طرق طرق   التشخيص التشخيص المعمليالمعملي

التشخيص المباشر :التشخيص المباشر :        نظرا الن االصابة بطفيل نظرا الن االصابة بطفيل

المالريا تكون عادة مصحوبة المالريا تكون عادة مصحوبة بارتفاع في درجات الحرارة بارتفاع في درجات الحرارة

مثل العديد من االمراض مثل العديد من االمراض البكتيرية والفيروسية لذا فانه البكتيرية والفيروسية لذا فانه من الصعب التفرقة بينها وبين من الصعب التفرقة بينها وبين االصابات . وللتأكد من اصابة االصابات . وللتأكد من اصابة المريض بطفيل المالريا يجب المريض بطفيل المالريا يجب

فحص عينة دم للمريض للتحقق فحص عينة دم للمريض للتحقق من وجود االطوار المختلفة من وجود االطوار المختلفة للطفيل بما يؤكد االصابة للطفيل بما يؤكد االصابة

بالمرض. بالمرض.

يتم جمع عينة دم للمريض يتم جمع عينة دم للمريض - - بطريقة المسحة السميكة او بطريقة المسحة السميكة او الرقيقة بعد صبغها بصIبغة الرقيقة بعد صبغها بصIبغة

جيمسا )يفضل فحص العينة جيمسا )يفضل فحص العينة السميكة المكان احتوائها السميكة المكان احتوائها

علي كمية اكبر من طبقات علي كمية اكبر من طبقات طبقة(. من طبقة(. من 4040--2020الدم )الدم )

المهم دقة التمييز بين المهم دقة التمييز بين الطفيل وباقي محتويات الطفيل وباقي محتويات

الدم مثل الصفائح الدموية الدم مثل الصفائح الدموية والشوائب العالقة.والشوائب العالقة.

الدم فيلمالسميك

التشخيص الغير مباشر التشخيص الغير مباشر - - 11  )التشخيص السيرولوجي()التشخيص السيرولوجي(

منذ بداية الستينات وجدت العديد منذ بداية الستينات وجدت العديد من الطرق التي اعتمدت علي من الطرق التي اعتمدت علي

التحقق من وجود االجسام التحقق من وجود االجسام المضادة للطفيل بسائل الدم المضادة للطفيل بسائل الدم

)المصل( وهو ما يعرف )المصل( وهو ما يعرف بالتشخيص المصلي او بالتشخيص المصلي او

السيرولوجي ومن هذه الطرق:السيرولوجي ومن هذه الطرق: فحص المناعي الوميضيفحص المناعي الوميضي

((ImmunofluorescnceImmunofluorescnce ) )    

الفحص المناعي الفحص المناعي الوميضيالوميضي

((ImmunofluorescnceImmunofluorescnce ) )    

Iالتجلط المناعي الدموي Iالتجلط المناعي الدموي الغير مباشرالغير مباشر

((Indirect Indirect HaemoagglutinationHaemoagglutination))

وهذه الطرق تفيد في وهذه الطرق تفيد في اعمال المسح االولي اعمال المسح االولي

الشامل ، وقد تستعملها الشامل ، وقد تستعملها بعض الدول في موانيها بعض الدول في موانيها

ومطاراتها.ومطاراتها.

Malaria. Thin blood film showing Malaria. Thin blood film showing gametocyte of P. vivax with stippling gametocyte of P. vivax with stippling (Schuffner's dots) in the cytoplasm. (Schuffner's dots) in the cytoplasm.

Giemsa stain. Giemsa stain.

Malaria. Thin blood film showing Malaria. Thin blood film showing trophozoites (ring forms) of P. trophozoites (ring forms) of P.

falciparum. Note two parasites within falciparum. Note two parasites within the same red cell and double chromatin the same red cell and double chromatin

knobs. Giemsa stain. knobs. Giemsa stain.

Malaria. Thin blood film Malaria. Thin blood film showing early trophozoite (ring showing early trophozoite (ring

form) of P. vivax. form) of P. vivax.

Malaria. Thin blood film showing band Malaria. Thin blood film showing band forms (trophozoites) of P. malariae. forms (trophozoites) of P. malariae. This is a characteristic feature of P. This is a characteristic feature of P.

malariae. Giemsa stain. malariae. Giemsa stain.

Malaria. Thin blood film showing Malaria. Thin blood film showing trophozoite of P. ovale. Note trophozoite of P. ovale. Note

pronounced stippling of red cell and pronounced stippling of red cell and coarse pigment within parasite. Giemsa coarse pigment within parasite. Giemsa

stain. stain.

Malaria. Thin blood film showing Malaria. Thin blood film showing several ring forms and a schizont of P. several ring forms and a schizont of P. falciparum. This is only seen in severe falciparum. This is only seen in severe

cases. Giemsa stain. cases. Giemsa stain.

