Abstract Ref Number = APCP947
DELAYED PARASITE CLEARANCE ON CHILD WITH SEVERE MALARIA
Widdy Winarta,Imanuel Yulius Malino
Dian Harapan Hospital
Background : The use of artemisinin derivatives as the main treatment of malaria and severe malaria is prevalent throughout Indonesia since the introduction of the policy in 2004. Therefore, it is interesting to study the individual response towards artemisinin therapy in severe malaria.
Case Presentation Summary : A 5-years-old-girl, 17 kg/117 cm was admitted to the hospital with severe falciparum malaria, severe anemia, jaundice and hemoglobinuria. Initial laboratory examination (upon admission to the ER) revealed severe anemia (5.5 g/dL), thrombocytopenia (68,000/mm3), elevated total bilirubin level (4.6 mg/dL), and normal eGFR. Semiquantitative microscopic thick blood films examination showed falciparum malaria +4 (? 300 parasite/field). The patient was treated with intravenous artesunate injection for 24 hours (0, 12, 24 hours protocol). Six hours after the first dose of artesunate, hematologic and microscopic thick blood film were re-examined. The result showed decreasing hemoglobin level (4.0 g/dL), and roughly the same falciparum malaria +4 (? 300 parasite/field). The treatment was then continued and several laboratory tests were repeated the next day. The microscopic thick blood film examination after the third dose of artesunate showed decreasing but still high parasite density +4 faciparum malaria (? 15 parasite/field). Due to the patients’ declining condition, the artesunate administration was then replaced by quinine dihydrochloride. The day after initial quinine administration, microscopic examination showed +2 falciparum malaria. The patient was further treated for 4 days using this new regiment of treatment. Her condition improved and was discharged after 5 days of hospitalization. No adverse effect following quinine administration was observed.
Learning Points/Discussion : Delayed parasite clearance following intravenous artesunate administration for the treatment of severe falciparum malaria was observed in this individual case. However, this does not confirm the existence of artesunate resistant P.falciparum strain in Indonesia. A proper efficacy study would be required to reveal the magnitude of this problem.
Keywords: Child Delayed parasite clearance Malaria