MALARIA

Pedahuluan
• Malaria is a mosquito-borne disease caused by the parasites of the
genus Plasmodium (P. falciparum, P. vivax, P. malariae, P. ovale, P.
knowlesi) and acquired through the bites of infected Anopheles
mosquitos

Łukasz Pielok , Cerebral malaria and multi-organ dysfunction in an adult woman with Plasmodium falciparum infection imported from Cameroon: a case report . Annals of Parasitology
2019, 65(4), 427–431 2019 Polish Parasitological Society doi: 10.17420/ap6504.231
Michael Waisberg et al, The immune response in mild and severe malaria: Two sides of the same coin. ChapTer 18. Advances in Malaria Research, First Edition. Edited by Deepak
Gaur, Chetan E. Chitnis, and Virander S. Chauhan. © 2017 John Wiley & Sons, Inc. Published 2017 by John Wiley & Sons, Inc.
• The P. falciparum life cycle. The P. falciparum life cycle in humans includes the asymptomatic liver stage; the blood stage which causes disease; and the
sexual gametocyte blood stage which infects mosquitoes that transmit the parasite. Infection begins when Anopheles mosquitoes inject sporozoites into
the skin where they may persist for days
• (a). Sporozoites migrate from the skin via the blood to the liver and invade a small number of hepatocytes
• (b). Some sporozoites migrate to the draining lymph nodes where sporozoites antigens can be presented by dendritic (DCs) to CD8+ T cells that then
migrate to the liver (b′). Each sporozoite gives rise to tens of thousands of asexual parasites called merozoites
• (c). Approximately one week after hepatocyte invasion merozoites exit the liver into the bloodstream and begin a 48 h cycle
• (d) of RBC invasion, replication, RBC rupture, and merozoites release
• (e). Symptoms only occur during the blood‐stage and can begin as early as 3 days after the release of merozoites from the liver. Once inside RBCs the
parasite exports proteins such as PfEMP1s to the RBC surface. PfEMP1s mediate binding of iRBCs to the microvascular endothelium of various tissues
• (f) sequestering the parasites from clearance in the spleen and promoting the inflammation and circulatory obstruction associated with clinical
syndromes. In severe disease, such as cerebral malaria, the iRBC sequester in the brain and are associated with microhemorrhages and brain damage
• (g). PfEMP1‐mediated rosetting (binding of iRBCs to RBCs) may also contribute to disease
• (h). A small number of blood‐stage parasites differentiate into sexual gametocytes
• (i) which are taken up by mosquitoes
• (j) where they differentiate into gametes that fuse to form zygotes, and then develop into motile ookinetes
• (k). The ookinetes cross the midgut wall and form oocysts
• (l) that develop into sporozoites that enter mosquito salivary glands to complete the life cycle
ANAMNESIS
a.demam, menggigil, berkeringat dan dapat disertai sakit kepala, mual,
muntah, diare dan nyeri otot atau pegal-pegal.
b. Riwayat sakit malaria dan riwayat minum obat malaria.
c. Riwayat berkunjung ke daerah endemis malaria.
d. Riwayat tinggal di daerah endemis malaria.
Pemeriksaan fisik
• a. Suhu tubuh aksiler ≥ 37,5 °C
• b. Konjungtiva atau telapak tangan pucat
• c. Sklera ikterik
• d. Pembesaran Limpa (splenomegali)
• e. Pembesaran hati (hepatomegali)
Pemeriksaan laboratorium
Pemeriksaan dengan mikroskop Pemeriksaan sediaan darah (SD) tebal
dan tipis di Puskesmas/lapangan/ rumah sakit/laboratorium klinik untuk
menentukan:
• a) Ada tidaknya parasit malaria (positif atau negatif).
• b) Spesies dan stadium plasmodium.
• c) Kepadatan parasit.
Pemeriksaan dengan uji diagnostik cepat (Rapid Diagnostic Test)
Mekanisme kerja tes ini berdasarkan deteksi antigen parasit malaria,
dengan menggunakan metoda imunokromatografi. Sebelum menggunakan
RDT perlu dibaca petunjuk penggunaan dan tanggal kadaluarsanya.
Pemeriksaan dengan RDT tidak digunakan untuk mengevaluasi pengobatan
Malaria berat
• Buku saku penatalksanaan kasus malaria, 2017. Kementerian
kesehatan republic Indonesia,614.532 indm, Subdit Malaria Direktorat
P2PTVZ KEMETENTERIAN KESEHATAN REPUBLIK INDONESIA