Perbandingan Persentase Hemozoin Dan Derajat Parasitemia Pada Pasien Malaria Falciparum Tanpa Komplikasi Dan Dengan Komplikasi 1)
Loeki Enggar Fitri, Meralda Nindyasti E.B, Didi Candradikusuma, Ninik Burhan, Utama Budi Saputra, 2)Eko Suhartono, Bambang Setiawan, 3)Erma Sulistyaningsih 1)
2)
Fakultas Kedokteran Universitas Brawijaya Fakultas Kedokteran Lambung Mangkurat Banjarbaru 3) Fakultas Kedokteran Universitas Jember Abstrak
Hemoglobin pada eritrosit yang terinfeksi P.falciparum terdegradasi menjadi hemozoin. Hemozoin akan difagositosis oleh makrofag dan neutrofil, sehingga menyebabkan sekresi berbagai sitokin proinflamasi (IL-1, IL-6 , TNF-б) yang erat hubungannya dengan imunitas tubuh. Penelitian ini bertujuan untuk membuktikan adanya perbedaan persentase jumlah pigmen hemozoin pada sel mononuklear dan derajat parasitemia antara penderita malaria tanpa komplikasi dengan penderita malaria yang mengalami komplikasi serta menjelaskan hubungan antara presentase hemozoin dengan derajat parasitemia pada penderita malaria tanpa komplikasi dan penderita malaria dengan komplikasi. Penelitian ini merupakan penelitian cross sectional dengan mengambil sampel penelitian berupa darah pasien malaria tanpa komplikasi dari Kabupaten Tanah Laut Kalimantan Selatan dan darah pasien malaria dengan komplikasi dari Rumah Sakit dr. Saiful Anwar Malang. Metode yang digunakan adalah pengamatan mikroskopik pada hapusan sel mononuklear dan hapusan darah tipis dengan pewarnaan Giemsa. Hasil penelitian menunjukkan terdapat perbedaan presentase hemozoin dan derajat parasitemia yang signifikan antara malaria tanpa komplikasi dengan malaria komplikasi (p<0,05). Rata-rata hemozoin pada malaria tanpa komplikasi 2.1 dan malaria komplikasi 19.8 dalam 1000 sel mononuklear. Rata-rata eritrosit terinfeksi (parasitemia) malaria tanpa komplikasi 2.9 dan malaria komplikasi 34.1 dalam 1000 sel eritrosit. Uji Pearson correlation menunjukkan adanya hubungan antara persentase hemozoin dalam sel mononuklear dengan derajat parasitemia pada malaria tanpa komplikasi dan pada malaria dengan komplikasi (r=0.326 dan r=0.602), walaupun hubungan tersebut tidak signifikan ((p =0,359; p =0,066). Dapat disimpulkan bahwa terdapat perbedaan persentase hemozoin dan derajat parasitemia yang signifikan antara penderita malaria tanpa komplikasi dan malaria dengan komplikasi, dan tidak ada hubungan yang signifikan antara presentase hemozoin dan derajat parasitemia pada penderita malaria selama infeksi P.falciparum. Kata kunci: Hemozoin, Parasitemia, Malaria komplikasi, Malaria tanpa komplikasi
The Difeferences In The Percentage Of Hemozoin And The Degree Of Parasitemia Between Uncomplicated And Complicated Malaria Falciparum Patients Abstract The difeferences in the percentage of hemozoin and the degree of parasitemia between uncomplicated and complicated malaria falciparum patients .Hemoglobin in Plasmodium falciparum infected erytrocytes, degraded into hemozoin. Hemozoin was phagocyted by macrophages and neutrophils, lead to pro-inflammation cytokines (IL-1, IL-6, TNF-б) secretion, which are closely related to the immunity. This study aimed to prove the differences in the percentage of hemozoin on mononuclear cells and the parasitemia degree between uncomplicated and complicated malaria patients and explain the correlation between the percentages of hemozoin and the degree of parasitemia in uncomplicated and complicated malaria patients. This study was a cross sectional study. Samples of uncomplicated malaria were obtained from Tanah Laut district of South Kalimantan and samples of complicated malaria were obtained from dr.Saiful Anwar Hospital. Percentage of hemozoin on mononuclear cells and the degree of parasitemia were determined using microscopic observations of isolated mononuclear cells and thin blood smear stained with Giemsa. The results showed, there was a significant differences in the percentage of hemozoin and the degree of parasitemia between uncomplicated and complicated malaria. Average of uncomplicated and complicated malaria hemozoin were 2.1 and 19.8 in 1000 mononuclear cells. Average infected erythrocytes (parasitemia) of uncomplicated malaria and complicated malaria were 2.9 and 34.1 in 1000 erythrocytes. Analysis of data by Pearson correlation
showed, there was a positive correlation between percentage hemozoin and percentage of parasitemia malaria in uncomplicated and complicated malaria (r = 0,326; r = 0,602), however this correlation was not significant (p = 0,359; p = 0,066). It can be concluded, there are a significant differences in the percentage of hemozoin and parasitemia degree between uncomplicated and complicated malaria patiens, and there is no correlation between the percentage of hemozoin and the degree of parasitemia in malarial patients during P.falciparum infection. Keyword: Hemozoine, Parasitemia, Complicated Malaria, Uncomplicated Malaria.
