memahami dan menjelaskan plasmodium k

1 Memahami dan menjelaskan plasmodium11 Klasifikasi

Plasmodium Vivax

P vivax has the widest geographical distribution extending through the tropics subtropics and temperate regions It is believed to account for 80 of all malaria infections It is the most common species of malaria parasite in Asia and America but is much less common in Africa It causes benign tertian malaria with frequent relapses

The sporozoites of P vivax are narrow and slightly curved On entering the liver cells the sporozoites initiate 2 types of infection Some develop promptly into exoerythrocytic schizonts while others persist in the dormant state for varying periods as hypnozoites There may be 2 distinct types of sporozoites the tachysporozoites (tachy fast) which develops into the primary exoerythrocytic schizont and the bradysporozoite (brady slow) which becomes the hypnozoite

The pre-erythrocytic schizogony lasts for 8 days and the average number of merozoites per tissue schizont is 10000

Merozoites of P vivax preferentially infect reticulocytes and young erythrocytes

All stages of erythrocytic schizogony can be seen in peripheral smears (Fig 65)

The degree of parasitization is not generally heavy each infected red cell usually having only one trophozoite and not more than 2ndash5 of the red cells being affected Reticulocytes are preferentially infected

The trophozoite is actively motile as indicted by its name vivax The ring form is well-defined with a prominent central vacuole One side of the ring is thicker and the other side thin Nucleus is situated on the thin side of the ring The ring is about 25ndash3 μm in diameter about a third of the size of an erythrocyte The cytoplasm is blue and the nucleus red in stained films The ring develops rapidly to the amoeboid form and accumulates malarial pigment (Figs 66 and 67)

The infected erythrocytes are enlarged and show red granules known as Schuffnerrsquos dots on the surface They become irregular in shape lose their red color and present a washed out appearance A few of the parasitized erythrocytes retreat into the blood spaces of the internal organs

The schizont appears in about 36ndash40 hours It occupies virtually the whole of the enlarged red cell The schizont matures in the next 6ndash8 hours with the development of merozoites each with its central nucleus and surrounding cytoplasm The pigment granules agglomerate into a few dark brown collections at the center and with the merozoites around it this stage presents a rosette appearance There are about 12ndash24 (usually 16) merozoites per schizont

Erythrocytic schizogony takes approximately 48 hours The red cell which now measures about 10 μm in diameter is heavily stippled and often distorted It bursts to liberate the merozoites and pigment The pigment is phagocytosed by reticuloendothelial cells

The merozoites measure about 15 μm and have no pigment

Gametocytes appear early usually within 4 days after the trophozoites first appear Both male and female gametocytes are large nearly filling the enlarged red cell The macrogametocyte has dense cytoplasm staining deep blue and a small compact nucleus The microgametocyte has pale-staining cytoplasm and a large diffuse nucleus Pigment granules are prominent in the gametocytes

Plasmodium Falciparum

The name falciparum comes from the characteristic sickle shape of the gametocytes of this species (falx sickle parere to bring forth) This is the highly pathogenic of all the plasmodia and hence the name malignant tertian or pernicious malaria for its infection 11130911113091The disease has a high rate of complications and unless treated is often fatal The species is responsible for almost all deaths caused by malaria

11130911113091Schizogony The sporozoites are sickle-shaped The tissue phase consists of only a single cycle of pre- erythrocytic schizogony No hypnozoites occur The mature liver schizont releases about 30000 merozoites

11130911113091They attack both young and mature erythrocytes and so the population of cells affected is very large Infected erythrocytes present a brassy coloration

11130911113091Ring form The early ring form in the erythrocyte is very delicateandtinymeasuringonlyasixth(16)ofthered cell diameter Rings are often seen attached along the margin of the red cell the so-called form appliqueacute or accole Binucleate rings (double chromatin) are common resembling stereo headphones in appearance Several rings may be seen

within a single erythrocyte In course of time the rings become larger about a third of the size of the red cell and may have 1 or 2 grains of pigment in its cytoplasm (Figs 68 and 69)

