REFERAT

“MALARIA”
Preceptor:
dr.Ihsanil Husna, Sp.PD
By:
Indah Novika 2013730051

MEDICAL PROFESSION PROGRAMME DEPARTMENT OF INTERNAL MEDICINE

JAKARTA ISLAMIC HOSPITAL CEMPAKA PUTIH
FACULTY OF MEDICINE UNIVERSITY OF MUHAMMADIYAH JAKARTA
2018
 BACKGROUND

• In 2016 an estimated 216 million cases of malaria occurred worldwide

and 445,000 people died, mostly children in the African Region.
• About 1,700 cases of malaria are diagnosed in the United States each
year.
• It has been estimated that 90% of infected travelers do not develop
symptoms until they return home.
• Indonesia have programme “Malaria Control Program” and gradually
integrate malaria control activities into the health care.
• Indonesia committed to eliminate malaria in the whole country by
2030.
 DEFINITION

• Malaria is a mosquito-borne disease caused by a parasite.

It has been known to be a serious acute and chronic
relapsing infection characterised by periodic paroxysms of
chills and fever, anaemia, splenomegaly and often fatal
complications.
• The word malaria is derived from the Italian words “Mal”
and “aria” which mean “bad air”.
 EPIDEMIOLOGY

• The most affected locations are in Papua (33%), the Lesser Sundas
(29%) and Sumatra (21%) .
• P. falciparum’s prevalence was higher in the eastern Indonesia than
in the rest of the country and it was not distributed equally across
the island groups.
• P. vivax which has been reported at 1786 location (75% of all
surveys), is the most common of the Plasmodium in Indonesia after
P. falciparum.
• These parasites have been confirmed at 5% and 0.6% survey
locations subsequently.
 EPIDEMIOLOGY

• Malaria transmission is higher in the forest areas, particularly in

the eastern part of the country with approximately 88.8 million
(37%) of total populations who lives in the high transmission
district.
• The past 6 years epidemiological profile of malaria in Indonesia
(2005-2010) reveals that in the year 2009 reported deaths due to
malaria increased by about 34% which can be minimized by
about 48%. Only 20% of the cases were confirmed and most of
them due to Plasmodium falciparum and mix infection (about
50%).
 Based on Annual Parasite Incidence (API), there are huge
variations in the level of malaria burden between districts and
within provinces.
 Papua is the worst affected province. All districts are highly endemic. Of the 14
districts, 2 had APIs in 2010 over 200/1,000 population while 8 have APIs between 50
and 100/1,000 population. The remaining 4 Districts had APIs higher than the national
API of 1.89/1,000 population. Unlike in other provinces, P. falciparum is the
predominant malaria species in Papua.
 ETIOLOGY
• Malaria is caused by intracellular protozoa which is transmitted by
mosquito bite mainly between dusk and dawn. The parasite, a
protozoan (unicellular organism) is known by the generic name
Plasmodium. They can be identified in the peripheral blood because of
their specific shapes in the red blood cells (RBC).
• Five species can infect humans :
1. P. falciparum (malaria tropika/malignant)
2. P. vivax (malaria tertiana/benign)
3. P. ovale (malaria ovale)
4. P. malariae (malaria quartana)
5. P. knowlesi (Plasmodium species that
normally infect animals)
Female Anopheles
mosquito
 MODE OF TRANSMISSION

