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    Malaria

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    Aulia Ratu Pritari
    Malaria is a disease caused by intracellular protozoan parasites from the Plasmodium genus. There are four species that infect humans: P. malariae, P. vivax, P. falciparum, and P. ovale. The parasites are transmitted via the bites of infected Anopheles mosquitoes. Plasmodium falciparum causes severe and complicated malaria such as cerebral malaria, severe anemia, acute renal failure, pulmonary edema, hypoglycemia, shock, spontaneous bleeding, convulsions, hyperthermia and acidosis. Diagnosis involves identifying the parasites and species in blood smears under the microscope along with clinical symptoms. Treatment depends on the severity and species, ranging from oral medications

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    Malaria

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    Aulia Ratu Pritari
    340 views39 pages
    Malaria is a disease caused by intracellular protozoan parasites from the Plasmodium genus. There are four species that infect humans: P. malariae, P. vivax, P. falciparum, and P. ovale. The parasites are transmitted via the bites of infected Anopheles mosquitoes. Plasmodium falciparum causes severe and complicated malaria such as cerebral malaria, severe anemia, acute renal failure, pulmonary edema, hypoglycemia, shock, spontaneous bleeding, convulsions, hyperthermia and acidosis. Diagnosis involves identifying the parasites and species in blood smears under the microscope along with clinical symptoms. Treatment depends on the severity and species, ranging from oral medications

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    Malaria is a disease caused by intracellular protozoan parasites from the Plasmodium genus. There are four species that infect humans: P. malariae, P. vivax, P. falciparum, and P. ovale. The parasites are transmitted via the bites of infected Anopheles mosquitoes. Plasmodium falciparum causes severe and complicated malaria such as cerebral malaria, severe anemia, acute renal failure, pulmonary edema, hypoglycemia, shock, spontaneous bleeding, convulsions, hyperthermia and acidosis. Diagnosis involves identifying the parasites and species in blood smears under the microscope along with clinical symptoms. Treatment depends on the severity and species, ranging from oral medications

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    340 views39 pages

    Malaria

    Uploaded by

    Aulia Ratu Pritari
    Malaria is a disease caused by intracellular protozoan parasites from the Plasmodium genus. There are four species that infect humans: P. malariae, P. vivax, P. falciparum, and P. ovale. The parasites are transmitted via the bites of infected Anopheles mosquitoes. Plasmodium falciparum causes severe and complicated malaria such as cerebral malaria, severe anemia, acute renal failure, pulmonary edema, hypoglycemia, shock, spontaneous bleeding, convulsions, hyperthermia and acidosis. Diagnosis involves identifying the parasites and species in blood smears under the microscope along with clinical symptoms. Treatment depends on the severity and species, ranging from oral medications

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    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 39

    MALARIA

    Yuli Hermansyah, dr, SpPD

    INTRODUCTION
    / intracellular obligate protozoa plasmodium gene. P.Malariae, P.Vivax, P.Falciparum, P.Ovale anopheles. 400 Anopheles 67 contagioused 24 (INA) Blood transfusion / syringe. Pregnant women baby.

    Malaria

    Parasitemia
    P.vivax reticulocyte 2% erithrocyte P.malariae older erithrocyte 1%
    P.falciparum all ages of erithrocyte erithrocyte infectious rate severe complication

    P.falciparum severe & complicated malaria

    Falciparum. Pernicious. Sub tertian. Malignan. Estivoautumnal.

    Shock. Cerebral malaria. Haemolysis. Haematologic manifestation Pulmonary oedema.

    Fatal complication

    CFR severe malaria 10 50%. Mortality of malaria / complication of


    severe malaria (P.falciparum).

    DEFINITION
    Severe Malaria
    WHO : Asexual stage infection of P.falciparum with one or more complication.
    1. Cerebral malaria : * Coma (GCS < 11). * 30 minutes after convulsion (not caused by another diseases). 2. Severe anemia (Hb < 5 gr% or Hct < 15%). 3. ARF (urine < 400ml/24 hours in adult, < 12 ml/kg BW in children) creatinine serum > 3 mg%.

