Diffuse lepromatous leprosy caused by dual infection of mycobacterium leprae and mycobacterium lepromatosis: A case report

M. lepromatosis is the dominant cause of leprosy in Mexico and it co-exists with M. leprae in endemic areas as the once elusive second cause of leprosy. A 41-year-old Madurese woman came with multiple ulcer on her legs, hands and buttock. The ulcers were described as wide and deep, covered with blackish crusts and some exudative area with irregular edges. On face, there were difusse infiltration, madarosis and saddle nose. Histopathology showed thinning of epidermis with a lot of foam cells containing BTA, including endotel and perivascular tissues. Nested PCR examination with LERF2-MLER4 primers for detecting M. leprae showed a positive result. Advanced PCR examination using LPMF2-MLER4 primers for detecting M. lepromatosis also showed a positive result. Based on the clinical, hystopathological results and PCR examination, it was consistent with diffuse lepromatous leprosy. M. lepromatosis mainly causes lepromatous leprosy and also specifically diffuse lepromatous leprosy

Studi Retrospektif: Reaksi Kusta Tipe 1

Latar Belakang: Reaksi kusta tipe 1 terjadi akibat perubahan keseimbangan antara cell mediated immunity (CMI) dan basil Mycobacterium leprae di saraf dan kulit pasien kusta dengan hasil akhir berupa upgrading atau reversal. Pasien kusta tipe subpolar memiliki imunitas yang tidak stabil sehingga sering mengalami reaksi tipe 1 yang berulang terutama tipe Borderline Borderline (BB). Gejala klinis reaksi tipe 1 berupa peradangan kulit maupun saraf dapat menimbulkan kecacatan bila tidak ditangani secara tepat. Tujuan: Mengevaluasi gambaran umum, diagnosis, dan terapi reaksi kusta tipe 1. Metode: Studi retrospektif terhadap rekam medis kunjungan baru pasien kusta selama 4 tahun (2014 – 2017) di Divisi Kusta Unit Rawat Jalan Kesehatan Kulit dan Kelamin RSUD Dr Soetomo Surabaya. Hasil: Total 68 pasien baru kusta dengan reaksi tipe 1 (13,2% dari seluruh pasien baru Divisi Kusta), 60,3% berjenis kelamin laki-laki, 41,2% berusia 15–34 tahun, dan tipe kusta terbanyak adalah tipe BB (72,1%). Gejala reaksi pada kulit berupa keluhan penebalan bercak merah lama (80,9%), reaksi terutama terjadi saat masih dalam pemberian multidrug therapy (66,2%). Gejala saraf tepi pada reaksi tipe 1 yang terbanyak adalah tanpa gejala (66,7%). Terapi terbanyak yang diberikan adalah obat antiinflamasi nonsteroid (45,6%) dan kortikosteroid (29,4%). Simpulan: Diagnosis reaksi tipe 1 perlu ditegakkan dengan benar melalui anamnesis dan pemeriksaan fisik untuk menentukan penatalaksanaan yang tepat. Penggalian riwayat tentang faktor pemicu sangat penting untuk mencegah reaksi tipe 1 berulang atau berkepanjangan

Effect of Lactobacillus plantarum IS-10506 supplementation with oral metronidazole for the treatment of bacterial vaginosis: A randomized placebo-controlled clinical trial

Abstract Background: Replacement of Lactobacillus spp. by anaerobic and facultative bacteria is central in pathogenesis of bacterial vaginosis (BV). Oral metronidazole is currently recommended treatment. However, cure rate is variable. Probiotic supplementation was explored as alternative therapy. This study aimed to find out the effect of oral microencapsulated Lactobacillus plantarum IS-10506 supplementation on oral metronidazole 500 mg twice daily for the treatment of BV. Methods: Twenty nine females with BV were treated with oral metronidazole and randomized into probiotic (Pro) (n=14) and placebo (Pla) (n=15) groups. Pro group received microencapsulated L. plantarum IS-10506 supplementation at 0.9x109 CFU, twice daily. Pla group received placebo twice daily. Cure is defined from Amsel criteria and Nugent score 0-3. Metronidazole was stopped if subjects were cured. Probotic and placebo were continued for 4 weeks. Cure rate and mean Nugent score were assessed at baseline, end of week 1, 2 and 4. Results: Mean Nugent score for Pro against Pla group were 8.07 vs. 8.07, 5.36 vs. 6.20, 4.07 vs. 4.93, and 3.57 vs. 4.33 respectively at baseline, end of week 1, 2 and 4. Cure rate for Pro against Pla group were 28.6% vs 20.0%, 50.0% vs 33.3%, 64.3% vs 40.0% respectively at end of week 1, 2 and 4. Mean Nugent score significantly decreased in both groups at end of week 1, 2 and 4 (p£ 0.05). Although not statistically significant, mean Nugent score was lower and cure rate was higher in Pro than Pla group at end of week 1, 2 and 4 (p>0.05). No adverse effects was recorded. Conclusions: Oral probiotic L. plantarum IS-10506 supplementation in addition to oral metronidazole were safe and potentially better than oral metronidazole alone for treatment of BV. Studies with longer probiotic supplementation and more subjects may be required to demonstrate significant effect of this combination treatment on BV

Kualitas Hidup Pasien Dewasa Muda dengan Akne Vulgaris Derajat Sedang di Indonesia

