Enteropathogens associated with acute diarrhea in community and hospital patients in Jakarta, Indonesia.

The prevalence of bacteria, parasite and viral pathogens in 3875 patients with diarrhea in community and hospital settings from March 1997 through August 1999 in Jakarta, Indonesia was determined using routine bacteriology and molecular assay techniques. Bacterial pathogens isolated from hospital patients were, in decreasing frequency, Vibrio cholerae O1, Shigella flexneri, Salmonella spp. and Campylobacter jejuni, while S. flexneri, V. cholerae O1, Salmonella spp. and C. jejuni were isolated from the community patients. V. cholerae O1 was isolated more frequently (P<0.005) from the hospital patients than the community patients. Overall, bacterial pathogens were isolated from 538 of 3875 (14%) enrolled cases of diarrhea. Enterotoxigenic Escherichia coli were detected in 218 (18%) of 1244 rectal swabs. A small percentage of enterohemorrhagic E. coli (1%) and of Clostridium difficile (1.3%) was detected. Parasitic examination of 389 samples resulted in 43 (11%) positives comprising Ascaris lumbricoides (1.5%), Blastocystis hominis (5.7%), Giardia lamblia (0.8%), Trichuris trichiura (2.1%) and Endolimax nana (0.5%). Rotavirus (37.5%), adenovirus (3.3%) and Norwalk-like virus (17.6%) were also detected. Antimicrobial resistance was observed among some isolates. Bacterial isolates were susceptible to quinolones, with the exception of some isolates of C. jejuni which were resistant to ciprofloxacin, nalidixic acid and norfloxacin. Data obtained from this community- and hospital-based study will enable the Indonesian Ministry of Health to plan relevant studies on diarrheal diseases in the archipelago.

Integrating environmental goals into urban redevelopment schemes: lessons from the Code River, Yogyakarta, Indonesia.

The settlement along the bank of the Code River in Yogyakarta, Indonesia provides housing for a large mass of the city's poor. Its strategic location and the fact that most urban poor do not have access to land, attracts people to "illegally" settle along the bank of the river. This brings negative consequences for the environment, particularly the increasing domestic waste along the river and the annual flooding in the rainy season. While the public controversies regarding the existence of the settlement along the Code River were still not resolved, at the end of the 1980s, a group of architects, academics and community members proposed the idea of constructing a dike along the River as part of a broader settlement improvement program. From 1991 to 1998, thousands of local people mobilized their resources and were able to construct 6,000 metres of riverside dike along the Code River. The construction of the riverside dike along the River has become an important "stimulant" that generated not only settlement improvement, but also a better treatment of river water. As all housing units located along the River are now facing the River, the River itself is considered the "front-yard". Before the dike was constructed, the inhabitants used to treat the River as the "backyard" and therefore just throw waste into the River. They now really want to have a cleaner river, since the River is an important part of their settlement. The settlement along the Code River presents a complex range of persistent problems with informal settlements in Indonesia; such problems are related to the issues of how to provide more affordable and adequate housing for the poor, while at the same time, to improve the water quality of the river. The project represents a good case, which shows that through a mutual partnership among stakeholders, it is possible to integrate environmental goals into urban redevelopment schemes.

Characterization of Norwalk-like virus associated with gastroenteritis in Indonesia.

Norwalk Virus and Norwalk-like viruses (NLVs) are reportedly responsible for 2.5-4.0% of nonbacterial acute gastroenteritis (NBAG) worldwide. To help clarify the impact of NLVs on NBAG in Indonesia, stool specimens from 102 patients, 74 with NBAG and 28 with BAG, were screened for the presence of NLVs, using a reverse transcription-polymerase chain reaction (RT-PCR) assay. The specimens were subtyped using prototype-specific oligonucleotide probes and were sequenced and compared with published NLV sequences. Of the 102 specimens examined, 31 (30%) were found to be positive for NLVs. Type-specific probe analysis of the RT-PCR products indicated that 31 isolates hybridized to UK1 (Taunton agent) and UK3/4 (Hawaii agent/Snow Mountain agent) prototype strains. The results of this study indicate that prototype strains of NV or NLVs co-circulate in Indonesia and contribute to the overall level of acute gastroenteritis throughout the region.

Toxins and colonization factor antigens of enterotoxigenic Escherichia coli among residents of Jakarta, Indonesia.

Infection caused by enterotoxigenic Escherichia coli (ETEC) poses a serious health problem among children and adults in developing countries. Colonization of the small intestinal mucosa by ETEC strains is mediated by antigenically specific fimbriae, also known as colonization factor antigens (CFA). The significance of this study arises from reports that active and passive immunization with ETEC strains harboring CFAs has previously been shown to induce protective immunity against diarrhea in animal models. The aim of this study was to determine toxin-associated CFAs of ETEC isolated from a diarrheal disease case-control study in Jakarta, Indonesia. Thirteen hundred and twenty-three diarrheic and control patients with lactose-fermenting colonies were screened by ganglioside GM1-enzyme-linked immunosorbent assay (GM1-ELISA) for heat-labile (LT) and heat-stable (ST) toxins. Two hundred and forty-six (19%) ETEC isolates identified by GM1-ELISA for the LT/ST toxins were screened for CFAs by Dot blot assay using monoclonal antibodies against CFA/I, II, and IV and against the putative colonization antigens (PCF) PCFO159, PCFO166, CS7, and CS17. Of the 246 ETEC isolates, 177 (72%) elaborated ST, 56 (23%) produced LT, while 13 (5%) elicited both the ST and LT toxins. CFA testing of the 246 ETEC isolates showed that 21 (8%) expressed CFA/I, 3 (1%) exhibited CFA/II, 14 (6%) elaborated CFA/IV, while 7 (3%) expressed PCFO159 and PCFO159 plus CS5. No CFAs or PCFs could be associated with 201 (82%) of the ETEC strains. This report documents the types of CFAs associated with ETEC strains in Jakarta, Indonesia. These data may help current research efforts on the development of CFA-based vaccines for humans against ETEC and provide additional information for future ETEC vaccine trials in Southeast Asia.

