Malaria: Perbedaan antara revisi

| field = [[InfectiousPenyakit disease (medical specialty)|Infectious diseaseinfeksi]]

== Tanda-tanda dan gejala ==

[[FileBerkas:Symptoms of Malaria.png|thumbjmpl|250px|Gejala utama dari malaria<ref name="PPID 2010"/>]]

Tanda-tanda dan gejala malaria biasanya mulai 8-25 hari setelah terinfeksi;.<ref name="PPID 2010"/> namunNamun, gejala dapat terjadi kemudian pada orang-orang yang telah mengambil obat antimalaria sebagai pencegahan.<ref name="Nadjm 2012"/> Manifestasi awal dari penyakit—umumpenyakit—berlaku umum untuk semua spesies malaria—mirip dengan gejala [[flu]],<ref name="Bartoloni 2012"/> dan dapat menyerupai kondisi lain seperti [[sepsis]], [[gastroenteritis]], dan [[penyakit virus]].<ref name="Nadjm 2012"/> PresentasiGejala yang mungkintimbul termasuk [[sakit kepala]], [[demam]], [[menggigil]], [[artralgia|nyeri sendi]], [[muntah]], [[anemia hemolitik]], [[penyakit kuning]], [[hemoglobinuria|hemoglobin dalam urin]], [[Retinopati|kerusakan retina]], dan [[kejang|kejang-kejang]].<ref name="Beare 2006"/>

Gejala klasik malaria adalah [[paroksismal]]—kejadian bersiklusdemam kedinginanmenggigil tiba-tibayang diikutihilang dengantimbul menggigilberulang sesuai siklus dan kemudian demam dan berkeringat, terjadi setiap dua hari ([[Demam#Jenis-jenis|demam tertiana]]) di infeksi ''P.&nbsp;vivax'' dan ''P.&nbsp;ovale'', dan setiap tiga hari ([[Demam#Jenis-jenis|demam kuartana]]) untuk ''P.&nbsp;malariae''. Infeksi ''P.&nbsp;falciparum'' dapat menyebabkan demam berulang setiap 36-48 jam, atau demam kurang menonjol dan hampir terus menerus.<ref name="Ferri 2009"/>

=== Komplikasi ===

Malaria memiliki beberapa [[Komplikasi (kedokteran)|komplikasi]] yang serius. Di antaranya adalahdapat pengembanganterjadi [[gangguan pernapasan]], yang terjadi di hingga 25% dari orang dewasa dan 40% dari anak-anak, denganpada malaria ''P.&nbsp;falciparum'' parahberat. Kemungkinan penyebab termasuk kompensasi pernapasan terhadap [[asidosis metabolik]], [[edema paru]] nonkardiogenik, [[pneumonia]] yang terjadi bersamaan, danserta [[anemia]] berat. Meskipun jarang terjadi pada anak-anak dengan malaria berat, [[sindrom gangguan pernapasan akut]] terjadi pada 5-25% dari orang dewasa dan sampai 29% dari wanita hamil.<ref name="Taylor 2012"/> [[Koinfeksi]] [[HIV]] dengan malaria meningkatkan angka kematian.<ref name="Korenromp 2005"/> Gagal ginjal adalah fiturtanda dari komplikasi malaria yang disebut [[demam blackwaterair hitam]], di mana hemoglobin dari sel darah merah yang [[Lisis|pecah]] bocor ke dalam urin.<ref name="Bartoloni 2012"/>

Infeksi ''P.&nbsp;falciparum'' dapat mengakibatkan malaria serebral, bentuk malaria berat yang melibatkan [[ensefalopati]]. Hal ini terkait dengan memutihnya retina, yang mungkin merupakan tanda klinis yang berguna dalam membedakan malaria dari penyebabpenyakit lain dariyang juga memiliki keluhan demam.<ref name="Beare 2011"/> [[Splenomegali]], sakit kepala parah, [[hepatomegali]] (pembesaran hati), [[hipoglikemia]], dan hemoglobinuria dengan [[gagal ginjal]] dapat terjadi.<ref name="Bartoloni 2012"/> Komplikasi dapat mencakup perdarahan spontan dan koagulopati. Dapat(gangguan pembekuan darah) hingga menyebabkan [[syok]].<ref>Davidson's Principles and Practice of Medicine/21st/351</ref>

