Plasmodium ovale Infection After One Year Mefloquine Prophylaxis in A Young Indonesian Soldier: A Case Report.

Malaria chemoprevention using mefloquine has become the WHO standard regimen for military personnel who stay in the endemic area for an extended period of time. We reported a case of Plasmodium ovale infection in a young Indonesian Soldier following one year mefloquine prophylaxis 250 mg weekly. Typical fever and chills were experienced two weeks after returning from one year duty in Congo, West-Central Africa. The diagnosis of ovale malaria was made by peripheral blood smear, and 35/250 parasites in small microscopic view was found. Then, he recovered after dihydroartemisin and primaquine combination therapy. This was an unusual case of long-term prophylaxis failure since mefloquine has been recognized as the agent for malaria prevention, even multi-drug-resistance Plasmodium. Dormant stage of Plasmodium ovale, quinoline-resistance potential, and the efficacy of mefloquine itself are discussed as the cause of that phenomenon.

The correlation between CD4+ T-lymphocyte count and tuberculosis form in TB-HIV coinfected patients in Indonesia.

AIM: to find whether there is a correlation between CD4+ count and TB form in TB-HIV Coinfected patients in Indonesia. METHODS: this is a cross-sectional study of the TB-HIV patients at National HIV Center POKDISUS, Cipto Mangunkusumo Hospital in 2008-2011. We classified TB form as pulmonary TB, extrapulmonary TB, milliary TB, and combination form. The data were analyzed by Spearman and lambda correlation test. We also did partial correlation test to eliminate some counfounding factors, including demography and clinical characteristics, that had been determinated before. RESULTS: there were 122 TB-HIV patients (aged median 31 [18-34], 80% male) included in this study. The most common TB form was pulmonary TB (71.2%), then extrapulmonary TB (7.4%), the combined type (18.9%), and milliary TB (2.5%). Median of CD4+ count was 40 cells/mL (IQR 17.5-100.6). There was a very weak correlation between CD4+ count and TB form in TB-HIV patients in Indonesia (r=0.185; p=0.042). The other factor that also showed a significant correlation to TB form is HIV staging (r=0.289; p=0.001). After adjusting those factors, we found an increase on correlation between CD4+ count and TB form (r=0.353; p=0.000). CONCLUSION: there was a correlation between CD4+ count and TB form in TB-HIV patients in Indonesia, but in a very weak correlation.