We Must Pay Attention to The Malaria Disease if it will go to Developing Countries

For those of us who like to go travel to a developing country or we will run the job then we must consider various aspects of safety factors other than the destination country we are. One aspect that is also very important for us to consider among other factors communicable diseases like malaria, filariasis, dengue fever, etc., which exist in the country. Especially for malaria, the disease is spread almost evenly in developing countries such as countries in the continent of Africa, Indonesia, India, and so forth. Malaria is a disease that can be either acute or chronic, caused by protozoa of the genus plasmodium characterized by fever, anemia and splenomegali.

                 figure via : uni-tuebingen.de

Etiology

Plasmodium malaria as a cause consists of four species, namely Plasmodium vivax, Plasmodium falciparum, Plasmodium malariae, and Plasmodium ovale. Malaria also involve an intermediary host, human or other vertebrate and definitive host is the mosquito.

Pathogenesis

The life cycle of malaria species consists of an exogenous sexual phase (sporogoni) in the body of the Anopheles mosquito and the asexual phase (skizogony) in the host body vertebra including humans.

a. Asexual Phase

Asexual phase is divided into phases and phase erythrocyte network. In the network phase, sporozoits enter the bloodstream into liver cells and multiply to form liver schizont containing thousands of merozoites. This process is called skizogony praeritrosit. Long this phase is different for each phase. At the end of this phase, schizont rupture and merozoites exit and enter the bloodstream, called sporulation. In P.vivax and P.ovale, partly hipnozoit sporozoits forming in the heart that can lead to long-term relapse and rekurens.

Phase erythrocytes and merozoites in the blood begins to attack trophozoit erythrocyte shape. The process continues to be trophozoit-schizont-merozoites. After 2-3 generations of merozoites formed, some merozoites turn into sexual forms. The period between the beginning of infection until the discovery of parasites in peripheral blood is prapaten period, while the shoots / incubation sporozoits intrinsic starts from the entry in the host body until the clinical symptoms of fever.

b. Sexual Phase

Sexual parasites in the stomachs of female mosquitoes enter. These forms have become micro and makrogametosit maturation and fertilization occurs, called the zygote (ookinet)). Ookinet then penetrate the mosquito stomach wall and into oocysts. When oocyst rupture the thousands sporozoits be released and reach the salivary glands of mosquitoes.

Pathogenesis of malaria are two ways:

1. Naturally, through the bite of mosquitoes to the human body.

2. Induction, if the asexual stage in erythrocytes into human blood through transfusions, injections or in the

    newborn through the placenta of infected mothers (congenital).

Clinical Manifestations

To find or make a diagnosis of malaria is the most basic necessary information from the disease. symptoms and signs that can be found are fever, splenomegali, anemia, and jaundice. Fever generally occurred periodically since the outbreak associated with the mature schizont (sporulation). In malaria tertiana (P.vivax and P.ovale), schizont maturation occurs every 48 hours so the periodicity of the fever every third day. While on malaria kuartana (P.malariae) maturation occurs every 72 hours so that the periodicity of fever occurs every four days. Each attack is marked by periodic fever attacks. Fever typical of malaria consists of three stages, namely shivering (15-1 hours) with the peak of fever (2-6 hours), and diaphoretic patients (2-4 hours). Fever will decrease gradually because the body can adapt to the parasites in the body and there is immune response.

Examination Support

Peripheral blood examination can still be done and how this is the most suitable although there are other ways ie using rapid test kits (Rapid Diagnostic Test) to detect malaria.

Treatment

Use of antimalarial drugs used not only for curative treatment alone but more than that, it can be used as:

1. Preventive treatment (prophylaxis) which aims to prevent infection or clinical symptoms. Healing can be obtained with this type of therapy on infection by P. falciparum malaria because it does not have parisit eksoeritrosit phase.
2. Curative treatment can be done with malaria drug skizontisid types.
3. Prevention of transmission useful for preventing infection in mosquitoes or mosquito sporogonik influence. Antimalarial drugs that can be used like a type of gametosid or sporotosid.