Malaria epidemics, Malaria is widespread in round the world, either in tropical, temperate and cold climates. To determine the level of malaria endemicity in a region, should be examined spleen index (spleen index, SI), and the index of parasites (parasite index, PI). In addition it should be investigated to determine the Anopheles mosquito infection rate (infection rate) and the density of mosquitoes (mosquito density). In addition tu socio-cultural life of the population and the environment endemic areas should be studied carefully.
The degree of endemicity of malaria. According to the World Heal Organization (WHO), based on the index override malaria areas are classified into four levels, namely:
Hipoendemis: override index between O to 10 percent;
Mesoendemis: override index between li to 50 percent;
Hiperendemis: seialu spleen index above 75 percent with a high index of spleen in adults
Holoendemis: override the index is always in the top 75 percent of the spleen index in adults is low. This indicates a strong tolerance adults against malaria.
Berbagal influential factor in malaria epidemiology that is the source of infection, either the patient or career gametocytes, namely the capability of transmitting Anopheles mosquito, and sensitive human presence. In endemic areas, people especially children are the most important source of infection.
Anopheles mosquitoes factors to be considered are the breeding grounds for mosquitoes (breeding places), longevity mosquito, Anopheles and effectiveness in acting as the capability of transmitting, as well as a dose of sporozoites inoculated every time suck the blood of the donor and recipient patients.
The clinical symptoms of malaria, malaria incubation period for each type is different. On malaria vivax and ovale malaria incubation lasts between 10 to 17 days, the falciparum malaria between 8 to 12 days and the malaria malariae, the incubation period lasts between 21 and 40 days.
Malaria show typical symptoms, namely:
Recurring fever which consists of three stages: chills (rigor), which lasts between 20 minutes to 1 hour, hot stage body (l-4 hours) and the stage sweating a lot (2-3 hours). Splenomegaly.
Anemia with malaise.
Patterns of malaria fever. Cycle fever occurred in accordance with the time of skizogeni erythrocytic on each species of Plasmodium.
At tertian malaria, whether malignant or benign, fever takes place every 3rd day (48 hour cycle) and on malariae malaria, fever occurs every 4th day (72 hour cycle). 24-hour cycles of fever can occur if there is a second-generation maturation Pl. vivax within 2 days (called tertian duplex), or third-generation maturation Pl. malariae within 3 days (called kuartana triplex).
Various symptoms and complaints of patients can follow the stage of fever, for example on the stage of rigor, the patient was shivering despite the patient's body temperature above normal. In the hot stage patients skin to become dry, red and advance patient pulse rate increases. Patients also complained of dizziness, nausea, and sometimes vomiting. In children, high fever can cause seizures. At the stadium sweating due to excessive discharge, the patient feels very tired and weak.
Anemia in malaria. Due to rupture of erythrocytes repeatedly during the segmentation process parasites in erythrocytes, patients experience anemia hypochromic microcytic or normocytic hypochromic anemia.
Enlargement of the spleen. One of the important symptoms of malaria are splenomegaly that occurs after the patient has experienced several bouts of fever. Palpable spleen usually start the second week since the first fever.
In the primary malaria, enlarged spleen is unclear and difficult to determine magnifying. The size of the spleen enlargement is important in determining the degree of malaria endemic region.
Diagnosis of malaria, malaria diagnosis must be determined if found parasites. Examination of peripheral blood is easy to do though sometimes Plasmodium elusive.
Microscopic examination is done with thick drops (thick smear) or with a blood smear (thin-smear). Thick drops were conducted to determine the diagnosis of malaria quickly, but undetermined species of Plasmodium parasite. Blood smear can be used to determine the species of the parasite that causes malaria.
To help with the diagnosis of malaria, especially the concentration of parasites in the blood is very low, serology performed on peripheral blood, for example precipitins test and complement fixation test.
Blood tests also showed a picture of patients decreased hemoglobin, abnormal or decreased leukocytes, platelets decreased, aspartate amino transferase increased, increased alanine amino transferase and increased bilirubin.
Malaria treatment, anti-malarial medicine can be grouped into two groups, namely natural alkaloids, such as quinine and synthetic antimalarial.
Synthetic antimalarial drug is 9-aminoakridin (mepakrin) atabrin example, kuinakrin, 4-aminokuinoiin (kiorokuin, amodiaquine), 8-aminokuinolin (pamakuin, primaquine), biguanide (proguanil, klopoguanil) and pyrimidine (pyrimethamine). Antimalarial drugs can be administered in the form of a combination of pyrimethamine and sulfadoxine are marketed as Fansidar.
Quinine.
This natural alkaloid can be administered together with makuin to treat recurrent malaria, acute and severe malaria (given intravenously) or to treat falciparum malaria which is resistant to chloroquine.
Immunity (resistance) to anti-malarial drugs. One of the obstacles in combating and controlling malaria is the malaria parasite immunity to anti-malarial drugs are used.
A species is declared Plasmodfum still susceptible (sensitive) against certain anti-malarial drugs, if within 7 days of treatment, parasitemi asexual form has disappeared without a subsequent recurrence (rekrudesensj). This parasite is still sensitive expressed Sensitive (S).
If there has been a parasite resistance to anti-malarial drugs, the malaria drugs should be immediately replaced with other anti-malarial drugs, while malaria control is done by increasing the eradication of malaria vector mosquito Anopheles ie.
Malaria prevention, malaria prevention is done to individuals and communities, namely: Treat people and people who are sensitive, who live in endemic areas.
Career treating malaria using primaquine, because it is able to eradicate the gametocytes. However, use of these drugs should not be done en masse because of side effects.
Preventive treatment in people who will go to malaria-endemic areas
Eradicate the Anopheles mosquito vectors of vector by using appropriate insecticides and destroy the nests of the Anopheles mosquito.
Avoid mosquito bites by using mosquito nets when sleeping, or using repellen are rubbed on the skin of the body evenings if outside the house at night.
Pernicious malaria (pernicious malaria) is a collection of symptoms that result from the treatment of falciparum malaria are not perfect, so the cause of death of patients within one to three days after treatment.
Kanagiutinasi causing any parasite Plasmodium falciparum infected erythrocytes so capillaries of various organs unstoppable. This is due to the parasite erythrocytic skizogoni process occurs in the organ capillary blood vessels. The result is a parasitic emboli that are not able to pass through capillaries. In addition trofozoit shape and sexual forms of the parasite is sticking together and also attached to the capillary wall. At pernicious malaria always happen parasitemi weight, either a ring shape or form schizonts.
There are three clinical forms of pernicious malaria, namely cerebral malaria, algid malaria and malaria septikemik.
Cerebral malaria occurs due to a brain disorder that causes symptoms hyperpyrexia, paralysis and coma. At aigid malaria, due to peripheral circulatory failure, patients experience symptoms of collapse with clammy skin. At the algid malaria-type gastric collapse accompanied by vomiting, diarrhea koleraik type, and dysentery on the type disenterik.
Septikemik malaria symptoms are hot body is always high, accompanied by symptoms of pneumonia and cardiac syncope.
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