Malaria. Thin blood film showing fully Malaria. Thin blood film showing fully developed schizont of P. vivax with developed schizont of P. vivax with

merozoites ready to burst out. Giemsa merozoites ready to burst out. Giemsa stain. stain.

Malaria. Thin blood film showing Malaria. Thin blood film showing banana-shaped gametocyte of P. banana-shaped gametocyte of P.

falciparum. Note the central mass of falciparum. Note the central mass of pigment. Giemsa stain. pigment. Giemsa stain.

Malaria. Thin blood film showing Malaria. Thin blood film showing gametocyte of P. vivax with stippling gametocyte of P. vivax with stippling (Schuffner's dots) in the cytoplasm. (Schuffner's dots) in the cytoplasm.

Giemsa stain. Giemsa stain.

Malaria. Child with mild jaundice, pallor Malaria. Child with mild jaundice, pallor and bilateral conjunctival haemorrhages and bilateral conjunctival haemorrhages associated with P. falciparum infection.associated with P. falciparum infection.

Malaria. Tropical Malaria. Tropical splenomegaly in a splenomegaly in a

patient with evidence patient with evidence of of hypersplenism hypersplenism

living in a living in a P. P. falciparumfalciparum endemic endemic

area.area.

Malaria. Very heavy Malaria. Very heavy parasitaemia in a parasitaemia in a

patient with severe P. patient with severe P. falciparum infection. falciparum infection.

Despite chemotherapy Despite chemotherapy and exchange and exchange

transfusion the patient transfusion the patient died of cerebral died of cerebral

malaria.malaria.

Babesiosis. Peripheral blood film Babesiosis. Peripheral blood film showing red cell infestation with the showing red cell infestation with the typical small coccoid and dumb-bell typical small coccoid and dumb-bell

shaped Babesia organisms. shaped Babesia organisms.

This is a thin film from a 27 year old This is a thin film from a 27 year old female backpacker, with a recent history female backpacker, with a recent history of trekking through Northern Thailand of trekking through Northern Thailand

and high feverand high fever. .

Salient features are: Salient features are:

Numerous fine ring forms Numerous fine ring forms

Double chromatin dots Double chromatin dots

Marginal forms Marginal forms

Red cells are not enlarged. Red cells are not enlarged.

This is a typical This is a typical Plasmodium falciparum Plasmodium falciparum

presentation. presentation.

A thin film from a 22 year old male A thin film from a 22 year old male holidaying in Lombok holidaying in Lombok ((IndonesiaIndonesia) ) one one month previouslymonth previously. . Intermittent fevers Intermittent fevers

since returningsince returning. .

Salient features are: Salient features are:

Developing and thick Developing and thick (signet) ring forms (signet) ring forms

Enlarged red cells Enlarged red cells

This is a typical This is a typical Plasmodium vivax Plasmodium vivax

presentation. presentation.

Recent travel in AfricaRecent travel in Africa. . Pyrexia of unknown originPyrexia of unknown origin. .

Salient features are: Salient features are:

Developing form of Developing form of plasmodium plasmodium

"Comet-like" red cells "Comet-like" red cells

Enlarged red cell Enlarged red cell

This is a typical This is a typical Plasmodium ovale Plasmodium ovale

presentation. presentation.

Female patient, arrived from Brazil Female patient, arrived from Brazil two weeks previouslytwo weeks previously. . Flu like Flu like

symptoms since arrivalsymptoms since arrival. .

Salient features are: Salient features are:

Broad band form of plasmodium Broad band form of plasmodium

Red cells not enlargedRed cells not enlarged

This is a typical Plasmodium malariae This is a typical Plasmodium malariae presentation. presentation.

This is a thick film prepared from a 32 This is a thick film prepared from a 32 year old male recently returned from year old male recently returned from

VietnamVietnam. .

Salient features are: Salient features are:

Numerous ring form of Plasmodium Numerous ring form of Plasmodium can be seen as indicated by the arrowscan be seen as indicated by the arrows..

Note size of neutrophils (for Note size of neutrophils (for comparisoncomparison

The only definitive diagnosis that can The only definitive diagnosis that can be made from this film is that Malaria be made from this film is that Malaria is present. Thin films would have to be is present. Thin films would have to be

examined for species identification. examined for species identification.

This is a thick film prepared from a This is a thick film prepared from a recent arrival from India who recent arrival from India who

presented with a high temperature presented with a high temperature

Salient features are: Salient features are:

No parasites seen in this field No parasites seen in this field

This film would need to be examined This film would need to be examined for 10 minutes before being called for 10 minutes before being called negative. Repeat films should be negative. Repeat films should be

prepared and examined on at least 2 prepared and examined on at least 2 further occasions, ideally as the further occasions, ideally as the temperature peaks, before the temperature peaks, before the

presence of Malaria can be excluded. presence of Malaria can be excluded.