1. Through bite by an infected female Anopheles mosquito.

2. Blood transfusion i.e if the blood is contaminated by malaria
parasite.
3. Transplacental mother to child.
 PATHOGENESIS
1. A female mosquito that has already fed on a
blood meal from an infected person bites
another person and injects sporozoites which are
found in its saliva (invasive forms).
2. This is also known as the liver stage. The
sporozoites rapidly enter the liver cells and
transform into tissue schizonts that reproduce
asexually to generate large numbers of
merozoites. Note that in plasmodium vivax and
plasmodium ovale a dormant stage (hypnozoite)
can persist in the liver and cause relapses by
invading the blood stream weeks or even years
later.
4. After the asexual cycle, some merozoites develop into
3. After 5-20 days the merozoites rapture the
gametocytes the sexual form which are ingested by the
liver cells and begin the erythrocytic cycle
mosquito sucking blood.
(RBC cycle). During the cycle the merozoites
invade the RBCs in the peripheral blood system, 5. In the mosquito gut, male and female gametes merge
where they feed and multiply further resulting from the gametocytes and fuse into zygote which migrate
into a large increase of parasite population in the into the gut wall where they produce the oocysts. Each
human host. The release of merozoites produces oocyst generates approximately 1000 sporozoites. After 2
the characteristic fever in the patient. weeks the sporozoites migrate into the mosquito’s salivary
gland becoming highly infective after 9 days and the cycle
begins again.
 CLINICAL MANIFESTATION
Patients with malaria typically become symptomatic a few weeks after infection,
although the host's previous exposure or immunity to malaria affects the
symptomatology and incubation period. In addition, each Plasmodium species has a
typical incubation period. Importantly, virtually all patients with malaria present with
headache. Clinical symptoms also include the following :
• Headache (noted in virtually all patients with malaria)
• Fatigue
• Malaise
• Shaking chills
• Arthralgia
• Myalgia
• Paroxysm of fever, shaking chills, and sweats (every 48 or 72 h, depending on
species)
The classic paroxysm begins with a period of shivering and chills, which lasts for
approximately 1-2 hours and is followed by a high fever. Finally, the patient
experiences excessive diaphoresis, and the body temperature of the patient drops to
normal or below normal.
 CLINICAL MANIFESTATION
The classical (but rarely observed) malaria attack lasts 6-10 hours. It
consists of :
 A cold stage (sensation of cold, shivering)
 A hot stage (fever, headaches, vomiting; seizures in young children)
 And finally a sweating stage (sweats, return to normal temperature,
tiredness).

Less common symptoms include the following :

• Anorexia and lethargy
• Nausea and vomiting
• Diarrhea
• Jaundice
 INCUBATION PERIOD

• Plasmodium falciparum 9 – 14 days

• Plasmodium vivax 12 – 17 days – 12mo
• Plasmodium ovale 16 – 18 days
• Plasmodium malariae 18 – 40 days
• Plasmodium knowlesi 9 – 12 days
 DIAGNOSIS
1. Clinical manifestations
2. A new history of traveling to a malaria
endemic area
3. Microscopic examination remains the
"gold standard" for laboratory
confirmation of malaria. Blood smears
(thick and thin smear). Found
gametocyte on blood test (specimens
were taken at the peak of fever).
4. RDT (Rapid diagnostic Test)
Immunochromatographic tests based on
antibody. Specific malaria antigens like
Histidine rich protein-2 (HRP2) and
Plasmodium Lactate dehydrogenase
(PLHD) by a colour change on a
Nitrocellulose strip. They are rapid,
simple and sensitive. They can be as
sensitive as the thick blood smear.
5. PCR (Polymerase Chain Reaction)
 MANIFESTATION OF PLASMODIUM
INFECTION

• Uncomplicated malaria
A patients with symptoms of malaria and a positive parasitological test
(microscopy or RDT) but with no features of severe malaria is defined as
having uncomplicated malaria. (WHO)

• Severe malaria
1. Severe falciparum malaria
2. Severe vivax and knowlesi malaria
1. Severe falciparum malaria
2. Severe vivax and knowlesi malaria
MEDICAMENTOSA
Guideline for the Treatment of Malaria 3rd edition, 2015
Guideline for the Treatment of Malaria 3rd edition, 2015
Guideline for the Treatment of Malaria 3rd edition, 2015
Guideline for the Treatment of Malaria 3rd edition, 2015
Guideline for the Treatment of Malaria 3rd edition, 2015
Guideline for the Treatment of Malaria 3rd edition, 2015
COMPLICATIONS

Guideline for the Treatment of Malaria 3rd edition, 2015

COMPLICATIONS

Guideline for the Treatment of Malaria 3rd edition, 2015

PREVENTION
Thank You