Congenital Malaria

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Definisi  Malaria

kongenital adalah penyakit infeksi yang disebabkan oleh parasit Plasmodium, ditransmisikan dari ibu ke anak melalui plasenta selama kehamilan ataupun pada saat melahirkan.

Etiologi  Malaria

kongenital disebabkan oleh infeksi protozoa, termasuk dalam kelas sporozoa, genus plasmodium dan terdiri dari 4 spesies yang menginfeksi manusia - Plasmodium falciparum - Plasmodium vivax - Plasmodium ovale - Plasmodium malariae

GEJALA KLINIS  Irritabilitas  Tidak

mahu menyusu  Demam  Pembesaran hati dan limpa  Anemia



True Congenital Malaria (acquired during pregnancy) - sudah terjadi kerusakan plasenta sebelum bayi dilahirkan -parasit malaria ditemukan pada darah perifer bayi 48 jam setelah lahir dan gejalanya ditemukan pada saat lahir atau 1 – 2 hari setelah lahir



False Congenital Malaria - terjadi pelepasan plasenta diikuti transmisi parasit malaria ke janin - gejala muncul 2-3 minggu setelah lahir

WHO mendefinisikan malaria berat 1. Gangguan kesedaran sampai koma (malaria serebral) 2. Anemi berat (Hb < 5%, Ht < 15%) 3. Hipoglikemi 4. Udem paru/ ARDS 5. Kolaps sirkulasi, syok, hipotensi, algid malaria dan septikemia 6. Gagal ginjal akut 7. Jaundice 8. Kejang umum berulang 9. Asidosis metabolik

10. 11. 12. 13. 14. 15.

Gangguan keseimbangan cairan,elektrolit,asam basa Perdarahan abnormal dan gangguan pembekuan darah Hemoglobinuri Kelemahan Hiperparasitemia Hiperpireksia

PENGARUH MALARIA PADA JANIN

1. 2. 3. 4. 5. 6. 7. 8.

Kematian janin dlm kandungan Abortus Persalinan prematur Berat badan lahir rendah Malaria plasenta Malaria kongenital Partus sulit Anemia

PATOFISIOLOGI GEJALA KLINIS IKTERUS

produksi bilirubin meningkat pengambilan bilirubin di hepar menurun proses konjugasi bilirubin di hepar menurun eksresi bilirubin ke bile menurun

Haem  biliverdin  bilirubin  unconjugated  conjugated  bile usus stercobilinogen fecal

diserap ke dlm

darah filtrasi oleh ginjal urobilinogen urine

BB meningkat tidak sesuai usia -Faktor ibu : anemia  nutrisi ke janin berkurang (BBLR)  nutrisi ke bayi berkurang

-Faktor bayi  saat sakit bayi kurang nafsu makan -  enzim tidak efisien pada suhu tinggi (makanan tidak diserap baik -  eritrosit lisis, makanan tidak dapat ditranspor ke dalam sel -  tenaga yang ada ditukar ke tenaga haba  demam

Mechanisms of congenital malaria  Maternal

transfusion into the fetal circulation either during pregnancy or at the time of delivery, direct penetration through the chori onic villi, or through premature separation of the placenta.

 Malaria

infection of the placenta may be accompanied by intervillous infiltrates of mo nonuclear cells (and other APC)

Mechanisms of congenital malaria  Intervillous

mononuclear inflammation (IVMI) is especially severe in the first pregnancy and it is associated with maternal anaemia and LBW.

 IVMI

induces an alteration in the cytokine balance and may cause pathological changes in trophoblasts that can damage the syncytiotroph oblastic membrane.

Malaria Diagnosis  Clinical

Diagnosis  Malaria Blood Smear  Fluorescent microscopy  Antigen Detection  Serology  Polymerase Chain Reaction

Interpreting Thick and Thin Films  THICK

FILM

 lysed

RBCs  larger volume  0.25 μl blood/100 fields  blood elements more concentrated  good screening test  positive or negative  parasite density  more difficult to diagnose species

 THIN

FILM

 fixed

RBCs, single layer  smaller volume  0.005 μl blood/100 fields  good species differentiation  requires more time to read  low density infections can be missed

Collection of Blood Smears 1. The second or third finger is usually selected and cleaned.

4. Slide must always be grasped by its edges.

2. Puncture at the side of the ball of the finger.

5. Touch the drop of blood to the slide from below.

3. Gently squeeze toward the puncture site.

Detection of Plasmodium antigens: pLDH (parasite lactate dehydrogenase)

Detection of Plasmodium antigens

A: HRP-2 (histidine-rich protein 2) (ICT) B: pLDH (parasite lactate dehydrogenase)(Flow) C: HRP-2 (histidine-rich protein 2) (PATH)

Polymerase Chain Reaction (PCR)  Molecular

technique to identify parasite genetic material  Uses whole blood collected in anticoagulated tube (200 µl) or directly onto filter paper (5 µl) 100%

DNA is extracted 10% blood volume used in PCR reaction

Pencegahan  Kemoprofilaksis

: Klorokuin 300 mg (2 tablet) setiap minggu, bagi wanita yang akan ke daerah endemik diberi 1 minggu sebelum bepergian, selama di daerah endemik, sampai 4 minggu setelah keluar dari daerah tsb  Pengendalianan vektor :  Mengurangi

kontak/gigitan nyamuk dengan kelambu/anti nyamuk  Membunuh nyamuk dewasa  Membunuh jentik nyamuk

Prognosis  Infection

w P. vivax, ovale or malariae  if excellent treatment, complication rare  Falciparum malaria  depends on clinical presentation (deep coma, MOF, lactic acidosis, hypoglycemia / hyperventilation)  poor prognosis  Presence of more mature parasites in falciparum infection indicate poor prognosis

ZzZzZzzZ….

KESIMPULAN  Ilham

mengalami Malaria Kongenital Berat dan diindikasikan untuk rawat inap

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