Toksoplasmosis Di Daerah Istimewa Yogyaicarta

ABSTRAK Toxoplasmosis is a parasitic disease of man and animal caused by Toxoplasma gondii. The life cycle of this parasite consists of two phases. The reproductive phase, which takes place in the intestine of the cat, and the proliferative phase, which takes place in birds and mammalian species including humans. Toxoplasmosis is described as being either post-natal infection or transplacental intrauterine infection. This paper tries to report the insidental and the clinical manifestations of Toxoplasmosis retrospectifly. The report obtained from the resulcs of consultations and Toxoplasmosis serologycal examinations by using latex agglutination method during the year of 1987 through 1989 at the Laboratory of Parasitology, Faculty of Medicine, Gadjah Mada University. The incidence of Toxoplasmosis at Yogyakarta Special Region was 44,63%. Most of the cases were found between age of 10 to 39 years old. Men were more commonly infected with T. gondii than the women. Awide variety of clinical symptomps, was reported and the most commonly found was chorioretinitis. Key words : Toxoplasmosis - life cycle - result of consultation - latex agglutination method - chorioretinitis

Measurement of Plasmodium falciparum transmission intensity using serological cohort data from Indonesian schoolchildren.

BACKGROUND: As malaria transmission intensity approaches zero, measuring it becomes progressively more difficult and inefficient because parasite-positive individuals are hard to detect. This situation may arise shortly before achieving local elimination, or during surveillance post-elimination to prevent reintroduction. Antibody responses against the parasite last longer than the infections themselves. This "footprint" of infection may thus be used for assessing transmission intensity. A statistical approach is presented for measuring the seroconversion rate (SCR), a correlate of the force of infection, from individual-level longitudinal data on antibody titres in an area of low Plasmodium falciparum transmission. METHODS: Blood samples were collected from 160 Indonesian schoolchildren every month for six months. Titres of antibodies against AMA-1 and MSP-1(19) antigens of P. falciparum were measured using ELISA. The distribution of antibody titres among seronegative and -positive individuals, respectively, was estimated by comparing the titres from the study data (a mixture of both seropositive and -negative individuals) with titres from a (unexposed) negative control group of Indonesian individuals. Two Markov-Chain models for the transition of individuals between serological states were fitted to individual anti-PfAMA-1 or anti-PfMSP-1 titre time series using Bayesian Markov-Chain-Monte-Carlo (MCMC). This yielded estimates of SCR as well as of the duration of seropositivity. RESULTS: A posterior median SCR of 0.02 (Pf AMA-1) and 0.09 (PfMSP-1) person(-1) year(-1) was estimated, with credible intervals ranging from 1E-4 to 0.2 person(-1) year(-1). This level of transmission intensity is at the lower range of what can reliably be measured with the present study size. A Bayesian test for seroconversion of an individual between two observations is presented and used to identify the subjects who have most likely experienced an infection. Furthermore, the theoretical limits of measuring transmission intensity, and how these depend on duration and size of a study as well as on transmission intensity itself, is illustrated. CONCLUSIONS: This analysis shows that it is possible to measure SCR's from individual-level longitudinal data on antibody titres. In addition, individual seroconversion events can be identified, which can be useful in assessing interruption of transmission. Analyses of further serological datasets using the present method are required to improve and validate it. This includes measurement of the duration of antibody responses, how it depends on host age or cumulative exposure, or on the particular antigen used

Early malaria resurgence in pre-elimination areas in Kokap Subdistrict, Kulon Progo, Indonesia