11130911113091The subsequent stages of the asexual cyclemdashlate trophozoite early and mature schizontsmdashare not ordinarily seen in peripheral blood except in very severe or pernicious malaria The presence of P falciparum schizonts in peripheral smears indicates a grave prognosis 11130911113091The mature schizont is smaller than in any other species and has 8ndash24 (usually 16) merozoites The erythrocytic schizogony takes about 48 hours or less so that the periodicity of febrile paroxysms is 36ndash48 hours

11130911113091Veryhighintensityofparasitizationisseeninfalciparum malaria In very severe infections the rate of parasitized cells may even be up to 50

11130911113091The infected erythrocytes are of normal size They show a few (6ndash12) coarse brick-red dots which are called Maurerrsquos clefts Some red cells show basophilic stippling

11130911113091Gametogony It begins after several generations of schizogony Gametocytes are seen in circulation about 10 days after the ring stage first appears The early gametocytes seldom appear in peripheral circulation The mature gametocytes which are seen in peripheral smears are curved oblong structures described as crescentic sickle sausage or banana-shaped They are usually referred to as crescents (Fig 610)

11130911113091The male gametocytes are broad and sausage- shaped or kidney-shaped with blunt rounded ends as compared to the female gametocytes which are thinner and more typically crescentic with sharply rounded or pointed ends The mature gametocyte is longer than the diameter of the red cell and so produces gross distortion and sometimes even apparent disappearance of the infected red cell The red cell is often seen as a rim on the concave side of the gametocyte The cytoplasm in the female gametocyte is deep blue while in the male it is pale blue or pink The nucleus is deep red and compact in the female with the pigment granules closely aggregated around it while in the male it is pink large and diffuse with the pigment granules scattered in the cytoplasm

11130911113091Falciparum crescents can survive in circulation for up to 60 days much longer than in other species Gametocytes are most numerous in the blood of young children 9 months to 2 years old They therefore serve as the most effective source of infection to mosquoties

Plasmodium Malariae

This was the species of malaria parasite first discovered by Laveran in 1880 and the name malariae is the one given by him It causes quartan malaria in which febrile paroxysms occur every fourth day with 72 hoursrsquo interval between the bouts

11130911113091The disease is generally mild but is notorious for its long persistence in circulation in undetectable levels for 50 years or more Recrudescence may be provoked by splenectomy or immunosuppression

11130911113091The development of the parasite in man and mosquito is much slower than with other species Chimpanzees

may be naturally infected with P malariae and may constitute a natural reservoir for quartan malaria11130911113091P malariae occurs in tropical Africa Sri Lanka Burma

and parts of India but its distribution is patchy11130911113091The sporozoites are relatively thick Pre-erythrocytic schizogony takes about 15 days much longer than in other species Each schizont releases about 15000 merozoites Hypnozoites do not occur The long latency of the infection is believed to be due to persistence of small numbers of erythrocytic forms in some internal organs 11130911113091Pmalariaepreferentiallyinfectsoldererythrocytesand

the degree of parasitization is low11130911113091The ring forms resembles those of P vivax although

thicker and more intensely-stained The old trophozoites are sometimes seen stretched across the erythrocyte as a broad band These band forms are a unique feature of P malariae Numerous large pigment granules are seen (Fig 611)

11130911113091The schizonts appear in about 50 hours and mature during the next 18 hours The mature schizont has an average of 8 merozoites which usually present a rosette appearance

11130911113091The infected erythrocytes may be of the normal size or slightly smaller Fine stippling called Ziemannrsquos stippling may be seen with special stains The degree of parasitization is lowest in P malariae

11130911113091Erythrocytic schizogony takes 72 hours11130911113091The gametocytes develop in the internal organs and

appear in the peripheral circulation when fully grown Gametocytes occupy nearly the entire red cell The male has pale blue cytoplasm with a large diffuse nucleus while the female has deep blue cytoplasm and a small compact nucleus