[[Malaria terkait-kehamilan|Malaria pada ibu hamil]] merupakan penyebab penting dari [[lahir mati]], [[kematian bayi]], [[aborsi]] dan [[berat badan lahir rendah]],<ref name="Hartman 2010"/> terutama pada infeksi ''P.&nbsp;falciparum'', tetapiwalau dapat terjadi juga dengan ''P.&nbsp;vivax''.<ref name="Rijken 2012"/>

== Penyebab ==

[[Parasit]] malaria termasuk dalam genus ''[[Plasmodium]]'' (filum [[Apicomplexa]]). Pada manusia, malaria disebabkan oleh ''[[Plasmodium falciparum|P.&nbsp;falciparum]]'', ''[[Plasmodium malariae|P.&nbsp;malariae]]'', ''[[Plasmodium ovale|P.&nbsp;ovale]]'', ''[[Plasmodium vivax|P.&nbsp;vivax]]'' dan ''[[Plasmodium knowlesi|P.&nbsp;knowlesi]]''.<ref name="Mueller 2007"/><ref name="Collins 2012"/> Di antara mereka yang terinfeksi, ''P.&nbsp;falciparum'' merupakan spesies yang paling umum diidentifikasi (~75%) diikuti oleh ''P.&nbsp;vivax'' (~20%).<ref name="Nadjm 2012"/> Meskipun ''P.&nbsp;falciparum'' secarabiasanya tradisionalmenyumbang menyumbangsebagian mayoritasbesar kematian,<ref name="Sarkar 2009"/> bukti terbaru menunjukkan bahwa malaria ''P.&nbsp;vivax'' terkait dengan kondisi yang berpotensi mengancam jiwa sekitarhampir sesering dengan diagnosis infeksi ''P. falciparum''.<ref name="Baird 2013"/> ''P.&nbsp;vivax'' secara proporsional lebih umum di luar Afrika.<ref name="Arnott 2012"/> Telah didokumentasikanterdokumentasikan infeksi manusia oleh beberapa spesies ''Plasmodium'' pada manusia dari [[Simiiformes|kera yang lebih tinggi]]; namun, kecualikhusus untuk ''P.&nbsp;knowlesi''—spesies [[zoonosis|zoonotik]] yang menyebabkan malaria pada [[makaka]]<ref name="Collins 2012"/>—hal ini kebanyakandianggap tidak begitu penting bagi kesehatan masyarakat.<ref name="Collins 2009"/>

[[Efek pemanasan global pada kesehatan manusia#Malaria|Pemanasan global]] kemungkinan akan mempengaruhi penyebaran malaria, namuntetapi tingkat keparahan dan distribusi geografis dari efek itutersebut tidakbelum pasti.<ref name="Parham 2011"/><ref name=who-chap6>{{cite web|title=Climate Change And Infectious Diseases|url=http://www.who.int/globalchange/climate/en/chapter6.pdf|work=CLIMATE CHANGE AND HUMAN HEALTH—RISK AND RESPONSES|publisher=World Health Organization |format=PDF}}</ref>

=== Siklus hidup ===

[[FileBerkas:Life Cycle of the Malaria Parasite.jpg|thumbjmpl|350px|Siklus hidup parasit malaria. Seekor nyamuk menyebabkan infeksi oleh gigitan. Pertama, sporozoit memasuki aliran darah, dan bermigrasi ke hati. Mereka menginfeksi [[sel hati|sel-sel hati]], di mana mereka berkembang biak menjadi merozoit, memecahkan sel-sel hati, dan kembali ke aliran darah. Merozoit menginfeksi sel darah merah, di mana mereka berkembang menjadi bentuk cincin, trofozoit dan skizon yang pada gilirannya menghasilkan lebih banyak merozoit. [[Gametosit|Bentuk seksual]] juga diproduksi, yang, jika diambil oleh nyamuk, akan menginfeksi serangga dan melanjutkan siklus hidup.]]

Hanya nyamuk betina yang menghisap darah;, sedangkan nyamuk jantan memakan [[nektar]] tanaman, dan tidak menularkan penyakit. Betina dari genus nyamuk ''Anopheles'' lebih suka makan pada malam hari. Mereka biasanya mulai mencari makan pada sore hari, dan akan terus berlanjut sepanjang malam sampai mendapatkan makanan.<ref name="Arrow 2004"/> Parasit malaria juga dapat ditularkan oleh [[transfusi darah]], meskipun hal ini jarang terjadi.<ref name="Owusu-Ofori 2010"/>

