Clinical Presentation and Laboratory Features in Pediatric Typhoid Fever Patient Susceptibility to First-line Antibiotic Therapy

Background: RTyphoid fever remainsa serious health problem in the world. The main cause of this disease is Salmonella enterica serovar Typhi. These microbes have developed resistance to first-line antibiotics (chloramphenicol, ampicillin, and co-trimoksazol) since 1950. Clinical presentation and laboratory features conducted in children infected with resistant strains tend to be more severe. The objective of this study was to determine the differences of clinical presentation and laboratory features in pediatric typhoid fever patient susceptibility to first-line antibiotics.Methods: This was an analytical cross-sectional study of total 119 typhoid fever children with positive blood culture of Salmonella Typhi based on medical data in Department of Child Health Dr. Hasan Sadikin General Hospital, Bandung during 2008–2012. Inclusion criteria included 76 patients with age range 1–15 years old, given an antibiotic, and had susceptibility test done. Numerical variable was the duration of fever in patients after given an antibiotic. Categorical variable included hepatomegaly, diarrhea, platelet count at admission, and leukocyte count at admission. Data were analyzed using a Mann-Whitney and Chi-square test.Results: There was no statistically significant difference in the duration of fever, leucocyte count at admission, and thrombocyte count at admission between sensitive and resistant response to chloramphenicol, ampicillin, and co-trimoksazol (p>0.05). Leucocyte count at admission in children with sensitive and resistant strain to ampicillin almost showed a difference (p=0.07) but still not statistically significant difference.Conclusions: There is no difference of clinical presentation and laboratory features in pediatric typhoid fever patient susceptible to first-line antibiotics. [AMJ.2015;2(4):584–90] DOI: 10.15850/amj.v2n4.65

Validity of Immunoglobulin M Anti Salmonella typhi Serologic Test in Childhood Typhoid Fever

Background: Typhoid fever, which mostly affects children, remains a major health problem in developing countries. Early diagnosis will help the management and thus, reduce morbidity and mortality. However, a rapid diagnostic test that detects the presence of immunoglobulin M (IgM) directed towards Salmonella typhi (S. typhi) antigen remains controversial despite its popularity. This study was aimed to assess the validity of IgM anti S. typhi serologic test in childhood typhoid fever. Methods: This retrospective diagnostic test, used blood culture as gold standard. Forty-one typhoid fever children with fever of 1–14 days admitted to Dr. Hasan Sadikin General Hospital Bandung from 2013 to 2015 were recruited. Diagnosis of typhoid fever is made clinically. Data were analyzed by Receiver Operating Characteristic (ROC) curve and diagnostic test.Results: Forty one children diagnosed with typhoid fever, 37 were positive for IgM anti S. typhi, but only 18 were positive for S. typhi in blood culture. IgM anti S. typhi (cut-off ≥4) test had an Area Under the Curve (AUC) of 59%, sensitivity of 100% and specificity of 17.39%. IgM anti S. typhi with cut-off >8 showed the highest AUC with sensitivity of 55.56% and specificity of 73.68%.Conclusions: IgM anti S. typhi test of cut-off >8 performs better than cut-off ≥4 in terms of AUC..[AMJ.2017;4(1):138–42] DOI: 10.15850/amj.v4n1.103

Clinical Presentation and Laboratory Features in Pediatric Typhoid Fever Patient Susceptibility to First-line Antibiotic Therapy

Background: RTyphoid fever remainsa serious health problem in the world. The main cause of this disease is Salmonella enterica serovar Typhi. These microbes have developed resistance to first-line antibiotics (chloramphenicol, ampicillin, and co-trimoksazol) since 1950. Clinical presentation and laboratory features conducted in children infected with resistant strains tend to be more severe. The objective of this study was to determine the differences of clinical presentation and laboratory features in pediatric typhoid fever patient susceptibility to first-line antibiotics.Methods: This was an analytical cross-sectional study of total 119 typhoid fever children with positive blood culture of Salmonella Typhi based on medical data in Department of Child Health Dr. Hasan Sadikin General Hospital, Bandung during 2008–2012. Inclusion criteria included 76 patients with age range 1–15 years old, given an antibiotic, and had susceptibility test done. Numerical variable was the duration of fever in patients after given an antibiotic. Categorical variable included hepatomegaly, diarrhea, platelet count at admission, and leukocyte count at admission. Data were analyzed using a Mann-Whitney and Chi-square test.Results: There was no statistically significant difference in the duration of fever, leucocyte count at admission, and thrombocyte count at admission between sensitive and resistant response to chloramphenicol, ampicillin, and co-trimoksazol (p>0.05). Leucocyte count at admission in children with sensitive and resistant strain to ampicillin almost showed a difference (p=0.07) but still not statistically significant difference.Conclusions: There is no difference of clinical presentation and laboratory features in pediatric typhoid fever patient susceptible to first-line antibiotics. [AMJ.2015;2(4):584–90] DOI: 10.15850/amj.v2n4.65

