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\author{Paularbear01}
\pdfinfo{
  /Title (malaria.pdf)
  /Creator (Cheatography)
  /Author (Paularbear01)
  /Subject (Malaria Cheat Sheet)
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Malaria Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Paularbear01} via \textcolor{DarkBackground}{\uline{cheatography.com/96492/cs/22456/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Paularbear01 \\
  \uline{cheatography.com/paularbear01} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 20th April, 2020.\\
   Updated 20th April, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{4}

\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Life Cycle}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Has 2 hosts: vertebrate ({\bf{intermediate}}) and mosquito ({\bf{definitive}})} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Definitive Host: Sporulating Cycle (Sporogony) & Intermediate Host: Asexual Cycle (Schizogony) \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{EXO-ERYTHROCYTIC CYCLE}}} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
1. Anopheles mosquito (definitive host), inoculates {\bf{sporozoites}} into human host (intermediate) & Sporozoites are the infective stage to man \tn 
% Row Count 11 (+ 5)
% Row 4
\SetRowColor{LightBackground}
2. Sporozoites infect {\bf{liver parenchymal cells}} and mature into {\bf{schizonts}}, which produce merozoites & {\emph{P. vivax}} and {\emph{P. ovale}} assume a dormant stage ({\bf{hypnozoites}}), and can persist in the liver \tn 
% Row Count 17 (+ 6)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{3. Infected cell ruptures and releases {\bf{merozoites}}} \tn 
% Row Count 19 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{ERYTHROCYTIC CYCLE}}} \tn 
% Row Count 20 (+ 1)
% Row 7
\SetRowColor{white}
4. Merozoites infect {\bf{RBCs}} and become {\bf{trophozoites}} (ring stage) & Merozoites are the infective stage for RBCs \tn 
% Row Count 24 (+ 4)
% Row 8
\SetRowColor{LightBackground}
5. Trophozoites mature into {\bf{schizonts}}, which rupture and release {\bf{merozoites}} & Some differentiate into {\bf{gametocytes}}, which are ingested by the mosquito looking for a blood meal \tn 
% Row Count 29 (+ 5)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{6. Ruptured schizonts are responsible for the {\bf{clinical manifestations}} of the disease} \tn 
% Row Count 31 (+ 2)
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\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Life Cycle (cont)}}  \tn
% Row 10
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\mymulticolumn{2}{x{3.833cm}}{{\bf{SPOROGONIC CYCLE}}} \tn 
% Row Count 1 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{7. The {\bf{gametocytes}} are ingested by an anopheles mosquito and make their way into the {\bf{stomach}} of the mosquito} \tn 
% Row Count 4 (+ 3)
% Row 12
\SetRowColor{LightBackground}
8. While in the stomach, the {\bf{microgametes}} (male) penetrate the {\bf{macrogametes}} (female), which generate {\bf{zygotes}} & Microgametocyte exflagellates and produces 8 sperm-like microgametes \tn 
% Row Count 10 (+ 6)
% Row 13
\SetRowColor{white}
9. The zygotes become {\bf{motile}} and {\bf{elongated}} & These are called {\bf{ookinetes}} \tn 
% Row Count 13 (+ 3)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{10. The ookinetes invade the {\bf{midgut wall}} of the mosquito, where they develop into {\bf{oocysts}}} \tn 
% Row Count 15 (+ 2)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{11. The {\bf{oocysts}} grow, rupture, and release {\bf{sporozoites}}, which makes their way into the {\bf{salivary glands}} of the mosquito} \tn 
% Row Count 18 (+ 3)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{12. Inoculation of the sporozoites into a new human host perpetuates the malaria life cycle} \tn 
% Row Count 20 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{The {\bf{merozoite}} recognizes a {\bf{specific receptor site}} on the {\bf{RBC}} and exposes several organelles for attachment. The red cells becomes {\bf{deformed}} and the merozoite enters through an invagination of the RBC membrane \newline  \newline For {\emph{P. vivax}}, the receptor site on the RBC is associated with the {\emph{Duffy Blood Group Antigen{\bf{. Over 90\% of }}Africans{\bf{ are }}Duffy Negative}} and are {\bf{resistant}} to Vivax Malaria}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{3.833cm}{x{1.3732 cm} x{2.0598 cm} }
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\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Pathogenicity and Virulence}}}}  \tn
% Row 0
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\mymulticolumn{2}{x{3.833cm}}{Pathological process is the result of {\bf{erythrocytic cycle}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{1. {\bf{Hemolysis}}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & RBC invasion by merozoites induces changes in {\bf{cytoskeleton}} and decreases in {\bf{deformability}} \tn 
% Row Count 8 (+ 5)
% Row 3
\SetRowColor{white}
 & {\bf{Increased capillary permeability}}, which allows fluid to lead into surrounding tissues, causing congestion in blood vessels and {\bf{tissue infarction and necrosis}} \tn 
% Row Count 15 (+ 7)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{2. {\bf{Liberation of Metabolites}}} \tn 
% Row Count 16 (+ 1)
% Row 5
\SetRowColor{white}
 & Rupture of RBCs bring on {\bf{malarial paroxysm}} and {\bf{increased hemosiderin}} in the {\bf{liver, spleen}}, and other organs, which become {\bf{black}} in color \tn 
