Unspecific congenital toxoplasmosis in a two-month-old baby.

A two-month-old baby boy diagnosed with unspecific congenital toxoplasmosis was referred by a pediatrician to the Clinical Parasitology referral center at the Faculty of Medicine, Universitas Indonesia. Baby was post-hospitalized in the NICU and required ventilation support for one month. Furthermore, there was history of from various medical conditions, such as intracranial bleeding, convulsion, hypertrophic cardiomyopathy, retinopathy, and renal failure. After two month, there was no significant weight gain, anti-Toxoplasma IgM showed positive results, and anti-Toxoplasma IgM and IgG of the mother were also positive. Baby and mother were successfully treated with pyrimethamine, cotrimoxazole, and folinic acid for one month. At 2 years, there signs of normal motoric, eye, and hearing development with underdeveloped kidneys. Therefore, pre-pregnancy counseling and education aimed at preventing toxoplasmosis during pregnancy should be increased and conducted routinely by health workers or trained cadres to reduce the risk of fetal defects.

Determinant of parasite clearance and density on uncomplicated falciparum malaria infections in malaria-endemic area of Lampung Province, Indonesia.

Lampung is a malaria-endemic region in Indonesia with an annual parasite incidence of 0.06 per 1,000 population. The socio-demographic factors, clinical conditions, and artemisinin combination therapy (ACT) types might affect parasite clearance and parasite density. This study aims to investigate factors that influence parasite clearance and parasite density in malaria patients. A retrospective analytic observational and a cross-sectional approach was used to conduct this study. A total of 66 malaria patients were examined to investigate parasite density and clearance, socio-demographic profiles, clinical conditions, and ACT types. To analyze data, univariate, bivariate, and multivariate tests were used. Age (P=0.045; r=0.238) and ACT type (P=0.021; r=0.273) were the only variables that had a significant correlation with parasite clearance. Age (P=0.003; r=0.345) had a significant correlation with parasite density. The most influential factors related to parasite clearance were the ACT type (dihydroartemisinin piperaquine) (P=0.017; odds ratio (OR) 0.109; 95.0% confidence interval (CI), 0.018-0.675) and age (P=0.030; OR 0.132; 95.0% CI, 0.021-0.823). Age (P=0.046; OR 0.320; 0.105-0.978, 95.0% CI) was the most significant variable associated with parasite density.

Asymptomatic Cryptosporidiosis in Children Living with HIV.

Children living with human immunodeficiency virus (HIV) have an increased risk of opportunistic Cryptosporidium infection. Cryptosporidium usually causes chronic diarrhea that may lead to impaired growth and cognitive function in children. This study aimed to estimate the prevalence of cryptosporidiosis in children, describe its clinical characteristics, and the risk factors. A cross-sectional study involving children aged 6 months to 18 years old with confirmed HIV infection was carried out in Sardjito General Hospital, Yogyakarta. Diagnosis of cryptosporidiosis was made by PCR of 18S rRNA after being screened by microscopic examination. The clinical characteristics and risk factors were obtained from medical records and structured questionnaires. A total of 52 participants were included in the final analysis. The prevalence of cryptosporidiosis was 42.3%. Approximately 68% of the HIV children with cryptosporidiosis were asymptomatic, while those who reported symptoms showed weight loss and diarrhea. Independent risk factors of cryptosporidiosis were diarrhea (AOR 6.5; 95% CI 1.16-36.67), well water as drinking water source (AOR 6.7; 95% CI 1.83-24.93), and drink untreated water (AOR 5.8; 95% CI 1.04-32.64). A high prevalence of asymptomatic cryptosporidiosis was observed among children with HIV infection and PCR screening of Cryptosporidium in high-risk children is advisable.

Irritable bowel syndrome in Indonesian adolescents

Abstract Objective: Irritable bowel syndrome is a frequent functional gastrointestinal disorder. The aims of this study were to investigate its epidemiology, focusing on the role of intestinal mucosal integrity and to evaluate the impact on the quality of life. Methods: A community-based survey applying a comparative cross sectional approach was conducted in six high schools in Palembang. Subjects were recruited using multistage random sampling divided in two groups. Rome III criteria were used to establish a diagnosis of IBS in combination with a questionnaire to determine risk factors. Determination of fecal alpha-1-antitrypsin and calprotectin levels was performed to determine impaired intestinal mucosal integrity. A questionnaire was used to evaluate how quality of life was affected by irritable bowel syndrome. Results: The survey was performed in 454 14−18 years old adolescents, of whom 30.2% fulfilled the Rome III criteria for IBS, with the following subtypes: 36.5% diarrhea, 18.9% constipation, 21.9% mixed, and 22.6% unclassified. Major risk factors were female gender, bullying, age 14-16 years, history of constipation and diarrhea, eating nuts, and drinking coffee, tea, and soft drinks. There was a significant association with intestinal inflammation (p = 0.013). A significantly impaired quality of life was found (p = 0.001). Conclusions: The prevalence of irritable bowel syndrome in adolescents was high, with bullying, female gender, age 14-16 years, constipation and diarrhea, and dietary consumption of soft drinks, coffee, and tea as risk factors. A significant association with intestinal inflammation was found.

