Comparison of Selenium Sulfide 1% and Zinc Pyrithione 1% and Combination of Them in Overcoming Malassezia Globosa in Vitro

Dandruff is a scalp disorder that is affected by three factors, namely the fungus Malassezia globosa, sebaceous gland activity, and individual susceptibility. Selenium sulfide (SeS2) and Zinc Pyrithion (ZPTO) is used as an antidandruff shampoo active ingredient because it has anti-fungal properties. The study was conducted to determine the potentiality of shampoo with active ingredient SeS2 1% and ZPTO 1% to M.globosa in vitro. The colonies of M.globosa (CBS 7966 ATCC 96 807) were exposed to a non-antifungal base shampoo, shampoo containing 1% SeS2, shampoo containing 1% ZPTO and shampoo containing combination of 1% SeS2 and 1% ZPTO. Fungal contact time with shampoo is 3 and 5 minutes. Fungal colonies are grown on Sabourraud Dextrose agar (SDA) medium coated with olive oil. Incubation was carried out at 37° C for 5 days. After fiveday, assessment was performed to observe whether the fungal culture was grown, and then the colony growth is calculated. The research was conducted at Clinical Parasitology Laboratory, Parasitology Department, Faculty of Medicine, University of Indonesia from November 2011 until April 2012. Data were analyzed using ANOVA and LSD Fisher test. Shampoo containing 1% SeS2 inhibited fungal growth in 5 min contact time (p = 0,000 <0.05), whereas 1% ZPTO shampoo fungal growth was inhibited either in 3 min or 5 min contact time (p = 0,000 <0,05), and combination of 1% SeS2 and 1% ZPTO shampoo in both contact times (p = 0,000 <0.05). In conclusion, combination of 1% SeS2 and 1% ZPTO shampoo has the most potency in inhibiting the growth of M.globosa colonies in vitro

Cryptococcal Meningitis among AIDS Patients in Jakarta

Abstract Cryptococcosis is a common opportunistics infections in AIDS and caused by the encapsulated yeast Cryptococcus neoformans. The predominant clinical manifestation in AIDS patients is meningitis. For the establishment of diagnosis, India ink test and culture were done. Serology test to detect capsular antigen glucoronoxylomannan (GXM) was done to support the diagnosis of cryptococcosis. The aim of this study is to know the prevalence of cryptococcosis among AIDS patients with CNS involvement in Jakarta and its surrounding places. The study was conducted from 2005 – 2007 at the Mycology laboratory Department of Parasitology, University of Indonesia, Faculty of Medicine. Spinal fluid from 154 AIDS patients with CNS involvement from Cipto Mangunkusumo hospital and other hospitals around Jakarta were tested using India ink test and cultured on sabouraud dextrose agar (SDA) and bird seed agar (BSA) and 48 were tested by latex agglutination test to detect GXM antigen. Out of 154 spinal fluids tested by india ink and culture, 32 (20,77%) samples contained Cryptococcus. GXM antigen was detected in 29 out of 48 samples. From 29 samples with GXM antigen, eight samples were also positive after mycology examination. The prevalence of cryptococcosis among AIDS patients with CNS involvement in Jakarta is 20.77%. Key words: spinal fluid, Cryptococcus neformans, prevalence, GXM antigen Abstrak Kriptokokosis yang disebabkan oleh khamir Cryptococcus neoformans merupakan infeksi oportunistik pada AIDS, dan meningitis adalah manifestasi klinis yang paling sering ditemukan. Untuk menegakkan diagnosis digunakan pemeriksaan tinta India dan kultur pada media agar. Uji serologi untuk deteksi antigen kapsular glucoronoxylomannan (GXM) dapat digunakan untuk mendukung penegakan diagnosis. Penelitian ini bertujuan untuk mengetahui prevalensi kriptokokosis pada penderita AIDS dengan gangguan serebral yang dilaksanakan sepanjang April 2005 – February 2007. Sebanyak 154 cairan otak penderita AIDS dari daerah Jakarta dan sekitarnya diperiksa dengan sediaan tinta India, dan kultur pada agar sabouraud dekstrose (ASD) dan bird seed agar (BSA). Dari 154 sampel, hanya 48 sampel yang menjalani pemeriksaan antigen GXM dengan metode agglutinasi lateks. Dari 154 cairan otak yang diperiksa dengan tinta india dan kultur 21 (20,77%) sampel mengandung Cryptococcus. Antigen GXM terdeteksi pada 29 dari 48 sampel. Dari 29 sampel yang positif antigen GXM, delapan positif mengandung Cryptococcus. Prevalensi kriptokokosis pada penderita AIDS dengan gangguan SSP di Jakarta sebesar 20,77%. Kata kunci: cairan otak, Cryptococcus neformans, prevalensi, antigen GX

