Referat

MALARIA
Prima Dewi Yuliani 1210312120
Widyatul Aina
Alfioni Parsiska

Preseptor:
dr. Roza, Sp.PD
• Malaria is an infectious disease that caused by
Protozoa infection, genus Plasmodium and
transmitted by the biting of female Anopheles

• The symptoms are disappear-and back low grade

fever, headache, myalgia, shivering, and malaise.

• It also can contagious from blood transfusion,

use of syringes simultaneously, transmitted from
the mother to the baby, and organ
transplantation
 BAB 1
BACKGROUND
Most common 207 million
infectious disease in cases/year in the
tropical and sub world wide and
tropical countries causes 627 of death

In Indonesia  6% case the In Indonesia:

highest province  Papua,
NTT, West Papua, Middle Plasmodium vivax
Sulawesi, and Maluku Plasmodium falciparum
 BAB 2
LITERATURE REVIEW

• Ifection disease that caused by Plasmodium

DEFINITION

that affected the eritrocyte and founded in

an asexual form in the blood
• Acute / Chronic.
• With / without systemic complication
O : place that there is no malaria cases founded ,
successfully eradicated or never exist;
+ : place with the low risk;
++ : place where the transmition occur
HOST OF MALARIA

• Intermediate Host :
▫ Human
▫ Other vertebrae

• Definitif Host:
▫ Anopheles Mosquito
 PLASMODIUM SPECIES

P.falciparum P.vivax

P.malariae P.ovale
 PLASMODIUM PLASMODIU PLASMODIUM PLASMODIUM
FALCIPARUM M VIVAX OVALE MALARIAE
Hipnozoit - + + -
Amount of 40000 10000 15000 15000
Merozoit
Eritrocyte 48 hours 48 hours 50 hours 72 hours
cycle
Cycle in 10 days 8-9 days 12-14 days 26-28 days
Anopheles
Pra- 5,5 days 8 days 9 days 10-15 days
eritrocyte
Eritrocyte Young ( can Reticulocyte Reticulocyte old
that would affected all
be affected the ages of
the eritrocyte)
Periode 9-14 days 12-17 days ; 16-18 days or 18-40 days or
Inkubasi 6-12 months more more
 LIFE CYCLE OF MALARIA
Human Female Anopheles
In the human In glandular saliva
liver Sporozoit

hipnozoit skizon
skizon ookista
merozoit

Dalam lambung
trofozoit
skizon merozoit

makrogamet makrogamet
Zigot (ookinet)
mikrogamet mikrogamet
MANIFESTASI KLINIK
• Periodic fever, anemia, and spleenomegali.
• Classic symptom and happen in sequence

Periode
Cold period Warm period
berkeringat
• Shivering, • Red face, • Sweating a
and rapid pulse, lot, the body
increasing of and hight temperature
body body decrease, and
temperature temperature the patient
in in a few felling well.
hours,
followed with
sweating.
DIAGNOSIS
Anamnesis
Fever, shivering, sweating, and can be
followed by headache, nausea, vomit, diarrhea,
and myalgia
History of visiting and stay overnight at the
last 1-4 weeks to the malaria endemic areas
History of stay in the endemic malaria areas
History of malaria disease before
History of take the malaria medication at the
last one month
History of getting blood transfusion
Physical Examination

Without Complication:

• T >37,5oC
• Pale of the conjungtiva and
palmar
• Spleenomegali
• Hepatomegali
 WITH COMPLICATION:
Found in asexual P.falciparum stadium

• Decrease of • Vomiting and cannot

consciousness drink and eat.
• General state is weak • The urin color like
(can’t sit/stand up) concentrated tea and
• Seizure sometimes black
• High fever • Oliguria till anuria
• Jaundice. • Very pale of the
• Bleeding . palmar
• Shortness of
breathing
Supporting examination
1. Mocroscopic examination
Thick and thin blood tests
• Existance of malaria infection.
• Spesies dan stadium plasmodium
• Kepadatan parasit
Gbr. 1: sel darah merah normal;

Gbr. 2-18: Tropozoit

(Gbr. 2-10:tropozoit stadium cincin);

Gbr. 19-26: Skizon (Gbr. 26 skizon ruptur

Gbr. 27,28: makrogametosid matur (♀);

Gbr. 29, 30: mikrogametosid matur (♂).

