Kinetics of CD69 Expression on Natural Killer Cells During Acute Phase of Dengue Infection`

ABSTRACTIntroduction: Dengue infection is major annual public health problem in Indonesia. NK cells have a role in cellular immunity to viral infection, however only a few studies of NK cells and were conducted in vivo especially in Indonesia.Objectives: To explore the kinetics of CD 69 expression on NK cells during the acute phase of dengue infection.Methods: Observational cohort study in Dr. Sardjito Hospital was conducted. Clinical data and laboratory data was collected to measure the number of activated NK cells (CD69) using flowcytometry. The percentage of CD69 then calculated using non- parametric test (Kuskal-Wallis Test) and Student t-test. The fluorescence intensity of CD69 was also analyzed.Results: The mean of activated NK cells (CD69) percentage was higher during the early days of acute phase (day 2 to day3), and continuously declined until the seventh day but statistically they were not significant. Fluorescence intensity of CD69 showed its peak during the fifth day of fever.Conclusion: CD69 expression on activated NK cells were increased during the early days (day 2-day 3) of acute fever but decreased after that (day 4-day 7). The highest intensity of CD69 expression was on the fifth day of fever. Keywords: Dengue infection, kinetics, NK cell, CD69, cellular immune response, acute phase, adults

The Kinetics of CD8+ T Lymphocytes in Dengue Patients in Yogyakarta

ABSTRACTIntroduction: Dengue    fever can be graded into dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The CD8+ T lymphocytes mediate antiviral activity by producing cytokines and directly destroyed the dengue virus infected cells. This study focuses in observing the kinetics of CD8+ T lymphocytes absolute and relative count in dengue patients.Objectives: To observe the kinetics of CD8+ T lymphocytes absolute and relative              count in dengue patients.Methods: The research design used is a descriptive study. This research measures and observes the kinetics CD8+ T lymphocytes absolute and relative count from day 2 to day 7. The CD8+ T lymphocytes count was determined using flowcytometry. Data was analyzed using ANOVA and independent t test with p<0.05 considered as significant.Results: The CD8+ T lymphocytes absolute count is low during the beginning of disease course and it gradually increases from day 2 to day 7. The CD8+ T lymphocytes relative count decreases from day 2 to day 3, and start to increase back from day 3 to day 7. There is no difference between the level of CD8+ T lymphocytes absolute count and relative count between DF and DHF patients.Conclusion: There is an increase in CD8+ T lymphocytes absolute count and relative count in dengue patients. There is no difference between DF and DHF patients in CD8+ T lymphocytes absolute and relative count. Keywords: dengue fever; dengue hemorrhagic fever; CD8+ T lymphocytes; absolute count; relative count

THE KINETIC OF ACTIVATED MONOCYTES IN ACUTE PHASE DENGUE INFECTION

Introductions: Nowadays dengue infection is at present one of the most common mosquito-borne viral diseases of humans worldwide. Initially, Dengue infections were primarily recorded when they occurred as epidemics in tropical and subtropical countries. Monocyte/macrophage infection is central to the pathogenesis of dengue fever and to the origin of dengue hemorrhagic fever. Increased activation of monocytes and greater numbers of DEN-infected cells were associated with more severe Dengue, implicating a role for monocyte activation in dengue immunopathogenesis. Thus, more knowledge about the relation between numbers of activated monocyte with dengue severities is essential for better understanding regarding this subject.Objectives: Studying the relation between numbers of activated monocyte, marked by HLA-DR marker intensity with Dengue Fever severity throughout the disease course, from day 2 until day 6 of acute dengue fever.Methods: This research is cross sectional observational study. The location in done at Dr. Sardjito Hospital in 6 months time.Results: There is a negative correlation between median number of activated monocyte with dengue severity, on day 3 of acute dengue fever.Conclusion: There was a negative correlation between numbers of activated monocyte marked by HLADR intensity with disease severity on day 3 of acute dengue infection.Keywords: Activated Monocyte; Human Leukocyte Antigen (HLA)-DR intensity; Percentage of Activated Monocyte; Dengue Fever Severity