Diagnosis Kriptokokosis Meningeal pada Penderita AIDS dengan Deteksi Antigen Glucuronoxylomanan pada Cairan Otak

AbstrakKriptokokosis meningeal karena ragi berkapsul Cryptococcus sering didapatkan pada penderita AIDS dan menyebabkan kecacatan dan kematian. Diagnosis dini yang diharapkan dapat diatasi dengan diagnosis pemeriksaan tinta India yang rendah dan kultur yang perlu 5-7 hari. Sebagai alternatif, WHO merekomendasikan deteksi antigen dengan cara uji aglutinasi lateks untuk deteksi antigen glucuronoxylomanan (GXM) dan lateral flow asay yang mendeteksi kompleks antigen Cryptococcus sp. Mengingat antigen GXM juga dapat ditemukan pada orang sehat, perlu ditetapkan nilai batas (cut off) yang untuk mendiagnosis kriptokokosis klinis. Pada penelitian ini, nilai cut off GXM dicari dengan memeriksa cairan otak yang tidak diencerkan, diencerkan 100×, 300×, dan 500× dengan menggunakan metoda aglutinasi lateks (PASTOREX TM CRYPTO PLUS 61747 (kat. 7EM2093, Bio-Rad Perancis). Tiap dilusi dihitung sensitivitas, spesifisitas, NPP, NPN, dan nilai kappa untuk menilai kesetaraan antara metode uji dengan baku emas (tinta india dan kultur) serta uji McNemar untuk mengetahui perbedaan antara metode uji dan baku emas. Receiver operating characteristics (ROC) curve dinilai untuk mengetahui kombinasi terbaik sensitivitas dan spesifisitas. Deteksi antigen GXM pada cairan otak menunjukkan sensitivitas dan spesifisitas yang bervariasi pada dilusi yang berbeda. Sensitivitas terbaik didapatkan pada LCS yang tidak diencerkan, namun spesifisitas terbaik ditemukan pada dilusi 500× (100%) disusul oleh dilusi 300× (98,1%). Secara keseluruhan berdasarkan sensitivitas, spesifisitas, NPP, NPN, nilai kappa dan nilai ROC, dilusi 300× merupakan dilusi terbaik. Uji McNemar memperlihatkan tidak ada perbedaan antara metode uji dan baku emas. Dilusi cairan otak 300× merupakan nilai cut off deteksi GXM untuk menegakkan diagnosis kriptokokosis meningeal. Kata kunci: Cryptococcus neoformans, meningitis, diagnosis AbstractMeningeal cryptococcosis is caused by encapsulated yeast Cryptococcus. This infection has a high morbidity and mortality rate. Early diagnosis is one of the keys to reduce morbidity and mortality. India ink examination is hampered by its low sensitivity, while culture is time consuming. WHO recommends antigen detection methods as an alternative, i.e. latex aglutination for Glucuronoxylomannan (GXM) and lateral flow assay (LFA) for antigen complex for Cryptococcus. Since GXM antigen is also found in healthy people, cut off value for clinical cryptococcosis needs to be established. In this studi, the GXM antigen detection was conducted by latex agglutination test (PASTOREXTM CRYPTO PLUS 61747 kat. 7EM2093, Bio-Rad, France). To establish the cut off value, a neat concentration, as well as 100, 300 and 500 times dilution of spinal fluids were tested. Sensitivity, specificity, PPV, NPV and kappa value for each dilution were calculated against the gold standard (india ink examination and culture). McNemar test was performed to evaluate the difference between the test and the gold standard. Receiver operating characteristics(ROC) curve was used to determine the best combination of sensitivity and specificity. GXM antigen detection on spinal fluid showed variation of sensitivity and specificity in different dilutions. The neat solution gave the best sensitivity, while the best specificity was shown by 500× dilution (100%) and then followed by 300× dilution (98,1%). Overall, 300× dilution gave the best combination of sensitivity, specificity, PPV, NPV, (p=0,07). In conclusion, 300× dilution of spinal fluid is the best cut off value for GXM detection for diagnosing meningeal cryptococcosis. Key words: Cryptococcus neoformans, meningitis, diagnosis &nbsp