    4. Pulmonary oedema / ARDS.

    5. Hypoglycaemia, blood sugar < 40 mg%.


    6. Circulatory collapse / shock : * systolic BP < 70 mmHg (children 1-5 years old < 50 mmHg). * Cold sweating. * temperature skin mucous > 1C. 7. Spontaneous bleeding : nose, gums, gastrointestinal tract + laboratory intravascular coagulation disturbances.

    8. Repeat convulsions > 2x/24 hours.

    9. Acidaemia (PH <7,25)/Acidosis (HCO3 <15mmol/L). 10.Macroscopic haemoglobinuria acute malaria infection. 11.Post mortem confirmation of diagnosis.

    Other manifestations of severe malaria


    1. Impairment of conciousness less marked than unrousable coma (GCS < 15). 2. Muscle weakness (can not sit / walk) without neurological disorder. 3. Hyperparasitemia > 5% hypoendemic area or unstable malaria area. 4. Jaundice (bil conc > 3 mg%).

    5. Hyperpyrexia (rectal temp > 40C).

    PATHOPHYSIOLOGI
    1) Cerebral Malaria 2% non immune patients. 10% of the patients hospitalized with falciparum malaria. 80% of the fatal case. Pathogenese still uncleared. Suggestion : Erithrocyte (contain parasite) unable to pass throught capillary vessels of the brain (citoadherence and sequestration) plug capillary vessel of the brain Anoxia.

    2) Anemia 30% case need transfusion.

    WHO transfusion Hb < 5 gr% / Hct < 15% parasite > 10.000/mm3.
    Correlated with parasitemia, skizontemia, total bilirubin serum, creatinine serum. Acute malariadisoriented,lost of conciousness untill coma, gallop rythm, hepatomegali and pulmonary oedema. Anemia : * haemolysis. * TNF-alfa.

    3) Acute Renal Failure >> adult. Sensitive indicator for severe malaria. Mortality 45%. << children. Pre-renal (dehidration) > 50%. Acute tubular necrose 5 10%.

    Plug capillary vessels blood flow to the kidney Anoxia glumerular filtration rate (oliguria)

    Anuria
    - diffuse cortical necrosis. - progressif glumerulonephritis - arteri renal occlussion / vasculitis renal. hyperkalemia. hyperphosphatemia. hypocalcemia. hypermagnesemia.

    A R F

    Acidosis metabolic. Hyperuricaemia. Amylase serum. Congestive heart failure. Aritmia.

    Pericarditis.
    Terminal stage uremia, GI & skin bleeding, septicemia

    4) Pulmonary Oedema
    >> adult; << children. The most severe complication of tropica malaria Two types : 1. Fluid overflow. 2. Adult respiratory distress syndrome. Past: * capillary membrane permeability. * microvascullar emboli. * intra vascullar coagulation. & pulmonary microcirculair disfunction. Recent : TNF-alfa

    5) Hypoglicaemia Metabolic demands of the parasites. Adult ~ tx/: quinine. Pregnancy primigravide. >> Adrenalin secretion. Failure of hepatic gluconeogenesis.

    6) Circulatory collapse / shock Malaria Algid. Shock with hypotension (systolic pressure < 70 mmHg). Changes of perifer resistance. tissue perfusion. Hypotension ~ gram negative septicemia.

    7) Spontaneous bleeding

    Gums, nose, ptechiae, purpura hematome thrombocytopenia. Intravascular coagulation disturbance rare (< 10%). Gastrointestinal bleeding steroid. stress ulcer. Bleeding + severe parasitemia + uremia poor prognose.

    8) Hyperpyrexia (hyperthermia) >> tropica malaria. Hot and dry skin, cyanosis in extremities. Delirium coma. Temp > 38C convulsion. Temp 39,5C - 41C delirium. Temp > 41C coma. Endemic area heat stroke malaria. 9) Metabolic acidosis Hyperventilation (kussmaul). Lung auscultation : N. Lactic acid . PH (< 7,25). Bicarbonat (< 15 mmol/L).

    10) Macroscopic haemoglobinuria (blackwater fever) Syndrome : * acute attack. * chills. * intravascular haemolysis. * haemoglobinemia. * haemoglobinuria. * renal failure. Back pain. Vomiting. Diarhea. Polyuria.