=== Malaria yang kambuh ===

Gejala malaria dapat kambuh setelah beberapa periode bebas gejala. Tergantung pada penyebabnya, kekambuhan dapat diklasifikasikan sebagai ''[[luapan barurecrudescence]]'', ''[[relapse]]'', atau reinfeksi. Luapan baru''Recrudescence'' adalah ketika gejala kembali setelah periode bebas gejala. Hal ini disebabkan oleh parasit hidup dalam darah sebagai akibat dari pengobatan yang tidak memadai atau tidak efektif.<ref>{{harvnb|WHO|2010|p=vi}}</ref> ''Relapse'' adalah ketika gejala muncul kembali setelah parasit telah dieliminasitereliminasi dari darah tapitetapi tetap aktif sebagai hipnozoit dalam sel-sel hati. ''Relapse'' umumnya terjadi antara 8-24 minggu dan umumnya terjadi dengan infeksi ''P.&nbsp;vivax'' dan ''P.&nbsp;ovale''.<ref name="Nadjm 2012"/> Kasus malaria ''P.&nbsp;vivax'' di daerah ber[[iklim sedang]] sering melibatkan ''[[overwintering]]'' oleh hipnozoit, dengan ''relapse'' dimulai setahun setelah gigitan nyamuk.<ref name="White 2011"/> Reinfeksi berarti parasit yang menyebabkan infeksi masasebelumnya lalutelah tersingkir dari tubuh, tetapi terinfeksi kembali oleh parasit baru diperkenalkan. Reinfeksi sulit dibedakan dari luapan baru''recrudescence'', meskipun kambuhnya infeksi dalam waktu dua minggu pengobatan. untuk infeksiInfeksi awal setelah sebelumnya sakit biasanya dikaitkan dengan kegagalan pengobatan.<ref>{{harvnb|WHO|2010|p=17}}</ref> Orang-orang mungkinyang mengembangkantelah terinfeksi sebelumnya masih memiliki sedikit kekebalan bila terkenaterhadap infeksi baru bila sering terpapar.<ref name="Tran 2012"/>

== Patofisiologi ==

[[FileBerkas:Maternal malaria placenta - cropped - very high mag.jpg|thumbjmpl|rightka|[[Mikrograf]] dari [[plasenta]] dari bayi [[lahir mati]] akibat malaria ibu. [[Pewarnaan H&E]]. Sel-sel darah merah tidak berinti; pewarnaan biru/hitam dalam struktur merah terang (sel darah merah) menunjukkan inti asing dari parasit.]]

Infeksi malaria berkembang melalui dua tahap: satumelalui tahap yang melibatkan [[hati]] (fase eksoeritrositik), dan satumelalui tahap yang melibatkan sel-sel darah merah, atau [[eritrosit]] (fase eritrositik). Ketika nyamuk yang terinfeksi menembus kulit seseorang untuk mengambil makan darah, sporozoit dalam air liur nyamuk memasuki aliran darah dan bermigrasi ke hati di mana mereka menginfeksi hepatosit, bereproduksi secara aseksual dan tanpa gejala untuk jangka waktu 8-30 hari.<ref name="Bledsoe 2005"/>

Setelah masa dorman potensial dalam hati, organisme ini [[Diferensiasi seluler|berdiferensiasi]] untuk menghasilkan ribuan merozoit, yang,. setelahSetelah pecahnya sel inang mereka, melarikanmerozoit dirimasuk ke dalam darah dan menginfeksi sel-sel darah merah untuk memulai tahap eritrositik dari siklus hidup.<ref name="Bledsoe 2005"/> Parasit lolosyang telah keluar dari hati menjadi tidak terdeteksi dengan membungkus dirinya dalam [[membran sel]] dari sel inang hati yang terinfeksi.<ref name="Vaughan 2008"/>

Beberapa sporozoit ''P.&nbsp;vivax'' tidak segera berkembang menjadi merozoit fase-eksoeritrositik, melainkan menghasilkan hipnozoit yang dorman untuk periode tertentu mulai dari beberapa bulan (7-10 bulan khas) sampaihingga beberapa tahun. Setelah masa dormansi, mereka aktif kembali dan menghasilkan merozoit. Hipnozoit bertanggung jawab untuk inkubasi yang panjang dan ''relapse'' akhir infeksi ''P.&nbsp;vivax'',<ref name="White 2011"/> meskipun keberadaannya dipada ''P.&nbsp;ovale'' tidak pasti.<ref name="Richter 2010"/>

