Multiple parasites

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In some cases more than one parasite (most often though not always early or late trophozoites) infect a single erythrocyte. This is a surprisingly frequent finding, and it has been suggested some red cells are more attractive to parasites, or that already infected cells are more susceptible.

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The most frequent form - two early trophozoites of P.falciparum in a single erythrocyte

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Species significance

This is most often considered a feature indicating P.falciparum infection and is sufficiently frequent in that species to support the diagnosis of P.falciparum malaria. However, it should not considered as a fully specific feature, and may occur in any malaria species - and particularly in P.knowlesi (this is also a frequent finding for babesia parasites).

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Additional images

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  A

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  B

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  C

Double parasites in: late trophozoite of P.malaria (A) late trophozoite of P.vivax (B) and late trophozoite of P.ovale (C)