Berat Badan Lahir Rendah pada Bayi Wanita Terinfeksi Plasmodium falciparum Saat Hamil

-, Machrumnizar

Cermin Dunia Kedokteran
Vol 42, No 6 (2015): Malaria

Plasmodium falciparum dapat memodifikasi permukaan eritrosit terinfeksi dengan membentuk knobs oleh protein yang dikenal sebagai Plasmodium falciparum Erythrocyte Membrane Protein-1 (PfEMP-1) dan dikode oleh famili gen var. Pembentukan knobs menyebabkan sel darah merah mudah melekat dan menggumpal di sel endotelial sehingga mengganggu mikrosirkulasi organ, termasuk plasenta. Gangguan invasi trofoblas menyebabkan penyumbatan mekanik sehingga terjadi insufisiensi plasenta dan fetal growth retardation (FGR). Antigen parasit malaria juga mampu menginduksi imunitas seluler oleh limfosit T dan imunitas humoral oleh limfosit B. Sitokin yang diduga banyak berperan pada patologi malaria adalah TNF-alfa karena meningkatkan ekspresi molekul adhesi pada sel-sel endotel kapiler. Semua hal tersebut menyebabkan gangguan aliran darah plasenta dan akhirnya gangguan nutrisi janin, yang dapat menyebabkan retardasi pertumbuhan janin sehingga bayi memiliki berat badan rendah.Plasmodium falciparum can modify the surface of infected erythrocytes with knobs formed by proteins known as Plasmodium falciparum erythrocyte membrane protein-1 (PfEMP-1) and encoded by var gene family. Formation of knobs causes red blood cells clumping and attachment to endothelial cells, affecting microcirculation in organs including placenta. Invasion of trophoblast causes mechanical obstruction resulting in placental insufficiency and Fetal Growth Retardation (FGR). Malaria parasite antigens are also able to induce cellular immunity by T lymphocytes and humoral immunity by B lymphocytes. TNF-alpha has a suspected role in the pathology of malaria, because it increases molecule adhesion in capillary endothelial cells. Plasmodium falciparum infection in pregnant women is associated with disruption of placenta microcirculation and trophoblast parasites invasion, as well as immune response that may increase cytoadherence of infected red blood cells. These mechanisms lead to placental blood flow disruption andmay ultimately cause fetal nutritional disorders resulting in fetal growth retardation and low birth weight.