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    Malaria

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    IBhe Damianry Qritezz
    This curriculum vitae summarizes the education and work experience of Dr. Jeanne Rini Poespoprodjo. She received her PhD in 2011 from Menzies School of Health Research in Australia, and received her medical specialization in Pediatrics from Universitas Gadjah Mada in 1999. She currently works as the Head of the Medical Committee and Pediatric Specialist at Mimika District Hospital. The CV lists her qualifications and career highlights in a concise manner.

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    Malaria

    Uploaded by

    IBhe Damianry Qritezz
    127 views23 pages
    This curriculum vitae summarizes the education and work experience of Dr. Jeanne Rini Poespoprodjo. She received her PhD in 2011 from Menzies School of Health Research in Australia, and received her medical specialization in Pediatrics from Universitas Gadjah Mada in 1999. She currently works as the Head of the Medical Committee and Pediatric Specialist at Mimika District Hospital. The CV lists her qualifications and career highlights in a concise manner.

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    This curriculum vitae summarizes the education and work experience of Dr. Jeanne Rini Poespoprodjo. She received her PhD in 2011 from Menzies School of Health Research in Australia, and received her medical specialization in Pediatrics from Universitas Gadjah Mada in 1999. She currently works as the Head of the Medical Committee and Pediatric Specialist at Mimika District Hospital. The CV lists her qualifications and career highlights in a concise manner.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    127 views23 pages

    Malaria

    Uploaded by

    IBhe Damianry Qritezz
    This curriculum vitae summarizes the education and work experience of Dr. Jeanne Rini Poespoprodjo. She received her PhD in 2011 from Menzies School of Health Research in Australia, and received her medical specialization in Pediatrics from Universitas Gadjah Mada in 1999. She currently works as the Head of the Medical Committee and Pediatric Specialist at Mimika District Hospital. The CV lists her qualifications and career highlights in a concise manner.

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    Curriculum Vitae

    Dr. Jeanne Rini Poespoprodjo, SpA, MSc, PhD


    Tempat/tanggal lahir : Bandung, 22 Februari 1966

    Pendidikan
    2011 : PhD dari Menzies School of Health Research Darwin, Australia
    2006 : Magister of Science Institute of Child Health University College, London, UK
    1999 : Program Pendidikan Dokter Sesialis Anak FK UGM
    1990 : Fakultas Kedokteran UNPAD

    Pekerjaan
    • 2008– sekarang: Ketua Komite Medik & Dokter Spesialis Anak RSUD Kab. Mimika

    PENDIDIKAN KEDOKTERAN BERKELANJUTAN – 1 IDAI CABANG PAPUA 2019


    Daily Clinical Practice in Pediatric 1
    Malaria Treatment in Children:
    The Pitfalls
    Daily Clinical Practice in Paediatrics Symposium
    Jayapura, 30-31 Maret 2019

    Jeanne Rini Poespoprodjo

    Mimika District Hospital - YPKMP, Papua-Indonesia


    Pediatric Research Office – Department of Child Health Universitas Gadjah Mada
    Pitfall #1
    Laboratory Diagnosis
    • Negative malaria smear result, but clinically
    strongly suggests malaria

    • Positive result after a “complete” DHP


    treatment for 3 days
    Microscopy

    • Gold standard of laboratory diagnosis of


    malaria: read by an experienced microscopist
    • Inexperienced microscopist: Sensitivity 54.7%
    and Specificity 81.5% RDT may be
    preferable
    • If in doubt, cross check with more experienced
    microscopist!

    Berzosa P, et al. Malar J. 2018;17(1):333; Ochola LB, et al. Lancet Infect Dis. 2006;6(9):582-8
    Field Microscopist:
    Lower sensitivity than RDT (high false negatives)
    Similar Specificity with RDT (low false positives)
    Trained microscopist:
    Parasitemia Fever without parasites
    found: No Malaria!
    600
    > 500
    Number of parasites per microL

    500

    400

    300

    200
    100
    100 Microscopist
    5-20 reading
    0 threshold: 5-20
    Asymptoma c malaria Symptoma c malaria Severe malaria parasites per
    with fever microliter blood

