Antibiotic Susceptibility of Salmonella, Shigella and Vibrio Isolated From Diarrhea Patients in Jakarta, Indonesia

Background: The rapid increase of antibiotic resistance among enteric pathogens in developing countries has become a great concern. In Indonesia, Salmonella, Shigella, and Vibro are still an important public health problem. Objectives: The purpose of this study was to determine the antibiotic resistance patterns of several diarrhea-causing enteric bacteria that are frequently found in Indonesia, particularly Salmonella, Shigella and Vibrio. Methods: A cross-sectional study was conducted , among 150 rectal swabs collected from patients with diarrhea, the enteric pathogens isolated comprised Shigella (11.4%), Salmonella (6.6%) and Vibrio(2.7%). Results: Antibiotic susceptibility test on Shigella species to several antibiotics such as ampicillin, chloramphenicol, tetracycline and, trimethoprim-sulfamethoxazole showed a considerably high resistance rate (25%-100%), whereas ceftriaxone, ciprofloxacin, norfloxacin and nalidixic acid were apparently still effective (resistance rate 0%). Non-typhoid Salmonella had similar resistance patterns as those of Shigella, particularly to ampicillin, tetracycline, chloramphenicol and trimethoprim- sulfamethoxazole However, for S. typhi it was found that all antibiotics were still effective. Vibrio was resistant to ampicillin (resistance rate 100%), whereas the other antibiotics were still effective. Conclusion: It may be concluded that for each of the enteric pathogens the antibiotic resistance pattern should be determined. Use of antibiotics should be based on the antibiotic susceptibility tests

Detection of Synergistic Hemolysis Between Vibrio Cholerae Non-o1 and Staphylococcal Beta-lysin with Modified Camp Test

Suatu hemolisis sinergistik pada lempeng agar darah domba diperlihatkan oleh Vibrio cholerae non-O1 dengan beta-lisin dari stafilokok. Sebanyak 167 galur (strains) non-Ol yang diuji dengan metode modifikasi CAMP menunjukkan suatu gambaran hemolisis berupa bulan sabit yang tipis; sedangkan V. cholerae biotipe El Tor dan biotipe klasik yang digunakan sebagai galur kontrol memperlihatkan reaksi CAMP berupa gambaran seperti sosis untuk biotipe El Tor dan negatif untuk biotipe klasik

Use of Modified Camp Test for Preliminary Nonserologic Identification of Vibrio Cholerae in Stool Specimens

Suatu modifikasi uji CAMP digunakan bersama dengan reaksi biokimiawi untuk identifikasi Vibrio cholerae pada sampel klinis. Dari 579 USAp dubur penderita diare, 92 (16%) memberikan hasil isolasi V. cholerae 01 biotipe El Tor dan 34 (6%) V. cholerae non-01. Semua isolat V. cholerae 01 El Tor menunjukkan reaksi CAMP positif kuat dengan gambaran hemolisis sinergistik lengkap berbentuk sosis; sedangkan V. cholerae non-01 memberikan reaksi CAMP yang sempit dengan pola hemolisis menyerupai bulan sabit. Hasil uji CAMP yang dilakukan bersama dengan reaksi biokimiawi sesuai dengan metode biakan konvensional yang menyertakan tes aglutinasi dengan antiserum V. cholerae 01 untuk mengidentifikasi V. cholerae

20 Years of Progress in Typhoid Research

In 1981, the reported number of cases of typhoid fever in Indonesia was 19,596, increasing to 26,606 m 1986, most of the increase was due to improved detection and recognition of the pathogen. A more realistic estimate of incidence for this underreported and underdiagnosed disease would be from 540,000 to 1,210,000 cases per year. This was based on results of a household survey done by Budiarso R. et al. in 1980 and 1986, and on result of a community surveillance done by Ruwido and Simanjuntak et al. from 1983-1988. These studies were done in Plaju, South Sumatera, representing an urban area and Paseh, West Java, representing a semi-rural area. The results showed that the incidence rate of typhoid fever in the semi rural area was 358/100,000 population/year, and between 760-810/100,000 population/year in the urban area. These studies also indicated that the high risk group in the population was school age children between ages of 3-19 years. From other observations, it is also noted that the case fatality in urbanized and growing areas of Indonesia, may be higher than it is reported in other areas of the worl

