An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting

Background Measles is a recurrent health problem in both advanced and developed countries. The World Health Organization (WHO) recommends anti-measles immunoglobulin M (Ig M) as the standard method of detecting the virus; however, many areas still present the inability to perform a serology test of anti-measles IgM. Therefore, a typical clinical feature is necessary to establish the diagnosis of measles. The objective of this study was to evaluate hyperpigmented rash and other clinical features as the diagnostic tools with respect to measles, especially in an outbreak setting. Methods In this observational diagnostic study, the inclusion criteria were as follows: between 6 and 144 months of age, fever, maculopapular rash for 3 days or more, accompanied by a cough, or coryza, or conjunctivitis. Those with a prior history of measles vaccination (1–6 weeks) were excluded, in addition to those with histories of corticosteroid for 2 weeks or more and immunocompromised conditions. The samples were taken from Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. We evaluated the sensitivity, specificity, the positive predictive value, and the negative predictive value of such clinical features. Hyperpigmented rash was validated using Kappa and Mc Nemar tests. Anti-measles Ig M was considered as the gold standard. Results This study gathered 82 participants. The clinical manifestations of all subjects included fever, cough, coryza, conjunctivitis, Koplik spots, and maculopapular rash (which turns into hyperpigmented rash along the course of the illness). Most maculopapular rashes turn out to be hyperpigmented (89%). Sensitivity, specificity, positive predictive value, and negative predictive values ​​of the combination of fever, maculopapular rash, and hyperpigmented rash were found to be at 90.7, 28.6, 93.2, and 22.2%, respectively. The Mc Nemar and Kappa tests showed p values of 0.774 and 0.119, respectively. Conclusion The combination of fever, maculopapular rash, and hyperpigmented rash can be used as a screening tool regarding measles infection in an outbreak setting, which can then be confirmed by anti-measles Ig M. Cough, coryza, and Koplik’s spot can be added to this combination, albeit with a slight reduction of sensitivity value

Antidiphtheria Antibody of Patients and Carriers Several Years after the Illness in Indonesia

Diphtheria is a lethal disease and toxin is the most important instrument of pathogenicity. Antidiphtheria antibody plays a role in determining someone to be healthy, carriers, or be ill. Diphtheria infection will not provide a sufficient antibody level to the patient few months or years after. This study aimed to determine anti-diphtheria antibody level of individuals several years after someone being patients or carriers. The participants of this cross-sectional study were all diphtheria carriers and patients aged < 18 years in East Java Province Indonesia from the period of 2011-2015. The record was obtained from East Java Provincial Health Office. Subjects were visited, interviewed, and underwent physical examinations. Blood samples were obtained and the anti-diphtheria antibody level was determined using the Vero cell method. The result was then modified using WHO criteria. Data analysis used Mann-Whitney U, Kruskal-Wallis, and Chi-Square tests as appropriate with p<0.05 and 95% confidence interval considered as significant. Among 25 carriers and 88 patients from 21 districts in the study, mostly above five-year-olds, only 11% carriers and 6% patients received three times immunization after the period of illness, indicating that the follow up by health care officers was not satisfactory. The antibody levels of the patients were significantly different from the carriers along with a prevalence ratio of 1.26 if the antibody was at a susceptible level. There were 8% carriers and 20% patients in the susceptible group. In conclusion, six months to 3.5 years after having the illness, diphtheria patients remained to have lower anti-diphtheria antibody levels as compared to the carriers

The Outcomes of Infants with HIV Infected Mother in a Tertiary Hospital in Indonesia