Plasmodium Ovale

This parasite produces a tertian fever resembling vivax malaria but with milder symptoms prolonged latency and fewer relapses11130911113091It is the rarest of all plasmodia infecting humans and

is seen mostly in tropical Africa particularly along the

West Coast11130911113091The pre-erythrocytic stage extends for 9 days

Hepatocytes containing schizonts usually have enlarged nuclei The mature liver schizont releases about 15000 merozoites Hypnozoites are present

11130911113091The trophozoites resemble those in vivax malaria but are usually more compact with less amoeboid appearance Schuffnerrsquos dots appear earlier and are more abundant and prominent than in vivax infection (Fig 612)

11130911113091The infected erythrocytes are slightly enlarged In thin films many of them present an oval shape with fimbriated margins This oval appearance of the infected erythrocyte is the reason for the name ovale given to this species

11130911113091The schizonts resemble those of P malariae except that the pigment is darker and the erythrocyte is usually oval with prominent Schuffnerrsquos dots

Panikers Textbook of Medical Parasitology 7E (2013)

12 siklus hidup

2 Memahami dan menjelaskan malaria21 Definisi

22 epidemiologiMalaria today is generally limited to the tropics and subtropics although outbreaks in Turkey attest to the capacity of this disease to reappear in areas cleared of the agent Malaria in the temperate zones is relatively uncommon although severe epidemic outbreaks may occur when the largely nonimmune populations of these areas are exposed it is usually unstable and relatively easy to control or eradicate Tropical malaria is usually more stable difficult to control and far harder to eradicate In the tropics malaria generally disappears at alti- tudes above 6000 ft Plasmodium vivax and P falciparum the most common species are found throughout the malaria belt

Plasmodium malariae is also broadly distributed but consid-

erably less common Plasmodium ovale is rare except in West Africa where it seems to replace P vivax All forms of malaria can be transmitted transplacentally or by blood transfu- sion or by needles shared among drug misusers when one is infected Such cases do not develop a liver infection thus relapse does not occur Natural infection (other than trans- placental transmission) takes place only through the bite of an infected female Anopheles mosquito

Malaria control depends on elimination of mosquito breeding places personal protection against mosquitoes (eg screens pyrethrin-treated netting [see Figure 46-11D] protective clothing with sleeves and long trousers and repel- lents) suppressive drugs for exposed persons and adequate treatment of cases and carriers Eradication requires prevention of biting contact between Anopheles mosquitoes and humans long enough to prevent transmission with elimination of all active cases by treatment and by spontaneous cure The results of massive efforts in highly endemic tropical areas have been unsuccessful Costly eradication proj- ects undertaken between 1955 and 1970 have been replaced with control programs specifically geared to the mosquito vector ecology and malaria epidemiology of each area These programs must be continued as permanent public health responsibilities A major WHO-led effort to ldquoroll back malariardquo is now under way

Currently there is no vaccine available for malaria A sporozoite surface antigen has been tried as an antisporozoite vaccine but its initial testing in humans was not successful A synthetic tripeptide vaccine SPf66 has been tested in

Colombia and was found to be partially effective (lt50) A complete prophylactic vaccine would have to be active against both sporozoites and merozoites of the target species with an antigametocytocidal effect to curb transmission With increased reports of multidrug-resistant falciparum malaria and the complex and variable regimens suggested for different areas for both prophylaxis and treatment referral to the Centers for Disease Control and Prevention for cur- rent recommendations is advised (httpwwwnccdcgov travel CDC Malaria Hot Line at 770-488-7788 CDC Voice Information System 1-888-CDC-FACT)