% Row Count 23 (+ 7)
% Row 6
\SetRowColor{LightBackground}
 & Lysis of cells \& phagocytosis of cell remnants, debris, and hemozoin congest the {\bf{kupffer cells}} of the liver, resulting in {\bf{hepatosplenomegaly}}. Tears of splenic capsule may occur due to trauma or coughing \& may require surgery \tn 
% Row Count 33 (+ 10)
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\begin{tabularx}{3.833cm}{x{1.3732 cm} x{2.0598 cm} }
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\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Pathogenicity and Virulence}} (cont)}}  \tn
% Row 7
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\mymulticolumn{2}{x{3.833cm}}{3. {\bf{Immunologic Response}}} \tn 
% Row Count 1 (+ 1)
% Row 8
\SetRowColor{white}
 & Antigens of {\emph{P. falciparum}} induces {\bf{cytokines}}, which stimulate the release of {\bf{TNF}} or {\bf{Cachexin}}, which causes {\bf{fever, paroxysms, HA, pains, and prostration}} \tn 
% Row Count 8 (+ 7)
% Row 9
\SetRowColor{LightBackground}
 & {\bf{TNF}} produces {\bf{neurologic symptoms}}, which play a role in {\bf{cerebral malaria}} \tn 
% Row Count 12 (+ 4)
% Row 10
\SetRowColor{white}
 & Repeated attacks of malaria produce {\bf{anemia}} \tn 
% Row Count 14 (+ 2)
% Row 11
\SetRowColor{LightBackground}
 & {\bf{Immune complexes}} are formed and may be deposited in the {\bf{kidney}} \tn 
% Row Count 17 (+ 3)
% Row 12
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{4. {\bf{Formation of Malarial Pigment}}} \tn 
% Row Count 18 (+ 1)
% Row 13
\SetRowColor{LightBackground}
 & In infected RBC, {\bf{Hgb}} is {\bf{digested}} forming the pigment {\bf{hemozoin}}, which can get deposited to various organs \tn 
% Row Count 23 (+ 5)
% Row 14
\SetRowColor{white}
 & Hemozoin formation {\bf{depletes iron stores}}, which leads to {\bf{anemia}} \tn 
% Row Count 26 (+ 3)
% Row 15
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{VIRULENCE FACTORS}}} \tn 
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% Row 16
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Knobs}} develop for {\bf{adhesion}} to parasitized and non-parasitized cells and platelets} \tn 
% Row Count 29 (+ 2)
% Row 17
\SetRowColor{LightBackground}
 & {\bf{{\emph{P. falciparum}} erythrocyte membrane Pr1}} ({\bf{PfEMP1}}) is the {\bf{most adhesive protein}} among the knobs \tn 
% Row Count 34 (+ 5)
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\begin{tabularx}{3.833cm}{x{1.3732 cm} x{2.0598 cm} }
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\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Pathogenicity and Virulence}} (cont)}}  \tn
% Row 18
\SetRowColor{LightBackground}
 & Knobs contain {\bf{Histidine-Rich Pr}} ({\bf{HRP}}) \tn 
% Row Count 2 (+ 2)
% Row 19
\SetRowColor{white}
 & {\bf{In Falciparum}}, {\bf{cytoadherence}} causes plugging of {\bf{small vessels}} by masses of parasitized RBCs and RBCs sticking to {\bf{endothelium}} causing: {\bf{ischemia of the brain, heart, kidney, lungs, and GIT}} \tn 
% Row Count 11 (+ 9)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{PREFERENCE}}} \tn 
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% Row 21
\SetRowColor{white}
{\bf{Vivax and Ovale}} & Only reticulocytes and young RBC \tn 
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% Row 22
\SetRowColor{LightBackground}
{\bf{Malariae}} & Senescent cells \tn 
% Row Count 15 (+ 1)
% Row 23
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{infections with these 3 parasites (vivax, ovale, and malariae) limits number of RBCs that can be parasitized to less than 3\% of all erythrocytes} \tn 
% Row Count 18 (+ 3)
% Row 24
\SetRowColor{LightBackground}
{\bf{Falciparum and Knowlesi}} & All ages of RBC \tn 
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% Row 25
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Results in increased parasitemia, early anemia, and increased severity of complications and mortality} \tn 
% Row Count 23 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.7165 cm} x{1.7165 cm} }
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\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Morphology}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Ring Form (Early Trophozoite)}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Earliest stage after invasion of RBC. The ring has a dot-like nucleus of {\bf{red chromatin}} & Falciparum ring: headphone type with a {\bf{double chromatin dot}}. \tn 
% Row Count 6 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Plasmodium Falciparum Ring Form}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{3.833cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/paularbear01_1587350818_Pf_rings_thinB.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Headphone type is also seen in {\emph{P. knowlesi}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Plasmodium Malariae Bird's Eye Ring Form}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{3.833cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/paularbear01_1587351039_Pm_ring_thinA.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\mymulticolumn{1}{x{3.833cm}}{\{\{nl\}\}}  \tn 
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Mature Trophozoites}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{The erythrocyte hemoglobin is metabolized to produce a darkly staining pigment {\bf{hemozoin}}} \tn 