BACKGROUND: Indonesia is among those countries committed to malaria eradication, with a continuously decreasing incidence of malaria. However, at district level the situation is different. This study presents a case of malaria resurgence Kokap Subdistrict of the Kulon Progo District in Yogyakarta Province, Java after five years of low endemicity. This study also aims to describe the community perceptions and health services delivery situation that contribute to this case. METHODS: All malaria cases (2007–2011) in Kulon Progo District were stratified to annual parasite incidence (API). Two-hundred and twenty-six cases during an outbreak (May 2011 to April 2012) were geocoded by household addresses using a geographic information system (GIS) technique and clusters were identified by SaTScan software analysis (Arc GIS 10.1). Purposive random sampling was conducted on respondents living inside the clusters to identify community perceptions and behaviour related to malaria. Interviews were conducted with malaria health officers to understand the challenges of malaria surveillance and control. RESULTS: After experiencing three consecutive years with API less than 1 per thousand, malaria in Kokap subdistrict increased almost ten times higher than API in the district level and five times higher than national API. Malaria cases were found in all five villages in 2012. One primary and two secondary malaria clusters in Hargotirto and Kalirejo villages were identified during the 2011–2012 outbreak. Most of the respondents were positively aware with malaria signs and activities of health workers to prevent malaria, although some social economic activities could not be hindered. Return transmigrants or migrant workers entering to their villages, reduced numbers of village malaria workers and a surge in malaria cases in the neighbouring district contributed to the resurgence. CONCLUSION: Community perception, awareness and participation could constitute a solid foundation for malaria elimination in Kokap. However, decreasing number of village malaria workers and ineffective communication between primary health centres (PHCs) within boundary areas with similar malaria problems needs attention. Decentralization policy was allegedly the reason for the less integrated malaria control between districts, especially in the cross border areas. Malaria resurgence needs attention particularly when it occurs in an area that is entering the elimination phase

Seasonal changes in the antibody responses against Plasmodium falciparum merozoite surface antigens in areas of differing malaria endemicity in Indonesia.

BACKGROUND: The transmission of malaria in Indonesia is highly heterogeneous spatially and seasonally. Anti-malaria antibody responses can help characterize this variation. In the present study antibody responses to Plasmodium falciparum MSP-1 and AMA-1 were measured to assess the transmission intensity in a hypo-endemic area of Purworejo and a meso-endemic area of Lampung during low and high transmission seasons. METHODS: Filter-paper blood spot samples collected from Purworejo and Lampung by cross-sectional survey during high and low transmission season were stored at -20°C. Indirect ELISA assays were carried out using PfMSP1-19 and PfAMA1 antigens. A positivity threshold was determined by samples from local unexposed individuals, and the differences in seroprevalence, antibody level and correlation between antibody level and age in each site were statistically analysed. RESULTS: Prevalence of antibodies to either PfMSP1-19 or PfAMA1 was higher in Lampung than in Purworejo in both the low (51.3 vs 25.0%) and high transmission season (53.9 vs 37.5%). The magnitude of antibody responses was associated with increasing age in both sites and was higher in Lampung. Age-adjusted seroconversion rates showed an approximately ten-fold difference between Lampung and Purowejo. Two different seroconversion rates were estimated for Lampung suggesting behaviour-related differences in exposure. In both settings antibody responses to PfMSP1-19 were significantly lower in the low season compared to the high season. CONCLUSION: Seasonal changes may be detectable by changes in antibody responses. This is particularly apparent in lower transmission settings and with less immunogenic antigens (in this case PfMSP1-19). Examination of antibody levels rather than seroprevalence is likely to be a more sensitive indicator of changes in transmission. These data suggest that sero-epidemiological analysis may have a role in assessing short-term changes in exposure especially in low or seasonal transmission settings

Analysis of serological data to investigate heterogeneity of malaria transmission: a community-based cross-sectional study in an area conducting elimination in Indonesia.