Jawetz Melnick amp Adelbergs Medical Microbiology 26th Edition

23 etiologi24 pathogenesis dan patofisiologi

The incubation period for malaria is usually between 9 and 30 days depending on the infecting species For P vivax and P falciparum this period is usually 10ndash15 days but it may be weeks or months The incubation period of P malariae averages about 28 days Falciparum malaria which can be fatal must always be suspected if fever with or without other symptoms develops at any time between 1 week after the first possible exposure to malaria and 2 months (or even longer) after the last possible exposure

Plasmodium vivax P malariae and P ovale parasitemias are relatively low grade primarily because the parasites favor either young or old red cells but not both P falciparum invades red cells of all ages including the erythropoietic stem cells in bone marrow so parasitemia may be very high Plasmodium falciparum also causes parasitized red cells to produce numerous projecting knobs that adhere to the endo- thelial lining of blood vessels with resulting obstruction thrombosis and local

ischemia Plasmodium falciparum infections are therefore far more serious than the others with a much higher rate of severe and frequently fatal complications (cerebral malaria malarial hyperpyrexia gastrointesti- nal disorders algid malaria blackwater fever) Consideration of malaria in the differential diagnosis in patients with a sug- gestive presentation and history of travel to an endemic area is critical because delays in therapy can lead to severe illness or death with falciparum malaria

Periodic paroxysms of malaria are closely related to events in the bloodstream An initial chill lasting from 15 minutes to 1 hour begins as a synchronously dividing generation of parasites rupture their host red cells and escape into the blood

Nausea vomiting and headache are common at this time The succeeding febrile stage lasting several hours is character- ized by a spiking fever that frequently reaches 40degC or more During this stage the parasites invade new red cells The third or sweating stage concludes the episode The fever subsides and the patient falls asleep and later awakes feeling relatively well In the early stages of infection the cycles are frequently asynchronous and the fever pattern is irregular later paroxysms may recur at regular 48- or 72-hour intervals although P falciparum pyrexia may last 8 hours or longer and may exceed 41degC As the disease progresses splenomegaly and to a lesser extent hepatomegaly appear A normocytic anemia also develops particularly in P falciparum infections

Normocytic anemia of variable severity may be detected During the paroxysms there may be transient leukocytosis subsequently leukopenia develops with a relative increase in large mononuclear cells Liver function tests may give abnormal results during attacks but revert to normal with treatment or spontaneous recovery The presence of protein and casts in the urine of children with P malariae is sugges- tive of quartan nephrosis In severe P falciparum infections renal damage may cause oliguria and the appearance of casts protein and red cells in the urine


Pathogenesis

All clinical manifestation in malaria are due to products of erythrocytic schizogony and the hostrsquos reaction to them 11130911113091The disease process in malaria occurs due to the local

or systemic response of the host to parasite antigens and tissue hypoxia caused by reduced oxygen delivery because of obstruction of blood flow by the parasitized erythrocytes

Liver is enlarged and congested Kupffer cells are increased and filled with parasites Hemozoin pigments are also found in the parenchymal cells (Fig 613) Parenchymal cells show fatty degeneration atrophy and centrilobular necrosis

Spleen is soft moderately enlarged and congested in acute infection In chronic cases spleen is hard with a

thick capsule and slate grey or dark brown or even black in color due to dilated sinusoids pigment accumulation and fibrosis (Fig 613)

Kidneys are enlarged and congested Glomeruli frequently contain malarial pigments and tubules may contain hemoglobin casts (Fig 613)

The brain in P falciparum infection is congested Capillaries of the brain are plugged with parasitized RBCsThecutsurfaceofthebrainshowsslategreycortex with multiple punctiform hemorrhage in subcortical white matter

Anemia is caused by destruction of large number of red cells by complement-mediated and autoimmune hemolysis Spleen also plays an active role by destroying a large number of unparasitized erythrocytes There is also decreased erythropoiesis in bore marrow due to tumor necrosis factor (TNF) toxicity and failure of the host to recycle the iron bound in hemozoin pigments 11130911113091Cytokines such as TNF interleukin (IL)-1 and interferon (IFN)-gamma play a pivotal role in the pathogenesis of end organ disease of malaria


