlled: (1) insecticide-treated mosquito nets, (2) indoor residual spraying and (3) antimalarial drugs. Long-lasting insecticidal nets (LLNs) are the preferred method of control because it is the most cost effective. The WHO is currently strategizing how to ensure that the net is properly maintained to protect people at risk. The second option is indoor residual spraying and has been proven effective if at least 80% of the homes are sprayed. However, such method is only effective for 3–6 months. A drawback to these two methods, unfortunately, is that mosquito resistance against these insecticides has risen. National malaria control efforts are undergoing rapid changes to ensure the people are given the most effective method of vector control. Lastly, antimalarial drugs can also be used to prevent infection from developing into a clinical disease. However, there has also been an increase resistance to antimalarial medicine.[20]
In 2015 the World Health Organization (WHO) drew up a plan to address vivax malaria,[21] as part of their Global Technical Strategy for Malaria.
Diagnosis
P. vivax and
Treatment
When chloroquine resistance is common or when chloroquine is contraindicated, then
32–100% of patients will relapse following successful treatment of P. vivax infection if a radical cure (inactivation of liver stages) is not given.[27][28][29]
Eradication of the liver stages is achieved by giving
The idea that primaquine kills parasites in the liver is the traditional assumption. However, it has been suggested that primaquine might, to a currently unknown extent, also inactivate noncirculating, extrahepatic merozoites (clarity in this regard is expected to be forthcoming soon).[32]
Tafenoquine
In 2013 a Phase IIb trial was completed that studied a single-dose alternative drug named tafenoquine.[33] It is an 8-aminoquinoline, of the same family as primaquine,[34] developed by researchers at the Walter Reed Army Institute of Research in the 1970s and tested in safety trials. It languished, however, until the push for malaria elimination sparked new interest in primaquine alternatives.[10]
Among patients who received a 600-mg dose, 91% were relapse-free after 6 months. Among patients who received primaquine, 24% relapsed within 6 months. "The data are absolutely spectacular," Wells [who?] says. Ideally, he says, researchers will be able to combine the safety data from the Army's earlier trials with the new study in a submission to the U.S. Food and Drug Administration for approval. Like primaquine, tafenoquine causes hemolysis in people who are G6PD deficient.[10]
In 2013 researchers produced cultured human "microlivers" that supported liver stages of both P. falciparum and P. vivax and may have also created hypnozoites.[10]
Eradication
Mass-treating populations with primaquine can kill the hypnozoites, exempting those with G6PD deficiency. However, the standard regimen requires a daily pill for 14 days across an asymptomatic population.[citation needed]
Korea
P. vivax is the only indigenous malaria parasite on the Korean peninsula. In the years following the
Drug targets
Given that drugs that target the various life stages of the parasite can sometimes have undesirable side effects, it is desirable to come up with drug molecules targeting specific proteins/enzymes that are essential for the parasite's survival or that can compromise the fitness of the organism. Enzymes in the purine salvage pathway had been favorite targets to this end. However, given the high degree of conservation in purine metabolism across the parasite and its host, there could be potential cross-reactivity making it difficult to design selective drugs against the parasite. To overcome this, recent efforts have focused on deducing the function of orphan hypothetical proteins whose functions have been unknown. Though, a lot of the hypothetical proteins have role in secondary metabolism, targeting them will be beneficial from two perspectives, i.e., specificity and reducing the virulence of the pathogen with no or minimal undesirable cross-reactivities.[citation needed]
Biology
Life cycle
Like all
Asexual forms:
- Sporozoite: Transfers infection from mosquito to human
- Immature trophozoites (Ring or signet-ring shaped), about 1/3 of the diameter of a RBC.
- Mature trophozoites: Very irregular and delicate (described as amoeboid); many pseudopodial processes seen. Presence of fine grains of brown pigment (malarial pigment) or hematin probably derived from the haemoglobin of the infected red blood cell.
- Schizonts (also called meronts): As large as a normal red cell; thus the parasitized corpuscle becomes distended and larger than normal. There are about sixteen merozoites.
Sexual forms:
- Gametocytes: Round. P. vivax gametocytes are commonly found in human peripheral blood at about the end of the first week of parasitemia.
- Gametes: Formed from gametocytes in mosquitoes.
- Zygote: Formed from combination of gametes
- Oocyst: Contains zygote, develops into sporozoites
Human infection
P. vivax human infection occurs when an infected mosquito feeds on a human. During feeding, the mosquito injects saliva, along with sporozoites, through the skin. A proportion of these sporozoites reach the liver. There they enter hepatic cells, on which they feed, and reproduce asexually, as described in the next section. This process gives rise to thousands of merozoites (plasmodial daughter cells) in the body.[37]
The incubation period of human infection usually ranges from ten to seventeen days and sometimes up to a year. Persistent liver stages allow relapse up to five years after elimination of red blood cell stages and clinical cure.