Background: Infant from HIV mother face the risk of HIV infection. Effective prevention on mother-tochild transmission (PMTCT) program increasing the number of uninfected infants in East Java Indonesia. This study describes the outcomes of infants with HIV mother in Dr. Soetomo Hospital, a tertiary referral hospital in East Java, related to outcome (infectious morbidity, nutritional status, immunodeficiency status, growth/development, and incidence of anemia). Method: This cross-sectional study analyzed 0-18 months infant and HIV mother pairs at HIV outpatient clinic Dr. Soetomo General Hospital from January to April 2017. The data were collected and analyzed using Fisher’s exact test and chi-square test with P<0.05. Results: Fourty HIV-infected mothers and infants pairs were analyzed, separated into two groups positive (3 infants) and negative (37 infants) Anti HIV PCR. There were 19 male. Age distribution (6 weeks-5 months 40%; 6-11 months 47.5%; 12-18 months 12.5%). Five percent were born prematurely, 77.5% infant has normal birth-weight. Only 2.5% were fed breast milk, AZT-cotrimoxazole were given to 87.5% infant while the rest received AZT/3TC/NVP. Immunizations of the infants were mostly (60%) up to date. Infectious morbidity (P=0.433), WAZ-score (P=0.666), LAZ-score (P=0,973), WLZ-score (P=0.219) and incidence of anemia (P=0.548) were not significant differences between groups. The development test using DDST II (P=0,001), as well as immunodeficiency status [presence of immunodeficiency (P<0.001)] was significantly different between groups. Conclusion: There were significant effects of HIV exposed on the development and immunodeficiency status in 0-18 months infant

TANTANGAN PENYAKIT INFEKSI ANAK MASA KINI

Sejak pertengahan abad 20, penyakit infeksi bukan lagi menjadi penyebab utama kematian di negara maju. Keberhasilan eradikasi penyakit cacar menjadi tonggak sejarah yang membuktikan bahwa penyakit infeksi bisa dieliminasi. Meskipun demikian dalam abad ini penyakit infeksi akan tetap mewarnai usaha-usaha di bidang kesehatan masyarakat, baik secara nasional dan internasional. Betapa tidak, penemuan antimikrobial yang poten serta vaksin yang diperkirakan mampu mengendalikan, bahkan berdampak eradikasi ternyata tidak sepenuhnya benar. Perspektif ini diredam dengan fakta bahwa ancaman penyakit infeksi baru senantiasa muncul dan penyakit lama beradaptasi secara berkesimnambungan

PROGNOSTIC FACTORS OF SEVERE DENGUE INFECTIONS IN CHILDREN

The incidence of dengue fever increase annually and can increase morbidity and mortality. Dengue fever is mosquito-borne disease and caused by one of four serotype dengue viruses. Severe dengue is characterized either by plasma leakage, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Mortality and serious morbidity of dengue were caused by several factors including the late recognition of the disease and the changing of clinical signs and symptoms. Understanding the prognostic factors in severe dengue will give early warning to physician thus decreasing the morbidity and mortality, and also improving the treatment and disease management. The aim of this study was to analyze the prognostic factors of severe dengue infection in children. This study was observational cohort study in children (2 months-18 years) with dengue infection according to WHO 2009 criteria which admitted in Soetomo and Soewandhie Hospital Surabaya. Analysis with univariate, bivariate and multivariate with IBM SPSS Statistic 17. All patients were confirmed by serologic marker (NS-1 or IgM/IgG Dengue). Clinical and laboratory examination such as complete blood count, aspartate aminotrasnferase (AST), alanine aminotrasferase (ALT), albumin, and both partial trombocite time and activated partial trombosit time (PTT and aPPT) were analyzed comparing nonsevere dengue and severe dengue patients. There were 40 subjects innonsevere and 27 subjects with severe dengue infection. On bivariate analysis, there were significant differences of nutritional status, abdominal pain, petechiae, pleural effusion, leukopenia, thrombocytopenia, hypoalbuminemia, history of transfusion, increasing AST>3x, prolonged PPT and APTT between severe and nonsevere dengue group. After multivariate analyzed, the prognostic factors of severe dengue were overweight/obesity (p=0.003, RR 94), vomiting (p=0.02, RR 13.3), hepatomegaly (p=0.01, RR=69.4), and prolonged APTT (p=0.005, RR=43.25). In conclusion, overweight/obesity, vomiting, hepatomegaly, and prolonged APTT were prognostic factors in severe dengue infection in children.Those factors should be monitored closely in order to reduce the mortality and serious morbidity