| Abstract | Malarija je jedna od najvažnijih zaraznih parazitarnih bolesti tropskih i suptropskih regija svijeta uzrokovana krvno-tkivnim protozoima roda Plasmodium. Procjenjuje se da je skoro 40% svjetske populacije pod rizikom za obolijevanje od malarije, a prema Svjetskoj zdravstvenoj organizaciji procijenjeno je da je u 2020. godini u svijetu bio 241 milijun kliničkih slučajeva malarije te je malarija bila uzrokom smrti kod 627 tisuća ljudi. Malarija je najčešći uzročnik vrućice u endemskim krajevima, a klinički razlikujemo nekompliciranu i kompliciranu ili tešku malariju. Kod nekomplicirane malarije klasični napad započinje malaksalošću, glavoboljom, bolovima u mišićima i zglobovima, naglom tresavicom, zimicom i vrućicom koja se penje do 40 °C. Kada liječenje nije učinkovito ili se nije započelo na vrijeme može se razviti teška, komplicirana malarija uz multisistemsko organsko zatajenje, a kliničke manifestacije tada mogu biti cerebralna malarija, akutno bubrežno zatajenje, akutni respiratorni distres sindrom, hipoglikemija, acidoza i teška anemija. Uobičajena dijagnoza malarije postavlja se mikroskopiranjem guste kapi i razmaza periferne krvi bojenih po Giemsi. Dodatno u dijagnostici je moguće napraviti brze dijagnostičke testove kojima se u krvi dokazuju različiti antigeni parazita, a također postoje i molekularne metode dijagnostike poput najčešće u tu svrhu primjenjivane metode PCR-a. Liječenje malarije provodi se antimalaričnim kemoterapeuticima, a najčešće se koriste klorokin, atovakvon-progvanil, artemeter-lumefantrin, meflokin, primakin, doksiciklin i drugi. Terapija bazirana na kombinaciji lijekova koje sadržavaju artemisinin glavni je i široko primjenjivani standard u liječenju ove bolesti. Odabir lijeka ovisi o vrsti plazmodija koji je uzrokovao bolest, težini kliničke slike te o kraju svijeta u kojemu je nastupila infekcija. Važni su i podaci o rezistenciji uzročnika na pojedine antimalarike. Liječenje teške malarije provodi se u jedinici intenzivnog liječenja te zahtijeva kontinuirani monitoring, a intravenozni artesunat je lijek izbora. |
| Abstract (english) | Malaria is one of the most important infectious parasitic disease in many tropical and subtropical regions in the world caused by blood-borne Plasmodium species parasites. It is estimated that nearly 40% of the world’s population is at risk for acquiring malaria and according to World Health Organisation, there were an estimated 241 million clinical cases of malaria in 2020 globally as well as 627 thousand deaths. Malaria is the most common cause of fever in endemic areas. It can be categorized as uncomplicated or severe, complicated malaria. Patients with uncomplicated malaria disease usually present with weakness, headache, muscle and joint pain, paroxysms of chills, rigor, fever which usually peaks at around 40°C, sweating, fatigue and sleepiness. When the treatment is not effective, or does not start on time, severe malaria can develop with multiple organ dysfunction syndrome. It is presented with cerebral malaria, acute kidney injury, acute respiratory distress syndrome, hypoglycaemia, acidosis and severe anaemia. Light microscopy of Giemsa-stained thick and thin blood smears is the accepted standard for malaria diagnosis. In situations in which expert microscopic examination is delayed or difficult to obtain, Rapid Diagnostic Tests are performed which are based on capturing of parasite antigen from peripheral blood. There are also molecular methods like PCR, biochemical methods, immunoassays, flow cytometry and different approaches to microscopy. Malaria is treated with antimalarial chemotherapeutics. Most commonly used are chloroquine, atovaquone-proguanil, artemether-lumefantrine, mefloquine, primaquine, doxycycline, artemisinin-based combination therapy etc. Drug selection is based on which plasmodium caused the disease, severity of clinical presentation and a part of the world where the infection occurred. The data about parasite resistance to antimalarials are also very important. The treatment of severe malaria is being implemented in intensive care unit and it requires continuous monitoring. Intravenous artesunate is a drug of choice. |