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% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Maurer's Clefts}}: {\emph{P. falciparum}} infections containing older ring-form trophozoites and asexual stages} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Schüffner's Dots}}: seen in {\emph{P. vivax}} and {\emph{P. ovale}}} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Parasite nutrition is hemoglobin and the metabolite is hemozoin or hematin}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Maurer's Clefts}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{3.833cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/paularbear01_1587351457_maurer's.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Schüffner's Dots}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{3.833cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/paularbear01_1587351505_schuffner.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Schizont}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{3.833cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/paularbear01_1587351811_schizont.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{When parasite divides and shows multiple masses of {\bf{nuclear chromatin}}. Mature schizonts contain {\bf{merozoites}}. \newline  \newline Rarely seen in peripheral blood of {\emph{P. falciparum}} except in severe infections \newline  \newline Falciparum schizonts stay in capillaries of organs and muscles. If schizont {\bf{spills into general circulation}}, indicates {\bf{bad prognosis}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Gametocytes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Sexual form ingested by the mosquito ({\bf{infective stage for mosquito}})} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Macrogametocyte}}: nucleus is {\bf{dense}} and {\bf{compact}}} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Microgametocyte}}: nucleus is a {\bf{pale, loose network}}} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Falciparum Gametocyte}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{3.833cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/paularbear01_1587352362_falcigame.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Banana shaped}  \tn 
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\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Knowlesi Gametocyte}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{3.833cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/paularbear01_1587352409_knowlesi game.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Gametocytes of {\bf{vivax, ovale, malariae}}, and {\bf{knowlesi}} are similar, except that {\bf{malariae}} is {\bf{smaller}} and {\bf{darker}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{3.833cm}{p{0.78959 cm} x{2.64341 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Diagnosis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{MICROSCOPIC IDENTIFICATION}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Gold standard \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Specimens can be taken any time \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
 & {\bf{Giemsa stain}} is preferred for visualization of certain structures (ex. Maurer's Clefts) \tn 
% Row Count 8 (+ 4)
% Row 4
\SetRowColor{LightBackground}
 & If high degree of synchrony exist, late developmental stages can be demonstrated in the repeated smears every 4-6hrs ({\bf{not recommended for falciparum}}) \tn 
% Row Count 14 (+ 6)
% Row 5
\SetRowColor{white}
 & Repeated testing is not recommended if parasites are not found initially \tn 
% Row Count 17 (+ 3)
% Row 6
\SetRowColor{LightBackground}
 & Blood smears are obtained to monitor response to treatment \tn 
% Row Count 19 (+ 2)
% Row 7
\SetRowColor{white}
 & {\bf{Thick Film}}: reveals if parasite is {\bf{present}} and is most efficient method of detection \tn 
% Row Count 23 (+ 4)
% Row 8
\SetRowColor{LightBackground}
 & {\bf{Thin Film}}: {\bf{identification}} of species \tn 
% Row Count 25 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{MALARIAL RDT}}} \tn 
% Row Count 26 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & Uses Immunochromatography to detect Plasmodium specific antigens in a finger prick blood sample \tn 
% Row Count 30 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{p{0.78959 cm} x{2.64341 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Diagnosis (cont)}}  \tn
% Row 11
\SetRowColor{LightBackground}
 & Antigens utilized are: HRP II, pLDH, Plasmodium Aldolase \tn 
% Row Count 2 (+ 2)
% Row 12
\SetRowColor{white}
 & {\bf{HRP II}}: produced by {\bf{trophozoites}} and young {\bf{gametocytes}} of {\emph{P. falciparum}} \tn 
% Row Count 5 (+ 3)
% Row 13
\SetRowColor{LightBackground}
 & {\bf{pLDH}}: produced by both {\bf{sexual and asexual}} stages, and can distinguish between falciparum and non-falciparum. Sensitive for severe malaria \tn 
% Row Count 10 (+ 5)
% Row 14
\SetRowColor{white}
 & {\bf{Plasmodium Aldolase}}: PA + HRP II = PMA which has 90\% specificity and can be performed in 30 minutes \tn 
% Row Count 14 (+ 4)
% Row 15
\SetRowColor{LightBackground}
{\bf{SEROLOGY}} & Cannot differentiate past from current infection \tn 
% Row Count 16 (+ 2)
% Row 16
\SetRowColor{white}
 & Indirect Hemagglutination (IHA) \tn 
% Row Count 18 (+ 2)
% Row 17
\SetRowColor{LightBackground}
 & Indirect Fluorescent Antibody Test (IFAT) \tn 
% Row Count 20 (+ 2)
% Row 18
\SetRowColor{white}
 & ELISA \tn 
% Row Count 21 (+ 1)
% Row 19
\SetRowColor{LightBackground}
{\bf{PCR}} & low parasitemia or mixed infection \tn 