DAFTAR PUSTAKA Dinkes Jabar, 2009. Malaria. http: www.diskes. jabarprov.go.id/index.php?Mod=pub InformasiPenyakit &idMenuKiri=56&id Selected=1&idInfo=13&page=3, diakses Mei 2010. Darlina, T D, 2008. Daya Infeksi Plasmodium berghei stadium eritrositik yang diiradiasi sinar gama. Nuclear Health Center. http: / /nhc.batan.go.id/devita3.php, diakses Mei 2010. Pascual CC, Kai O, Cheung JOP, Williams S, Lowe B, Nyanoti N, Williams TN, Maitland K, Molyneux M, Newton CRJS, Peshu N, Watt SM, Roberts DJ. 2006. Lactate levels in severe malarial anaemia are associated with haemozoin-containing neutrophils and low lev els of IL-12. Malaria Journal. 5: 101 Huy NT, Trang DT, Kariu T, Sasai M, Saida K, Harada S, Kamei K, 2005. Lekocyte Activation by Malarial Pigment. Parasitol Int. 55(1):75-81. Fitri, L. E, 2004. Analisa Patogenesis Malaria dengan Komplikasi : Tinjauan Molekuler terhadap peran molekul adhesi eritrosit terinfeksi Plasmodium falciparum Isolat Malang dan Keterlibatan Senyawa Oksigen Reaktif. Disertasi Ilmu Kedokteran Pasca Sarjana Fakultas Kedokteran Universitas Brawijaya. Hänscheid T, Längin M, Lell1 B, Pötschke M, Oyakhirome S, Kremsner PG and Grobusch MP. 2008. Full blood count and haemozoin-containing leukocytes in children with malaria: diagnostic value and association with disease severity. Malaria Journal 7:109. Lyke KE, Diallo DA, Dicko A, Kone A, Coulibaly D, Guindo A, Cissoko Y, Sangare L, Coulibaly S, Dakouo B, Taylor TE, Doumbo OK, Plowe CV. 2003. Association of intraleukocytic Plasmodium falciparum malaria pigment with disease severity, clinical manifestations, and prognosis in severe malaria. The American Journal of Tropical Medicine and Hygiene. 69 (3): 253-9. Moody A, 2002. Rapid Diagnostic Tests for Malaria Parasites. Clinical Microbiology Reviews. 15 (I) : 6678. Jaramillo M, Bellemare MJ, Martel C, Shio MT, Contreras AP, Godbout M, Roger M, Gaudreault E, Gosselin J, Bohle DS, Olivier M. 2009. Synthetic PlasmodiumLike Hemozoin Activates the Immune Response: A Morphology - Function Study. PLoS ONE 4 (9) : e6957 Michael J, Keller CC, Were T, Ouma C, Oti eno RO, Landis-Lewis Z, Ochiel D, Slingluff JL, Mogere S, Ogonji GA, Orago AS, Vulule JM, Kaplan SS, Day RD, Perkin AJ. 2006. Parasitemia, Anemia, And Malarial Anemia In Infants And Young Children In A Rural Holoendemic Plasmodium Falciparum Transmission Area. The American Journal of Tropical Medicine and Hygiene 74 (3): 376-385 McElroy PD, ter Kuile FO, Hightower AW, Hawley WA, Phillips-Howard PA, Oloo AJ, Lal AA, Nahlen BL, 2001. All-cause mortality among young children in western Kenya. VI: the Asembo Bay Cohort Project. The American Journal of Tropical Medicine and Hygiene 64: 18–27.
Kitua AY, Smith TA, Alonso PL, Urassa H, Masanja H, Kimario J, Tanner M.1997. The role of low level Plasmodium falciparum parasitaemia in anaemia among infants living in an area of intense and perennial transmission. Trop Med Int Health 2(4):325-33. Urban BC, Todryk S. 2006. Malaria pigment paralyzes dendritic cells. Journal of Biology Minireview 5 : 4. Lamikanra AA, Theron M, Kooij TW, Roberts DJ, 2009. Hemozoin (malarial pigment) directly promotes apoptosis of erythroid precursors. PLoS ONE. 4 (12): e8446.