BACKGROUND: Analysis of anti-malarial antibody responses has the potential to improve characterization of the variation in exposure to infection in low transmission settings, where conventional measures, such as entomological estimates and parasitaemia point prevalence become less sensitive and expensive to measure. This study evaluates the use of sero-epidemiological analysis to investigate heterogeneity of transmission in area conducting elimination in Indonesia. METHODS: Filter paper bloodspots and epidemiological data were collected through a community-based cross-sectional study conducted in two sub-districts in Sabang municipality, Aceh province, Indonesia in 2013. Antibody responses to merozoite surface protein 1 (MSP-119) and apical membrane antigen 1 (AMA-1) for Plasmodium falciparum and Plasmodium vivax were measured using indirect enzyme-linked immunosorbent assay (ELISA). Seroconversion rates (SCR) were estimated by fitting a simple reversible catalytic model to seroprevalence data for each antibody. Spatial analysis was performed using a Normal model (SaTScan v.9.4.2) to identify the clustering of higher values of household antibody responses. Multiple logistic regression was used to investigate factors associated with exposure. RESULTS: 1624 samples were collected from 605 households. Seroprevalence to any P. falciparum antigen was higher than to any P. vivax antigen, 6.9% (95% CI 5.8-8.2) vs 2.0% (95% CI 1.4-2.8). SCR estimates suggest that there was a significant change in P. falciparum transmission with no exposure seen in children under 5 years old. Plasmodium falciparum SCR in over 5 years old was 0.008 (95% CI 0.003-0.017) and 0.012 (95% CI 0.005-0.030) in Sukakarya and Sukajaya sub-districts, respectively. Clusters of exposure were detected for both P. falciparum and P. vivax, most of them in Sukajaya sub-district. Higher age, P. vivax seropositivity and use of long-lasting insecticide-treated bed net (LLIN) were associated with higher P. falciparum exposure. CONCLUSION: Analysis of community-based serological data helps describe the level of transmission, heterogeneity and factors associated with malaria transmission in Sabang. This approach could be an important additional tool for malaria monitoring and surveillance in low transmission settings in Indonesia

RESPON ANTIBODI TERHADAP MEROZOITE SURFACE PROTEIN-1 (MSP-1) DAN APICAL MEMBRANE ANTIGEN-1 (AMA-1) Plasmodium falciparum PADA PENDUDUK DAERAH ENDEMIS RENDAH DAN ENDEMIS SEDANG DI INDONESIA

Background. Malaria is distributed in almost all provinces in Indonesia in different levels of endemicity and transmission. In this study, antibody responses against Plasmodium falciparum Merozoite Surface Protein-1 (P.f.MSP-1) and Apical Membrane Antigen-1 (P.f.AMA-1) is measured in populations living in low and medium endemic malaria areas in Indonesia to evaluate the level of malaria endemicity in the region. Methods. Serum antibody are measured from blood samples collected from people living in low endemic malaria in Purworejo and medium endemic malaria in South Lampung during high transmission season (November 2008-January 2009 in Purworejo, December 2008-February 2009 in Lampung) and during low transmission season (May 2009-July 2009) in both regions. Blood samples are grouped in age groups as 0-5, 6-10, 11-20, 21-30, 31-40 and >41 years. Antibody titer is measured by indirect ELISA method using recombinant P.f.MSP-119 and P.f.AMA-1. The samples are considered seropositive if the titer is above cut off value (mean +3SD) titers of seronegative cluster from minimal of 120 samples). Percentage of seropositive individuals from both regions is analyzed with Mantel- Haenzel and Chi-Square, differences of mean antibody titer is analyzed with Kruskal-Wallis and Mann-Whitney, significances of correlation between antibody titers and age is analyzed with Pearson Correlation. Results. During high and low transmission season, seroprevalence of anti P.f MSP-1 and anti P.f AMA-1 antibodies in most of age groups in Purworejo is lower than in Lampung. In Purworejo, mean antibody titers and correlation of antibody titer with age of anti P.f MSP-1 and anti P.f AMA-1 antibodies during high and low transmission season are not different. Meanwhile, in Lampung, mean antibody titers and correlation of antibody titer with age of anti P.f MSP-1 and anti P.f AMA-1 antibodies during high and low transmission season shows a significant difference. Conclusion. Antibody anti P.f MSP-1 and anti P.f AMA-1 response as titers and seroprevalence gives an image that Purworejo is an unstable malaria area and Lampung is a stable malaria area. This study is analogous to previous theories that seroprevalence is a good parameter for assessing malaria transmission levels