    Blackwater fever
    Oliguria + coca-cola-coloured urine. (blackwater urine) Hepatosplenomegali + anemia + icteric. Haemolysis caused by quinine or antibody against quinine never be proved. Deficiency of G-6-PD enzyme.

    SUMMARY
    Malaria disease caused by protozoa intracellular obligate from plasmodium genus. Human P.malariae, P.vivax, P.falciparum, P.ovale Pathogenese still uncleared. Contagioused * mosquito bite. * blood transfusion. * syringe. * pregnant women baby.

    Plasmodium falciparum severe and complicated malaria : * malaria falciparum. * pernicious. * sub tertian. * malignan. * estivoautumnal. Severe malaria : infection caused by P.falciparum (asexual stage) + one/more complication : cerebral malaria, severe anemia, ARF, pulmonary oedema / ARDS, hypoglicemia, shock, spontaneous bleeding, convulsion, hyperthermia, acidosis, haemoglobinuria.

    Diagnosis
    Anamnesis : Demam, menggigil, nyeri kepala, nyeri otot, riwayat daerah endemik, transfusi, obat malaria Pemeriksaan fisik : Demam, pucat, hepatomegali, splenomegali, manifestasi malaria berat

    11/14/2013 Kuliah Tropik Infeksi 26

    Diagnosis
    Pemeriksaan laboratorium : Tetes tebal & tipis ~ parasit +, spesies & stadium plasmodium, kepadatan parasit (semikuantitatif, kuantitatif) Pemeriksaan lain : Deteksi antigen parasit malaria, metode imunokromatografi : HRP2, pLDH

    11/14/2013 Kuliah Tropik Infeksi 27

    Diagnosis banding

    Tifoid Dengue fever ISPA Leptospirosis ringan Infeksi virus

    Meningo ensefalitis CVA Tifoid ensefalopati Hepatitis Leptospirosis berat Glomerulonefritis Sepsis DSS
    28

    11/14/2013

    Kuliah Tropik Infeksi

    Pengobatan
    Obat anti malaria : Oral ~ malaria ringan tanpa komplikasi Parenteral ~ malaria berat / tak bisa minum obat Pengobatan suportif : demam, anti kejang, cairan dll. Pengobatan komplikasi

    11/14/2013 Kuliah Tropik Infeksi 29

    Anti malaria, dasar mikroskopik

    Falsiparum tanpa komplikasi (lini 1) Artesunat , 4 tab hari1-3 Amodiakuin, 4 tab hari 1-3 Primakuin, 4 tab hari 1 Lini 2 Kina, 3x2tab hari 1-7 Tetrasiklin, 4xi kaps hari 1-7 Primakuin, 3 tab hari 1
    Kuliah Tropik Infeksi 30

    11/14/2013

    Anti malaria, dasar mikroskopik

    Vivax, ovale (lini 1) Kloroquin , 4 tab hari1-2, 2 tab hari 3 Primakuin, 1 tab hari 1-3 Lini 2 Kina, 3x2tab hari 1-7 Primakuin, 1 tab hari 1-14 Relaps Klorokuin 4 tab/minggu , 8-12 minggu Primakuin 3 tab/minggu , 8-12 minggu
    Kuliah Tropik Infeksi 31

    11/14/2013

    Anti malaria, dasar klinis


    Lini 1 Kloroquin , 4 tab hari1-2, 2 tab hari 3 Primakuin, 3 tab hari 1 Lini 2 Kina, 3x2tab hari 1-7 Primakuin, 1 tab hari 1

    11/14/2013

    Kuliah Tropik Infeksi

    32

    Malaria berat

    Lini 1 Artesunat (60 mg); 2,4 mg/kgBB iv diikuti 1,2 mg/kgBB 1v jam 12, 24 ; selanjutnya 1,2 mg/kgBB setiap hari sd hari 7 Artemether (80mg); 2 ampul im hari 1; 1 ampul 1m hari 2-5 Lini 2 : Kina 500 mg dlm D5 selama 8 jam, diulang/8 jam
    Kuliah Tropik Infeksi 33

    11/14/2013

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