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Lambok Siahaan
Spesies Plasmodium
Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi
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Malaria Lifecycle
Human Liver Stages
Mosquito Stages
Exo-erythrocytic
(hepatic) Cycle:
P. falciparum
Erythrocytic Cycle:
Gametocytes
P. vivax
P. ovale
P. malariae
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Alteration of Host Cells
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Hill, Nature Reviews/Immunology, 2006.
Hemozoin
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Parameter epidemiologi
–Parasite rate (PR): persentase penduduk yang
darahnya megandung parasit malaria pada saat
tertentu
–Spleen rate (SR): ditentukan berdasarkan klasifikasi
Hacket
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Parameter epidemiologi
–Derajat endemisitas malaria pada suatu daerah
tertentu dapat diukur dengan mengetahui spleen
rate dari anak dan orang dewasa, yaitu:
– Hipoendemik : SR (anak 2-9 th) 0-10%
– Mesoendemik : SR (anak 2-9 th) 11-50%
– Hiperendemik : SR (anak 2-9 th) menetap di atas 50%
– Holoendemik : SR (anak 2-9 th) menetap di atas 75% (dewasa
25%)
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Pathogenesis
Pathogenesis
Inflammatory
Chill, fever, sweat
responses
Toxic mediators
metabolic hypoglycaemia
disturbances
Hemolysis
Phagocytosis renal failure
Splenomegaly Black water fever
Adhere to
+ Rosseting hepatomegaly
blood vessels
Cerebral malaria
Tissue hypoxia
Obstruct
Pulmonary edema
blood flow
Impaired
microcirculation DIC
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Pathogenesis
• Related to erythrocytic infection by the asexual stages
• Gametocytes not involve in pathogenesis
• Pathology is associated with:
Haemolysis
- Direct invasion & rupture of RBC during erythrocytic cycle
- Increased osmotic fragility of RBC
• Erythrophagocytosis in
spleen
• Hypersplenism
• Immune mediated
Spleen
• Bone marrow suppression
• TNF/IL-10 ratio
• Reversible
Immunologi Reaction
Laboratory Dx
Clinical Dx
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Diagnosa Malaria
Tanda dan Gejala Klinis
• Anamnesis:
– Main symptoms: triad (not always found)
– Might be coincide with headache, nausea,
vomiting, diarrhea, myalgia
– History of visiting endemic area (1-4 weeks prior
to symptom)
– History of living in endemic area
– History of having malaria
– History of taking anti-malarial drugs
– History of blood transfussion
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Diagnosa Malaria
Tanda dan Gejala Klinis
• Physical examination:
– Fever
– Anemic
– Hepatomegaly
– Splenomegaly
– With or without organ dysfunction in severe
malaria or malaria with complication
Diagnosa Malaria
Laboratorium
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Prinsip Pengobatan Malaria
Human Liver Stages
Mosquito Stages
Exo-erythrocytic
(hepatic) Cycle:
P. falciparum
Erythrocytic Cycle:
Gametocytes
P. vivax
P. ovale
P. malariae
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Pendekatan Terapi
• Terapi diberikan atas dasar hasil pemeriksaan
mikroskopis ataupun RDT
• Terapi kombinasi
• Terapi radikal
• Titik berat hasil adalah: kesembuhan klinis, parasite
clearance, dan tidak adanya penularan
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STANDARD
PENGOBATAN MALARIA
Endemicity
Resitency
Antimalaria
Spesies
Species
Insect Bite
Virulence
Mixed Infection
Immnunity
Genetic
Nutrient
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STRATEGIES
Endemicity level Transmission Parasite rate Comment
(%)a
Hypoendemic Usually Mosquito population
Low: subperiodic or unstable; usually difficult to
malaria sporadic < 10% detect; serious epidemic may
occur
Mesoendemic Seasonal or periodic 11-50, Mosquito populations
depending fluctuate, detectable;
malaria following good rains
seasonal outbreaks occur;
on survey
some detectable immunity in
timing the population
Hyperendemic Intense transmission 51-75 Seasonal fluctuation in
(seasonal )each year malaria cases; severe
malaria sequelae in young children;
some immunity in adults
Holoendemic Transmission may >75 Mosquitoes detectable
occur throughout the throughout the year although
malaria
year with periods of with seasonal peaks; high
levels of anemia in very
high transmission
young children; immunity
seen in adults
REFERENCE
Beaver, P.C., Jung, R.C. 1984. Clinical parasitology. 9th ed.
Philadelphia, Lea & Febringer. p.292-294; 345
Gillespie, S., Pearson, R.D. 2001. Principle and practice
of clinical parasitology.John Wiley & Son Ltd. p.124
Heelan, J. S., Ingersoll, F. W. 2002, Blood and Tissue
Sporozoa in Essentials of Human Parasitology,Delmar
Thomson Learning, US,
Peters, W., Pasvol, G. 2001, Arthropod-borne Infections
in Tropical Medicine and Parasitology, 5th ed., Mosby,
London
Schimidt, G.D., Roberts, L.S. 2005. Foundation of
parasitology. 7th ed. Mc Graw Hill. p. 118-119;136-137;
427-428; 458; 468-471
Antidisease Antiparasite
immnunity immnunity
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Daftar Penyakit Berdasarkan SKDI
• Malaria 4A
• Malaria serebral 3B
• Anemia hemolitik 3A
• Pneumonia, bronkopneumonia 4A
• Gastroenteritis (termasuk kolera, giardiasis) 4A
• Gangguan pembekuan darah (trombositopenia) 2
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Daftar Masalah Berdasarkan SKDI
• Sakit kepala
• Pusing
• Kesemutan
• Batuk dan sesak
• Nyeri perut dan ulu hati
• Perut kembung
• Mual dan muntah
• Diare
• Lemah/letih/lesu
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Daftar Masalah Berdasarkan SKDI
• Nafsu makan hilang
• Kelelahan
• Pucat
• Demam
• Mata kuning
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Daftar Ketrampilan Klinis
Berdasarkan SKDI
• Identifikasi parasit 4A
• Persiapan dan pemeriksaan hitung jenis leukosit 4A
• Finger prick 4A
• Pemeriksaan darah rutin (Hb, Ht, Leukosit,
Trombosit) 4A
• Permintaan pemeriksaan imunologi berdasarkan
indikasi
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Daftar Ketrampilan Klinis
Berdasarkan SKDI
• Pemeriksaan profil pembekuan (bleeding time,
clotting time) 4A
• Pemeriksaan Laju endap darah/kecepatan endap
darah (LED/KED) 4A
• Pengukuran suhu 4A
• Konsultasi terapi 4A
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