First-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae in Indonesia

Background Diphtheria has been reported as an outbreak in some regions in Indonesia, most especially in East Java Province. Resistance to penicillin, erythromycin, and other antibiotics, single or multiple, has been reported in several studies. This study aims to evaluate the first-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae isolates. Methods This descriptive observational study was performed from August to November 2018. C. diphtheriae isolates were collected from diphtheria patients and carriers in East Java from 2012 to 2017 and kept at the Balai Besar Laboratorium Kesehatan Daerah Surabaya or the Public Health Laboratory of Surabaya. Sample selection was done by random cluster sampling. The sensitivity test by E-test®of the five antibiotics (penicillin, oxacillin, erythromycin, azithromycin, and clarithromycin) was done to determine the minimum inhibitory concentration (MIC). The Clinical and Laboratory Standards Institute M45A (2015) Corynebacterium spp. for penicillin and erythromycin was used as standard. Results From 114 targeted isolates, 108 were viable and toxigenic. The E-test was performed on the viable isolates. The majority of the hosts were male (58.3%), with median (range) age of 6.5 (1–14) years. Half of the samples were from the 1 to 5-year-old age group. The isolates were acquired much more from patients (78.7%) than carriers (21.3%) and from pharyngeal swab (74.1%). Most of these isolates were from Madura Island (47.2%) and the northern and eastern parts of the province (horseshoe area). Mitis isolates were the major variant (76.9%). The susceptibility pattern of C. diphtheriae to erythromycin was better than that to penicillin. The E-test result for penicillin was 68.52% susceptible, 31.48% intermediate, and 0% resistant (MIC range,  256 μg/L) was 85.2% susceptible, 12% intermediate, and 2.8% resistant The MIC range for oxacillin was 1 to 96 μg/L, while for both azithromycin and clarithromycin were  256 μg/L. Conclusion The susceptibility rate of C. diphtheriae to erythromycin is higher than that to penicillin. The regular update of antibiotic selection to the national guidelines is recommended. The MIC reference standard to azithromycin and clarithromycin is also needed

OPTIMASI PRODUKSI BIOETANOL DARI TEPUNG GARUT (Maranta arundinacea Linn.) DENGAN VARIASI pH, KADAR PATI DAN SUMBER KHAMIR KOMERSIAL

Krisis sumberdaya minyak yang tidak dapat diperbaharui akibat eksploitasi berlebihan medorong terciptanya bahan bakar alternatif dari sumber hayati yang dapat diperbaharui, diantaranya adalah bioetanol. Tepung garut mengandung amilosa sebesar 29,03 -31,34% dapat digunakan sebagai bahan penghasil bioetanol. Penelitian ini bertujuan mengetahui suhu dan kadar pati optimum dalam menghasilkan gula reduksi tertinggi dengan menggunakan enzim glukoamilase pada tahap sakarifikasi. Penelitian ini juga bertujuan mengetahui kemampuan khamir komersial Fermipan, Mauripan dan Saft-instant yang paling efektif dalam menghasilkan bioetanol. Penelitian ini terdiri atas 2 tahap. Tahap pertama adalah sakarifikasi tepung garut dengan menggunakan enzim glukoamilase 0,3% (b/v) dengan variasi perlakuan kadar pati 1, 2, dan 3% (b/v), dan perlakuan pH 5,8, 6,2, 6,6, dan 7. Tahap kedua adalah fermentasi bioetanol oleh Saccharomyces cerevisiae dengan variasi sumber khamir komersial Fermipan, Mauripan, dan Saft-instant menggunakan medium hasil sakarifikasi dengan hasil gula reduksi yang paling optimum. Parameter yang diukur pada tahap sakarifikasi adalah kadar gula reduksi, dan pH medium. Parameter yang diukur pada tahap fermentasi bioetanol adalah kadar gula reduksi, pH, dan jumlah sel Saccharomyces cerevisiae. Rancangan percobaan acak lengkap pola faktorial digunakan pada kedua tahap penelitian ini. Analisis beda nyata dilakukan menggunakan SPSS versi 17 pada tingkat kepercayaan 95% dilanjutkan Uji Duncan. Hasil penelitian diperoleh kadar pati 2% pada pH 7 diketahui paling optimum dalam menghasilkan kadar gula reduksi, yaitu 0,487 mg/ml pada jam ke- 6. Khamir komersial yang paling efektif dalam fermentasi adalah Fermipan, menghasilkan kadar bioetanol tertinggi yaitu 2,042 % selama 96 jam inkubasi dengan efisiensi fermentasi 8,24