% Row Count 23 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} x{3.0897 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Plasmodium Falciparum}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{MALIGNANT TERTIAN MALARIA}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Also known as subtertian or Aestivoautumnal Malaria \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & {\bf{Deadliest species}} of plasmodium \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
 & Causes {\bf{50\%}} of all malaria cases \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Erythrocytic cycle of {\bf{48hrs}} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
 & Found in tropics, subtropics, and sub saharan Africa \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & Infected cell is {\bf{same size}} as normal RBC \tn 
% Row Count 10 (+ 2)
% Row 7
\SetRowColor{white}
 & Associated with the development of {\bf{Burkitt's Lymphoma}} \tn 
% Row Count 12 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{RING-FORM TROPHOZOITES}}} \tn 
% Row Count 13 (+ 1)
% Row 9
\SetRowColor{white}
 & {\bf{Headphone Type}}: Rings may possess 1 or 2 chromatin dots \tn 
% Row Count 15 (+ 2)
% Row 10
\SetRowColor{LightBackground}
 & They may be found on the {\bf{periphery}} of the RBC ({\bf{accolé, appliqué}}) and {\bf{multiply-infected RBCs}} may be seen. \tn 
% Row Count 19 (+ 4)
% Row 11
\SetRowColor{white}
 & Usually {\bf{no enlargement}} of infected RBC \tn 
% Row Count 21 (+ 2)
% Row 12
\SetRowColor{LightBackground}
 & {\bf{Maurer's Clefts}}: can be seen in infections w/ older ring-form trophozoites, and resembles {\bf{the Schüffner's dots}} but are {\bf{larger}} and {\bf{coarser}} \tn 
% Row Count 26 (+ 5)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{DEVELOPING AND OLDER TROPHOZOITES}}} \tn 
% Row Count 27 (+ 1)
% Row 14
\SetRowColor{LightBackground}
 & Remain in ring-form, but may become {\bf{thicker and more compact}} \tn 
% Row Count 29 (+ 2)
% Row 15
\SetRowColor{white}
 & Amount of {\bf{pigment}} and {\bf{chromatin}} may also {\bf{increase}} \tn 
% Row Count 31 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{p{0.3433 cm} x{3.0897 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Plasmodium Falciparum}} (cont)}}  \tn
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{SCHIZONTS}}} \tn 
% Row Count 1 (+ 1)
% Row 17
\SetRowColor{white}
 & Schizogony {\bf{DOES NOT}} take place in the {\bf{peripheral blood}}, but in {\bf{capillaries}} of {\bf{organs}} and {\bf{muscles}}. \tn 
% Row Count 5 (+ 4)
% Row 18
\SetRowColor{LightBackground}
 & The only stages seen in peripheral blood are {\bf{rings}} and {\bf{gametocytes}} \tn 
% Row Count 8 (+ 3)
% Row 19
\SetRowColor{white}
 & Contain anywhere from {\bf{8-24 merozoites}} \tn 
% Row Count 10 (+ 2)
% Row 20
\SetRowColor{LightBackground}
 & Mature schizont usually fills 2/3 of infected RBC \tn 
% Row Count 12 (+ 2)
% Row 21
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{GAMETOCYTES}}} \tn 
% Row Count 13 (+ 1)
% Row 22
\SetRowColor{LightBackground}
 & {\bf{Crescent}} or {\bf{sausage}} or {\bf{banana}} shaped \tn 
% Row Count 15 (+ 2)
% Row 23
\SetRowColor{white}
 & Pigment is {\bf{more coarse and concentrated}} in {\bf{macrogametocyte}} than microgametocyte \tn 
% Row Count 18 (+ 3)
% Row 24
\SetRowColor{LightBackground}
 & {\bf{Laveran's Bib}}: {\bf{remnants}} of host RBC \tn 
% Row Count 20 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} x{3.0897 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Plasmodium Ovale}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{OVALE MALARIA}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Has an erythrocytic cycle of {\bf{48hrs}} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Has a {\bf{hypnozoite}} stage in the liver, which is the cause of relapse \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
 & Infected RBC is {\bf{slightly enlarged}} compared to normal RBC \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Found in Tropical Africa, West Africa, South America, and Asia \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{RING-FORM TROPHOZOITES}}} \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Contains {\bf{single chromatin dot}}. Difficult to differentiate from vivax. \tn 
% Row Count 13 (+ 3)
% Row 7
\SetRowColor{white}
 & {\bf{Multiply-Infected}} RBC may be see \tn 
% Row Count 14 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{MATURE TROPHOZOITES}}} \tn 
% Row Count 15 (+ 1)
% Row 9
\SetRowColor{white}
 & As trophozoite matures, infected RBCs may exhibit {\bf{fimbriation}} and {\bf{Schüffner's dots}} \tn 
% Row Count 18 (+ 3)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{SCHIZONTS}}} \tn 
% Row Count 19 (+ 1)
% Row 11
\SetRowColor{white}
 & Similar to {\emph{P. vivax}}, though tend to contain fewer merozoites {\bf{(4-16, on average 8}}) \tn 
% Row Count 22 (+ 3)
% Row 12
\SetRowColor{LightBackground}
 & Elongation to an {\bf{oval shape}} and {\bf{fimbriation}} are common \tn 
% Row Count 24 (+ 2)
% Row 13
\SetRowColor{white}
 & {\bf{Schüffner's dots}} can be observed with proper staining \tn 
% Row Count 26 (+ 2)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{GAMETOCYTES}}} \tn 
% Row Count 27 (+ 1)
% Row 15
\SetRowColor{white}
 & Difficult to distinguish from {\emph{P. vivax}} \tn 
% Row Count 29 (+ 2)
% Row 16
\SetRowColor{LightBackground}
 & {\bf{Slight enlargement of infected RBC}} \tn 
% Row Count 31 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} x{3.0897 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Plasmodium Vivax}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{BENIGN TERTIAN MALARIA}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Erythrocytic cycle of {\bf{48 hours}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & {\bf{Hypnozoite}}: persistant dormant stage in the liver, which is the cause of {\bf{relapse}} \tn 