Irritable bowel syndrome in Indonesian adolescents.

OBJECTIVE: Irritable bowel syndrome is a frequent functional gastrointestinal disorder. The aims of this study were to investigate its epidemiology, focusing on the role of intestinal mucosal integrity and to evaluate the impact on the quality of life. METHODS: A community-based survey applying a comparative cross sectional approach was conducted in six high schools in Palembang. Subjects were recruited using multistage random sampling divided in two groups. Rome III criteria were used to establish a diagnosis of IBS in combination with a questionnaire to determine risk factors. Determination of fecal alpha-1-antitrypsin and calprotectin levels was performed to determine impaired intestinal mucosal integrity. A questionnaire was used to evaluate how quality of life was affected by irritable bowel syndrome. RESULTS: The survey was performed in 454 14-18years old adolescents, of whom 30.2% fulfilled the Rome III criteria for IBS, with the following subtypes: 36.5% diarrhea, 18.9% constipation, 21.9% mixed, and 22.6% unclassified. Major risk factors were female gender, bullying, age 14-16 years, history of constipation and diarrhea, eating nuts, and drinking coffee, tea, and soft drinks. There was a significant association with intestinal inflammation (p=0.013). A significantly impaired quality of life was found (p=0.001). CONCLUSIONS: The prevalence of irritable bowel syndrome in adolescents was high, with bullying, female gender, age 14-16 years, constipation and diarrhea, and dietary consumption of soft drinks, coffee, and tea as risk factors. A significant association with intestinal inflammation was found.

Toxoplasma gondii SAG2 type III in an atypical presentation of ocular toxoplasmosis in Indonesia.

OBJECTIVE: This study aimed to perform genotyping of Toxoplasma gondii strain or variant causing atypical toxoplasmic uveitis in Indonesian patients. METHODS: Ocular fluid samples originating from 46 uveitis patients with non-specific ocular manifestations were analysed for Toxoplasma infection by PCR of the B1 locus. The clonal type was determined by amplification, sequencing and phylogenetic analysis of SAG2 and GRA6 loci in B1-positive samples. Clinical data were obtained from the medical records. RESULTS: Pan uveitis was the most frequent manifestation (65.2%) and mostly unilateral (76.1%). PCR of the B1 locus identified eight positive subjects (12.5%); six had panuveitis and two of these had diabetes mellitus. Phylogenetic analysis with maximum likelihood of the SAG2 locus in the B1-positive samples resulted in Toxoplasma gondii SAG2 type III allele. No positive result was obtained from the PCR of GRA6 locus. CONCLUSION: Toxoplasma gondii SAG2-type III allele was identified in an atypical presentation of toxoplasmic uveitis in Indonesia.

Blastocystis ST-1 is associated with Irritable Bowel Syndrome-diarrhoea (IBS-D) in Indonesian adolescences.

OBJECTIVE: IBS is a functional gastrointestinal disorder and commonly presents in children and adolescences, presented as diarrhoea, constipation or mixed type. Blastocystis is a common intestinal protozoa found worldwide, which pathogenicity is still controversial. This study aimed to identify the risk factors of IBS, the association between IBS types with Blastocystis subtypes and analyse Blastocystis pathogenicity. DESIGN: A comparative cross-sectional study was conducted among senior high school students. Rome III Criteria for IBS diagnosis, questionnaires on the risk factors of IBS and types of IBS were recorded. Students were further selected and classified into IBS and non-IBS groups to analyse the association between IBS, IBS types with Blastocystis infection and its subtypes. Direct microscopic stool examination to identify single Blastocystis infection was performed, followed by culture in Jones' medium, PCR, sequencing of 18S rRNA and phylogenetic analysis to determine Blastocystis subtype. Data was analysed using SPSS v22.0 and P value <0.05 was considered statistically significant (95% confidence intervals). RESULTS: IBS was found in 30.2% of 454 students, consisted of 33.3% IBS Diarrhoea, 27.7% IBS Mixed, 27.7% IBS Unclassified and 11.1% IBS Constipation. Major risk factors to IBS consisted of family history of recurrent abdominal pain, abuse, bullying and female gender in respective order (OR 3.6-2.1). Blastocystis ST-1 was significantly associated to IBS-D with 2.9 times risk factor. CONCLUSIONS: Blastocystis infection is a risk factor to develop IBS-D type in adolescence; Blastocystis ST-1 can be regarded as a pathogenic subtype.

Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study.

BACKGROUND: Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings. METHODS: From January 2015 to April 2016, we prospectively included all adults with suspected CNS infection in a referral hospital in Jakarta, Indonesia. Systematic screening included HIV testing, CSF examination, and neuroimaging. RESULTS: A total of 274 patients with suspected CNS infection (median age 26 years) presented after a median of 14 days with headache (77%), fever (78%), seizures (27%), or loss of consciousness (71%). HIV coinfection was common (54%), mostly newly diagnosed (30%) and advanced (median CD4 cell count 30/µL). Diagnosis was established in 167 participants (65%), including definite tuberculous meningitis (TBM) (n = 44), probable TBM (n = 48), cerebral toxoplasmosis (n = 48), cryptococcal meningitis (n = 14), herpes simplex virus/varicella-zoster virus/cytomegalovirus encephalitis (n = 10), cerebral lymphoma (n = 1), neurosyphilis (n = 1), and mucormycosis (n = 1). In-hospital mortality was 32%; 6-month mortality was 57%. The remaining survivors had either moderate or severe disability (36%) according to Glasgow Outcome Scale. CONCLUSION: In this setting, patients with CNS infections present late with severe disease and often associated with advanced HIV infection. Tuberculosis, toxoplasmosis, and cryptococcosis are common. High mortality and long-term morbidity underline the need for service improvements and further study.

Diagnosis and Identification of Blastocystis Subtypes in Primary School Children in Jakarta.

Blastocystis hominis is an enteric protozoan with many subtypes. It is frequently found in children and may cause chronic diarrhea. This study revealed Blastocystis subtypes among primary school children and comparison of molecular technique and culture method in Blastocystis diagnosis. A total of 141 stools were collected, examined microscopically, selected into the Blastocystis and negative parasite groups, for diagnostic comparison between culture and 18S rRNA polymerase chain reaction (PCR) methods. Positive PCR amplicons were subsequently sequenced for subtyping. The PCR results revealed 89%, 78%, 80% and 88% sensitivity, specificity and positive and negative predictive values, respectively, in comparison with the culture method (McNemar, p > 0.05). Sixteen PCR samples were successfully sequenced and resulted in three Blastocystis subtypes 1, 3 and 4. In conclusion, PCR was sensitive enough and can be used to exclude Blastocystis infection up to 88% of the cases. Subtypes 3 and 1 were the main subtypes found in apparently healthy school children in Jakarta.

The relation between immunocompromised status and Strongyloides stercoralis infection: case-control study.

Strongyloides stercoralis infection is caused by intestinal nematodes in the human body, which in immunocompromised individual, may cause severe morbidity and fatality. This study aimed to reveal the current prevalence of S. stercoralis infection among the stool samples sent to Parasitology Laboratory FMUI and identify its association with the status of immunocompromised. A case-control study with consecutive sampling method was, conducted between March-June 2013. Subjects were the patients of hospitals/laboratory who sent their stool samples to the Parasitology laboratory of FMUI. All stools were examined through direct examination, followed by Harada-mori culture. The immune status of the patients was identified through their medical records. The total number of stools collected was 170 consisted of 108 males and 62 females. The age of the patients ranged from 2 to 80 years old (average 33.41±22.65 years); 18.2% (31/170) was immunocompromised and 81.8% (139/170) was immunocompetent. A total of 18/170 (10.6%) stools were positive of S. stercoralis larvae; 6 stools (19.4%, 6/31) were from the immunocompromised and 12 stools (8.6%, 12/139) originated from the immunocompetent. The result suggested that immunocompromised status has a positive relation towards S. stercoralis infection. Results from this study could serve as input for clinicians for better management of cases with diarrhoea, especially among the immunocompromised.

The secreted triose phosphate isomerase of Brugia malayi is required to sustain microfilaria production in vivo.

Human lymphatic filariasis is a major tropical disease transmitted through mosquito vectors which take up microfilarial larvae from the blood of infected subjects. Microfilariae are produced by long-lived adult parasites, which also release a suite of excretory-secretory products that have recently been subject to in-depth proteomic analysis. Surprisingly, the most abundant secreted protein of adult Brugia malayi is triose phosphate isomerase (TPI), a glycolytic enzyme usually associated with the cytosol. We now show that while TPI is a prominent target of the antibody response to infection, there is little antibody-mediated inhibition of catalytic activity by polyclonal sera. We generated a panel of twenty-three anti-TPI monoclonal antibodies and found only two were able to block TPI enzymatic activity. Immunisation of jirds with B. malayi TPI, or mice with the homologous protein from the rodent filaria Litomosoides sigmodontis, failed to induce neutralising antibodies or protective immunity. In contrast, passive transfer of neutralising monoclonal antibody to mice prior to implantation with adult B. malayi resulted in 60-70% reductions in microfilarial levels in vivo and both oocyte and microfilarial production by individual adult females. The loss of fecundity was accompanied by reduced IFNγ expression by CD4⁺ T cells and a higher proportion of macrophages at the site of infection. Thus, enzymatically active TPI plays an important role in the transmission cycle of B. malayi filarial parasites and is identified as a potential target for immunological and pharmacological intervention against filarial infections.