Validity of Immunoglobulin M Anti Salmonella typhi Serologic Test in Childhood Typhoid Fever

Background: Typhoid fever, which mostly affects children, remains a major health problem in developing countries. Early diagnosis will help the management and thus, reduce morbidity and mortality. However, a rapid diagnostic test that detects the presence of immunoglobulin M (IgM) directed towards Salmonella typhi (S. typhi) antigen remains controversial despite its popularity. This study was aimed to assess the validity of IgM anti S. typhi serologic test in childhood typhoid fever. Methods: This retrospective diagnostic test, used blood culture as gold standard. Forty-one typhoid fever children with fever of 1–14 days admitted to Dr. Hasan Sadikin General Hospital Bandung from 2013 to 2015 were recruited. Diagnosis of typhoid fever is made clinically. Data were analyzed by Receiver Operating Characteristic (ROC) curve and diagnostic test.Results: Forty one children diagnosed with typhoid fever, 37 were positive for IgM anti S. typhi, but only 18 were positive for S. typhi in blood culture. IgM anti S. typhi (cut-off ≥4) test had an Area Under the Curve (AUC) of 59%, sensitivity of 100% and specificity of 17.39%. IgM anti S. typhi with cut-off >8 showed the highest AUC with sensitivity of 55.56% and specificity of 73.68%.Conclusions: IgM anti S. typhi test of cut-off >8 performs better than cut-off ≥4 in terms of AUC..[AMJ.2017;4(1):138–42] DOI: 10.15850/amj.v4n1.103

High ESAT-6 Expression in Granuloma Necrosis Type of Tuberculous Lymphadenitis

A granuloma is one of host cellular immune response form to intracellular and persistent pathogens, and result in the aggregation of several activated immune cells. Intracellular pathogens manipulate host immune responses to avoid immune reactions. M. tuberculosis is the intracellular and persister pathogen, which can stimulate granuloma formation. The formation this granulomas still have different opinions, whether it is the host's way to isolate M. tuberculosis, or how these pathogens are to escape immune responses. Early secretory antigenic target (ESAT)-6 is a typical secretory protein produced by the locus of the gene region of difference (RD)-1 M. tuberculosis. ESAT-6 plays a role in the immunopathogenesis of tuberculosis. This study aims to compare ESAT-6 antigen expression from M. tuberculosis between granulomas with necrosis and granulomas without necrosis. This study was an analytic observation study with a cross-sectional design. Forty-six lymph node paraffin blocks from tuberculous lymphadenitis patients in Department of Anatomical Pathology, Dr. Hasan Sadikin General Hospital, Bandung in 2017 were made in preparations and stained by hematoxylin eosin to assess the presence of necrosis in granulomas, immunohistochemical using ESAT-6 antibodies, then it was quantified using histoscore. Histoscore for ESAT-6 not normally distributed, so it uses Mann-Whitney test used. The results showed that there were 31 granulomas with necrosis (histoscore mean=27.6%) and 15 granulomas without necrosis (histoscore mean=15.1%), there was a significant difference with p<0.05 (p=0.03). The conclusion of this study there is a high histoscore ESAT-6 expression in granuloma type of necrosis tuberculous lymphadenitis.   EKPRESI ESAT-6 TINGGI PADA GRANULOMA LIMFADENITIS TUBERKULOSIS TIPE NEKROSIS Granuloma merupakan salah satu bentuk respons imun seluler pejamu terhadap patogen intraseluler. Patogen intraseluler memanipulasi respons imun pejamu untuk menghindari reaksi imun. M. tuberculosis adalah patogen intraseluler dan persister yang dapat menstimulasi pembentukan granuloma. Terbentuknya granuloma masih memberikan pendapat yang berbeda, apakah merupakan cara tubuh untuk mengisolasi M. tuberculosis atau cara patogen ini untuk menghindari respons imun. Early secretory antigenic target (ESAT)-6 adalah protein sekretori khas yang dihasilkan oleh lokus gen region of difference (RD)-1 M. tuberculosis. ESAT-6 berperan dalam imunopatogenesis tuberkulosis. Penelitian ini bertujuan menganalisis perbedaan ekspresi antigen ESAT-6 M. tuberculosis antara granuloma dengan nekrosis dan granuloma tanpa nekrosis. Penelitian ini merupakan penelitian observasi analitik dengan desain cross sectional. Blok parafin kelenjar getah bening didapat dari pasien yang didiagnosis limfadenitis tuberkulosis di Departemen Patologi Anatomi, RSUP Dr. Hasan Sadikin Bandung pada tahun 2017. Blok parafin tersebut dibuat blangko preparat dan diwarnai dengan hematoksilin eosin untuk menilai nekrosis pada granuloma serta imunohistokimia menggunakan antibodi ESAT-6. Kemudian, sediaan preparat imunohistokimia tersebut dikuantifikasi menggunakan metode histoscore sehingga didapatkan data berupa nilai skor dari pewarnaan ESAT-6. Selanjutnya, dilakukan uji beda antara histoscore granuloma dengan nekrosis dan granuloma tanpa nekrosis tersebut dianalisis karena nilai skor ESAT-6 berdistribusi tidak normal sehingga menggunakan uji Mann-Whitney. Hasil penelitian menunjukkan terdapat 31 granuloma dengan nekrosis (histoscore rerata=27,6%) dan 15 granuloma tanpa nekrosis (histoscore rerata=15,1%), serta terdapat perbedaan signifikan dengan p<0,05 (p=0,03). Simpulan, ekspresi ESAT-6 tinggi pada granuloma limfadenitis tuberkulosis dengan nekrosis