- Semi kuantitatif:
• (-): no parasite in 100 LPB
• (+): found 1-10 paracyte in 100 LPB
• (++): found 11-100 paracyte in 100 LPB
• (+++): found 1-10 paracyte in 1 LPB
• (++++):found more than 10 paracyte in 1 LPB
- Kuantitatif
Amount of paracyte counted permicrometer of
blood in a thick peripheral blood sample
(leukocyte) and thin blood sample (eritrocyte).
Pemeriksaan Penunjang
2. Rapid Diagnostik Test ( RDT )  Cara kerja tes
diagnostik cepat ini berdasarkan atas pendeteksian antigen
yang terdapat dalam Plasmodium

3.Pemeriksaan penunjang untuk Malaria Berat :

oDarah Rutin (Hemoglobin,leukosit, trombosit,hematokrit)
o Kimia Darah: gula Darah, SGOT/ SGPT, Bilirubin, Alkali
fosfatase, albumin/globulin, ureum/kreatinin, Natrium dan
Kalium, Analisa Gas Darah (AGD)
o EKG
o Foto toraks
o Analisa cairan serebrospinalis
o Biakan darah dan uji serologi
o Urinalisis
Therapy
P. Falciparum

Line 1: ACT + Primaquine

ACT (Artemycin Combination Therapy) is given for 3 days,
there are 2 preparations:
- First line: Artesunat 4 mg / kgBB / times + amodiakuin
10 mg / kgBB / time
Can be added Dihydroartemisin 2-4mg / kgBB / times +
piperakuin 16-32 mg / kgBB / times for areas resistant
with Artesunat and Amodiakuin, such as Papua
Primaquine: P.falciparum: 0.75mg / kgBB, 1 time P. Vivax:
0.25mg / kgBB / times, 14 days
- Second Line
Quinine + Doxycycline or Tetracycline + Primaquine

Dose:
 Kina: 10mg / kgBB / day, 3 times / day, for 7 days
 Doxycycline:
• age 8-14 years: 2.2 mg / kgBW / day, 2kali / hari, 7 days
• Age ≥15 years: 3.5 mg / kgBB, 2kali / hari, 7 days
 Tetracycline: 4 mg / kg BW / times, 4 times / day 7 days
 Primaquine:
• P.falciparum: 0.75mg / kgBW, 1 time
• P. Vivax: 0.25mg / kgBB / times, 14 days
Treatment of vivax malaria and malaria ovale

First line: Chloroquine + Primaquine

• Chloroquine: u / kill parasite asexual and sexy
stadiums.
• Primaquine: u / kills hypnozoites in liver cells, can
also kill asexual parasites in erythrocytes.

Treatment of chloroquine-resistant vivax malaria

Second line: Quinine + Primaquine
Treatment of malaria malariae
• Klorokuin:
o 1 time per day for 3 days,
o total dose 25 mg / kgBB.

Chloroquine can kill the parasite of sexual asexual

and P. malariae forms. Treatment can also be given
by age group of the patient.
Monitoring Therapy
• For malaria programs, treatment monitoring is
performed on day 4, day 14 and day 28 through
microscopic examination and improvement of
clinical symptoms.
• In the event of fever after day 3 to day 28 the
patient is also required to return to Puskesmas
for blood examination and clinical evaluation.
Prognosis
• The prognosis of severe malaria depends on the
speed and accuracy of the diagnosis and treatment.
• In untreated severe malaria, the reported mortality
in children is 15%, adulthood is 20% and in
pregnancy increases to 50%.
• The prognosis of severe malaria with a disorder of one
organ function is better than the interference of 2 or
more organ functions.
Complication
• Coma (Cerebral Malaria)
• Severe anemia
• Hypoglycemia
• Shock
• Acute Kidney Failure
TERIMA KASIH
THANK YOU
GRACIAS