Cryptosporidium species from human immunodeficiency-infected patients with chronic diarrhea in Jakarta, Indonesia.

PURPOSE: Cryptosporidium is an opportunistic parasite that manifests as chronic and severe diarrhea in the immune-compromised subject. We investigated the species of Cryptosporidium to understand the epidemiology, mode of transmission, response to treatment, and prevention. METHODS: Polymerase chain reaction/restriction fragment length polymorphism of the 18 S rRNA gene and sequencing were performed on 41 Cryptosporidium-positive stools from 36 patients with HIV AIDS, which comprised 36 pretreatment stools and 5 stools after treatment with Paromomycin. RESULTS: C. hominis, C. meleagridis, C. felis, and C. parvum were detected; 28 of 36 (77.7%) patients were infected with C. hominis and two (5.5%) patients with multiple species of Cryptosporidium. Treatment with Paromomycin resulted in different outcomes, perhaps because patients harbored other intestinal parasitic infections. CONCLUSIONS: Multiple infection with various Cryptosporidium species in the presence of other intestinal parasites occurs in patients with HIV AIDS suffering from chronic diarrhea who are severely immune-compromised. Common transmission of Cryptosporidium is anthroponotic.

Intestinal parasitic infection of immunocompromised children with diarrhoea: clinical profile and therapeutic response.

BACKGROUND: Parasitic gastrointestinal infections have been variably reported among immunocompromised adults while data on children have been limited. This prospective cross-sectional study aimed to assess the clinical profile of intestinal parasitic infections among immunocompromised children with diarrhoea and their treatment response. METHODOLOGY: Two freshly voided stool samples taken for two consecutive days were examined by direct and formalin-ether concentrated smears. Modified Ziehl-Neelsen staining was used to detect Cryptosporidium, Isospora belli, and Cyclospora cayetanensis. Blastocystis hominis was identified using in vitro culture. Subjects positive for stool parasite(s) received standard therapy according to the aetiology and were evaluated afterward. RESULTS: Forty-two subjects from Jakarta, Indonesia were included in this study, mostly aged one to five years (78%) and HIV infected (52%). Parasites were found in 24/42 (57%) subjects in which B. hominis comprised the largest proportion (23/24 = 96%). Cryptosporidium was identified in two subjects who were HIV infected with CD4 percentages of < 15%. No helminth infestations were found. Parasites were most frequently found in preschool age children (16/23), in those with recurrent or watery diarrhoea (23/24 and 14/18, respectively), and in HIV subjects not receiving antiretrovirals (16/22). Of 13 subjects evaluated for response to a 10-day metronidazole course for B. hominis infection, seven achieved clinical remission and nine had their parasites eradicated. CONCLUSIONS: The prevalence of intestinal parasitic infection in immunocompromised children with persistent and/or recurrent diarrhoea is moderately high and dominated by B. hominis infection. Clinical remission and parasite eradication can be achieved in B. hominis infection treated with metronidazole.

Most of the response elicited against Wolbachia surface protein in filarial nematode infection is due to the infective larval stage.

Immune responses to the intracellular Wolbachia bacteria of filarial nematodes are thought to contribute to the pathologic process of filarial infection. Here, we compare antibody responses of subjects living in an area where lymphatic filariasis is endemic with antibody responses elicited in a murine model of filarial infection, to provide evidence that the infective larval stage (L3), not adult nematodes, are the primary inducer of responses against Wolbachia. In human subjects, antibody responses to Brugia malayi Wolbachia surface protein (WSP) are most often correlated with antibody responses to the L3 stage of B. malayi. Analysis of anti-WSP responses induced in mice by different stages of the rodent filariae Litomosoides sigmodontis shows that the strongest anti-WSP response is elicited by the L3 stage. Although adult filarial nematode death may play a role in the generation of an anti-WSP response, it is the L3 stage that is the major source of immunogenic material, and incoming L3 provide a continual boosting of the anti-WSP response. Significant exposure to the endosymbiotic bacteria may occur earlier in nematode infection than previously thought, and the level of exposure to infective insect bites may be a key determinant of disease progression.