Profil Isolat Corynebacterium diphtheriae Toksigenik di Jawa Timur Tahun 2012-2017

Pendahuluan: Penyakit difteri telah ditetapkan menjadi kejadian luar biasa di berbagai wilayah di Indonesia, sebagian besar kasus berasal dari Jawa Timur. Tujuan: Mengetahui profil isolat Corynebacteriumdiphtheriaetoksigenik di Jawa Timur. Metode. Penelitian deskriptif, dilakukan 20 Agustus sampai 30 November 2018. Isolat yang diteliti dipilih secara cluster random sampling kemudian dilakukan uji viabilitas dan toksigenisitas di BBLK Surabaya. Isolat yang viabel dan toksigenik dilakukan analisis karakteristik. Hasil: Penelitian ini melibatkan 114 isolat, 6 tidak viabel, 108 viabel dan toksigenik. Jenis kelamin pejamu ialah 58,3% laki-laki, 41,7% perempuan. Usia median 6,5 tahun (termuda 1 tahun, tertua 14 tahun). Mayoritas pada kelompok usia 1-5 tahun (50%) disusul 6-10 tahun (30,6%) dan 11-15 tahun (19,4%). Wilayah asal isolat didominasi dari Madura (47,2%) dan Jawa Timur tapal kuda (32,4%), sedangkan Jawa Timur bukan tapal kuda hanya 20,4%. Lokasi pengambilan sampel 74,1% dari usap tenggorok dan 25,4% dari usap hidung. Varian mitis mendominasi sejumlah 76,9%, sedangkan varian gravis hanya 23,1%. Kesimpulan: Isolat Corynebacterium diphtheriae toksigenik terbanyak didapatkan pada pejamu kelompok usia 1-5 tahun, mayoritas berdomisili di Madura dan Jawa Timur tapal kuda. Isolat terutama didapat dari usap tenggorok pasien. Varian mitis mendominasi dalam penelitian ini

THE ANTIDIPHTHERIA ANTIBODIES OF SEROEPIDEMIOLOGY SURVEY AMONG ADOLESCENTS IN BANGKALAN AND KEDIRI DISTRICTS

Background: An increase in diphtheria cases has occurred in East Java Province since 2011. The resistance level to diphtheria is considered as the most important cause. Purpose: The study aims analyzed the immunity level immunity to diphtheria in adolescents aged 16-18 years old in Bangkalan and Kediri Districts. Methods: This study was a cross-sectional study, conducted on students in eleven grade of senior high schools (SMAN) from both districts. The inclusion criteria included being 16-18 years old and students in eleven grades of senior high schools in Bangkalan and Kediri. This study was approved by their parents/guardians. The exclusion criteria included immunocompromised students and those who have a history of diphtheria infection. The data were obtained from 204 samples, 89 samples in Bangkalan, and 115 samples in Kediri. The antidiphtheria antibodies examination was carried out by the Vero cell method. The antibodies levels were grouped according to WHO standard, consist of vulnerable, basic, full, and long-term. Further analysis was done with 2 tiers of immunity, consist of immune and vulnerable. Results: The immunization coverage for basic and booster diphtheria vaccine is better in Kediri than in Bangkalan. In contrast, levels of antibodies samples in Bangkalan District is better. The participants who were immune in Bangkalan were higher than those in Kediri (91% vs. 44.3%). Conclusion: The immunity adolescents of Bangkalan is higher than in adolescent Kediri District. The adolescents in Kediri have a greater risk to get infected by the diseas