25 manifestasi26 diagnosis dan diagnosis banding27 tatalaksana28 komplikasi29 proagnosis

If diagnosed early and if the appropriate antibiotics are available and used the prognosis of malaria is very good

Worldwide malaria is responsible for 500000-800000 deaths per year The majority of victims are young children from sub-Saharan Africa Death is usually due to lack of available treatment or access to treatment

P falciparum tends to be the species causing the most complications and has a high mortality if untreated

Cerebral malaria a complication of P falciparum malaria has a 20 mortality rate even if treatedhttpwwwmedicinenetcommalaria_factspage5htm

210 pencegahan

3 Memahami dan menjelaskan anophelesHanya nyamuk Anopheles betina yang menghisap darah karena diperlukan untuk pertumbuhan telurnya Nyamuk betina hanya kawin satu kali selama

hidupnya dan terjadi setelah 24-48 jam dari saat keluar dari kepompong Oleh karena itu sarang nyamuk banyak ditemukan di telaga rawa sawah tempat penampungan air bekas jejak ban mobil dan lain-lain Nyamuk dewasa dapat terbang sampai sejauh 15 km Nyamuk jantan dewasa tidak berbahaya untuk manusia tetapi nyamuk betina berbahaya karena ia mengisap darah untuk kelangsungan hidupnya Nyamuk Anopheles suka menggigit pada sore menjelang malam hari hingga menjelang pagi namun pada siang hari di tempat-tempat yang gelap atau yang terhindartertutup dari sinar matahari

Perilaku nyamuk yang penting adalah

o Tempat hinggap atau istirahat eksofilik (di luar rumah) dan endofilik (di dalam rumah)

o Tempat menggigit eksofagik (di luar rumah) dan endofilik (di dalam rumah)

o Obyek yang digigit antrofofolik (menggigit manusia) dan zoofilik (menggigit hewan)

Umur nyamuk (longevity) Nyamuk dewasa dapat hidup selama dua minggu sampai beberapa bulan dengan perkembangbiakan nyamuk pada fase jentik dan kepompong selalu memerlukan air

Kerentanan nyamuk terhadap infeksi gametosit

Frekwensi menggigit menusia

Siklus gonotrofik yaitu waktu yang diperlukan untuk matangnya telur

31 Morfologi

atlas patologi kedokteranhttpsbooksgooglecoidbooksid=4_nU4J09RtkCamppg=PA179ampdq=morfologi+anophelesamphl=enampsa=Xampredir_esc=yv=onepageampq=morfologi20anophelesampf=false

aTelur anopheles diletakkan satu persatu di atas permukaan air sehingga seperti membentuk perahu yang bagian bawahnya konveks bagian atasnya konkaf dan mempunyai sepasang pelampung pada lateral

b Larva anopheles tampak mengapung sejajar dengan permukaan air spirakel pada posterior abdomen tergel plate pada tengah sebelah dorsal abdomen dan sepasang bulu palma pada lateral abdomencPupa anopheles mempunyai tabung pernafasan berbentuk seperti trompet yang lebar dan pendek digunakan untuk mengambil oksigen dari udarad Nyamuk dewasa pada jantan memiliki ruas palpus bagian apikal berbentuk gada (club form) pada betina ruasnya mengecil Sayap bagian pinggir (kosta dan vena I ) ditumbuhi sisik-sisik sayap berkelompok membentuk belang hitam putih ujung sayap membentuk lengkung Bagian posterior abdomennya melancipMalaria merupakan penyakit yang dapat bersifat akut maupun kronik malaria disebabkan oleh protozoa dari genus plasmodium ditandai dengan demam anemia dan splenomegali Sampai sekarang dikenal 4 jenis plasmodium yaitu a plasmodium falciparum sebagai penyebab Malaria Tropikab plasmodium vivaks sebagai penyebab penyakit Malaria Tertianac plasmodium malariae sebagai penyebab penyakit Malaria Quartanad plasmodium ovale yang menyebabkan penyakit Malaria yang hampir serupa dengan Malaria Tertiana