% Row Count 5 (+ 3)
% Row 3
\SetRowColor{white}
 & {\bf{Predominant}} malarial species \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Infected {\bf{RBC}} is {\bf{enlarged}} due to affinity for {\bf{young RBCs or reticulocytes}} \tn 
% Row Count 9 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{RING-FORM TROPHOZOITES}}} \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Has a {\bf{thick cytoplasm w/ single, large chromatin dot}}. Difficult to distinguish from {\emph{P. ovale}} \tn 
% Row Count 13 (+ 3)
% Row 7
\SetRowColor{white}
 & Cytoplasm becomes {\bf{ameboid}} and {\bf{Schüffner's dots}} may appear as trophozoites mature \tn 
% Row Count 16 (+ 3)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{LATE TROPHOZOITES}}} \tn 
% Row Count 17 (+ 1)
% Row 9
\SetRowColor{white}
 & Developing trophozoites become {\bf{amoeboid}}, with {\bf{pseudopodial processes}} and {\bf{large vacuoles}}.  Schüffner's dots are visible with proper staining \tn 
% Row Count 22 (+ 5)
% Row 10
\SetRowColor{LightBackground}
 & {\bf{band-form}} appearance of trophozoite may occur \tn 
% Row Count 24 (+ 2)
% Row 11
\SetRowColor{white}
 & May be mistaken for {\emph{P. Malariae}} or {\emph{P. knowlesi}} \tn 
% Row Count 26 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{SCHIZONTS}}} \tn 
% Row Count 27 (+ 1)
% Row 13
\SetRowColor{white}
 & Pigment is organized in {\bf{1-2 clumps}} \tn 
% Row Count 29 (+ 2)
% Row 14
\SetRowColor{LightBackground}
 & Mature schizonts contain {\bf{12-24 merozoites}}, each of which contains a {\bf{dot of chromatin}} and a {\bf{mass of cytoplasm}} \tn 
% Row Count 33 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{p{0.3433 cm} x{3.0897 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Plasmodium Vivax (cont)}}  \tn
% Row 15
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{GAMETOCYTE}}} \tn 
% Row Count 1 (+ 1)
% Row 16
\SetRowColor{white}
 & {\bf{Macrogametocyte}}: {\bf{round to oval}} and usually fill host cell. Infected RBC is larger and {\bf{cytoplasm}} is usually a {\bf{darker blue}} with {\bf{fine brown pigments}} throughout \tn 
% Row Count 6 (+ 5)
% Row 17
\SetRowColor{LightBackground}
 & {\bf{Microgametocyte}}: usually the size of an {\bf{uninfected RBC}} and has a {\bf{paler blue, pink or grey cytoplasm}} \tn 
% Row Count 10 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} x{3.0897 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Plasmodium Knowlesi}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{KNOWLESI MALARIA}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Vector is {\bf{{\emph{A. balabacensis}} \& {\emph{A. maculatus}}}} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Primate malaria in macaques in South East Asia \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
 & Infects {\bf{ALL}} stages of {\bf{RBC}}, and causes {\bf{severe malaria}} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Erythrocytic cycle has {\bf{quotidian}} pattern (every {\bf{24hrs}}) \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
 & Non-relapsing due to absence of hynozoites \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & Microscopically {\bf{indistinguishable}} from {\bf{{\emph{P. malariae}}}} (Use PCR to distinguish) \tn 
% Row Count 14 (+ 3)
% Row 7
\SetRowColor{white}
 & Quotidian pattern results in {\bf{high levels of parasitemia}} and {\bf{severe disease}} with {\bf{fatal consequence}} \tn 
% Row Count 18 (+ 4)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{TREATMENT}}} \tn 
% Row Count 19 (+ 1)
% Row 9
\SetRowColor{white}
 & Chloroquine \tn 
% Row Count 20 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & Primaquine \tn 
% Row Count 21 (+ 1)
% Row 11
\SetRowColor{white}
 & Should be treated aggressively and urgently \tn 
% Row Count 23 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{RING-FORM TROPHOZOITES}}} \tn 
% Row Count 24 (+ 1)
% Row 13
\SetRowColor{white}
 & Normal to 0.75x smaller than uninfected RBC \tn 
% Row Count 26 (+ 2)
% Row 14
\SetRowColor{LightBackground}
 & Rings may show {\bf{double chromatin dots}} \tn 
% Row Count 28 (+ 2)
% Row 15
\SetRowColor{white}
 & {\bf{Appliqué}} forms may be seen as well as rectangular rings harboring one or more {\bf{accessory chromatin dots}} \tn 
% Row Count 32 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{p{0.3433 cm} x{3.0897 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Plasmodium Knowlesi}} (cont)}}  \tn
% Row 16
\SetRowColor{LightBackground}
 & RBC may be {\bf{Multiply-infected}} \tn 
% Row Count 1 (+ 1)
% Row 17
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{OLDER, DEVELOPING TROPHOZOITES}}} \tn 
% Row Count 2 (+ 1)
% Row 18
\SetRowColor{LightBackground}
 & {\bf{Band forms}} may appear similar to {\emph{P. malariae}} \tn 
% Row Count 4 (+ 2)
% Row 19
\SetRowColor{white}
 & {\bf{Sinton and Mulligan's stippling}} may appear \tn 
% Row Count 6 (+ 2)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{SCHIZONTS}}} \tn 
% Row Count 7 (+ 1)
% Row 21
\SetRowColor{white}
 & {\bf{Sinton and Mulligan's stippling}} may appear \tn 
% Row Count 9 (+ 2)
% Row 22
\SetRowColor{LightBackground}
 & {\bf{10-16 merozoites}} \tn 
% Row Count 10 (+ 1)
% Row 23
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Gametocytes}}} \tn 
% Row Count 11 (+ 1)
% Row 24
\SetRowColor{LightBackground}
 & {\bf{Mature Macrogametocyte}}: usually {\bf{spherical}} and fill the host RBC. {\bf{Cytoplasm}} stains {\bf{blue}} and {\bf{eccentric nucleus}} stains {\bf{red}} \tn 
