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Plasmodium malariae: Causes, Symptoms and Treatment

Plasmodium malariae is a malaria-causing parasite transmitted by Anopheles mosquitoes, responsible for quartan malaria with fever recurring every 72 hours.

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Things worth knowing about "Plasmodium malariae"

Plasmodium malariae is a malaria-causing parasite transmitted by Anopheles mosquitoes, responsible for quartan malaria with fever recurring every 72 hours.

What is Plasmodium malariae?

Plasmodium malariae is a single-celled parasite belonging to the genus Plasmodium and one of five species known to cause malaria in humans. The disease it produces is called quartan malaria, named after its hallmark fever pattern that recurs every 72 hours (every third day). While generally considered less life-threatening than malaria caused by Plasmodium falciparum, infection with P. malariae can become chronic if left untreated and may lead to serious kidney complications.

Distribution and Transmission

Plasmodium malariae is found in tropical and subtropical regions worldwide, with the highest prevalence in sub-Saharan Africa, South Asia, Southeast Asia, and parts of South America. Transmission occurs almost exclusively through the bite of infected female Anopheles mosquitoes. Less commonly, the parasite can be transmitted through blood transfusions, shared needles, or from mother to child during pregnancy or birth (congenital malaria). A distinctive feature of P. malariae is its ability to persist in the human bloodstream for years or even decades at low levels, often without causing symptoms.

Life Cycle

The life cycle of P. malariae involves two hosts:

The human host (intermediate host): After an infected mosquito bite, sporozoites enter the bloodstream and travel to the liver, where they multiply asexually. The resulting merozoites infect red blood cells (erythrocytes), where further replication takes place. Every 72 hours, infected red blood cells rupture, releasing new merozoites and triggering the characteristic fever cycle.
The Anopheles mosquito (definitive host): When a mosquito feeds on an infected person, the sexual stage of the parasite's life cycle continues within the mosquito, eventually producing infectious sporozoites.

Symptoms

The incubation period is typically 18 to 40 days, but with P. malariae it can occasionally extend much longer. Common symptoms include:

Periodic fever occurring in a 72-hour cycle (quartan fever)
Chills, rigors, and profuse sweating
Headache and muscle pain
Fatigue and general malaise
Splenomegaly (enlarged spleen) in chronic infections
Nephrotic syndrome: A serious complication in which the parasite damages the kidneys, leading to protein loss in the urine, swelling (oedema), and impaired kidney function

Diagnosis

Diagnosis of Plasmodium malariae infection relies on several methods:

Thick blood film and blood smear microscopy: The gold standard in malaria diagnostics. Stained blood preparations allow identification and differentiation of the parasite species. P. malariae is characteristically identified by band-form trophozoites within infected red blood cells.
Rapid Diagnostic Tests (RDTs): Immunological tests that detect malaria-specific antigens. Sensitivity for P. malariae is generally lower than for P. falciparum.
Polymerase Chain Reaction (PCR): A highly sensitive molecular method for definitive species identification, especially useful when parasite levels are low.

Treatment

Treatment of quartan malaria follows the current recommendations of the World Health Organization (WHO) and national guidelines. Because P. malariae does not form dormant liver stages (hypnozoites), no additional therapy is required to prevent liver-stage relapses.

Chloroquine: Remains the first-line treatment in most regions, as resistance in P. malariae is rare.
Artemisinin-based Combination Therapies (ACTs): Used when chloroquine is unavailable or when co-infection with P. falciparum is suspected.
Supportive care: Includes antipyretics for fever, adequate hydration, and nephrology-focused management if kidney complications arise.

Prevention

As no approved vaccine exists against P. malariae, prevention relies on personal protective measures against mosquito bites and, for travellers to endemic areas, antimalarial chemoprophylaxis:

Use of insect repellents (e.g., DEET-based products)
Sleeping under insecticide-treated bed nets
Wearing protective clothing (long sleeves and trousers) at dawn and dusk
Pre-travel medical consultation and appropriate antimalarial prophylaxis

References

World Health Organization (WHO): World Malaria Report 2023. Geneva: WHO Press, 2023. Available at: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023
Vinetz JM: Plasmodium malariae Infection and its Clinical Relevance. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier, 2020.
Centers for Disease Control and Prevention (CDC): Malaria Biology – Plasmodium malariae. Atlanta: CDC, 2023. Available at: https://www.cdc.gov/malaria/about/biology/index.html

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