Peranan Laboratorium dalam Prevention of Mother to Child Transmission (PMTCT) HIV

Human Immunodeficiency Virus (HIV) adalah retrovirus RNA yang dapat menyebabkan penyakit klinis, yaitu Acquired Immunodeficiency Syndrome (AIDS). Transmisi virus dari ibu ke anak (mother to child transmission/MTCT) dapat terjadi melalui darah maternal, sekresi saluran genital, dan ASI. Risiko penularan HIV dari ibu ke bayi dapat ditekan hingga 2% dengan program PMTCT. Tulisan ini bertujuan untuk memaparkan tentang peran laboratorium dalam mendukung program PMTCT HIV. Dalam hal ini laboratorium memegang peranan yang penting dalam mendeteksi HIV secara dini dan diikuti dengan evaluasi. Untuk menentukan bayi tidak mengidap HIV, diperlukan minimal dua kali pemeriksaan polymerase chain reaction (PCR) RNA HIV dengan hasil negatif, yaitu pada usia 4-6 minggu dan pada usia 4-6 bulan. Pada saat bayi berusia 18 bulan dilakukan pemeriksaan antibodi terhadap HIV dengan cara Enzyme-linked Immunosorbent Assay (ELISA) untuk konfirmasi. Laboratorium memegang peranan penting dalam melakukan deteksi dini HIV serta membantu dalam proses follow up sehingga dapat mendukung program PMTCT.                                                                        Kata kunci: PMTCT, HIV, PCR, ELISA   [Laboratory Role In The Prevention of Mother to Child Transmission (PMTCT) of HIV]The Human Immunodeficiency Virus (HIV) is a RNA retrovirus which causes the clinical disease termed the acquired immunodeficiency syndrome (AIDS). Mother-to-child transmission (MTCT) may occurred because of the intrapartum maternal blood exposure, infected genital tract secretions and during breastfeeding. The aim of this paper is to explain the role of laboratory to support PMTCT program. Laboratory plays an important role in PMTCT, that given the starting point of PMTCT is early detection of HIV and followed by evaluation. To determine the baby does not have HIV, it takes at least two times the HIV RNA PCR with negative results, (at 4-6 weeks of age and at the age of 4-6 months). And then infants examined for HIV antibodies by Enzyme-linked Immunosorbent Assay (ELISA) for confirmation at 18-month-old. Laboratory has an important role to support diagnose of HIV and their follow up, so it can be support PMTCT program.Keywords: PMTCT, HIV, PCR, ELIS

The Kinetics of White Blood Cells in Acute Dengue Infection

ABSTRACTIntroduction: Dengue is a mosquito borne viral febrile illness with a high incidence rate of approximately 50 million cases of infection world wide every year. Dengue virus can infect many cells, e.g. monocytes, dendritic cells, Kuppfer cells, B cells including bone marrow and lung. Leukocytes plays an important roles in eliminating dengue virus especially monocytes. However, dengue virus sometimes attack the monocytes and uses them for replication causing monocyte to unde go apoptosis in order to prevent spreading by certain mechanisms.Objectives: To explore the difference in white blood cells count in acute dengue patients from day 2 to day 6.Methods: This research is conducted in a cross sectional observational study method by recording the WBC count, Lymphocytes count, Neutrophils Count, Relative Monocytes Count, and Absolute Monocytes Count from NS-1 positive dengue infection patient using the hematology analyzer. The data was taken from day 2 to day 6 of the fever. One-way ANOVA test was used and a p value <0.05 was considered as significant.Results: In this study, there is a significant difference of leukocyte count, relative and absolute lymphocytes count, relative and absolute neutrophils count, and relative and absolute monocytes count from day 2 to day 6 of dengue infection (p value less than 0.05).Conclusion: Dengue patient have leucopenia on day 2 until day 6 of dengue fever. Lymphocytosis occurs on day 6 of dengue fever. Neutrophils decrease in early infection. Monocytes count is normal in dengue fever, but decrease in DHFKeywords: dengue in fection, leukocyte, lymphocytes, neutrophils, monocyte