Demam Tifoid pada Anak Usia di bawah 5 Tahun di Bagian Ilmu Kesehatan Anak RS Hasan Sadikin, Bandung

Latar belakang: Di Indonesia demam tifoid bersifat endemik dan dari telaah kasus di beberapa rumah sakit, menunjukkan kecenderungan yang meningkat dari tahun ke tahun dengan rata-rata kesakitan 500/100.000 penduduk dan kematian 0,6 – 5,0 %. Penelitian mengenai demam tifoid pada kelompok usia < 5 tahun belum banyak dilaporkan. Tujuan: mengetahui gambaran klinis dan laboratoris demam tifoid pada anak usia kurang dari 5 tahun dan membandingkan dengan anak usia di atas 5 tahun (5-14 tahun). Metoda: penelitian non-eksperimental bersifat retrospektif. Subjek penelitian adalah pasien demam tifoid anak dengan konfirmasi biakan Salmonella. Data diambil dari catatan rekam medik pasien demam tifoid yang dirawat di Bagian Ilmu Kesehatan Anak FK Unpad/RSHS Bandung dari bulan Januari 1996 sampai dengan Desember 2003. Hasil: Selama kurun waktu 1996 - 2003 didapatkan kasus demam tifoid berusia < 5 tahun 108/256 (42,2%). Dengan rasio laki-laki dan perempuan 1 : 1,20. Selain keluhan demam, obstipasi dan diare merupakan gejala yang paling sering ditemukan. Bradikardi relatif, hepatomegali dan lidah tifoid merupakan pemeriksaan yang sering ditemukan selain demam. Lebih dari setengah pasien didapatkan anemia dan trombositopenia. Komplikasi terjadi pada 25% kasus, yaitu gangguan neuropsikiatrik, sepsis dan syok septik, miokarditis dan ileus. Satu pasien meninggal dengan penyebab kematian syok septik. Kesimpulan: insidens demam tifoid pada anak usia < 5 tahun cukup tinggi, insides semakin tinggi sesuai dengan bertambahnya usia. Tidak ada perbedaan yang bermakna dalam gambaran klinis, laboratoris dan komplikasi pada demam tifoid kelompok anak berumur 5 tahun

Clinical risk factors for dengue shock syndrome in children

Background Dengue shock syndrome (DSS) is a serious complication of dengue hemorrhagic fever (DHF) which may cause death in more than 50% cases if not treated properly and promptly. Clinical, viral, and epidemiological risk factors determine the occurrence of DSS. Identifying risk factors for the development of shock in patients with DHF can increase the awareness of clinicians to perform a close monitoring. Objective To determine the clinical risk factors for DSS. Methods This case control study was conducted on DHF and DSS patients admitted to the Department of Child Health, Medical School, University of Padjadjaran, Dr. Hasan Sadikin Hospital Bandung from January 2004 to December 2005. The subjects were patients aged less than 14 years who fulfilled WHO criteria (1997). The exclusion criteria were history of asthma, diabetes mellitus, sickle cell anemia, typhoid, sepsis, and measles. The risk factors for DSS were analyzed using chi-square test, calculation of odds ratio, and logistic regression analysis. Results Of 1,404 patients with suspected DHF, 600 met the study criteria; 200 patients of DSS and 400 patients of DHF as control group were identified. Univariate analysis showed that there was association between DSS and age 5-9 years (OR=1.67, 95%CI 1.08;2.58), overweight (OR=1.88, 95%CI 1.22;2.90), vomiting (OR=1.44, 95%CI 1.02;2.04), abdominal pain (OR=2.07, 95%CI 1.46;2.92), and severe bleeding (OR=13.6, 95%CI 5.96;31.03). By logistic regression analysis, it was found that age 5-9 years (OR=1.62, 95%CI=1.03–2.53), overweight (OR=1.97, 95%CI=1.29–3.08), and persistent abdominal pain (OR=2.08, 95%CI =1.44–2.99) were independent risk factors for DSS. Conclusion Age 5-9 years, overweight, and persistent abdominal pain are the risk factors for DSS

