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