32 KlasifikasiNyamuk Anopheles sp adalah nyamuk vektor penyakit malaria Di dunia kurang lebih terdapat 460 spesies yang sudah dikenali 100 diantaranya mepunyai kemampuan menularkan malaria dan 30-40 merupakan host dari parasite Plasmodium yang merupakan penyebab malaria di daerah endemis penyakit malaria Di Indonesia sendiri terdapat 25 spesies nyamuk Anopheles yang mampu menularkan penyakit MalariaAnopheles gambiae adalah paling terkenal akibat peranannya sebagai penyebar parasit malaria dalam kawasan endemik di Afrika sedangkan Anopheles sundaicus adalah penyebar malaria di AsiaUrutan penggolongan klasifikasi nyamuk Anopheles seperti binatang lainnya adalah sebagai berikut Kingdom AnimaliaPhylum Arthropoda Class Hexapoda InsectaSub Class PterigotaOrdo DipteraFamilia CulicidaeSub Famili AnophellinaeGenus Anopheles

Ada beberapa spesies Anopheles yang penting sebagai vektor malaria di Indonesia antara lain a Anopheles sundauicusSpesies ini terdapat di Sumatra Kalimantan Jawa Sulawesi dan Bali Jentiknya ditemukan pada air payau yang biasanya terdapat tumbuhndashtumbuhan enteromopha chetomorpha dengan kadar garam adalah 12

sampai 18 Di Sumatra jentik ditemukan pada air tawar seperti di Mandailing dengan ketinggian 210 meter dari permukaan air laut dan Danau Toba pada ketinggian 1000 meterb Anopheles aconitusDi Indonesia nyamuk ini terdapat hampir di seluruh kepulauan kecuali Maluku dan Irian Biasanya terdapat dijumpai di dataran rendah tetapi lebih banyak di daerah kaki gunung pada ketinggian 400ndash1000 meter dengan persawahan bertingkat Nyamuk ini merupakan vector pada daerahndashdaerah tertentu di Indonesia terutama di Tapanuli Jawa Barat Jawa Tengah dan Balic Anopheles barbirostrisSpesies ini terdapat di seluruh Indonesia baik di dataran tinggi maupun di dataran rendah Jentik biasanya terdapat dalam air yang jernih alirannya tidak begitu cepat ada tumbuhndashtumbuhan air dan pada tempat yang agak teduh seperti pada tempat yang agak teduh seperti pada sawah dan paritd Anopheles kochiSpesies ini terdapat diseluruh Indonesia kecuali Irian Jentik biasanya ditemukan pada tempat perindukan terbuka seperti genangan air bekas tapak kaki kerbau kubangan dan sawah yang siap ditanamie Anopheles maculatusPenyebaran spesies ini di Indonesia sangat luas kecuali di Maluku dan Irian Spesies ini terdapat didaerah pengunungan sampai ketinggian 1600 meter diatas permukaan air laut Jentik ditemukan pada air yang jernih dan banyak kena sinar mataharif Anopheles subpictusSpesies ini terdapat di seluruh wilayah Indonesia Nyamuk ini dapat dibedakan menjadi dua spesies yaitu 1) Anopheles subpictus subpictusJentik ditemukan di dataran rendah kadangndashkadang ditemukan dalam air payau dengan kadar garam tinggi2) Anopheles subpictus malayensisSpesies ini ditemukan pada dataran rendah sampai dataran tinggi Jentik ditemukan pada air tawar pada kolam yang penuh dengan rumput pada selokan dan paritg Anopheles balabacensis

Spesies ini terdapat di Purwakarta Jawa Barat Balikpapan Kalimantan Timur Kalimantan Selatan Jentik ditemukan pada genangan air bekas tapak binatang pada kubangan bekas roda dan pada parit yang aliran airnya terhenti