Parasit ini relatif terlindungi dari serangan [[sistem kekebalan]] tubuh karena pada sebagian besar siklus hidup manusia parasit itu berada di dalam sel-sel hati dan darah dan relatif tidak terlihat bagi surveilans kekebalan tubuh. Namun, sel darah yang beredar yang terinfeksi hancur di [[limpa]]. Untuk menghindari nasibhal ini, parasit ''P.&nbsp;falciparum'' menampilkan [[protein]] perekat pada permukaan sel-sel darah yang terinfeksi, menyebabkan sel-sel darah menempel pada dinding pembuluh darah kecil, sehingga parasit tidak melalui sirkulasi umum dan limpa.<ref name="Tilley 2011"/> Penyumbatan mikrovaskulatur menyebabkan gejala seperti malaria plasenta.<ref name="Mens 2010"/> Sel darah merah bisa menembus [[penghalang darah-otak]] dan menyebabkan malaria serebral.<ref name="Rénia 2012"/>

==Resistensi= resistansi genetik ===

Dampak dari sifat sel sabit pada kekebalan malaria menggambarkan beberapa pertukaran evolusi yang terjadi karena malaria endemik. Sifat sel sabit menyebabkan perubahan pada molekul hemoglobin dalam darah. Biasanya, sel-sel darah merah memiliki bentuk bikonkaf yang sangat fleksibel yang memungkinkan mereka untuk bergerak melalui [[pembuluh darah kapiler|kapiler]] yang sempit; Namun, ketika molekul [[hemoglobin S|hemoglobin&nbsp;S]] yang dimodifikasi terkena jumlah rendah oksigen, atau berkerumun bersama-sama karena dehidrasi, mereka bisa menyatu membentuk untaian yang menyebabkan sel berbentuk sabit atau berdistorsi menjadi bentuk melengkung. Dalam bentuk untaian molekul hemoglobin tidak efektif dalam mengambil atau melepaskan oksigen, dan sel tidak cukup fleksibel untuk beredar secara bebas. Pada tahap awal malaria, parasit dapat menyebabkan sel darah merah yang terinfeksi menjadi berbentuk sabit, dan sehingga mereka dihapus dari peredaran dengan cepat. Hal ini akan mengurangi frekuensi parasit malaria menyelesaikan siklus hidupnya di dalam sel. Individu yang [[homozigot]] (dengan dua salinan dari [[alel]] hemoglobin beta abnormal) memiliki [[anemia sel sabit]], sementara mereka yang heterozigot (dengan satu alel abnormal dan satu alel normal) memiliki resistensiresistansi terhadap malaria tanpa anemia berat. Meskipun harapan hidup yang lebih pendek bagi mereka dengan kondisi homozigot akan cenderung merugikan kelangsungan hidup sifat ini, sifat ini dipertahankan di daerah rawan malaria karena [[Keuntungan heterozigot|manfaat]] yang diberikan oleh bentuk heterozigot.<ref name="Hedrick 2011"/><ref name="Weatherall 2008"/>

=== Disfungsi hati ===

==Pencegahan Diagnostik ==

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* {{Cite book |author=Schlagenhauf-Lawlor P |title=Travelers' Malaria |year=2008 |publisher=PMPH-USA |isbn=978-1-55009-336-0 |url=https://books.google.com/books?id=54Dza0UHyngC |ref=harv}}

== Bacaan lebih lanjut ==

* {{Cite book |author=Bynum WF, Overy C |title=The Beast in the Mosquito: The Correspondence of Ronald Ross and Patrick Manson |url=https://books.google.com/books?id=5BXbsSJLaToC |year=1998 |publisher=Rodopi |isbn=978-90-420-0721-5 |series=Wellcome Institute Series in The History of Medicine}}

* {{cite book|title=Guidelines for the treatment of malaria|date=2015|publisher=World Health Organization|isbn=9789241549127|edition=3rd |url=http://www.who.int/malaria/publications/atoz/9789241549127/en/}}

== Pranala luar ==

* [http://www.unhco.org/malaria/ UNHCO site on malaria] {{Webarchive|url=https://web.archive.org/web/20111220220958/http://www.unhco.org/malaria/ |date=2011-12-20 }}

* [http://www.rollbackmalaria.org/gmap/ Global Malaria Action Plan] {{Webarchive|url=https://web.archive.org/web/20100411074836/http://www.rollbackmalaria.org/gmap/ |date=2010-04-11 }} (2008)

* [http://www.antimalariaomd.org/en/index.php Anti-malaria and sustainable development] {{Webarchive|url=https://web.archive.org/web/20180317174946/http://www.antimalariaomd.org/en/index.php |date=2018-03-17 }}

[[CategoryKategori:Apicomplexa]]