    Murray, CK et al. Clinical microbiology reviews. 2008;21(1):97-110


    Uninterupted Infections

    Each infections can consist of 2-3 asexual cycles,


    each cycle takes 48 hours (2 days)

    Day 0 1 2 3 4 5 6 7-20 days

    Infected Gametocytes

    Parasite Multiplication Rate: Median number of viable


    merozoites liberated by rupturing schizonts
    Parasite Multiplication Rate:
    Jumlah merozoite yang viabel
    yang diproduksi oleh Schizont

    Parasite Reduction Ratio (PRR):


    Laju kecepatan obat antimalaria
    mengurangi jumlah parasit
    dalam satu siklus aseksual

    White, N.J, 2004; J Clin Invest 113, 1084-1092


    Parasite Reduction Ratio

    Antimalarial drug with Parasite Reduction Ratio


    (PRR): 10-1 to 10-4 per cycle

    Example:
    Total number of P. falciparum parasites in the body: 1012
    Treated with antimalarial drug with PRR 10-4:
    1,000,000,000,000 parasite biomass will be reduced 99% in
    48 hours
    Time Required to Clear Parasites

    Artemisinin
    Derivatives

    Antibiotics: eg
    Cotrimoxazole,
    Clindamycin,
    Doxicyclin

    Adult with 2% parasitaemia: total number of parasites 1012


    Drug Concentration
    • A: Artesunate
    • Q: Quinine
    • P: Pyrimethamine
    • C: Chloroquine
    • M: Mefloquine
    Artemisinin Combination Therapy/ACT:
    Artemisinin derivatives + Partner Drug
    3 day Artesunate and Mefloquine

    Nosten, F et al. Am J Trop Med Hyg. 2007;77(suppl 6):181-92


    Dihydroartemisinin-Piperaquine

    • Dihydroartemisinin:
    – short half life (30 minutes) and high PRR (10-4)

    • Piperaquine:
    – long half life (28 days) and low PRR (10-1-10-2)

    Timika,2
    015
    • ACPR day 42 (PCR Corrected)
    – P. falciparum : 100% (95%CI, 90.1-100) – 35/35
    – P. vivax : 91.7% (95%CI, 64.6-98.5) – 11/12
    • Day 3 positive proportion: 0%
    Severe Malaria and Parasite Count

    • Low parasite count but severe manifestation:


    is it possible?

    • Can we use RDT at Emergency Unit to


    diagnose malaria and severe malaria?
    The stages of P. falciparum:
    Fig 1 Normal red cell

    Figs. 2-18: Trophozoites (among these,


    Figs. 2-10 correspond to ring-stage
    trophozoites)

    Figs. 19-26: Schizonts (Fig. 26 is a


    ruptured schizont);

    Figs. 27, 28: Mature macrogametocytes


    (female)

    Figs. 29, 30: Mature microgametocytes


    (male

    Sequestered at micro-
    vascular of internal
    organs
    Sequestration
    Malnourished Children
    • Evidence on drug pharmacokinetic is lacking
    • Diarrhea, vomiting, rapid gut transit, small
    intestinal mucosal atrophy: may reduce oral
    drug absorption
    • Hypoalbuminaemia: reduce protein binding,
    rapid drug clearance
    • Volume distribution may be larger, plasma
    drug concentration may be lower
    • Hepatic dysfunction: reduce drug metabolism

    Oshikoya KA, Senbanjo IO (2009); Krishnaswamy K (1978)


    • However, not enough evidence to modify dose
    • Use mg/kg body weight as normal nutritional
    status children

    Verret WJ et al. 2011


    The 2nd National
    Symposium ASMPID,
    April 20-21 2019
    Topics: A to Z about
    - Antibiotics
    - Corticosteroid
    - Dengue
    - Diphtheriae
    - Immunomodulator
    - IvIg
    - Laboratory Tests in Daily Practice
    - Leptospirosis
    - Pertussis
    - Catheter Line-associated Infection
    - Rabies
    - Sepsis
    Seminar and Workshop
    - Travel Advice before Umroh/Hajj Aryaduta Hotel, Bandung
    - Typhoid
    - Vaccines

    Registration
    Fitri 082 1202 62 878
    Arifin 081 2210 44 782
    Terimakasih

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