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MALARIA
Presented by :
Syed M. Kamal (110100415)
Supervised by :
Dr. Tina Christina, Sp.A (K)
DEPARTMENT OF CHILD HEALTH
MEDICAL FACULTY NORTH SUMATRA UNIVERSITY
H. ADAM MALIK GENERAL HOSPITAL
MEDAN
2015
Introduction
Malaria is a common and life-threatening disease in
many tropical and subtropical areas. There are
currently over 100 countries and territories where
there is a risk of malaria transmission
Between 200 million and 500 million cases of clinical
malaria occur each year, leading to an estimated 1
million deaths. Most malarial deaths occur among
infants and young children
Indonesia is one of the countries that are endemic for
Malaria
Definition
Malaria is an acute and chronic illness caused by
intracellular Plasmodium protozoa transmitted to
humans by female Anopheles mosquitoes
Malaria is characterized by paroxysms of fever,
chills, sweats, fatigue, anemia, and splenomegaly
Plasmodium that cause malaria in humans: P.
falciparum, P. malariae, P. ovale, and P. vivax, P.
knowlesi
Epedimiology
World
Indonesia
North Sumatera
80% of districts in
Indonesia to be
endemic while
45% of
poppulation live
in places that are
high risk for
Malarial
transmission
Death rate due to
malaria was 11
per 100,000 for
male and 8 per
100,000 for
females
respectively
Endemic areas
incude Deli
Serdang, Labuhan
Batu, Serdang
Bedagai, Asahan,
Samosir, Tapanuli
Tengah, North
Tapanuli,
Mandailing Natal,
Nias, South Nias,
Langkat, Batu
Bara, Padang
Lawas, North
Padang Lawas
and Kabupaten
Labuhan Batu
Pathogenesis
Fever
Anemia
Immunopathologic events
Tissue anoxia
Clinical Manifestation
Prodromal symptoms include
headache, fatigue, anorexia, myalgia,
slight fever, and pain in the chest,
abdomen, and joints
Febrile paroxysms are characterized by
high fever, sweats, and headache, as
well as myalgia, back pain, abdominal
pain, nausea, vomiting, diarrhea,
pallor, and jaundice
Diagnosis
Fever, Shivering,
Suspected
Sweating
Malaria
Palmar pallor
Parasitolo
gical
Diagnosis
Microscopic
evaluation
RDT
Treatment
Artemisinin base Combination treatment (ACT) is
a combination of a rapidly acting artemisinin
derivative with a longer-acting (more slowly
eliminated) partner drug
ACTs recommended for treatment of malaria are:
artemether + lumefantrine
artesunate + amodiaquine
artesunate + mefloquine
artesunate + SP
dihydroartemisinin + piperaquine.
Primaquine
Relapses originating from liver
hypnozoites are prevented by giving
primaquine
Given for 14 days
Complication
CASE REPORT
Name
: SS
Age
: 5 years 11 month
Sex
: Female
Date of Admission : September 14th 2015
at 06.45 PM
Chief of complaint
: Fever
History of Present Illness :
Fever since +/- 2 weeks prior to admitted to the
hospital.
Body
temperature
is
unstable,
sometimes high grade fever and it is was
reduced with antipyretics. Patient experienced
shiverring while high fever. Convulsions was not
found. Patient reported vomiting since 2 weeks.
Vomiting happened after took medicine. It was
food and drink that she ate. Patient also reported
Previous
illness
: Referred from RS
Pirngadi and diagnosed
with Plasmodium vivax
malaria.
History of medication : Novalgin
History of feeding : Unclear
History
of
immunization :
Complete
immunization
Present Status:
Consciousness : Alert, Compos mentis.
Blood pressure : 100/40 mmHg
Respiratory rate : 24 x/i, regular
Body temperature : 38,3C,
Body weight : 14 kg
Body height : 104 cm.
Anemic (+), ikteric (-), dyspnea (-),
cyanotic (-), edema (-).
