DWI - Protozoologi_ Sporozoa (Malaria I Dan II)

7/25/2019 DWI - Protozoologi_ Sporozoa (Malaria I Dan II)

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MALARIA

dr. DWI HANDAYANI, MKesStaf Bagian ParasitologiFakultas Kedokteran Unsri


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alariaInfeksi oleh genus

Pl smodium

P. f lcip ru m

P. m l ri e

P. viv x

P. ov le

Endemis di 105

negara di dunia

300-500 jua kasus !hn

1"5-#"$ jua

kemaian!ahun

%0& penduduk Indonesia

inggal di daerah endemis


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MAP OF MALARIA ENDEMICITY AT

DISTRICT/MUNICIPALITY LEVEL IN INDONESIA, 2010

Source: DG of D!e"!e Co#$ro% "#&

E#'ro#(e#$"% )e"%$*, M#!$r+ of )e"%$*RI, 2011

(Yoes Prijatna Dachlan,2013)


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IMPA! "F MA#A$IA

Malaria %auses a&out '()*()) +illioninfe%tions in u+ans anda--roi+atel/ one to tree +illion

deats annuall/. !e 0ast +a1orit/ of %ases o%%ur in

%ildren under te age of (. Pregnant 2o+en are also es-e%iall/

0ulnera&le.


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Monkey plasmodium

P. cynomolgi

P. knowlesi


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Morphology:

- Chromatin

- Cytoplasm- Pigment

- Granula


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#ife %/%le

- Intrinsic phase:

in the vertebrate host,

asexual schizogony

Extrinsic phase:

in the female

anopheles mosquito,sexual sporogony


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#ife %/%le Plasmodium


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LIFE CYCLE OFP. VIVAX OR P.OVALE

Man Female anopheles

In the liver

In !"

MIKROGAM!O"Y!

s#oro$oite%no$oite

'chi$ont

ero$oite

!ROP%OOI!

'"%IO*! MROOI!

MAKROGAM!O"Y! a+roaete

i+roaete$&ote

oo+inete

ooc&st


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PHYSI"#"3Y

#atent -eriod in te &od/ 4* P. fal%i-aru+ 4 sortest P. +alariae 4 longest

$B4 su+&er energi untuk -arasit $B4 He+e 5iron -or-/rin6

73lo&in5-rotein6 He+e toksik &agi -arasit -oli+erisasie+o8oin9 :*e+atin 5-ig+en +alaria6


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For sur0i0al te +alarial -arasitesneed4 H"; P$"!


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MORFOLOGI


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!ro-o$oit ./a (Rin or) !ro-o$oit t.a

'+i$on ./a

'+i$on

Gaetosit


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Plasmodium vivax

+en/e&a&kan +alaria 0i0aks 5+alaria tersiana6" Stadiu+ trofo8oit dala+ dara

Peru&aan -ada eritrosit

* eritrosit +e+&esar * ada titik S%=>ner

"!rofo8oit aktif, a+e&oid

Infeksi +ulti-el 5kadang*kadang6 Pig+en &er2arna kuning tengguli


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Plasm odium vivax

stadium trofozoit


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Plasm odium vivax

Stadium trofozoit lanjut


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Plasm odium vivax

stadium skizon

* inti &an/ak 5?@ * @6

+en1adi +ero8oit

* -ig+en &erku+-ul


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Plasm odium vivax

stadium m akrogam etosit m ikrogam etosit

mikrogametosit

makroganetosit


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Menyebabkan: malaria malariae (malaria quartana)

PLASMODIUM MALARIAE

Per.ahan #a/a eritrosit

eritrosit ti/a+ eesar

a/an&a titi+ ieann

!ro-o$oit ti/a+ a+ti- (+o#a+)

ent.+ #ita4 #ient ten.li t.a, +asar


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Plasm odium m alariae

Stadium trofozoit

Stdium troozoit


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stadium trofozoit lanjut


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stadium skizon

* inti * ?@ &ua &entuk &ungaserunai

5inti C +ero8oit6 * -ig+en &erku+-ul di tenga


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stadium gam etosit

makrogametosit

mikrogametosit


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P. falciparum

Pen/e&a& +alaria tro-ika atautertiana

Pen/e&aran tinggi di daera tro-is Indonesia4 frekuensi tinggi Ko+-likasi &erat * ke+atian