Standard WHO-ORS Versus Reduced-osmolarity ORS in the Management of Cholera Patients

The study compared the safety and efficacy of an oral rehydration salts (ORS) solution, containing 75 mmol/L of sodium and glucose each, with the standard World Health Organization (WHO)-ORS solution in the management of ongoing fluid losses, after initial intravenous rehydration to correct dehydration. The study was conducted among patients aged 12-60 years hospitalized with diarrhoea due to cholera. One hundred seventy-six patients who were hospitalized with acute diarrhoea and signs of severe dehydration were rehydrated intravenously and then randomly assigned to receive either standard ORS solution (311 mmol/L) or reduced-osmolarity ORS solution (245 mmol/L). Intakes and outputs were measured every six hours until the cessation of diarrhoea. During maintenance therapy, stool output, intake of ORS solution, duration of diarrhoea, and the need for unscheduled administration of intravenous fluids were similar in the two treatment groups. The type of ORS solution that the patients received did not affect the mean serum sodium concentration at 24 hours after randomization and the relative risk of development of hyponatraemia. However, patients treated with reduced-osmolarity ORS solution had a significantly lower volume of vomiting and significantly higher urine output than those treated with standard WHO-ORS solution. Reduced-osmolarity ORS solution was as efficacious as standard WHO-ORS solution in the management of cholera patients. The results indicate that reduced-osmolarity ORS solution is also as safe as standard WHO-ORS solution. However, because of the limited sample size in the study, the results will have to be confirmed in trials, involving a larger number of patients

20 Years of Progress in Diarrheal Disease Research

When NAMRU started its collaboration work with the National Institute of Health, Research and Development (NIHRD), it became apparent that diarrheal disease was one of the most important causes of morbidity and mortality in Indonesia, especially in children. Many of the most important etiologic agents of diarrhea were not known and the percentage of diarrheas with an identifiable etiologic agent was very low. Since these early times NAMRU and NIHRD have worked together in all aspects of diarrheal disease research. Increased capabilities for the identification of bac­tériologie, parasitic and viral enteropathogens, new vaccines, and better treatment via oral rehydration solutions are some of the results of this collaboration

The burden of diarrhoea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance

BACKGROUND: In preparation of vaccines trials to estimate protection against shigellosis and cholera we conducted a two-year community-based surveillance study in an impoverished area of North Jakarta which provided updated information on the disease burden in the area. METHODS: We conducted a two-year community-based surveillance study from August 2001 to July 2003 in an impoverished area of North Jakarta to assess the burden of diarrhoea, shigellosis, and cholera. At participating health care providers, a case report form was completed and stool sample collected from cases presenting with diarrhoea. RESULTS: Infants had the highest incidences of diarrhoea (759/1 000/year) and cholera (4/1 000/year). Diarrhea incidence was significantly higher in boys under 5 years (387/1 000/year) than girls under 5 years (309/1 000/year; p < 0.001). Children aged 1 to 2 years had the highest incidence of shigellosis (32/1 000/year). Shigella flexneri was the most common Shigella species isolated and 73% to 95% of these isolates were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline but remain susceptible to nalidixic acid, ciprofloxacin, and ceftriaxone. We found an overall incidence of cholera of 0.5/1 000/year. Cholera was most common in children, with the highest incidence at 4/1 000/year in those less than 1 year of age. Of the 154 V. cholerae O1 isolates, 89 (58%) were of the El Tor Ogawa serotype and 65 (42%) were El Tor Inaba. Thirty-four percent of patients with cholera were intravenously rehydrated and 22% required hospitalization. V. parahaemolyticus infections were detected sporadically but increased from July 2002 onwards. CONCLUSION: Diarrhoea causes a heavy public health burden in Jakarta particularly in young children. The impact of shigellosis is exacerbated by the threat of antimicrobial resistance, whereas that of cholera is aggravated by its severe manifestations

Correction: The burden of diarrhoea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance

This is a correction of an earlier published article

Screening for prostate cancer: what are the benefits ?

In men of advanced age, the epithelial cells of the prostate gland undergo substantial stress-associated changes that may result in DNA damage. The aging prostate gland acquires several cancer cell foci originating from special clonal transformation. Most of these foci never develop into clinically detectable cancer