Cryptococcal Meningitis among AIDS Patients in Jakarta

Abstract Cryptococcosis is a common opportunistics infections in AIDS and caused by the encapsulated yeast Cryptococcus neoformans. The predominant clinical manifestation in AIDS patients is meningitis. For the establishment of diagnosis, India ink test and culture were done. Serology test to detect capsular antigen glucoronoxylomannan (GXM) was done to support the diagnosis of cryptococcosis. The aim of this study is to know the prevalence of cryptococcosis among AIDS patients with CNS involvement in Jakarta and its surrounding places. The study was conducted from 2005 – 2007 at the Mycology laboratory Department of Parasitology, University of Indonesia, Faculty of Medicine. Spinal fluid from 154 AIDS patients with CNS involvement from Cipto Mangunkusumo hospital and other hospitals around Jakarta were tested using India ink test and cultured on sabouraud dextrose agar (SDA) and bird seed agar (BSA) and 48 were tested by latex agglutination test to detect GXM antigen. Out of 154 spinal fluids tested by india ink and culture, 32 (20,77%) samples contained Cryptococcus. GXM antigen was detected in 29 out of 48 samples. From 29 samples with GXM antigen, eight samples were also positive after mycology examination. The prevalence of cryptococcosis among AIDS patients with CNS involvement in Jakarta is 20.77%. Key words: spinal fluid, Cryptococcus neformans, prevalence, GXM antigen Abstrak Kriptokokosis yang disebabkan oleh khamir Cryptococcus neoformans merupakan infeksi oportunistik pada AIDS, dan meningitis adalah manifestasi klinis yang paling sering ditemukan. Untuk menegakkan diagnosis digunakan pemeriksaan tinta India dan kultur pada media agar. Uji serologi untuk deteksi antigen kapsular glucoronoxylomannan (GXM) dapat digunakan untuk mendukung penegakan diagnosis. Penelitian ini bertujuan untuk mengetahui prevalensi kriptokokosis pada penderita AIDS dengan gangguan serebral yang dilaksanakan sepanjang April 2005 – February 2007. Sebanyak 154 cairan otak penderita AIDS dari daerah Jakarta dan sekitarnya diperiksa dengan sediaan tinta India, dan kultur pada agar sabouraud dekstrose (ASD) dan bird seed agar (BSA). Dari 154 sampel, hanya 48 sampel yang menjalani pemeriksaan antigen GXM dengan metode agglutinasi lateks. Dari 154 cairan otak yang diperiksa dengan tinta india dan kultur 21 (20,77%) sampel mengandung Cryptococcus. Antigen GXM terdeteksi pada 29 dari 48 sampel. Dari 29 sampel yang positif antigen GXM, delapan positif mengandung Cryptococcus. Prevalensi kriptokokosis pada penderita AIDS dengan gangguan SSP di Jakarta sebesar 20,77%. Kata kunci: cairan otak, Cryptococcus neformans, prevalensi, antigen GX

HIV-Associated Sensory Neuropathy

As advances in the treatment of HIV are now allowing patients a longer life span, further comorbidities become apparent. This includes sensory neuropathy (HIV-SN) which can affect a patient’s quality of life. Here, we review factors influencing HIV-SN in patients receiving antiretroviral therapy that promotes this condition and in the modern era when these therapies have been withdrawn. This has halved the incidence of HIV-SN, but the condition remains significant in the lives of many sufferers. Genetic polymorphisms that influence pathogenesis of HIV-SN have indicated likely mechanisms, but studies of skin biopsies and animal models are needed to confirm the roles of the encoded proteins

INTEGRATED DEVELOPMENT OF AGRICULTURE DISTRICT PINRANG REGENCY SOUTH SULAWESI

Abstract: This study aims to determine the area of integration of agricultural development strategy developed by the community in Pinrang Regency through the optimization of its potential. This study is a qualitative study using a phenomenological approach. Based on the type of research data source of this research is the head of Planning Agency, and the Department of Agriculture and Animal Husbandry Pinrang. The focus of this research is the development strategy of the measured area of agricultural integration of processing and utilization of agricultural waste, and increase the income and food security. Data collection techniques performed using individual interviews. Partcipant observation, and documentation. Data validation techniques through triangulation consisting of transferability. Dependability, and confirmability. Data pbtained from interviews with informants, and the results were analyzed in a structured observation from data collection, data reduction, the categorization of data interpretation and meaning of data. Presenting Datain an organized and systematic, then do inference. Keywords : Public Administration, Public Policy, Management Strategy, Development Zone

