The mature
merocysts are visible to the naked eye on the hepatic surface. These appear as raised, grayish-white to translucent foci with a central accumulation of fluid. Multiple, depressed areas of fibrosis with calcification representing healed lesions may also be found. Microscopically the liver cysts have an irregular central space filled with faintly eosinophilic, acellular, flocculent material. Surrounding this is a peripheral rim of myriad, round, lightly basophilic
merozoites which measure ~1.0–2.0 mm in diameter. The cysts themselves are delineated by a thin, convoluted, eosinophilic, hyaline capsule. A significant inflammatory response to the merocysts may or may not be present. If a reaction is present, it is typically granulomatous with an admixture of
eosinophils and
lymphocytes. The first appearance in the blood is normally two months after infection. The only stage seen in the blood are gametocytes. These double in number for the first three days and mature. Having reached maturity, they gradually decline in number and normally disappear after a month. Secondary episodes may occur at variable intervals. The early gametocytes consist of minute dense spots of chromatin with a tiny loop of cytoplasm. As the parasite grows, the chromatin tends to spread in a semicircle or into multiple dots. There is no stippling of the erythrocyte. Mature gametocytes are larger than a normal erythrocyte stain poorly compared to other protozoa. In both male and female gametocytes, the nucleus consists of two portions. The
macrogametocyte is a steel blue color measuring 9.5 micrometres in diameter. The nucleus has a pale pink area with dense chromatin in the middle and is much smaller than that of the microgametocyte. The
microgametocyte stains less densely, is biscuit-colored and measures 9.0 micrometres in diameter. The nucleus is a large, oval, pale pink area occupying one-third to one-half of the parasite. ==Clinical features==