Latar Belakang: Akne vulgaris (AV) adalah penyakit inflamasi kronik yang menyerang unit pilosebasea yang paling banyak menyerang pasien dewasa muda di hampir seluruh negara. Pasien dengan akne vulgaris dapat mengalami tekanan psikologis sehingga memengaruhi kualitas hidup pasien. Tujuan: Mengevaluasi kualitas hidup pasien akne vulgaris derajat sedang. Metode: Merupakan penelitian potong lintang observasional dengan menggunakan kuesioner yang melibatkan pasien AV derajat sedang yang mendapatkan terapi AV standar dan penambahan fototerapi sinar biru pada periode Desember 2017 hingga Februari 2018 di Divisi Kosmetik Medik Unit Rawat Jalan Kesehatan Kulit dan Kelamin RSUD Dr.Soetomo Surabaya. Hasil: Sejumlah 40 pasien berusia 16 – 25 tahun dengan rata-rata 19,22 ± 2,76 tahun. Subjek merasakan AV berefek berat terhadap kualitas hidupnya (65%), diikuti dengan yang merasakan berefek sedang (20%), berefek ringan (10%), berefek sangat berat (2,5%), dan tidak ada efek terhadap kualitas hidup (2,5%). Skor total kuesioner Dermatology Life Quality Index (DLQI) dianalisis korelasi dengan variabel lama sakit dan usia subjek menggunakan uji Spearman’s rho. Analisis tersebut menunjukkan adanya korelasi yang bermakna antara skor DLQI total dengan lamanya subjek menderita AV (p = 0,037; CI 95%). Kekuatan korelasi antar kedua variabel (r) negatif lemah. Hal tersebut berarti semakin lama durasi menderita AV maka semakin kecil skor DLQI total. Skor DLQI total dikatakan tidak berkorelasi dengan usia subjek (p = 0,318; CI 95%). Simpulan: Penelitian ini menunjukkan penurunan kualitas hidup pada pasien akne derajat sedang, dan kualitas hidup berkorelasi dengan lama durasi menderita AV

The Efficacy of Lactobacillus plantarum as Adjunctive Therapy of Bacterial Vaginosis: A Double-blind, Randomized, Placebo-controlled Trial

Background: Bacterial vaginosis (BV) is a clinical syndrome caused by the changing of Lactobacillus spp., a producer of hydrogen peroxide, in the normal vagina with a high concentration of anaerobic bacteria, Gardnerella vaginalis and Mycoplasma hominis. This study reports a resistance of BV therapy regimens, high recurrence rates, and side effects of an antibiotic. Therefore, adjunctive therapy for BV management is needed. Research has reported the therapeutic effects of probiotic in BV; however, the results are inconsistent. Purpose: To evaluate the efficacy of standard therapy using metronidazole and Lactobacillus plantarum for BV measured by the cure rate and vaginal flora balance. Methods: A randomized, double-blind, placebo-controlled trial, 30 subjects were randomized to take metronidazole 500 mg twice a day for seven days with weekly evaluation. The Lactobacillus plantarum or placebo group was evaluated every 4 weeks. The cure rate and vaginal flora balance were evaluated using the Amsel criteria and Nugent score before and after the intervention. Result: A total of 30 subjects returned for 28-day follow-up, of which 60% subjects of the antibiotic/probiotic group were cured compared to 40% in the antibiotic/placebo group (p>0.05). Conclusion: There was no difference in the increase of cure rate and vaginal flora balance between the treatment group and significant control group

Effect of Lactobacillus plantarum IS-10506 supplementation with oral metronidazole for the treatment of bacterial vaginosis: A randomized placebo-controlled clinical trial

Abstract Background: Replacement of Lactobacillus spp. by anaerobic and facultative bacteria is central in pathogenesis of bacterial vaginosis (BV). Oral metronidazole is currently recommended treatment. However, cure rate is variable. Probiotic supplementation was explored as alternative therapy. This study aimed to find out the effect of oral microencapsulated Lactobacillus plantarum IS-10506 supplementation on oral metronidazole 500 mg twice daily for the treatment of BV. Methods: Twenty nine females with BV were treated with oral metronidazole and randomized into probiotic (Pro) (n=14) and placebo (Pla) (n=15) groups. Pro group received microencapsulated L. plantarum IS-10506 supplementation at 0.9x109 CFU, twice daily. Pla group received placebo twice daily. Cure is defined from Amsel criteria and Nugent score 0-3. Metronidazole was stopped if subjects were cured. Probotic and placebo were continued for 4 weeks. Cure rate and mean Nugent score were assessed at baseline, end of week 1, 2 and 4. Results: Mean Nugent score for Pro against Pla group were 8.07 vs. 8.07, 5.36 vs. 6.20, 4.07 vs. 4.93, and 3.57 vs. 4.33 respectively at baseline, end of week 1, 2 and 4. Cure rate for Pro against Pla group were 28.6% vs 20.0%, 50.0% vs 33.3%, 64.3% vs 40.0% respectively at end of week 1, 2 and 4. Mean Nugent score significantly decreased in both groups at end of week 1, 2 and 4 (p£ 0.05). Although not statistically significant, mean Nugent score was lower and cure rate was higher in Pro than Pla group at end of week 1, 2 and 4 (p>0.05). No adverse effects was recorded. Conclusions: Oral probiotic L. plantarum IS-10506 supplementation in addition to oral metronidazole were safe and potentially better than oral metronidazole alone for treatment of BV. Studies with longer probiotic supplementation and more subjects may be required to demonstrate significant effect of this combination treatment on BV