Boston University
Research Occupational Health Program (ROHPResearch Occupational Health Program ROHP is part of the ...)
617-358-7647

Agent

Plasmodium spp. parasites belong to the Apicomplexa group of protozoa and encompass a wide variety of genus including Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. Plasmodium is most known for causing malaria, a mosquito-borne disease that manifests itself as fever, chills, and flu-like illness. If left untreated patients may develop severe complications and die.

Disease/Infection

Causes malaria

Pathogenicity

The Plasmodium parasite infects Anopheles mosquitoes, which then in turn feed on humans, transmitting the disease. Once in the body, Plasmodium grows and multiplies first in the liver cells and then in the red cells of the blood. The infected erythrocytes invade deep microvasculature, and can cause many symptoms. Of all the Plasmodium species, most deaths from malaria are caused by severe complications of P. falciparum infection such as cerebral malaria, severe anemia, renal failure, and respiratory failure. Fatal complications usually result from multi-organ failure and superimposed bacterial infections. As many as 34 lab acquired infections have been reported with Plasmodium spp.  Fifty percent of them are vector borne.

  • Special Populations at Risk
    In sub-Saharan Africa, most severe cases and deaths occur in children younger than 5 years old and in pregnant women. Malaria of pregnancy can be a life threatening condition for both the mother and the fetus. Patients with HIV have more severe disease.

Biosafety Information

Risk Group/BSL
Risk Group 2
Biosafety Level 2 Practices

Modes of Transmission
Malaria cannot be spread from person to person.

Transmission
Skin Exposure (Needlestick, bite, scratch, or infected mosquito bite):Accidental parenteral inoculation, direct blood meal by vector, exposure via wound

Host Range/Reservoir
Female Anopheles mosquito, humans

Symptoms
Malaria presents as an acute febrile illness, headache and confusion. It is mostly characterized by the classic malaria cycles of chills and rigors, followed by fever spikes up to 104° F. Symptoms vary widely and can either be acutely painful, or more indolent and asymptomatic. Patients often then experience profuse sweating and fatigue. These paroxysmal cycles can last several hours, and usually coincide with the synchronous rupture of blood schizonts. Cycles usually happen every 48 to 72 hours. Severe disease and high parasitemia can be marked with cerebral edema, shock and multi-organ failure.

Incubation Period
Usually, the malaria incubation period ranges from 10 days to four weeks in duration.

Viability
Unknown

Survival Outside Host
Injected sporozoites require hepatocytes to continue their life cycle and replication.

Information for Lab Workers

Laboratory PPE

Personal protective equipment includes but is not limited to gowns with tight wrists and ties in back, disposable gloves, combination safety glass and mask or a face shield. Facilities for washing and changing clothing after work should be available.

Containment

BSL-2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures. Procedures that are likely to generate aerosols should be conducted in a biosafety cabinet. Practices may be enhanced based on risk assessment.  Insectary containment of arthropod vectors performed at arthropod containment level 3.

In Case of Exposure/Disease

  • For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…):
    • Medical Campus: call or have a coworker call the Control Center at 617-414–4144.
    • Charles River Campus: call or have a coworker call campus security at 617-353-2121.
      You will be referred to or transported to the appropriate health care location by the emergency response team.
  • For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
  • Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
  • Provide the wallet-size agent ID card to the physician.

Vaccination

None

Information for First Responders/Medical Personnel

Public Health Issues

Malaria is not transmitted person to person. Standard precautions should be used in care of patients with suspected infections.

Diagnosis/Surveillance

Patients with fever who have had recent lab exposure or recently traveled in malaria-endemic areas should be immediately evaluated using the appropriate diagnostic tests for malaria. Blood smears or a rapid diagnostic test (RDT) should be performed, and if the RDT is positive, a smear is required for speciation.

First Aid/Post Exposure Prophylaxis

Perform one of the following actions:

Skin Exposure (Needlestick or scratch):Immediately go to the sink and thoroughly wash the wound with soap and water for 15 minutes. Decontaminate any exposed skin surfaces with an antiseptic scrub solution.
Mucous Membrane Splash to Eye(s), Nose or Mouth:Exposure should be irrigated vigorously.
Splash Affecting Garments:Remove garments that may have become soiled or contaminated and place them in a double red plastic bag.

Consideration for post exposure prophylaxis should be made on a case by case basis. More research is needed regarding post exposure prophylaxis in occupational settings.

Treatment

Treatment is often based on the species of parasite and known resistance patterns. Presumptive first line treatments for Plasmodium falciparum or plasmodium vivax include atovaquone-proguanil, artemether lumefantrine, quinine, chloroquine (if chloroquine sensitve), doxycycline, tetracycline, clindamycin or mefloquine, or tafenoquine.

References

Malaria. http://www.cdc.gov/malaria/

Treatment of Uncomplicated falciparum malaria, UpToDate, 2019

Treatment of Non-falciparum malaria, UpToDate, 2019

http://www.uptodate.com/contents/search?source=MISSPELL&sp=0&search=overview+of+non+malaria&searchOffset=0&searchType=PLAIN_TEXT

Herwaldt, B. L. (2001). “Laboratory-acquired parasitic infections from accidental exposures.” Clin Microbiol Rev 14(4): 659-688, table of contents.

D.O. Fleming and D.L. Hunt, 4th Edition Biological Safety Principle and Practices , pg.132-137

Revised: 3/7/19