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P. falciparum

3a+&aran dara te-i Stadium troozoit muda

'e/iaan /arah ti#is

P.lasan Giesa

"iriciri4

eritrosit 4 ti/a+eesar

#arasit /i te#i eritrosit

(accole)


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P. falciparum

Stadium troozoit muda

'e/iaan /arah ti#is

P.lasan Giesa"iriciri 4

eritrosit 4 ti/a+

eesar

#arasit ent.+cincinhal.s

ta#a+ leih /ari sat.

#arasit /ala se.ah

eritrosit


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P. falciparum

Stadium skizon muda

! "arang ditemukan dalam darah

te#i$ 'e/iaan /arah ti#isP.lasan Giesa

"iriciri4

ritrosit ti/a+ eesar Parasit4 j.lah inti 2 5

#ien s./ah

en.#al,

6arnan&a hita


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P. falciparum

Stadium skizon matang

'e/ian /arah ti#is

P.lasan Giesa

"iriciri4

eritrosit 4 ti/a+ eesar #arasit 4

7 iasan&a ti/a+ enisi

sel.r.h eritrosit7 j.lah inti 829

#ien en.#al

6arna hita


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P. falciparum

Stadium makrogametosit

'e/iaan /arah ti#is

P.lasan Giesa"iriciri 4

eritrosit ti/a+ eesar

Parasit4

: ent.+ #isan aa+

lonjon

: #lasa ir.

: inti #a/at, +ecil

: #ien /i se+itar inti


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P. falciparum

Stadium mikrogametosit

'ta/i. Mi+roaetosit

se/iaan /arah ti#isP.lasan Giesa

"iriciri 4

eritrosit ti/a+ eesar4

#arasit 4 : ent.+ sosis

: #lasa erah ./a

: inti ti/a+ #a/at

: #ien tersear


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Plasmodium ovale

Mor-oloi 4 en&er.#ai P;


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Ve%tors in indonesia4

Anopheles annularis

Anopheles vagus Anopheles barbirostris Anopheles aconitus Anopheles sundaicus Anopheles maculatus

Anopheles balabacensis Anopheles punctularis Anopheles subpictus Ano;heles indefnitus

Ano-eles +osuitoes

*(E id i l )


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*(Epidemiology)

*Endemic : connotes natural transmission in an area so thatthere are autochthonous, locally contracted cases

*Imported malaria: is acquired outside the area

*Introduced malaria : cases derived from Imported malaria

*Sporadic : cases are few and scattered


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Masa -ra*-aten4 Waktu antara -er+ulaan infeksi

5s-oro8oit +asuk6 sa+-ai -arasit

+alaria dite+ukan dala+ dara te-i


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Masa inku&asi9tunas instrinsik4 Waktu antara -er+ulaan infeksi

sa+-ai ti+&ul ge1ala klinis9de+a+


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Masa tunas ekstrinsik:

Waktu antara ga+etosit +asuk kedala+ tu&u n/a+uk sa+-ai

ter&entukn/a s-oro8oit dala+ kelen1arluda n/a+uk


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Malaria ende+i%it/4

!e -re0ailing freuen%/ and intensit/of ende+i% +alaria.

lassiE%ation of ende+i%it/4Based on s-leen inde 56 of %ildrenin age grou- @*G, and te s-leen rateof adult


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(Epidemiology)

Classification of endemicity:

1; %oen/eic alaria 4 s#leen rate in ae

ro.# 2? @ 102; Mesoen/eic alaria 4 B B B BB 2?4 11C0

3; %eren/eic alaria 4 B B B BB 2 ? 7 C0 an/ a/.lt s#leen rate

9; %oloen/eic alaria 4 s#leen rate in aero.# 2? 7 C .t a/.lt tolerance hih an/a/.lt s#leen rate


