Professional Documents
Culture Documents
Parasitology Department
Medical Faculty of USU
1
Malaria
General
Caused by obligate intracellular protozoan of the
phylum Apicomplexa
Causative organisms are vectored primarily by
female Anopheles mosquito, belong to the genera
Plasmodium
Complex life cycle, involving both sexual and asexual
phases
Produces febrile hemolytic anemias, resembles to
babesiosis
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Malaria
Distribution
The agents are four species of the genus
Plasmodium: P. vivax, P. ovale, P. malariae, and P.
falciparum
P. vivax accounts for the vast majority of malarial
infection, because o/t wide distribution o/t parasite
P. vivax is the only one that extends through tropical,
subtropical, and temperate regions
Malaria
Distribution
Malaria
Epidemiology
Malaria
Epidemiology
Malaria
Pathology
Malaria
Malarial paroxysm
The release of merozoits from ruptured RBCs
triggers the malarial paroxysm
Patients experience a period of shaking chills
or rigor for 10-15 minutes
Followed by 2-6 hours of fever, body aches and
disorientation
As the fever subsides, the patient starts to
sweat profusely and returns to normal until the
onset o/t next paroxysm
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Malaria
Malarial paroxysm
Malaria
Pathology
Malaria
Vivax Malaria
11
Malaria
Vivax Malaria
Malaria
Vivax Malaria
13
Malaria
Vivax Malaria
14
Malaria
Ovale Malaria
15
Malaria
Ovale Malaria
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Malaria
Malariae Malaria
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Malaria
Malariae Malaria
Malaria
Falciparum Malaria
19
Malaria
Falciparum Malaria
Malaria
Falciparum Malaria
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Malaria
Falciparum Malaria
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Malaria
Falciparum Malaria
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Malaria
Falciparum Malaria
Renal complications, e.g. glomerulonephritis,
nephrotic syndrome, and renal failure
Cerebral malaria is the most serious
complication, may lead to coma and death
Blackwater fever is rare, but it is brought on by
sudden intravascular hemolysis, marked with
hemoglobinuria
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Malaria
Diagnosis
25
Malaria
Diagnosis
26
Malaria
Diagnosis
27
Malaria
Diagnosis
Rapid tests are available now to detect
parasite protein in peripheral vessels
(histidine rich protein II)
Immunochromatographic test to detect
plasmodium lactate dehydrogenase (pLDH)
The two latest test have equal sensitivity and
specificity with the conventional, only the
results will drop to 30-70% if parasitemia is
below 100/l blood
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Malaria
Treatment
Classification of antimalarial drugs is based on
the antimalaria activities and pharmacological
structure
Due to antimalaria activities:
1.
Tissue schizontocides for causal prophylaxis:
theoretically not practical; pyrimethamine and
primaquine
2.
Tissue schizontocides for preventing relaps:
works in hypnozoit phase; pyrimethamine and
primaquine
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Malaria
Treatment
3. Blood schizontocides, which are the most important:
chloroquine, quinine, mefloquine, halofantrine,
pyrimethamine, sulfadoxine, sulfones, tetracycline,
etc
4. Gametocides: chloroquine and quinine is effective
for P. vivax and P. malariae, primaquine is effective
for all species
5. Sporontocides: inhibit the development of oocyst in
mosquito; primaquine and chloroguanide
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Malaria
Treatment
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(LPF = Late Parasitological Failure) - Parasitemia H7, H14, H21, dan H28 ( Parasit = H0)
-Klinis memburuk
-- Parasit > 25 %
-- Parasit +, Temp > 37.5
Klinis
Memburuk
Hasil
Mal +
H-2
H0
H-1
Datang
RS/Dr
- Klinis
- memburuk
-- Parasit +
H14
H4
H3
H5
H6
-Klinis memburuk
H21
H7
Mulai
Obat
E.T.F = G.O.Dini
- memburuk
-- Parasit +
-Klinis memburuk
-- Parasit +,
-Temp > 37.5
H2
H1
- Klinis
H28
- Klinis
-Klinis memburuk
-- Parasit +, Temp > 37.5
- memburuk
-- Parasit +
- Klinis
- memburuk
-- Parasit +
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Kombinasi ACT
Keuntungan :
Kerugian:
Tablet banyak selama 3 hari : masalah kepatuhan
Fixed dose combination diperkirakan 2006-07
Diwaspadai cross-resistance terhadap chloroquine
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ARTESDIAQUINE
ARSUAMOON
37
INDIKASI A.C.T
38
DOSIS ARTESDIAQUINE
Obat/Umur
Hari
H1
H2
H3
Total tablet
Amodiaquine
H1
(200mg)
H2
H3
Total tablet
Artesunate
( 50 mg)
1-5 th
5-10th
10-15th
>15th
1
1
1
3
1
2
2
2
6
1
1
1
4
3
3
3
9
2
2
1
6
4
4
4
12
3
3
1
7-8
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OBAT NON-ACT
Monoterapi ( CQ3/ SP1/ Q7 )
Kombinasi :
SP + CQ
Quinine + Doxy/ Tetrasiklin
Qunine + Clindamycin
Quinine + SP
40
Malaria
Treatment
The treatment of chloroquine-sensitive P. falciparum
No
Drug
Chlor
<1
Prim
2.
Chlor
3.
Chlor
1.
1-4
5-9
10-14
>15
3-4
2-3
3-4
2
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Malaria
Treatment
Primaquine
Causal prophylaxis activity, destroys preerythtocytic
parasites
Dose 0.5mg/kg base (max 30mg) since 1-2 days
before entering the area to 2-7 days after leaving
Artemisinin
Rapid onset in all malaria cases
Available in Indonesia with the name Maltron
(artemether), each tablet contains 50mg base
42
Malaria
Treatment
Mefloquine
Drug of choice to prevent malaria in chloroquine
resistant areas
Contraindication: heart arrhythmia, history of
psychic disorder (psychotic, anxiety)
Doxycycline
To prevent malaria in chloroquine resistant areas
Contraindication: children < 8 yrs, pregnant and
gestation women
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Malaria
Treatment
The treatment of chloroquine-resistant patients:
Quinine sulfate
Malarone (combination of atovaquone and
proguanil)
Combination of atovaquone and doxycycline
Mefloquine
Halofantrine
Artemisinin
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Malaria
Treatment
The treatment of P. vivax, P. ovale, and P. malariae:
No.
1.
Drugs
Chlor
Prim
2.
Chlor
Prim
1-4
5-9
10-14
>15
3-4
3-4
Chlor
Prim
4.
Prim
5.
Prim
3.
1
1
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Malaria
Treatment
Malaria
Prevention
Malaria
Prevention
Malaria
References
Heelan, J. S., Ingersoll, F. W.: Blood and Tissue Sporozoa
in Essentials of Human Parasitology, Delmar Thomson
Learning, US, 2002
Pasaribu, S.: Malaria Pencegahan dan Pengobatan
Terkini, Nusantara 37 (I) 2004, Balai Penerbitan FK USU
Peters, W., Pasvol, G.: Arthropod-borne Infections in
Tropical Medicine and Parasitology, 5th ed., Mosby,
London, 2001
Harijanto, Paul.: Tata Laksana Malaria Baru 2005
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Thank you
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