% Row Count 15 (+ 4)
% Row 25
\SetRowColor{white}
 & {\bf{Microgametocyte}}: {\bf{smaller}} and {\bf{cytoplasm}} stains {\bf{pale pink}}, while {\bf{nucleus}} stains a {\bf{darker red}} \tn 
% Row Count 19 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{p{0.3433 cm} x{3.0897 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Plasmodium Malariae}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{QUARTAN MALARIA}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Erythrocytic cycle of {\bf{72hrs}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Found in {\bf{subtropical}} and {\bf{temperate}} areas \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
 & Infected cells are {\bf{normal to smaller}} in size than most RBCs \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & {\bf{Old cells}} are preferentially infected** \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{RING-FORM TROPHOZOITES}}} \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Have {\bf{1 chromatin dot}} and a {\bf{cytoplasm ring that is thicker than {\emph{P. falciparum}}}}. \tn 
% Row Count 12 (+ 3)
% Row 7
\SetRowColor{white}
 & Infected RBC is {\bf{normal to smaller}} \tn 
% Row Count 14 (+ 2)
% Row 8
\SetRowColor{LightBackground}
 & {\bf{Bird's-eye}} forms may appear \tn 
% Row Count 15 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{MATURE TROPHOZOITES}}} \tn 
% Row Count 16 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & {\bf{Rounded chromatin}} and {\bf{compact cytoplasm}} \tn 
% Row Count 18 (+ 2)
% Row 11
\SetRowColor{white}
 & As the trophozoite matures, the cytoplasm may {\bf{elongate}} across the host RBC, forming a {\bf{band-form}} \tn 
% Row Count 21 (+ 3)
% Row 12
\SetRowColor{LightBackground}
 & Pigment granules become larger and tend to have a more {\bf{peripheral}} arrangement \tn 
% Row Count 24 (+ 3)
% Row 13
\SetRowColor{white}
 & {\bf{Zeimann's stippling}} may be present \tn 
% Row Count 26 (+ 2)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{SCHIZONTS}}} \tn 
% Row Count 27 (+ 1)
% Row 15
\SetRowColor{white}
 & {\bf{6-12 merozoites}}, often arranged in a {\bf{rosette}} or irregular cluster \tn 
% Row Count 30 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{p{0.3433 cm} x{3.0897 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Plasmodium Malariae}} (cont)}}  \tn
% Row 16
\SetRowColor{LightBackground}
 & Mature schizonts nearly fill the normal-sized host \tn 
% Row Count 2 (+ 2)
% Row 17
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{GAMETOCYTES}}} \tn 
% Row Count 3 (+ 1)
% Row 18
\SetRowColor{LightBackground}
 & {\bf{Compact}} and {\emph{fills}}* host RBC \tn 
% Row Count 4 (+ 1)
% Row 19
\SetRowColor{white}
 & Sometimes, there is a {\bf{reduction in size}} of the infected RBC \tn 
% Row Count 6 (+ 2)
% Row 20
\SetRowColor{LightBackground}
 & {\bf{Cytoplasm}} stains {\bf{blue}} and the {\bf{chromatin is pink to red}}. \tn 
% Row Count 8 (+ 2)
% Row 21
\SetRowColor{white}
 & {\bf{Abundant dark pigment}} may be scattered throughout the cytoplasm \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Band forms are present in {\emph{malariae, vivax}}, and {\emph{knowlesi}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.20155 cm} x{2.23145 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Clinical Manifestations}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{PRE-PATENT PERIOD}} & Interval from {\bf{sporozoite injection}} to {\bf{detection of parasites in blood}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & P.falciparum: 11-14 days \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & vivax: 11-15 days \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
 & ovale: 14-26 days \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & malariae: 3-4 weeks \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
 & knowlesi: 9-12 days \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
{\bf{INCUBATION PERIOD}} & time between {\bf{sporozoite injection}} and appearance of {\bf{clinical symptoms}} (8-40) \tn 
% Row Count 12 (+ 4)
% Row 7
\SetRowColor{white}
 & falciparum: 8-15 days \tn 
% Row Count 13 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & vivax: 12-20 days \tn 
% Row Count 14 (+ 1)
% Row 9
\SetRowColor{white}
 & ovale: 11-16 days \tn 
% Row Count 15 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & malariae: 18-40 days \tn 
% Row Count 16 (+ 1)
% Row 11
\SetRowColor{white}
 & knowlesi: 5 days- few weeks \tn 
% Row Count 18 (+ 2)
% Row 12
\SetRowColor{LightBackground}
{\bf{PRODROMAL SYMPTOMS}} & Weakness, exhaustion, aching bones, limbs, and back; loss of appetite; nausea; vomiting \tn 
% Row Count 22 (+ 4)
% Row 13
\SetRowColor{white}
 & malaise, backache, diarrhea, and epigastric discomfort \tn 
% Row Count 25 (+ 3)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{MALARIAL PAROXYSM}}} \tn 
% Row Count 26 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{1. Cold Stage} \tn 
% Row Count 27 (+ 1)
% Row 16
\SetRowColor{LightBackground}
 & Sudden feelings of coldness and apprehension \tn 
% Row Count 29 (+ 2)
% Row 17
\SetRowColor{white}
 & Mild shivering quickly turns to violent teeth chattering and shaking of entire body \tn 
% Row Count 33 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{x{1.20155 cm} x{2.23145 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Clinical Manifestations}} (cont)}}  \tn
% Row 18
\SetRowColor{LightBackground}
 & Vomiting may occur \tn 
% Row Count 1 (+ 1)
% Row 19
\SetRowColor{white}