THE ENVIRONMENTAL BEHAVIOR OF COMMUNITY AT UPSTREAM MAROS CATCHMENT AREA

Abstract: The purpose of this study is to examine and to analyze the ecosystem knowledge, conservation knowledge, and pollution knowledge that have effect on the community attitudes in preserving the environment, toward the community behavior at the upstream Maros catchment area This study used a quantitative approach and survey method with a questionnaire instrument. The instruments used were developed by researchers, including: questionnaire of environmental behavior and attitudes, test of knowledge ecosystems; conservation knowledge and pollution knowledge the model that used for this study is Structural Equation Model to understand the relationship of all variables. The results show that the ecosystem knowledge variables (X1), conservation knowledge (X2), and pollution knowledge (X3) have direct and significant impact on environmental attitudes (X4). Moreover, the conservation knowledge variable (X2), pollution knowledge (X3), is also has direct and significant impact on people’s behavior (Y). Meanwhile the ecosystem knowledge variables (X1) has no direct effect on the community behavior and no significant impact on environment aspect, it represents a significant value of p – value> 0.05

PKM PELATIHAN PENGEMBANGAN MEDIA PEMBELAJARAN INTERAKTIF UNTUK GURU-GURU DI PONDOK PESANTREN SYEKH HASAN YAMANI KABUPATEN POLEWALI MANDAR

PKM PELATIHAN PENGEMBANGAN MEDIA PEMBELAJARAN INTERAKTIF UNTUK GURU-GURU DI PONDOK PESANTREN SYEKH HASAN YAMANI KABUPATEN POLEWALI MANDA

Diagnosis Kriptokokosis Meningeal pada Penderita AIDS dengan Deteksi Antigen Glucuronoxylomanan pada Cairan Otak

AbstrakKriptokokosis meningeal karena ragi berkapsul Cryptococcus sering didapatkan pada penderita AIDS dan menyebabkan kecacatan dan kematian. Diagnosis dini yang diharapkan dapat diatasi dengan diagnosis pemeriksaan tinta India yang rendah dan kultur yang perlu 5-7 hari. Sebagai alternatif, WHO merekomendasikan deteksi antigen dengan cara uji aglutinasi lateks untuk deteksi antigen glucuronoxylomanan (GXM) dan lateral flow asay yang mendeteksi kompleks antigen Cryptococcus sp. Mengingat antigen GXM juga dapat ditemukan pada orang sehat, perlu ditetapkan nilai batas (cut off) yang untuk mendiagnosis kriptokokosis klinis. Pada penelitian ini, nilai cut off GXM dicari dengan memeriksa cairan otak yang tidak diencerkan, diencerkan 100×, 300×, dan 500× dengan menggunakan metoda aglutinasi lateks (PASTOREX TM CRYPTO PLUS 61747 (kat. 7EM2093, Bio-Rad Perancis). Tiap dilusi dihitung sensitivitas, spesifisitas, NPP, NPN, dan nilai kappa untuk menilai kesetaraan antara metode uji dengan baku emas (tinta india dan kultur) serta uji McNemar untuk mengetahui perbedaan antara metode uji dan baku emas. Receiver operating characteristics (ROC) curve dinilai untuk mengetahui kombinasi terbaik sensitivitas dan spesifisitas. Deteksi antigen GXM pada cairan otak menunjukkan sensitivitas dan spesifisitas yang bervariasi pada dilusi yang berbeda. Sensitivitas terbaik didapatkan pada LCS yang tidak diencerkan, namun spesifisitas terbaik ditemukan pada dilusi 500× (100%) disusul oleh dilusi 300× (98,1%). Secara keseluruhan berdasarkan sensitivitas, spesifisitas, NPP, NPN, nilai kappa dan nilai ROC, dilusi 300× merupakan dilusi terbaik. Uji McNemar memperlihatkan tidak ada perbedaan antara metode uji dan baku emas. Dilusi cairan otak 300× merupakan nilai cut off deteksi GXM untuk menegakkan diagnosis kriptokokosis meningeal. Kata kunci: Cryptococcus neoformans, meningitis, diagnosis AbstractMeningeal cryptococcosis is caused by encapsulated yeast Cryptococcus. This infection has a high morbidity and mortality rate. Early diagnosis is one of the keys to reduce morbidity and mortality. India ink examination is hampered by its low sensitivity, while culture is time consuming. WHO recommends antigen detection methods as an alternative, i.e. latex aglutination for Glucuronoxylomannan (GXM) and lateral flow assay (LFA) for antigen complex for Cryptococcus. Since GXM antigen is also found in healthy people, cut off value for clinical cryptococcosis needs to be established. In this studi, the GXM antigen detection was conducted by latex agglutination test (PASTOREXTM CRYPTO PLUS 61747 kat. 7EM2093, Bio-Rad, France). To establish the cut off value, a neat concentration, as well as 100, 300 and 500 times dilution of spinal fluids were tested. Sensitivity, specificity, PPV, NPV and kappa value for each dilution were calculated against the gold standard (india ink examination and culture). McNemar test was performed to evaluate the difference between the test and the gold standard. Receiver operating characteristics(ROC) curve was used to determine the best combination of sensitivity and specificity. GXM antigen detection on spinal fluid showed variation of sensitivity and specificity in different dilutions. The neat solution gave the best sensitivity, while the best specificity was shown by 500× dilution (100%) and then followed by 300× dilution (98,1%). Overall, 300× dilution gave the best combination of sensitivity, specificity, PPV, NPV, (p=0,07). In conclusion, 300× dilution of spinal fluid is the best cut off value for GXM detection for diagnosing meningeal cryptococcosis. Key words: Cryptococcus neoformans, meningitis, diagnosis &nbsp

