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DEFINISI:
Penyakit infeksi akut atau kronis
Disebabkan oleh Plasmodium malariae
Ditularkan melalui gigitan nyamuk Anopheles
Ditandai dengan:
Demam paroksismal
Anemia
Splenomegali
ETIOLOGI:
Plasmodium:
Falciparum
Vivax
Malariae
Ovale
Berghei
EPIDEMIOLOGI:
Tersebar di 103 negara
Menjangkiti sekitar 1 milyar penduduk
Angka kematian mencapai 1 -3 juta kasus/tahun
Menempati peringkat ke-5 penyebab kematian
Menempati 3 besar penyakit yang mengancam
nyawa (terutama di Negara Berkembang di samping HIV dan TBC)
Di Kabupaten Malang: 320 350 kasus/tahun (52 kasus
di antaranya di rawat di RSSA dalam kondisi sakit parah
Kendala pemberantasan:
Resistensi Plasmodium terhadap obat
Resistensi vektor terhadap insektisida
White NJ, Breman JG. Malaria and babesiosis: Diseases caused by red blood cell parasites. In Harrisons Principles of Internal Medicine. 16th
ed. NY: MacGraw-Hill Co. 2005: 1220
White NJ, Breman JG. Malaria and babesiosis: Diseases caused by red blood cell parasites.
In Harrisons Principles of Internal Medicine. 16th ed. NY: MacGraw-Hill Co. 2005: 1220
White NJ, Breman JG. Malaria and babesiosis: Diseases caused by red blood cell parasites.
In Harrisons Principles of Internal Medicine. 16th ed. NY: MacGraw-Hill Co. 2005: 1220
rosettes
A. Trophozoites
B. Gametocytes
White NJ, Breman JG. Malaria and babesiosis: Diseases caused by red blood cell parasites.
In Harrisons Principles of Internal Medicine. 16th ed. NY: MacGraw-Hill Co. 2005: 1220
A. Throphozoites
B. Schozonts
C. Gametocytes
White NJ, Breman JG. Malaria and babesiosis: Diseases caused by red blood cell parasites.
In Harrisons Principles of Internal Medicine. 16th ed. NY: MacGraw-Hill Co. 2005: 1220
A. Throphozoites
B. Schozonts
C. Gametocytes
White NJ, Breman JG. Malaria and babesiosis: Diseases caused by red blood cell parasites.
In Harrisons Principles of Internal Medicine. 16th ed. NY: MacGraw-Hill Co. 2005: 1220
A. Throphozoites
B. Schozonts
C. Gametocytes
White NJ, Breman JG. Malaria and babesiosis: Diseases caused by red blood cell parasites.
In Harrisons Principles of Internal Medicine. 16th ed. NY: MacGraw-Hill Co. 2005: 1220
P. falciparum
P. vivax
P. ovale
P. malariae
Duration of intrahepatic
phase (days)
5,5
15
Number of merozoites
released per infected
hepatocyte
30.000
10.000
15.000
15.000
Duration of erythrocytic
cycle (hours)
48
48
50
72
Reticulocytes
Older cells
Morphology
Irregularly shaped
large rings and
tropozoites; enlarged
erythrocytes;
Schuffners dots
Infected erythrocytes,
enlarged and oval with
tufted ends;
Schuffners dots
Band or rectangular
forms of trophozoites
common
Pigment color
Black
Yellow-brown
Dark brown
Brown-black
Ability to cause
relapses
No
Yes
Yes
No
White NJ, Breman JG. Malaria and babesiosis: Diseases caused by red blood cell parasites.
In Harrisons Principles of Internal Medicine. 16th ed. NY: MacGraw-Hill Co. 2005: 1220
Imunitas
Mencegah masuknya Plasmodium
ANAMNESIS:
MANIFESTASI KLINIS:
Konjungtiva pucat
Sklera ikterik
Splenomegali
Manifestation
Major
Unarousable
coma/cerebral malaria
Failure to localize or respond appropriately to noxiuos stimuli; coma persisting for > 30
min after generalized convulsion
Acidemia/acidosis
Arterial pH < 7,25 or plasma bicarbonate level of < 15 mmol/L; venous lactate level
breathing, often termed respiratory distress
Severe normochromic,
normocytic anemia
Hematocrit of < 15% or hemoglobin level of < 50 g/L (<5g/dL) with parasitemia of >
100.000/L
Renal failure
Urine output (24 h) of < 400 mL in adults or < 12 mL/kg in children; no improvement with
rehydration; serum creatinine level of > 265 mol/L (> 3,0 mg/dL)
Pulmonary edema/ARDS
Hypoglycemia
Hypotension/shock
Systolic blood pressure of < 50 mmHg in children 1-5 years or < 80 mmHg in adults;
core/skin temperature difference of > 100C
Bleeding/DIC
Significant bleeding and haemorrhage from the gums, nose, and gastrointestinal tract
and/or evidence of disseminated intravascular coagulation
Convulsions
Hemoglobinuria
Macroscopic black, brown, or red urine; not associated with effects of oxidant drugs and
red blood cell enzyme defects (such as G6PD deficiency)
Sign
Manifestations
Other
Impaired conciousness
Extreme weakness
Hyperparasitemia
Jaundice
Serum bilirubin level of > 50 mmol/L (> 3.0 mg/dL) if combined with other evidence of
vital-organ dysfunction
Bleeding
Deep coma
Repeated convulsions
Anuria
Shock
Laboratory
Biochemistry
Hypoglycemia (<2,2 mmol.L)
Hyperlactatemia (>5 mmol/L)
Acidosis (arterial pH <7,3; serum HCO3 <15 mmol/L)
Elevated serum creatinine (>265 mol/L)
Elevated total bilirubin (> 50 mol/L)
Hematology
Leukocytosis (>12.000/L)
Severe anemia (PCV < 15%)
Coagulopathy
Decreased platelet count (< 50.000/L)
Prolonged prothrombin time (> 3s)
Prolonged partial thromboplastin time
Decreases fibrinogen (< 200 mg/dL)
Parasitology
Hyperparasitemia
Increased mortality at > 100.000/L
High mortality at > 500.000/L
> 20% of parasites indentified as pigment-containing trophozoites and schizonts
> 5% of neutrophils with visible pigment
Nonpregnant adults
Pregnant women
Children
Anemia
++
+++
Convulsion
+++
Hypoglycemia
+++
+++
Jaundice
+++
+++
Renal failure
+++
+++
Pulmonary edema
++
+++
DIFFERENTIAL DIAGNOSIS
Viral infection
Toxic typhoid fever
Fulminant hepatitis
Leptospirosis
Encephalitis
Menurut Depkes RI
Hari 1
Hari 2
Hari 3
Hari 4-5
Hari 1
Hari 2
Hari 3
<1
14
1+
58
2+1
9 15
3+1
> 15 /
dewasa
4+2
Dosis permulaan
Dosis lanjutan
Kuinin
Kuinidin
Klorokuin (untuk
yang masih sensitif)
Artesunate (IV)
Artemeter
80 mg IM selama 14 hari
PROFILAKSIS
Obat antimalaria
Vaksin malaria:
Antisporozoit (pra-eri)
Stadium aseksual / eritrositik
Dosis dewasa
Dosis anak-anak
Mefloquine (Lariam)
15 19 kg: tab/mgg
20 30 kg: tab/mgg
31 45 kg: tab/mmg
> 45 kg: 1 tab/mmg
Doxycycline
100 mg 1x / hari
Chloroquine phosphate
(Aralen)
Primaquine
Hydroxychloroquine
sulfate (Plaquine)
Proguanil (Paludrine)