Retrospective Study: Management of Atopic Dermatitis

Background: Atopic dermatitis (AD) is a chronic skin inflammatory disease, characterized with mild to severe itching, relapses, and mostly appears in infants and children. Although there has been current advances in the management of AD but satisfactory treatment has not been obtained. Purpose: To evaluate the treatment of patients with AD, hence better management can be provided. Methods: Retrospective study of newly diagnosed AD patients in Allergy Immunology Division of Dermatology and Venereology Outpatient Clinic Dr. Soetomo General Hospital Surabaya during 2012-2014. Result: Antihistamine is the most widely prescribed medication, as many as 234 (36.3%) of all patients visits and cetirizine was the most given antihistamine in 142 (58%) of the patients. Emollients still used minimally, such as urea 10% cream in 71 (11%) patients, ambiphilic cream (biocream®) in 52 (8.1%) patients, and vaseline album in 11 (1.7%) patients. Conclusion: Emollients therapy is important in the management of AD and hence its usage should be adequate. Key words: atopic dermatitis, management, retrospective

Genotyping Analysis of Mycobacterium leprae isolated in Water Environment of Leprosy Endemic Places in Lamongan, East Java

Finding of Mycobacterium leprae from water of leprosy endemic areas were reported. East Java Province is ranked number eight as the endemic area of leprosy in Indonesia and Lamongan district is the local area with the highest new cases reported. To study the transmission of Mycobacterium leprae infection in endemic areas, it is important to detect the distribution of Mycobacterium leprae in the environment and population, also to analyze the genetic variation pattern. Keywords: endemic; environment; genotyping; leprosy; Mycobacterium leprae

Potential for serodiagnosis of indonesian leprosy patients by detecting antibodies against LID-1

Leprosy is caused by Mycobacterium leprae infection and remains a major public health problem in many areas of the world. The Leprosy IDRI Diagnostic (LID)-1 antigen has demonstrated potential to improve the diagnostic capacity of local health centers and aid the development of strategies for the eventual control and elimination of leprosy from endemic areas. The diagnostic capacity of LID-1 has not yet, however, been studied in Indonesia. Objective: To determine the proportion of Indonesian leprosy patients that have circulating antibodies against LID-1. Sera from thirtyfive leprosy patients from Surabaya, Indonesia were evaluated using an Enzyme Linked Immunosorbent Assay (ELISA) detecting IgG antibodies against the LID-1 antigen. Anti-LID-1 antibody levels correlated with both the clinical form of leprosy and the bacterial index (BI). LID-1-specific IgG responses were higher in multibacillary (MB) than in paucibacillary (PB) leprosy patients. Our data indicate that the detection and measurement of serum IgG against LID-1 could be an effective tool for use in control programs in various states and municipalities in Indonesia

Scabies incognito

Atypical appearance of scabies such as chronic excoriation and eczematization of the skin, is frequently found in patients with long-standing infestations. Cases of less impressive scabies are not easily diagnosed, especially when topical or systemic corticosteroids mask the typical itch and inflammation. These cases frequently occur in individuals with good hygiene and are referred as scabies incognito – a diagnosis that can be easily mistaken for other skin diseases. A fourteen-year-old male patient had been irregularly taking systemic corticosteroid for two months due to intermittent papular reaction and itching. Four weeks after treatment with anti-scabiotic therapy, the patient has no complaint of itch and no sign of new papular lesion suggesting that he had scabies all along. It is very important to make a correct diagnosis of scabies incognito because misdiagnosis is associated with serious consequences such as spreading and superinfection of the lesions; this can sometimes lead to life-threatening consequences

Immunoglobulin AMG Anti Natural Disaccharide Octyl - Leprosy IDRI Diagnostic (NDO-LID) Serologic Test for Leprosy Diagnosis: a Pilot Study

Leprosy remains a public health problem in Indonesia. Diagnostic tools have been developed in order to aid early diagnosis and prompt treatment. Phenolic glycolipid (PGL)-1 has been considered as a good candidate for leprosy diagnosis but has been found to have several limitations. More recently, the conjugation between natural disaccharide octyl (NDO) and leprosy IDRI diagnostic (LID)-1, known as NDO-LID, shows great promise because of its high specificity and sensitivity and its ability to detect leprosy before any clinical signs are present. The test incorporates the detection of IgM antibodies towards NDO and IgG antibodies towards LID-1. This study aimed to show the profile of IgM, IgG, and IgAMG antibody titers against NDO-LID to further discover its diagnostic potential. Sera from eight new leprosy patients from Surabaya, Indonesia were evaluated using ELISA detecting levels of IgG, IgM and IgAMG antibodies against NDO-LID antigen. Skin slit biopsy was also taken for smear and histopathology test. This study shows that the titer levels IgAMG anti NDO-LID were consistent with the results from smear and were consistently higher compared to IgM or IgG titer alone. IgAMG might have the potential to improve the sensitivity of NDO-LID serologic tests but further investigation is needed