Number of natural killer cells and cytokine levels in peripheral blood at various degrees of severity

This study aims to investigate NK cell number and cytokines level in various degrees of severity in COVID-19 cases. A total of 63 COVID-19 patient aged >18 y were divided into mild-moderate and severe-critical groups. Patient characteristics and peripheral blood count were obtained from medical records. NK cells number, levels of IFN-?, IL-10, and IL-12 in peripheral blood were examined by means of flow cytometry. The severe-critical group had leukocytosis, neutrophilia, lymphopenia, higher Neutrophil Lymphocyte Ratio, lower NK cell number and higher level of IL-10. In severe-critical group, those aged >60 years had higher IL-10. In both groups, patients with diabetes comorbidities had a higher number of NK cells (p<0.05). NK cell number and IL-10 in peripheral blood have potential as a predictor of severe COVID-19 patients

The HLA-DR Expression on Monocytes in Acute Dengue Infection

Introduction: Dengue is the most common disease of mosquito-borne infection. According to the World Health Organization, it is estimated that 50 million cases ofdengue infection have been reported annually. Macrophages andmonocyte are thought to play an important role in dengue infection both as primary targets of viral infection and as a source of immunomodulatory cytokines.Whenmonocytes are infectedby dengue viruses, it processed the virus by lyses it and expressed the antigen on its surfacemembrane bind together with HLA class II molecules. HLA-DR-expressing monocytes in acute dengue patientsespecially the intensity is still poorly understood.Measurement of at difference days of infectionwill give an evidence about the role ofmonocytes in dengue pathogenesisObjectives: To observe the kinetics on percentage of HLA-DR expressingmonocytes and themedian of HLA-DR expression intensity in acute dengue infection.Methods: This researchwas an observational type study conducted by cross sectionalmethod towards all the dengue patients in Dr. Sardjito’s General Hospital. Blood samples were drawn from 32 acute dengue infected patients from Day 1 to Day 6th. The HLA-DR expression was measured flow cytometrically using FACS Calibur.Results: The data showed that the mean difference in acute dengue infection from Day 1 to Day 6 is not significant with the p-value larger than 0.05, (p>0.05).Conclusion: The peak level of activated HLA-DR monocyte was at day 2 and then decreasing until day 6. There were no significant changes in percentage of HLA-DR-expressing monocytes from the day 1 to the day 6 and the median intensity of HLA-DR expression in acute dengue infection.Keywords HLA-DR-expressing monocytes, Acute Dengue Infectio

High-sensitivity C-reactive protein/albumin (hs-CRP/albumin) ratio as a predictor of deterioration of clinical outcome in central nervous system infections

Central nervous system (CNS) infections such as encephalitis, meningitis, or myelitis have high morbidity and mortality in Indonesia. High sensitivity C-reactive protein (hs-CRP) is a sensitive marker of acute inflammation, while albumin is the most abundant protein component in plasma and cerebrospinal fluid (CSS). Infection triggers an inflammatory response so that an increase in the hs-CRP/albumin ratio (CAR) can be a predictor of worsening clinical outcome in patients with CNS infections. However, studies examining the predictor value of serum and CSF CAR on worsening clinical outcomes of patients are limited, particularly in CNS infections. The purpose of this study was to prove the CAR as a predictor of worsening clinical outcome in patients with CNS infections.  It was an observational study using a prospective cohort design. Fifty subjects recruited until October 2021 at Dr. Sardjito General Hospital were involved.  The multivariate regression analysis showed that serum CAR (OR=3.604; 95%CI=1.487-8.736; p =0.005) could be a single predictor. However, by combining three variables, namely serum CAR, CSF CAR, and decreased consciousness at admission, could be a stronger predictor of worsening clinical outcome in patients with CNS infection (AUC = 97.1%; 95%CI = 0.929-1.00; p <0.001). The optimal cut-off value for serum CAR was 1.35 (Youden index = 0.88, sensitivity = 96%, specificity = 92%) while for CSF CAR was 0.14 (Youden index = 0.60, sensitivity = 76%, specificity = 84%). In conclusion, a combination predictive model of three variables, namely serum CAR, CSF CAR, and awareness at admission can be a stronger predictor of clinical outcome in patients with CNS infection than serum CAR alone