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P./01023

45 Vascular blockade o vascular by#arasistized rbc

Rosetting

Sitoadherens Se6uestrasi uto-agglutinasi

%5 no7ia !organ$

85 ,e#osition o #igments

Mode o inections:45 Bitten by emale ano#heles%5 Congenital

85 .ransusion)5 0rgan trans#lantation


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PA!H"#"3Y


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MALARIA ROSETTE


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INCUBATION PERIOD:

P malariae : 12-14 days (18-40days)

P. falciparum : 10-12 days (8-11days)

P. ovale : 10-12 days

P. vivax : 14-17 days (10-17 days)


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45 .he ebrile #aro7ysm may bedivided into 8 clinical stages:

- cold stage !49-4 minutes$

- host stage !about % hours: 8;-)(oC$

- s*eating stage !about 4 hour$

%5 Secondary anemia

85 S#lenomegaly

S/+-to+atolog/


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!e atta%k of -aro/s+

"P. vivax and P. ovale 4 ours"P. alciparum 4@* 5'*6

ours

"P. malariaae 4 @ ours


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2


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2


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P.0@>S>0102> 2


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3


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*GEJALA KLINIS*Anemia

1. %ancurnya eritrosit yang mengan&ung parasit*e& cell rigi&ity an& &eformabilityincrease splenic clearance

'( Eritrosit normal ti&a) &apat hi&up lama *( +epresi sumsum tulang &iseritropoesis oleh

sito)in

.( %emozoin-in&uce& apoptosis in &eveloping

erytroi& cells

*/a&a P.falciparum ter0a&i secara a+.t

pa&aP. vivax ter0a&i secara +ronis


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2


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1anAutan55

Pe+&esaran li+-a teruta+a -ada infeksiP. vivax, -aling 1arang -ada P. malariae

Setela infeksi &erkali*kali, li+-a E&rotik dan +enge%il 5+endekati nor+al6

Seingga di daera ende+isitas tinggi,li+-a -ada orang de2asa &erukurannor+al


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Pernicious manifestation

Warning signs:

aseual parasitemia 5%, 10 %with multiple rings in red cells andschizonts in peripheral blood


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Pernicious manifestation:

Cere!ral malaria

Malaria "ith #aundice

$iarrhoea% dysentery

Renal failure Pulmonary edema

&lac' "ater fe(er

)lgic malaria% shoc'

*yperpyreia


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Algi% +alaria

A %ondition analogous to %ere&ral+alaria, e%e-t tat te gut and oter

a&do+inal 0is%era are in0ol0ed.

!e skin is %old and %la++/, &utinternal te+-erature is ig.


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DeEnition of se0ere +alaria 5WH"6

0ne or more o the ollo*ingcriteria the #resence o ase7ual#arasitaemia deDnes severemalaria

45 Cerebral malariaEunarousable coma

%5 Severe anaemia

85 Renal ailure)5 Pulmonary oedemaEadult

res#iratory distress syndrome!R,S$


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DeEnition of se0ere +alaria 5WH"6O

9 /y#oglycaemia

/y#otensionEshock

' BleedingEdisseminatedintravascular coagulation !,>C$

F Convulsion

; cidosisE cidaemia4( Macrosco#ic haemoglobinuria


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I$ ! e"c$%+ #o$ -#o.#

Proo!e& *+o$*e!e!:1 Per(e"%$+ *+o$*e!! M"e3r"$* "#& f%e$c*er4

2 Toc/c+$o-#e *+o$*e!!

5 Mec*"#c"% *+o$*e!!

Pato-/siolog/ of ere&ral +alaria4


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!lac) 1ater fever

HaemoglobinuriafeverNausia & vomitusIcterus

Pamaquine

quinine

(qinghousu)

Death due to Renal failure

i i


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Diagnosis

1 !hic" film (DDR)# !hin film$ %' (%uantitative uff 'oat) IR+ (Immunoradiometric assa)

, -lisa for +gp. falcliparum(HRP.# / histidine Rich Protlein.#)