Rodent is Potential Reservoir of Zoonoses Fungi in Jakarta, Indonesia

Some potentially human pathogenic fungi are known to be zoonoses. Rodent is one of potential reservoir of fungi. To date, little is known about the role of rodent in transmitting fungal disease in Indonesia. Therefore, purpose of this study was to find evidence of potential fungal zoonoses in rodent. We caught two house rats, one rat was from the house of patient suffering from talaromycosis and the other one was from a healthy person house. These rats internal organs (lung, liver, and spleen) were inoculated onto sabouraud dextrose agar (SDA) and SDA with additional of chloramphenicol. Fungi grown in the medium were analyzed using polymerase chain reaction (PCR) of internal transcribed spacer (ITS) continued by sequence-based approach. In addition PCR was also conducted using primers developed from beta tubulin gene. Amplified regions were sequenced and compared to database that contains reference sequences.We found three fungal species. Talaromyces atroroseus was isolated from the rat that caught from the house of patient with talaromycosis, while Purpureocillium lilacinum and Penicillium citrinum were isolated from the other rat caught in the house of healthy individual. Although naturally could be found in the environment, these species had been reported to cause fatal systemic mycosis in human. In conclusion Talaromyces atroroseus, Purpureocillium lilacinum and P. citrinum could be found in rat. This result indicates that rat could be a reservoir for these fung

Talaromyces atroroseus in HIV and non-HIV patient: A first report from Indonesia

We performed morphology, molecular study and antifungal susceptibility test on 10 Talaromyces sp. isolates: eight clinical isolates (human immunodeficiency virus (HIV) and non-HIV-patient) and two isolates from rats. All strains produced red soluble pigment and microscopically showed Penicillium-like structure in room temperature and yeast-like structure in 37◦C. Based on molecular analysis, nine isolates were identified as Talaromyces atroroseus (including the isolates from rats) and one as T. marneffei. Our susceptibility result of T. marneffei supports the use of amphotericin B, itraconazole for talaromycosis marneffei management. Talaromyces atroroseus showed variable MIC to echinocandin, azole derivatives, 5-flucytosine and amphotericin B

Diversity of Fungal Colonization in Respiratory Tract of Naïve Lung Cancer and The Emergence of Voriconazole Resistant Aspergillus

Fungal spores in the air can be inhaled and enter the human respiratory tract. The entry of fungi into the respiratory tract can cause colonization or infection depending on the host immune response. Fungal colonization is the first step into debilitating fungal disease in humans, especially in immunocompromised groups. The increased rate of drug-resistant fungi has been reported in human disease and the environment. This study aims to examine the diversity of fungal colonization in humans and the rate of fungal resistance to voriconazole. This cross-sectional study was done in patients with naïve lung cancer who had not been previously treated with any cancer therapy nor given antifungal agent. Induced sputum from 70 subjects was collected and inoculated in the Sabouraud Dextrose Agar medium. Macroscopic and microscopic examinations were performed to identify fungal species. Voriconazole susceptibility tests were done using the disc diffusion method. This study found Candida albicans, Aspergillus niger, Aspergillus fumigatus, and Penicillium sp. among the most common lower respiratory tract colonies. This study also found the colonization of up to 5 species in a single subject. A high rate of voriconazole-resistant Aspergillus sp. was found (42.4%) among 59 isolates tested. Given that these subjects had never taken antifungal agents previously, the high rate of voriconazole resistance might be attributed to the environment, such as community and agriculture. Mitigation of antifungal use in the agricultural sector, fungal diversity in the environment, and clinical study of fungal colonization/ infection in other high-risk groups are needed

Touch Biopsy: A Simple and Rapid Method for the Diagnosis of Systemic Mycoses with Skin Dissemination in HIV-Infected Patients

Systemic fungal infection can disseminate to the skin and require prompt treatment, making early diagnosis very important. This study describes the use of a simple, quick touch biopsy method for the diagnosis of invasive mycoses in patients with AIDS with cutaneous manifestations. We identified fungal infections in 24 of the 29 investigated patients. Histoplasma capsulatum, Cryptococcus neoformans, Talaromyces artroroseus, Aspergillus flavus, Candida tropicalis, and Malassezia sp. were visualized directly in samples obtained from cutaneous lesions and confirmed by culture and molecular examination. The results suggested that touch biopsy is a simple, rapid method for the diagnosis of systemic mycoses with skin dissemination. It can be performed using simple tools and provides quick results, allowing for early intervention with appropriate antifungal therapy

Resistance of Asian Cryptococcus neoformans Serotype A Is Confined to Few Microsatellite Genotypes