The inappropriate use of antibiotics in hospitalized dengue virus-infected children with presumed concurrent bacterial infection in teaching and private hospitals in Bandung, Indonesia.

BackgroundDengue virus infection (DVI) among children is a leading cause of hospitalization in endemic areas. Hospitalized patients are at risk of receiving unnecessary antibiotics.MethodsA retrospective medical review analysis study was conducted to evaluate the prevalence, indication, and choice of antibiotics given to hospitalized patients less than 15 years of age with DVI in two different hospital settings (teaching and private hospitals) in the Municipality of Bandung. Epidemiological, clinical, and laboratory data were obtained using a pre-tested standardized questionnaire from patients' medical records admitted from January 1 to December 31, 2015.ResultsThere were 537 (17.5%) out of 3078 cases who received antibiotics. Among 176 cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in 1 (0.6%) case and 6 (0.3%) cases. In private hospitals among 2902 cases, presumed bacterial URTI was found in 324 (11.2%) cases, typhoid fever in 188 (6.5%) cases and urinary tract infection (UTI) in 18 (0.6%) cases. The prevalence of URTI and typhoid fever were significantly lower in the teaching hospitals compared to the private hospitals (pConclusionThe use of antibiotics in private hospitals was inappropriate in most cases while the use of antibiotics in the teaching hospital was more accountable. This study indicated that interventions, such as the implementation of the antibiotics stewardship program, are needed especially in private hospitals to reduce inappropriate use of antibiotics

Hubungan Kadar Aspartat Aminotransferase (AST) dan Alanin Aminotransferase (ALT) Serum dengan Spektrum Klinis Infeksi Virus Dengue pada Anak

Latar belakang. Infeksi dengue memiliki spektrum klinis yang luas, yaitu dapat asimtomatis maupun bermanifestasi klinis sebagai demam dengue (DD), demam berdarah dengue (DBD) maupun sindrom syok dengue (SSD). Pada infeksi dengue didapatkan peningkatan kadar aspartat aminotransferase (AST) dan alanin aminotransferase (ALT) serum. Kadar AST dan ALT serum diduga berperan sebagai indikator tingkat keparahan penyakit. Tujuan. Mengetahui hubungan kadar AST dan ALT serum dengan spektrum klinis infeksi dengue pada anak. Metode. Penelitian observasional dengan rancangan cross sectional dilakukan pada 1 Maret-30 April 2007 di Bagian Ilmu Kesehatan Anak RS Dr. Hasan Sadikin Bandung. Subjek penelitian kasus infeksi dengue, berusia < 14 tahun secara berurutan memenuhi kriteria klinis DD, DBD, dan SSD menurut WHO (1997) yang disertai bukti serologis infeksi dengue. Uji ANOVA digunakan untuk menilai hubungan kadar AST dan ALT serum dengan spektrum klinis infeksi dengue pada anak. Kemaknaan ditentukan berdasarkan nilai p<0,05. Seluruh perhitungan statistik dikerjakan dengan piranti lunak SPSS versi 13,0 for Windows. Hasil. Terdapat 60 subjek penelitian terdiri dari 25 (41,7%) laki-laki dan 35 (58,3%) perempuan, dengan usia termuda 6 bulan dan tertua 14 tahun. Berdasarkan spektrum klinis subjek terdiri dari kelompok DD 17 (28,3%), DBD 21 (35%), dan SSD 22 (36,3%) anak. Nilai rerata AST pada DD 63,2±6,6, DBD 267,5±116,1, SSD 1491,5±492,4. Nilai rerata ALT pada DD 29,4±2,4, DBD 78,0±25,3, SSD 435,0±122,1. Hasil uji ANOVA menunjukkan terdapat hubungan kadar AST dan ALT serum dengan spektrum klinis infeksi dengue pada anak (F=6,018; p=0,000). Kesimpulan. Pada anak dengan infeksi dengue semakin tinggi kadar AST dan ALT serum, semakin berat derajat penyaki