33 HabitatPerilaku saat menghisap darahHanya nyamuk betina yang sering menghisap darah nyamuk Anopheles sering menghisap darah diluar rumah dan suka menggigit diwaktu senja sampai dini hari (Eksofagik) serta mempunyai jarak terbang sejauh 16 Km sampai dengan 2 Km Waktu antara nyamuk menghisap darah yang mengandung Gametosit sampai mengandung sporozoit

dalam kelenjar liurnya disebut masa tunasekstrinsik Sporozoit adalah bentuk infektifUntuk terjadi penularan penyakit malaria harus ada empat faktor yaitu1 Parasit (agent penyebab penyakit malaria)2 Nyamuk Anopheles (vektor malaria)3 Manusia (host intermediate)4 Lingkungan (environment)1113091 Empat faktor terjadinya penularan malariaPerilaku pada waktu hinggap dan beristirahatNyamuk Anopheles lebih suka hinggap di batang-batang rumput di alam atau luar rumah (Eksofilik) yaitu tempat-tempat lembab terlindung dari sinar matahari gelapPerilaku pada saat berkembang biak (Breeding Place)Nyamuk Anopheles dapat berkembang biak ditempat-tempat yang airnya tergenang seperti sawah irigasi yang bagian tepinya banyak ditumbuhi rumput dan tidak begitu deras airnya

4 Memahami dan menjelaskan gebrak malaria

Gebrak Malaria adalah gerakan nasional seluruh komponen masyarakat untuk memberantas Malaria secara intensif melalui kemitraan antara pemerintah dunia usaha lembaga swadaya masyarakat dan badan-badan internasional serta penyandang dana mengingat masalah Malaria merupakan masalah yang komplek karena berhubungan dengan berbagai aspek seperti penyebab penyakit (parasit) lingkungan (fisik dan biologis) dan nyamuk sebagai vektor penularStrategi dalam Pemberantasan Malaria antara lain adalah dengan sistem kewaspadaan dini dan upaya penanggulangan epidemi agar tidak semakin menyebar intensifikasi pengawasan diagnosis awal dan pengobatan yang tepat dan kontrol vektor secara selektif Kebijakan-kebijakan yang diambil dalam pemberantasan malaria antara lain penekanan pada desentralisasi keterlibatan masyarakat dalam pemberantasan malaria dan membangun kerja sama antarsektor NGO dan lembaga donor Gerakan Berantas Kembali Malaria atau Gebrak Malaria yang dimulai pada 2000 adalah bentuk operasional dari Roll Back Malaria (RBM) Gebrak Malaria memprioritaskan kemitraan antara pemerintah swastasektor bisnis dan masyarakat untuk mencegah penyebaran penyakit malariaProgram pemberantasan malaria di Indonesia saat ini terdiri atas delapan kegiatan yaitu diagnosis awal dan pengobatan yang tepat program kelambu dengan insektisida penyemprotan pengawasan deteksi aktif dan pasif survei demam dan pengawasan migran deteksi dan kontrol epidemik langkah-langkah lain seperti larvaciding dan peningkatan kemampuan (capacity building) Untuk menanggulangi galur yang resisten terhadap klorokuin pemerintah pusat dan daerah akan menggunakan kombinasi baru obat-obatan malaria untuk memperbaiki kesuksesan pengobatan Karena kombinasi obat-obatan itu sangat mahal penggunaannya akan ditargetkan di daerah dengan prevalensi resistensi yang tinggi