Contains fulltext : 109375.pdf (publisher's version ) (Open Access)BACKGROUND: Cryptococcus neoformans is a pathogenic yeast that causes cryptococcosis, a life threatening disease. The prevalence of cryptococcosis in Asia has been rising after the onset of the AIDS epidemic and estimates indicate more than 120 cases per 1,000 HIV-infected individuals per year. Almost all cryptococcal disease cases in both immunocompromised and immunocompetent patients in Asia are caused by C. neoformans var. grubii. Epidemiological studies on C. neoformans in pan-Asia have not been reported. The present work studies the genetic diversity of the fungus by microsatellite typing and susceptibility analysis of approximately 500 isolates from seven Asian countries. METHODOLOGY/PRINCIPAL FINDINGS: Genetic diversity of Asian isolates of C. neoformans was determined using microsatellite analysis with nine microsatellite markers. The analysis revealed eight microsatellite complexes (MCs) which showed different distributions among geographically defined populations. A correlation between MCs and HIV-status was observed. Microsatellite complex 2 was mainly associated with isolates from HIV-negative patients, whereas MC8 was associated with those from HIV-positive patients. Most isolates were susceptible to amphotericin B, itraconazole, voriconazole, posaconazole, and isavuconazole, but 17 (3.4%) and 10 (2%) were found to be resistant to 5-flucytosine and fluconazole, respectively. Importantly, five Indonesian isolates (approximately 12.5% from all Indonesian isolates investigated and 1% from the total studied isolates) were resistant to both antifungals. The majority of 5-flucytosine resistant isolates belonged to MC17. CONCLUSIONS: The findings showed a different distribution of genotypes of C. neoformans var. grubii isolates from various countries in Asia, as well as a correlation of the microsatellite genotypes with the original source of the strains and resistance to 5-flucytosine

Comparison of Selenium Sulfide 1% and Zinc Pyrithione 1% and Combination of them in Overcoming Malassezia Globosa in Vitro

Dandruff is a scalp disorder that is affected by three factors, namely the fungus Malassezia globosa, sebaceous gland activity, and individual susceptibility. Selenium sulfide (SeS2) and Zinc Pyrithion (ZPTO) is used as an antidandruff shampoo active ingredient because it has anti-fungal properties. The study was conducted to determine the potentiality of shampoo with active ingredient SeS2 1% and ZPTO 1% to M.globosa in vitro. The colonies of M.globosa (CBS 7966 ATCC 96 807) were exposed to a non-antifungal base shampoo, shampoo containing 1% SeS2, shampoo containing 1% ZPTO and shampoo containing combination of 1% SeS2 and 1% ZPTO. Fungal contact time with shampoo is 3 and 5 minutes. Fungal colonies are grown on Sabourraud Dextrose agar (SDA) medium coated with olive oil. Incubation was carried out at 37° C for 5 days. After fiveday, assessment was performed to observe whether the fungal culture was grown, and then the colony growth is calculated. The research was conducted at Clinical Parasitology Laboratory, Parasitology Department, Faculty of Medicine, University of Indonesia from November 2011 until April 2012. Data were analyzed using ANOVA and LSD Fisher test. Shampoo containing 1% SeS2 inhibited fungal growth in 5 min contact time (p = 0,000 <0.05), whereas 1% ZPTO shampoo fungal growth was inhibited either in 3 min or 5 min contact time (p = 0,000 <0,05), and combination of 1% SeS2 and 1% ZPTO shampoo in both contact times (p = 0,000 <0.05). In conclusion, combination of 1% SeS2 and 1% ZPTO shampoo has the most potency in inhibiting the growth of M.globosa colonies in vitro

Histoplasma antigen detection in unconfirmed pulmonary tuberculosis and cross-reactivity with Aspergillus antigen in patients and in food in Jakarta, Indonesia

PURPOSE: H. capsulatum is endemic in Indonesia, but the value of Histoplasma antigen detection has not been studied.PATIENTS AND METHODS: Histoplasma galactomannan (GM) ELISA was applied to sera of patients with unproven pulmonary tuberculosis (TB) and patients with a positive Aspergillus GM. Both Histoplasma and Aspergillus GM tests were performed to determine any possible cross-reaction with certain foods.RESULTS: Fourteen of 122 (11.5%) sera of patients with newly diagnosed clinical TB were positive for Histoplasma GM. The positivity rate in the serum of patients 5-6 and 12 months after TB diagnosis was 3.8% and 3.5%, respectively. Of 88 positive Aspergillus GM sera, 63 (71.6%) were also positive for Histoplasma GM. All tested foods were positive for Aspergillus GM, while 65% of foods were positive for Histoplasma GM.CONCLUSION: Galactomannan is widespread in sera and food in Jakarta, possibly related to food consumption. Histoplasma and Aspergillus antigen detection for the diagnosis will require additional means of confirming the diagnosis; negative tests may be more helpful for ruling out invasive histoplasmosis and aspergillosis.</p