0 RN+ robe2 DN+ Hbridi3ation

4 Raid anuel test (P.falciparum)HRP.IIalso available for viva5

6 Indirect fluorescence +ssa (I7+)

18 Polmerase 'hain Reaction (P'R)

Pengo&atan


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Pengo&atan


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e+o-ro-/lais

lorouine4 ')) +g &ase2eekl/

Sulfadoine ? g 7 P/ri+eta+ine

() +ge0er/ t2o 2eeks

Sulfadoine .?.( g 7

P/ri+eta+ine ) +ge0er/ four 2eeks

MeLouine4 ( +g9kg

BB92eekl

Su--ressi0e treat+ent4


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Su--ressi0e treat+ent4

lorouine4 ).( g 2eekl/


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Re!!$"#ce of "!eu"% "r"!$e! P. falciparum)

to schizontocidal drugs (4-aminoquinolines)

Resistance:

+he a!ility of a parasite strain to

sur(i(e and ,or to multiply despitethe administration and a!sorption ofa drug gi(en in doses eual to orhigher than those usually

recommended !ut "ithin the limits oftolerance of the su!#ect.

$ i t i


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$esistensi

Mengubah kebiAakan

#engobatanmalaria

Rekomendasi G/0:

Arteisinin ase/ coination thera#& (A"!)4

e;;4 Artes/iaE.ine (Artes.nate C0 F ao/iaE.ine 200 );

$ i t i


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$esistensi

!erkait -eru&aan gen Plas+odiu+ Pf%rt, Pf+dr?, DHF$, DHPS

Kea#.an strain #arasit.nt.+ teta# hi/.# /an ata.


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er+eania+ 6ala.#.n

#eerian /an asor#si oat

ses.ai /osis stan/ar leih

tini /ari /osis &an

/ire+oen/asi+an teta#i

asih /a#at /itoleransi oleh

hos#es

'E(I()E*(I

Ineraksi

o+a"

parasi" dan

manusia

Pen.naan antialaria

secara onotera#i ,

+oinasi &an ti/a+

rasional , +eti/a+#at.han

/ala #enoatann&a

M.tasi s#ontan #a/a le


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#ate treat+ent failure4

if te follo2ing %onditions o%%ur on da/R @, di0ided into @ su& grou-4

?. #ate lini%al 5and -arasitologi%al6 Failure

5#F6* Parasite+ia 5te sa+e s-e%ies 2ittat of da/ )6 %o+-li%ated 2it se0ere+alaria after da/ '.

* !e aial te+-erature 'Q 2it-arasite+ia &et2een da/ * @.

f il


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#ate treat+ent failure

2ate /arasitological Failure 2/F

/arasitemia the same species 1ith &ay

$

on &ay 3, 4. or '5 1ithout rising of theaxial temperature 6 *37 "


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P. vivax

P. berghei

IMMUN"#"3I "F MA#A$IA

In the li


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I++unologi of +alaria

S-e%ies s-e%iE%Strain s-e%iE%Stage s-e%iE%

Age*de-endantSlo2 to de0elo-Antigeni% di0ersit/Antigeni% 0ariation

! i i f l i


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!e i++unit/ of +alaria!e %o+&ination of tose +e%anis+s 2i%4

?. Pre0ent infe%tion

@. Pre0ent reinfe%tion'. Pre0ent su-er infe%tion

Wit te out%o+e of4 Destru%tion of te +alarial -arasites Hindran%e of teir +ulti-li%ation, ModiE%ation of teir e>e%ts and Hel-ing s-e%iE%all/ for te re-airing of

tissues.

(IMMUNITY)


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P. falciparum : infection disappearswithin a year

P. vivax : !"years#

P. Malariae : infection persists $nti%

&'!(' years

(IMMUNITY)


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?. Innate4

Su% as4

* 3PD deE%ien%/* Du>/ fa%tor negati0e* Si%kle %ell ane+ia* !allase+ia H& H& AAKJMJLLA%

DWI - Protozoologi_ Sporozoa (Malaria I Dan II)

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