Scabies incognito

Atypical appearance of scabies such as chronic excoriation and eczematization of the skin, is frequently found in patients with long-standing infestations. Cases of less impressive scabies are not easily diagnosed, especially when topical or systemic corticosteroids mask the typical itch and inflammation. These cases frequently occur in individuals with good hygiene and are referred as scabies incognito – a diagnosis that can be easily mistaken for other skin diseases. A fourteen-year-old male patient had been irregularly taking systemic corticosteroid for two months due to intermittent papular reaction and itching. Four weeks after treatment with anti-scabiotic therapy, the patient has no complaint of itch and no sign of new papular lesion suggesting that he had scabies all along. It is very important to make a correct diagnosis of scabies incognito because misdiagnosis is associated with serious consequences such as spreading and superinfection of the lesions; this can sometimes lead to life-threatening consequences

A 5‑year evaluation of chemoprophylactic treatment in elementary school children with subclinical leprosy

Subclinical leprosy is an infectious disease in which the immune system remains infected with Mycobacterium leprae (M. leprae). The progress of subclinical leprosy to clinical cases within 1 year of infection is 1.5%, with an increase to 6% in the following 4 years. Rifampicin is frequently used for prevention of leprosy, and clarithromycin has a bactericidal effect on M. leprae. Thus, the combination of both is expected to improve disease control in patients with subclinical leprosy. The aim of the present study was to evaluate the efficacy of a chemoprophylactic treatment involving rifampicin and clarithromycin against subclinical leprosy in elementary school children from endemic areas of East Java over a 5‑year period. The study was performed between 2011 and 2015. Samples were collected from 2,548 healthy elementary school children in Nguling (Pasuruan) and Raas (Sumenep), and analysed using ELISA for anti‑PGL (phenolic glycolipid)‑1 IgM antibodies. Children who were seropositive for anti‑PGL‑1 IgM antibodies received a chemoprophylactic regimen consisting of rifampicin (300 mg/day) and clarithromycin (250 mg/day) daily for the initial 10 days, followed by the same regimen every 2 weeks for 3 months. Clinical and serological evaluations were performed annually for 5 years. Amongst the 2,548 healthy elementary school children, 200 were seropositive. The anti‑PGL‑1 IgM antibody levels significantly decreased between 2011 and 2015 in Nguling (from 1,066.7 to 137.4 U/ml) and Raas (from 773.1 to 563.4 U/ml), the levels decreased every year. In addition, the proportion of patients with decreased anti‑PGL‑1 IgM antibody levels was consistently higher than patients with increased anti‑PGL‑1 IgM antibody levels in all periods, except during 2013‑2014, in Nguling and Raas. Chemoprophylactic treatment involving rifampicin and clarithromycin may thus be effective against subclinical leprosy amongst elementary school children

PROFIL KADAR ANTIBODI LEPROSY INFECTIOUS DISEASE RESEARCH INSTITUTE (IDRI) DIAGNOSTIC-1 (LID-1) PADA PASIEN KUSTA DAN NARAKONTAK SERUMAH PASIEN KUSTA MULTI BASILER DI DIVISI KUSTA UNIT RAWAT JALAN (URJ) KESEHATAN KULIT DAN KELAMIN RSUD DR. SOETOMO SURABAYA

Background: Leprosy is caused by Mycobacterium leprae infection and remains a major public health problem in many areas of the world. Although PGL-1 antigen has been reported as auxiliary diagnostic tool, currently there is no serological assay routinely used in leprosy diagnosis. LID-1 antigen has showed potential to improve diagnostic capacity at local health centers and aid development of strategies for the eventual control and elimination of leprosy from endemic areas. Purpose: To determine LID-1 antibody level in leprosy patients and household contacts at Dermato-venereology outpatient clinic, dr. Soetomo teaching hospital, Surabaya. Method: Sera from 35 leprosy patients (8 PB type and 27 MB type) and 22 household contacts were evaluated using Enzyme Linked Immunosorbent Assay (ELISA) with LID-1 antigen. Clinical form and bacterial index (BI) were recorded and analyzed to correlate with the LID-1 antibody levels. Results: There were 3 from 5 PB leprosy patients (60%) and 25 from 27 MB leprosy patients (93%) showed anti LID-1 seropositivity with mean value for PB leprosy patients 0,136±0,023 OD unit and for MB leprosy patients 0,710±0,524 OD unit. Household contacts revealed 10 from 25 people (40%) showed anti LID-1 seropositivity with mean value 0,065±0,025 OD unit. Conclusions: Detection of antibody against LID-1 in leprosy patients showed LID-1 antigen as a potential serodiagnosis of leprosy. It is well established that the earlier a leprosy patient is identified, the better their response to treatment. Serological tests that do not require significant labor can detect asymptomatic M. leprae infection may contribute to the control and eradication of leprosy. Keywords: antibody, leprosy, LID-