*Malaria Diagnosis CalculationParasitology Dept.

*Malaria diagnosisLaboratory DxBlood film (microscopic)Gold standardSensitivity 40 parasites/l

PCRSensitivity up to 4 parasites/l

RDT (Rapid Diagnostic Test)Dipstick Antigen detection:HRP-2 detection pLDH Ag Pan-malaria AgSensitivity 100 parasites/l

*Malaria diagnosisMicroscopicThick blood film: 10l blood (3 drops)Blood smear: 2l blood (1 drop)

*Malaria diagnosisCalculationSemi quantitative:(-)no parasites in 100 fields(+)1-10 parasites in 100 fields(++)11-100 parasites in 100 fields(+++)1-10 parasites in 1 field(++++)>10 parasites in 1 field

*Malaria diagnosisCalculationBased on leucocytes countThick blood filmNumber of parasites in 200 leucocytes (n/200) x 8,000 parasites per l bloodHyperparasitemia: parasites 250,000 parasites per l blood

*Malaria diagnosisCalculationBased on erythrocytes countThin blood smearNumber of parasites in 1000 leucocytes(n/1,000) x 450,000 parasites per l bloodHyperparasitemia: parasites 5% or 50 parasites in 1,000 erytrocytes

*Malaria diagnosisCalculationCalculation and identification can both derived from thick and thin blood filmAsexual stages (rings, trophozoites, and schizonts) counted togetherSexual stage (gametocytes) counted separately

*Malaria diagnosisReportExample: P. falciparum found in thick film with parasite count as following:number of asexual stages: 120number of sexual stage: 4

Therefore: Asexual stages density: (120/200) 8,000= 4,800Sexual stage density: (4/200) 8,000= 160

How to report:P. falciparum 4,800 / 160 per l blood

*Malaria therapyEfficacyEfficacy monitoring:Monitoring schedule: D0, D1, D2, D3, D7, D14, D21, and D28Low-moderate endemic areas: follow up to 7 daysHigh endemic areas: follow up to 28 days

Classification (WHO 2003):Adequate clinical response (ACPR/RPKM)Early treatment failure (ETF/KPD)Late treatment failure (LTF/KPK)Drop Out (DO)

*DatangRS/DrH-2H0HasilMal +H-1MulaiObatH1H2H3H4H5H6H7H14H21H28KlinisMemburukKlinis memburukKlinis memburuk- Parasit > 25 %- Parasit +, Temp > 37.5MONITORING RESPONS DI POLI/ DOKTER PRAKTEKE.T.F = G.O.DiniL.T.F = G.O. LambatKlinis memburuk- Parasit +, Temp > 37.5 Klinis memburuk- Parasit +Klinis memburuk- Parasit +, Temp > 37.5 Klinis memburuk- Parasit + Klinis memburuk- Parasit + Klinis memburuk- Parasit +

*Thank You

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