Liver stage
The P. vivax sporozoite enters a hepatocyte and begins its exoerythrocytic schizogony stage. This is characterized by multiple rounds of nuclear division without cellular segmentation. After a number of nuclear divisions, the parasite cell will segment and
There are situations where some of the sporozoites do not immediately start to grow and divide after entering the hepatocyte, but remain in a dormant,
However, such recurrent parasitemia is probably being over-attributed to hypnozoite activation.[39] Two newly recognized, non-hypnozoite, probable contributing sources to recurrent peripheral P. vivax parasitemia are erythrocytic forms in bone marrow and the spleen.[40] Between 2018 and 2021, it was reported that vast numbers of non-circulating, non-hypnozoite parasites occur unobtrusively in tissues of P. vivax-infected people, with only a small proportion of the total parasite biomass present in the peripheral bloodstream. This finding supports an intellectually insightful, paradigm-shifting viewpoint, which had prevailed since 2011 (albeit not believed between 2011 and 2018 by most malariologists and therefore ignored), that an unknown percentage of P. vivax recurrences are recrudescences (having a non-circulating or sequestered merozoite origin), and not relapses (which have a hypnozoite source). The recent discoveries concerning bodily parasite biomass distribution did not give rise to this new theory; it was pre-existing, as explained above.[41] The recent bone marrow and spleen, etc., findings merely confirm the likely validity of the theory.
Erythrocytic cycle
P. vivax preferentially penetrates young red blood cells (reticulocytes), unlike Plasmodium falciparum which can invade erythrocytes. In order to achieve this, merozoites have two proteins at their apical pole (PvRBP-1 and PvRBP-2). The parasite uses the
The parasitised
Unusual erythrocytic forms were detected in a few cases of an outbreak in Brazil.[44]
Mosquito stage
Parasite life cycle in mosquitoes includes all stages of sexual reproduction:
- Infection and Gametogenesis
- Fertilization
- Ookinite
- Oocyst
- Sporogony
Mosquito infection and gamete formation
When a female Anopheles mosquito bites an infected person, gametocytes and other stages of the parasite are transferred to the mosquito stomach. Gametocytes ultimately develop into gametes, a process known as gametogony.
Microgametocytes become very active, and their nuclei undergo fission (i.e. amitosis) to each give 6-8 daughter nuclei, which becomes arranged at the periphery. The cytoplasm develops long thin flagella like projections, then a nucleus enter into each one of these extensions. These cytoplasmic extensions later break off as mature male gametes (microgametes). This process of formation of flagella-like microgametes or male gametes is known as exflagellation. Macrogametocytes show very little change. They develop a cone of reception at one side and becomes mature as macrogametocytes (female gametes).[citation needed]
Fertilization
Male gametes move actively in the stomach of mosquitoes in search of female gametes. Male gametes then enter into female gametes through the cone of reception. The complete fusion of 2 gametes results in the formation of zygote. Here, fusion of 2 dissimilar gametes occurs, known as anisogamy.
The zygote remains inactive for sometime but it soon elongates, becomes vermiform (worm-like) and motile. It is now known as ookinete. The pointed ends of ookinete penetrate the stomach wall and come to lie below its outer epithelial layer. Here the zygote becomes spherical and develops a cyst wall around itself. The cyst wall is derived partly from the stomach tissues and partly produced by the zygote itself. At this stage, the zygote is known as an oocyst. The oocyst absorbs nourishment and grows in size. Oocysts protrude from the surface of stomach, giving it a blistered appearance. In a highly infected mosquito, as many as 1000 oocysts may be seen.[citation needed]
Sporogony
The oocyst nucleus divides repeatedly to form large number of daughter nuclei. At the same time, the cytoplasm develops large vacuoles and forms numerous cytoplasmic masses. These cytoplasmic masses then elongate and a daughter nuclei migrates into each mass. The resulting sickle-shaped bodies are known as sporozoites. This phase of asexual multiplication is known as sporogony and is completed in about 10–21 days. The oocyst then bursts and sporozoites are released into the body cavity of mosquito. Sporozoites eventually reach the salivary glands of mosquito via its hemolymph. The mosquito now becomes infectious. Salivary glands of a single infected mosquito may contain as many as 200,000 sporozoites.[citation needed] When the mosquito bites a healthy person, thousands of sporozoites are infected into the blood along with the saliva and the cycle starts again.
Taxonomy
P. vivax can be divided into two clades: one that appears to have origins in the Old World and a second that originated in the New World.
At present, both types of P. vivax circulate in the Americas. The monkey parasite – Plasmodium simium – is related to the Old World strains rather than to the New World strains.
A specific name – Plasmodium collinsi – has been proposed for the New World strains, but this suggestion has not been accepted to date.
Miscellaneous
It has been suggested that P. vivax has horizontally acquired genetic material from humans.[46]
Plasmodium vivax is not known to have a particular gram stain (negative vs. positive) and may appear as either.
There is evidence that P. vivax is itself infected by viruses.[47]
Therapeutic use
P. vivax was used between 1917 and the 1940s for
See also
- List of parasites (human)
- Apicomplexan life cycle
- Gametocyte
- Host (biology)
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