Dalam rangka merealisasikan Gebrak Malaria ini telah disusun Rencana Kegiatan Pengendalian Malaria melalui Rencana Strategi Pembebasan (Eliminasi) Malaria di Indonesia yang akhirnya dituangkan dalam Keputusan Menteri Kesehatan Republik Indonesia Nomor 293MenkesSKIV2009 tanggal 28 April 2009 tentang Eliminasi Malaria di Indonesia dengan sasaran wilayah Eliminasi yang dilaksanakan secara bertahap yaitua Eliminasi Daerah Khusus Ibukota Jakarta (Kepulauan Seribu) Bali dan Batam pada tahun 2010b Eliminasi Jawa Nanggroe Aceh Darussalam Kepulauan Riau pada tahun 2015c Eliminasi Sumatera Nusa Tenggara Barat Kalimantan Sulawesi pada tahun 2020d Eliminasi Papua Papua Barat Maluku Maluku Utara Nusa Tenggara Timur pada tahun 2030Kegiatan Eliminasi Malaria harus dilaksanakan secara terpadu dan menyeluruh antara Pemerintah Pemerintah Daerah dan mitra kerja lainnya Dari berbagai pengalaman Eliminasi Malaria pada masa lalu telah terbukti bahwa tanpa keterlibatan dan dukungan legislatif pemerintah daerah masyarakat termasuk organisasi sosial keagamaan dan pihak swasta maka hasil yang dicapai belum optimalKegiatan Eliminasi Malaria lebih banyak terfokus kepada kegiatan promotif dan preventif Oleh karena itu peranan Promosi Kesehatan akan semakin besar agar pelaksanaannya lebih optimal Strategi promosi kesehatan untuk Eliminasi Malaria adalah Advokasi Bina Suasana Pemberdayaan Masyarakat yang didukung dengan Kemitraan (Kemenkes RI 2010)

The schizont appears in about 36ndash40 hours It occupies virtually the whole of the enlarged red cell The schizont matures in the next 6ndash8 hours with the development of merozoites each with its central nucleus and surrounding cytoplasm The pigment granules agglomerate into a few dark brown collections at the center and with the merozoites around it this stage presents a rosette appearance There are about 12ndash24 (usually 16) merozoites per schizont

Erythrocytic schizogony takes approximately 48 hours The red cell which now measures about 10 μm in diameter is heavily stippled and often distorted It bursts to liberate the merozoites and pigment The pigment is phagocytosed by reticuloendothelial cells

The merozoites measure about 15 μm and have no pigment

Gametocytes appear early usually within 4 days after the trophozoites first appear Both male and female gametocytes are large nearly filling the enlarged red cell The macrogametocyte has dense cytoplasm staining deep blue and a small compact nucleus The microgametocyte has pale-staining cytoplasm and a large diffuse nucleus Pigment granules are prominent in the gametocytes

Plasmodium Falciparum

The name falciparum comes from the characteristic sickle shape of the gametocytes of this species (falx sickle parere to bring forth) This is the highly pathogenic of all the plasmodia and hence the name malignant tertian or pernicious malaria for its infection 11130911113091The disease has a high rate of complications and unless treated is often fatal The species is responsible for almost all deaths caused by malaria

11130911113091Schizogony The sporozoites are sickle-shaped The tissue phase consists of only a single cycle of pre- erythrocytic schizogony No hypnozoites occur The mature liver schizont releases about 30000 merozoites

11130911113091They attack both young and mature erythrocytes and so the population of cells affected is very large Infected erythrocytes present a brassy coloration

11130911113091Ring form The early ring form in the erythrocyte is very delicateandtinymeasuringonlyasixth(16)ofthered cell diameter Rings are often seen attached along the margin of the red cell the so-called form appliqueacute or accole Binucleate rings (double chromatin) are common resembling stereo headphones in appearance Several rings may be seen








Plasmodium Malariae












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12 siklus hidup

















Pathogenesis















210 pencegahan











31 Morfologi




















Plasmodium Malariae












Plasmodium Ovale









12 siklus hidup

















Pathogenesis















210 pencegahan











31 Morfologi













Plasmodium Ovale









12 siklus hidup

















Pathogenesis















210 pencegahan











31 Morfologi


























Pathogenesis















210 pencegahan











31 Morfologi























210 pencegahan











31 Morfologi






















31 Morfologi













memahami dan menjelaskan plasmodium k

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