Plasma homocysteine concentrations of Indonesian children with inadequate and adequate vitamin B-6 status.

The objective of the study was to determine the usefulness of utilizing plasma homocysteine concentrations as an indicator of vitamin B-6 status in subjects with inadequate and adequate status as demonstrated by currently accepted indicators. Plasma homocysteine concentrations of 77 third-grade Indonesian children (aged 8-9 y; boys and girls) were measured. About a quarter of these subjects had inadequate vitamin B-6 status as indicated by their plasma pyridoxal-5'-phosphate concentrations, erythrocyte alanine aminotransferase activity coefficients, and reported dietary vitamin B-6 intakes. No significant differences in plasma homocysteine concentrations were observed between subject groups shown to have inadequate and adequate vitamin B-6 status using currently accepted indicators. Plasma homocysteine concentrations of the subjects were not correlated with values for other vitamin B-6 indices. Plasma homocysteine concentration was not an indicator of vitamin B-6 status in these children, as it did not differentiate between children shown otherwise to have inadequate and adequate status of the vitamin.

Shigella spp. surveillance in Indonesia: the emergence or reemergence of S. dysenteriae.

From June 1998 through November 1999, Shigella spp. were isolated in 5% of samples from 3,848 children and adults with severe diarrheal illness in hospitals throughout Indonesia. S. dysenteriae has reemerged in Bali, Kalimantan, and Batam and was detected in Jakarta after a hiatus of 15 years.

Cholera in Indonesia in 1993-1999.

Cholera-specific surveillance in Indonesia was initiated to identify the introduction of the newly recognized Vibrio cholerae non-O1, O139 serotype. Findings from seven years (1993-1999) of surveillance efforts also yielded regional profiles of the importance of cholera in both epidemic and sporadic diarrheal disease occurrence throughout the archipelago. A two-fold surveillance strategy was pursued involving 1) outbreak investigations, and 2) hospital-based case recognition. Rectal swabs were transported to Jakarta for culture and isolates were characterized by serotypic identification. Outbreak findings showed that V. cholerae O1, Ogawa serotype, was the predominant etiology in all 17 instances of investigated epidemic transmission. Monitoring of eight hospitals representing seven provinces provided 6,882 specimens, of which 9% were culture positive for V. cholerae: 589 (9%) for O1 and 20 (< 1%) for non-O1 strains. Proportional representation of V. cholerae O1 among cases of sporadic diarrheal illness was variable, ranging from 13% in Jakarta to < 1% in Batam. Overall, 98% of V. cholerae O1 cases were the Ogawa serotype. There was no instance of non-O1, O139 serotype introduction in either epidemic or sporadic disease form. Anti-microbial drug susceptibility was consistently demonstrated, both temporally and spatially, except against colistin. Evidence is provided that epidemic and sporadic cholera occurrence in western Indonesia is associated with periods of low rainfall. Conversely, in the more eastern portion of the country, heavy rainfall may have contributed to epidemic cholera transmission.

Vitamin B-6 inadequacy is prevalent in rural and urban Indonesian children.

The vitamin B-6 status of Indonesian children was evaluated by determining their dietary vitamin B-6 intakes, erythrocyte alanine aminotransferase activity coefficients and plasma pyridoxal phosphate (PLP) concentrations. Thirty-eight third-grade elementary school children (ages = 8-9 y) in rural and 39 in urban areas of Bogor, West Java, Indonesia, voluntarily served as subjects. The subjects included 39 male and 38 female students. The mean vitamin B-6 intake of the subjects was 0.57 mg/d. Fifty-five percentage of the children reported consuming <0.5 mg/d of vitamin B-6 (the 1998 Estimated Average Requirement for those 4-8 y). Erythrocyte alanine aminotransferase activity coefficients >/= 1.25 were observed in 30%, and plasma PLP concentrations

YM-32890 A and B, new types of macrolide antibiotics produced by Cytophaga sp.

Two new types of macrolide antibiotics, YM-32890 A and B, have been isolated from the fermentation broth of cytophaga sp. YL-02905S. In this paper, the taxonomy of the producing strain, fermentation, isolation, structure elucidation, and biological activity of the antibiotics are reported. YM-32890 A inhibits the growth of staphylococci including a macrolide-resistant strain, but shows no antimicrobial activity against other Gram-positive, Gram-negative bacteria and yeast.

Kalimantacins A, B and C, novel antibiotics from Alcaligenes sp. YL-02632S. I. Taxonomy, fermentation, isolation and biological properties.

Novel antibacterial antibiotics, kalimantacins A, B and C, have been isolated from the fermentation broth of Alcaligenes sp. YL-02632S. In this paper, the taxonomy of the producing strain, fermentation, isolation and biological activities of kalimantacins are reported. Kalimantacins inhibit the growth of Staphylococcus aureus and S. epidermidis including multiple-drug resistant strains.