 & Rigors last for 15min-1hr, then stops \tn 
% Row Count 3 (+ 2)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{2. Hot Stage or Flush Phase} \tn 
% Row Count 4 (+ 1)
% Row 21
\SetRowColor{white}
 & Patient becomes hot (41° C ), with headache, palpitations, tachypnea, epigastric discomfort, thirst, nausea, and vomiting \tn 
% Row Count 9 (+ 5)
% Row 22
\SetRowColor{LightBackground}
 & Skin is hot and flushed, patient is confused and delerious \tn 
% Row Count 12 (+ 3)
% Row 23
\SetRowColor{white}
 & Lasts 2-6hrs \tn 
% Row Count 13 (+ 1)
% Row 24
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{3. Sweating Stage} \tn 
% Row Count 14 (+ 1)
% Row 25
\SetRowColor{white}
 & Defervesence and diaphoresis or profuse sweating occurs \tn 
% Row Count 17 (+ 3)
% Row 26
\SetRowColor{LightBackground}
 & Temperature lowers in the next 2-4hrs and symptoms diminish accordingly \tn 
% Row Count 20 (+ 3)
% Row 27
\SetRowColor{white}
 & Total duration is 8-12hrs \tn 
% Row Count 21 (+ 1)
% Row 28
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Periodicity of attack only occurs if patient is left untreated} \tn 
% Row Count 23 (+ 2)
% Row 29
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Interval length is determined by length of erythrocytic cycle} \tn 
% Row Count 25 (+ 2)
% Row 30
\SetRowColor{LightBackground}
 & falciparum, vivax and ovale – 48 hours \tn 
% Row Count 27 (+ 2)
% Row 31
\SetRowColor{white}
 & malariae – 72 hours \tn 
% Row Count 28 (+ 1)
% Row 32
\SetRowColor{LightBackground}
 & knowlesi – 24 hours \tn 
% Row Count 29 (+ 1)
% Row 33
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{COMPLICATIONS}}} \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{x{1.20155 cm} x{2.23145 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Clinical Manifestations}} (cont)}}  \tn
% Row 34
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{Vivax, ovale and quartan malaria}} are relatively {\bf{benign}}} \tn 
% Row Count 2 (+ 2)
% Row 35
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Knowlesi} \tn 
% Row Count 3 (+ 1)
% Row 36
\SetRowColor{LightBackground}
 & Severe thrombocytopenia, jaundice, deranged liver enzymes. \tn 
% Row Count 6 (+ 3)
% Row 37
\SetRowColor{white}
 & Acute Respiratory Distress Syndrome with tachypnea, hypoxemia, and pulmonary infiltrates on CXR. \tn 
% Row Count 10 (+ 4)
% Row 38
\SetRowColor{LightBackground}
 & Acute Renal Failure with elevated serum creatinine \tn 
% Row Count 12 (+ 2)
% Row 39
\SetRowColor{white}
 & Hypotension \tn 
% Row Count 13 (+ 1)
% Row 40
\SetRowColor{LightBackground}
 & Acidosis \tn 
% Row Count 14 (+ 1)
% Row 41
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Chronic Malariae} \tn 
% Row Count 15 (+ 1)
% Row 42
\SetRowColor{LightBackground}
 & immune-complex deposition on the glomerular walls, leading to {\bf{nephrotic syndrome}} in children \tn 
% Row Count 19 (+ 4)
% Row 43
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Falciparum} \tn 
% Row Count 20 (+ 1)
% Row 44
\SetRowColor{LightBackground}
 & Cerebral Malaria (requires prompt administration of {\bf{quinidine IV}} and then {\bf{quinine PO}}) \tn 
% Row Count 24 (+ 4)
% Row 45
\SetRowColor{white}
 & Anemia \tn 
% Row Count 25 (+ 1)
% Row 46
\SetRowColor{LightBackground}
 & Acute Renal Failure (tubular necrosis and nephrotic syndrome) \tn 
% Row Count 28 (+ 3)
% Row 47
\SetRowColor{white}
 & Blackwater fever: from massive intravascular hemolysis and hemoglobinuria \tn 
% Row Count 31 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{x{1.20155 cm} x{2.23145 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Clinical Manifestations}} (cont)}}  \tn
% Row 48
\SetRowColor{LightBackground}
 & Dysenteric Malaria \tn 
% Row Count 1 (+ 1)
% Row 49
\SetRowColor{white}
 & Algid Malaria: rapid development of hypotension and impairment of vascular perfusion \tn 
% Row Count 5 (+ 4)
% Row 50
\SetRowColor{LightBackground}
 & Pulmonary Edema \tn 
% Row Count 6 (+ 1)
% Row 51
\SetRowColor{white}
 & Tropical Splenomegaly Syndrome \tn 
% Row Count 8 (+ 2)
% Row 52
\SetRowColor{LightBackground}
 & Hyperparasitemia (\textgreater{}10-20\% of RBC mean high mortality rate) \tn 
% Row Count 11 (+ 3)
% Row 53
\SetRowColor{white}
 & Hypoglycemia \tn 
% Row Count 12 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{x{1.33887 cm} x{2.09413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Proper use of the antimalarial drugs is based on knowledge of their effects on the parasite at {\bf{various stages of the life cycle}}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Suppressive therapy}}: & destroy the parasites as they enter the bloodstream; effective against the {\bf{erythrocytic stages}}. \tn 
% Row Count 8 (+ 5)
% Row 2
\SetRowColor{LightBackground}
{\bf{Clinical Cure}}: & full and rapid elimination of plasmodiumfrom the blood to prevent complications \tn 
% Row Count 12 (+ 4)
% Row 3
\SetRowColor{white}
{\bf{Radical cure}}: & elimination of not only the bloodstream infection but the tissue stages in the liver as well. \tn 
% Row Count 16 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{BLOOD SCHIZONTICIDES}}} \tn 
% Row Count 17 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Clinical cure of an acute attack, no effect on pre-erythrocytic and gametocyte stage} \tn 
% Row Count 19 (+ 2)
% Row 6
\SetRowColor{LightBackground}
1. Quinine & blood schizonticide against all five species of human malarial parasites. Side effects of treatment include tinnitus and headache, vertigo \tn 
% Row Count 25 (+ 6)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{2. Quinidine} \tn 