Localized Status
Head
Neck
Thorax
Abdomen
Laboratory Findings
Hematology
Test
Result
Unit
Referal
Hemoglobin
5.60
g%
12.0-14.4
Erythrocyte
1.76
106/mm3
4.75-4.85
Leucocyte
6.11
103/mm3
4.5-11.0
Thrombocyte
164
103/mm3
150-450
Lymphocyte
27.00
20-40
8.30
2-8
MCV
64.70
fL
75-87
MCH
31.80
Pg
25-31
MCHC
37.60
g%
33-35
Monocyte
Electrolyte
Test
Natrium
Kalium
Chloride
Result
138
4.1
105
Unit
mEq/L
mEq/L
mEq/L
Referal
135-155
3.6-5.5
96-106
Follow Up
S
O
Fever (+)
Sens: Alert, T: 38,3 oC, BW: 14 kg, BH: 104 cm
Head: eye reflect +/+, isocor, pale conj. palpebral
inferior +/+
ear/nose/mouth: normal
Neck: JVP R-2 cmH2O
Thorax: Symetris fusiformis, retraction (-)
HR: 140x/i, regular, murmur (-)
RR: 24 x/i, Ronchi -/Abdomen: Soepel, Normal peristaltic
Hepar : palpable 2 cm BAC, Lien : palpable S II
Extremities: Pulse: 140 x/i, regular, adequate pressure
and volume, warm, CRT < 3, pale (+), pretibial edema (-)
Others: Normal
Malaria+ anaemia
Fever (-)
Sens: Alert, T: 36,8 oC, BW: 14 kg, BH: 104 cm
Head: eye reflect +/+, isocor, pale conj. palpebral inferior
+/+
ear/nose/mouth: normal
Neck: JVP R-2 cmH2O
Thorax: Symetris fusiformis, retraction (-)
HR: 120x/i, regular, murmur (-)
RR: 24 x/i, Ronchi -/Abdomen: Soepel, Normal peristaltic
Hepar : palpable 2 cm BAC, Lien : palpable S II
Extremities: Pulse: 140 x/i, regular, adequate pressure
and volume, warm, CRT < 3, pale (+), pretibial edema (-)
Others: Normal
Malaria+ anaemia
S
O
Malaria+ anaemia
Clinical Pathology
(11.42 AM)
Urinalysis
Complete Urine Morphology
Color : Yellow
Glocose : (-)
Bilirubin : (-)
Keton : (-)
Berat Jenis : 1.015
pH : 6
Urobilinogen : (-)
Nitrit : (-)
Leucocyte : (+)
Blood : (-)
P Urine Sediment
Erythrocyte : 0-1
Leucocyte : 1-2
Epytel : 0-1
Casts : (-)
Crystal : (-)
Fever (-)
Sens: Alert, T: 36,6 oC, BW: 14 kg, BH: 104 cm
Head: eye reflect +/+, isocor, pale conj. palpebral inferior
+/+
ear/nose/mouth: normal
Neck: JVP R-2 cmH2O
Thorax: Symetris fusiformis, retraction (-)
HR: 100x/i, regular, murmur (-)
RR: 22x/i, Ronchi -/Abdomen: Soepel, Normal peristaltic
Hepar : palpable 2 cm BAC, Lien : palpable S II
Extremities: Pulse: 110 x/i, regular, adequate pressure and
volume, warm, CRT < 3, pale (+), pretibial edema (-)
Others: Normal
Result
Hemoglobin
10.40
Erythrocyte
2.70x103
Leucocyte
5.40x103
Thrombocyte
275x103
Hematocryte
23.20
MCV
85.90
MCH
38.50
MCHC
44.80
Fever (-)
Sens: Alert, T: 36,8 oC, BW: 14 kg, BH: 104 cm
Head: eye reflect +/+, isocor, pale conj. palpebral inferior
+/+
ear/nose/mouth: normal
Neck: JVP R-2 cmH2O
Thorax: Symetris fusiformis, retraction (-)
HR: 100x/i, regular, murmur (-)
RR: 24 x/i, Ronchi -/Abdomen: Soepel, Normal peristaltic
Hepar : palpable 2 cm BAC, Lien : palpable S II
Extremities: Pulse: 140 x/i, regular, adequate pressure
and volume, warm, CRT < 3, pale (+), pretibial edema (-)
Others: Normal
A
P
Malaria
IVFD D5% NaCl 0,45% 50 gtt/i
Diet MB 1200 kcal with 28 gram protein
Primakuin tablet 1 x 1/4 for 14 days (Day
3)
Fever (-)
Sens: Alert, T: 36,6 oC, BW: 14 kg, BH: 104 cm
Head: eye reflect +/+, isocor, pale conj. palpebral inferior
+/+
ear/nose/mouth: normal
Neck: JVP R-2 cmH2O
Thorax: Symetris fusiformis, retraction (-)
HR: 84x/i, regular, murmur (-)
RR: 20 x/i, Ronchi -/Abdomen: Soepel, Normal peristaltic
Hepar : palpable 2 cm BAC, Lien : palpable S II
Extremities: Pulse: 140 x/i, regular, adequate pressure
and volume, warm, CRT < 3, pale (+), pretibial edema (-)
Others: Normal
A Malaria
P IVFD D5% NaCl 0,45% 50 gtt/i
Diet MB 1200 kcal with 28 gram
protein
Primakuin tablet 1 x 1/4 for 14 days
(Day 4)
Discussion
In this case, the patient is children, 5
years, 11 month and has Plasmodium
vivax malaria
Malaria is one of endemic disease in
tropical country or subtropic country.
Malaria is a health problem in Mexico,
Caribia, Central America, Africa, India,
South East, and Indo Cina. It is
estimated the prevalence of malaria
up to 160-400 million cases. In
Indonesia, malaria is still found in
some
provinces.
Plasmodium
WHO (2015)
Malaria should be treated with at least two
effective antimalarial medicines that is by
using Artemisinin base Combination treatment
(ACT) combined with Primaquine.
Patient treated with Dihydroartemisinin+Piperaquine combined with Primaquine
Summary
SS, 5 years and 11 months girl, with BW of 14 kg
and height of 104 cm, admitted from emergency
unit in H. Adam Malik General Hospital Medan on
September 14th 2015 at 06.45 PM developed fever
since a 2 weeks ago. Patient also experienced
shivering after high fever. Patient reported vomiting
since 2 weeks. Vomiting occurred after taking
medicine. Patient also reported headache, myalgia
if she had fever. She lives in Langkat. She is
diagnosed with Plasmodium vivax malaria. Patient
was treated with DHP for 3 days and Primaquine for
14 days.