Could CD8/38 predict virological response to antiretroviral therapy (ART) in human immunodeficiency virus (HIV) infected patients?

ABSTRACT The success rate of antiretroviral therapy (ART) depends on the efficacy of the drug and the immune system’s ability to control virus replication. Viral load (VL) examination is a standard test for ART monitoring. Unfortunately, this test is still very limited, especially in Indonesia. CD38 expression has been studied as a predictor for disease progression and decreases once ART is initiated. The aim of this study was to evaluate the possible usage of declining CD8/38 T-cell percentages in predicting the VL. Forty-five subjects naïve to ART were evaluated in this observational analytic study with a prospective design. Data collected included the medical history, physical examination, WHO clinical staging, complete blood counts, CD4 cell count, and plasma VL. These data then reevaluated six months after ART initiation. A paired t-test, and correlation test were used to analyze the data. Significant differences were found in all of the laboratory parameters between pre and post ART. There was a weak significant positive correlation between declining CD8/38 T-cell percentages and declining VL after 6 months of ART (r=0.33; p=0.026), with r2 = 0.11. Therefore despite the linear relationship, CD38 has limited value for prediction of VL

Suggested Rational Considerations for ANA-IF and ENA-Profile Test Requisition: Clinical Manifestation, Gender, Pattern, and Titer of ANA-IF

BACKGROUND: The anti-nuclear antibody immunofluorescence (ANA-IF) test is used for screening of autoantibody presence in patients with suspected autoimmune disease. Positive ANA-IF should be followed-up with extractable nuclear antigens profile (ENA-profile). High ANA-IF sensitivity combined with low ENA-profile sensitivity, and the evolution of ANA-IF requests may result in a higher number of positive ANA-IF but negative ENA-profile. It is necessary to make an objective assessment in determining the conditions in which rational ANA-IF and ENA-profile should be suggested. METHODS: Data were retrieved retrospectively from the medical records of subjects who performed both ANA-IF and ENA-profile. ANA-IF were examined using immunofluorescence principle with cut-off 1:100. ENA-profile which contained sixteen purified antigens was performed using line-immunoblot principle. Data was analyzed descriptively and analytically using SPSS, and significant result was indicated if p<0.05. RESULTS: The ANA-IF result was dominated by negative (44.9%) and positive-speckled, titer 1:100 (32.9%). Of 923 subjects with positive ANA-IF, 45.4% had a negative ENA-profile. Of 751 subjects with negative ANA-IF, 10.2% had positive ENA-profile. In subjects whose specific clinical entity, the ANA-IF sensitivity and negative predictive value (NPV) in detecting ENA-profile were 93.8% and 93.3%, respectively, but the positive predictive value (PPV) was 63.2%. Women with specific autoimmune manifestation accompanied by ANA-IF homogeneous ≥1:100, or centromeres ≥1:100, or speckled ≥1:320 might have been predicted as subsequent positive ENA-profile with area under curve (AUC) of 77.2%, 76.9%, 79.2%, respectively. CONCLUSION: ANA-IF should only be indicated for those with specific clinical symptoms. For woman with typical symptoms, the presence of positive ANA-IF with homogeneous ≥1:100, or centromeres ≥1:100, or speckled ≥1:320 should be further followed-up by ENA-profile. KEYWORDS: ANA-IF, ENA-profile, autoimmune, autoantibod