Neuromyelitis optic with positive Anti-AQP4 and Anti-SSA/Ro antibody

Neuromyelitis Optic (NMO) is an inflammatory disorder involving central nervous system which often co-exists with other autoimmune diseases such as Sjögren’s syndrome (SS). NMO manifestation could precede or follow SS, but the role of anti-SSA in the pathogenesis of NMO remains unclear. We present a case of NMO with anti-AQP4 anti-SSA antibody positive. A-44-year-old female presented with right side weakness. The symptoms began with numbness that improved spontaneously. She also complained pain and dry sensations on her eyes. Schirmer test on her left eye, antinuclear antibody (ANA) and anti- SSA antibody were positive. Cervical MRI revealed intramedullary lesion on T2- weighted-image at C2-C5 level. She was diagnosed as NMO with positive anti- AQP4 and probable SS. She received 1g methylprednisolone for 5 days proceeded with mycophenolic acid. One-year observation showed clinical improvement. Systemic autoantibodies must substantially be evaluated in NMO. Comprehensive diagnosis and providing appropriate immunosuppressant might prevent further disability and relapse

Adjunctive dexamethasone for tuberculous meningitis in HIV-positive adult

BACKGROUND Adjunctive glucocorticoids are widely used to treat human immunodeficiency virus (HIV)–associated tuberculous meningitis despite limited data supporting their safety and efficacy. METHODS We conducted a double-blind, randomized, placebo-controlled trial involving HIV-positive adults (≥18 years of age) with tuberculous meningitis in Vietnam and Indonesia. Participants were randomly assigned to receive a 6-to-8-week tapering course of either dexamethasone or placebo in addition to 12 months of antituberculosis chemotherapy. The primary end point was death from any cause during the 12 months after randomization. RESULTS A total of 520 adults were randomly assigned to receive either dexamethasone (263 participants) or placebo (257 participants). The median age was 36 years; 255 of 520 participants (49.0%) had never received antiretroviral therapy, and 251 of 484 participants (51.9%) with available data had a baseline CD4 count of 50 cells per cubic millimeter or less. Six participants withdrew from the trial, and five were lost to follow-up. During the 12 months of follow-up, death occurred in 116 of 263 participants (44.1%) in the dexamethasone group and in 126 of 257 participants (49.0%) in the placebo group (hazard ratio, 0.85; 95% confidence interval, 0.66 to 1.10; P=0.22). Prespecified analyses did not reveal a subgroup that clearly benefited from dexamethasone. The incidence of secondary end-point events, including cases of immune reconstitution inflammatory syndrome during the first 6 months, was similar in the two trial groups. The numbers of participants with at least one serious adverse event were similar in the dexamethasone group (192 of 263 participants [73.0%]) and the placebo group (194 of 257 participants [75.5%]) (P=0.52). CONCLUSIONS Among HIV-positive adults with tuberculous meningitis, adjunctive dexamethasone, as compared with placebo, did not confer a benefit with respect to survival or any secondary end point. (Funded by the Wellcome Trust; ACT HIV ClinicalTrials.gov number, NCT03092817. opens in new tab.

Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients

Systemic fungal infection can disseminate to the skin and require prompt treatment, making early diagnosis very important. This study describes the use of a simple, quick touch biopsy method for the diagnosis of invasive mycoses in patients with AIDS with cutaneous manifestations. We identified fungal infections in 24 of the 29 investigated patients. Histoplasma capsulatum, Cryptococcus neoformans, Talaromyces artroroseus, Aspergillus flavus, Candida tropicalis, and Malassezia sp. were visualized directly in samples obtained from cutaneous lesions and confirmed by culture and molecular examination. The results suggested that touch biopsy is a simple, rapid method for the diagnosis of systemic mycoses with skin dissemination. It can be performed using simple tools and provides quick results, allowing for early intervention with appropriate antifungal therapy

Barriers to diagnosis and management of CNS infections in Indonesia

Little is known about the management and outcome of CNS infections in Indonesia (population: approximately 261 million), and the burden of CNS infections is increasing as result of a rapidly growing HIV epidemic. Indeed, in a recent study in Jakarta,1 54% of patients with a CNS infection were HIV-infected, vs 25% in a similar study conducted in Bandung, the second largest city on Java.2 Establishing the etiology of CNS infections is important for clinical management and outcome, but anecdotal evidence suggests that there are major gaps in clinical management, including a failure to recognize CNS infections, perform appropriate diagnostics, or initiate necessary drug treatment. In this study, we address some of these barriers by interviewing a group of Indonesian neurologists