% Row Count 26 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{3. Chloroquine} \tn 
% Row Count 27 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{4. Amodiaquine} \tn 
% Row Count 28 (+ 1)
% Row 10
\SetRowColor{LightBackground}
5. Mefloquine & effective against both chloroquine-sensitive and –resistant strains of P. falciparum and P. vivax. It is also effective against P. malariae and P. ovale \tn 
% Row Count 35 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{x{1.33887 cm} x{2.09413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Treatment (cont)}}  \tn
% Row 11
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{6. Doxycycline} \tn 
% Row Count 1 (+ 1)
% Row 12
\SetRowColor{white}
7. Proguanil & Prevents development of oocysts in mosquito \tn 
% Row Count 3 (+ 2)
% Row 13
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{8. Halofantrine} \tn 
% Row Count 4 (+ 1)
% Row 14
\SetRowColor{white}
9. Artemisinin & effective against  P. falciparum , P. knowlesi and P. vivax, and in patients with cerebral malaria \tn 
% Row Count 9 (+ 5)
% Row 15
\SetRowColor{LightBackground}
{\bf{TISSUE SCHIZONTICIDES}} & destroy the developmental     stages in the liver \tn 
% Row Count 12 (+ 3)
% Row 16
\SetRowColor{white}
1. Primaquine & effective against the hypnozoites of P. vivax and P. ovale. \tn 
% Row Count 15 (+ 3)
% Row 17
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\emph{*GAMETOCYTICIDES}}} \tn 
% Row Count 16 (+ 1)
% Row 18
\SetRowColor{white}
1. Primaquine & gametocyticidal for all five species of malaria parasites and acts to render the patient noninfectious to the mosquito \tn 
% Row Count 21 (+ 5)
% Row 19
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{UNCOMPLICATED P. FALCIPARUM}}} \tn 
% Row Count 22 (+ 1)
% Row 20
\SetRowColor{white}
1. \seqsplit{Atovaquone-Proguanil} & (Malarone™) 4 adult tabs po qd x 3 days \tn 
% Row Count 24 (+ 2)
% Row 21
\SetRowColor{LightBackground}
2. \seqsplit{Artemether-Lumefantrine} & (Coartem™) 1 tablet = 20mg artemether and 120 mg lumefantrine . 4 tabs initial dose, followed by 4 tabs as second dose 8 hours later, then 4 tabs po bid for the following 2 days. \tn 
% Row Count 32 (+ 8)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{x{1.33887 cm} x{2.09413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Treatment (cont)}}  \tn
% Row 22
\SetRowColor{LightBackground}
3. Quinine Sulfate & plus one of the following: Doxycycline, Tetracycline, or Clindamycin (for pregnant) \tn 
% Row Count 4 (+ 4)
% Row 23
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{4. Mefloquine} \tn 
% Row Count 5 (+ 1)
% Row 24
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{CHLOROQUINE-SENSITIVE FALCIPARUM OR UNCOMPLICATED P. MALARIAE}}} \tn 
% Row Count 7 (+ 2)
% Row 25
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{1. Chloroquine phosphate} \tn 
% Row Count 8 (+ 1)
% Row 26
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{UNCOMPLICATED P. VIVAX OR OVALE}}} \tn 
% Row Count 9 (+ 1)
% Row 27
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{1. Chloroquine phosphate plus Primaquine phosphate} \tn 
% Row Count 10 (+ 1)
% Row 28
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{CHLOROQUINE RESISTANT VIVAX}}} \tn 
% Row Count 11 (+ 1)
% Row 29
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{1. Quinine sulfate plus either Doxycycline or Tetracycline plus Primaquine phosphate} \tn 
% Row Count 13 (+ 2)
% Row 30
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{SEVERE MALARIA}}} \tn 
% Row Count 14 (+ 1)
% Row 31
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{1. Quinidine gluconate  plus one of the following: Doxycycline, Tetracycline, or Clindamycin} \tn 
% Row Count 16 (+ 2)
% Row 32
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{2. Exchange transfusion has been recommended for very severe falciparum malaria associated with high parasitemia ( \textgreater{}10\% of RBCs )} \tn 
% Row Count 19 (+ 3)
% Row 33
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{{\bf{P. KNOWLESI}}} \tn 
% Row Count 20 (+ 1)
% Row 34
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{Uncomplicated} \tn 
% Row Count 21 (+ 1)
% Row 35
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{1. Chloroquine} \tn 
% Row Count 22 (+ 1)
% Row 36
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{2. Primaquine} \tn 
% Row Count 23 (+ 1)
% Row 37
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{Severe} \tn 
% Row Count 24 (+ 1)
% Row 38
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{1. Quinine} \tn 
% Row Count 25 (+ 1)
% Row 39
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{2. Artemether-Lumefantrine} \tn 
% Row Count 26 (+ 1)
% Row 40
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{{\bf{MALARIA PROPHYLAXIS}}} \tn 
% Row Count 27 (+ 1)
% Row 41
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{1.Atovaquone/Proguanil} \tn 
% Row Count 28 (+ 1)
% Row 42
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{2. Doxycycline} \tn 
% Row Count 29 (+ 1)
% Row 43
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{3. Chloroquine} \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{3.833cm}{x{1.33887 cm} x{2.09413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{3.833cm}}{\bf\textcolor{white}{Treatment (cont)}}  \tn
% Row 44
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{3.833cm}}{4. Mefloquine} \tn 
% Row Count 1 (+ 1)
% Row 45
\SetRowColor{white}
\mymulticolumn{2}{x{3.833cm}}{5. Primaquine} \tn 
% Row Count 2 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}