The body mass index profiles in chronic pulmonary aspergillosis: trend and variability in post tuberculosis patients

Tuberculosis (TB) is the main risk factor for chronic pulmonary aspergillosis, especially in patients with residual cavitary lesions after completion of TB therapy. The body mass index (BMI) is one of the established markers in predicting the mortality of CPA. However, the data regarding BMI profiles of CPA patients in Indonesia is still limited. We evaluated the BMI profiles of CPA patients among post-TB patients. Patients diagnosed as CPA based on clinical, radiology and the Aspergillus IgG test. 50 patients were included with a mean age of 35 years; 13 patients met the criteria of CPA. The overall median of BMI in these patients was 21. The median BMI in the CPA group was 19,3. The lowest (19,8) median BMI value was observed in the positive Aspergillus IgG group (11,5 – 30 mg/L) with a minimum BMI of 14,7 and a maximum BMI of 29,2. The differences in median BMI across CPA and non CPA groups and Aspergillus IgG level were not statistically significant. However, there is a trend that lower BMI were distributed among patients with positive Aspergillus IgG. More than one third of CPA patients in this study were classified as underweight. Future study is necessary to better  depict the BMI profiles in larger scale of populations of CPA in Indonesia in order to achieve better diagnosis and management of CPA

Density of Dermatophagoides spp. and Its Relationship with House-dust Mite Specific Serum IgE in Persistent Asthma

Background: Asthma is a chronic inflammation of the bronchial tree that emerges as a response to exogenous factors, such as allergens, irritants, and infections. Some asthmatic patients had been reported having symptoms of asthma due to house-dust mites (HDM) allergen exposure. It is associated with immune responses which were increased in the form of specific Immunoglobulin E (IgE) production against HDM allergens. This case-control study aimed to determine the HDM profiles in persistent asthmatic patients, including density of mites, as well as its relationship with specific IgE anti-HDM serum levels.Materials and Methods: A total of 13 patients with persistent asthma and 12 control patients had their specific anti-HDM IgE levels examined using Immulite 2000 xpi. The house dust samples were taken and analyzed with the Fain method.Results: The results have shown that 69% of patients in the persistent asthma group and 25% of normal patients were positive for IgE anti-HDM. Dermatophagoides pteronyssinus is a predominant species with a total of 120 mites (83.9%) of 143 mites. Correlation analysis indicated a positive relationship between IgE anti-HDM levels within the serums of patients and the density of mites in the dust obtained from bedroom spaces (Spearmen Rho, R=0.35, p=0.04).Conclusion: Positive IgE anti-HDM patients in the persistent asthma group were higher (69%) than those in the clinically normal group (25%). The density of mites were dominated by D. Pteronyssinus. The bedroom-dust mites density revealed a positive correlation with serum IgE anti-HDM levels in persistent asthma patients.Keywords: asthma, density, Dermatophagoides spp.,Ig

Diagnosis dan Penatalaksanaan Ventilator-Associated Pneumonia

Abstrak Ventilator-associated pneumonia (VAP) atau pneumonia terkait penggunaan ventilator masih menjadi masalahdalam penatalaksanaan pasien pengguna ventilasi mekanis. Kejadian VAP dihubungkan dengan meningkatnyamorbiditas, lama rawat di rumah sakit atau ICU serta biaya yang harus dikeluarkan pasien. Etiologi VAP sangatbervariasi, hal itu berdasarkan atas populasi pasien, lama rawat di rumah sakit serta terapi antimikrobasebelumnya. Identifikasi segera pasien terinfeksi dan pemilihan antimikroba yang tepat berperan penting dalampenatalaksanaan. Pemilihan terapi antimikroba awal hendaknya didasarkan atas flora paling dominan yangbertanggungjawab terhadap terjadinya VAP pada tiap pusat perawatan, jenis ruang rawat, data laboratoriumpemeriksaan langsung bahan klinis paru, aktivitas antimikroba serta karakteristik farmakokinetiknya. Kata kunci : ventilator-associated pneumonia, diagnosis, penatalaksanaan, pemilihan antimikroba Abstract Ventilator-associated pneumonia (VAP) continues to complicate the management of patients receiving mechanical ventilation (MV). The VAP is associated with excess morbidity, increasing intensive care unit (ICU)/hospital stay and patient costs. The etiologic agents widely differ depend on the population of patients, duration of hospital stay and prior antimicrobial therapy. Rapid identification of the infected patients and accurate selection of the antimicrobial agents represent important clinical goals. Selection of the initial antimicrobial therapy should be based on the predominant flora responsible for VAP at each institution and clinical setting. Furthemore, the information provided by direct examination of pulmonary secretions. Finally, it should also be based on the antimicrobial agents activities and their pharmacokinetic characteristics. Keywords: ventilator-associated pneumonia, diagnosis, management, antimicrobial therapy&nbsp

The Review of Histoplasmosis Endemicity and Current Status in Asia

Histoplasmosis is a common disease among immunocompromised patients and a notable endemic disease among immunocompetent patients. Disseminated histoplasmosis in acquired immunodeficiency syndrome (AIDS) patients is mostly lethal. We conducted a literature review of histoplasmosis and histoplasmin skin test in Asia. There were around 1692 cases of histoplasmosis reported from Asian countries. India (623 cases), China (611 cases) and Thailand (234 cases) are detected as endemic areas of histoplasmosis although the complete mapping of this disease is still missing in some Asian countries. However, definite diagnosis is difficult since the symptoms frequently mimicking tuberculosis (TB), tissue samples are rarely obtained, and lacked of serology tests in Asian countries

Kriptokokosis Meningeal: Epidemiologi Berbasis Molekular, Manifestasi Klinis dan Luarannya

Abstrak Cryptococcus sp. sebagai penyebab kriptokokosis meningeal telah banyak diteliti di dunia, tetapi epidemiologi molekular, manifestasi klinis, penegakan diagnostik dan luaran klinisnya belum dibahas secara komprehensif. Tujuh nama baru Cryptococcus sp. telah diusulkan dan berdasarkan hal itu penyebarannya bervariasi di beberapa negara. Cryptococcus. gattii masih lebih terbatas area penyebarannya dibandingkan C. neoformans. Keragaman genotipe dapat diperoleh baik dalam satu negara maupun pada satu pasien kriptokokosis meningeal. Manifestasi klinis yang mucul berbeda-beda, namun utamanya adalah sakit kepala, demam dan penurunan kesadaran. Prosedur diagnosis dapat dipilih mulai dari pemeriksaan konvensional hingga uji berbasis molekular dan protein. Luaran klinis dipengaruhi oleh beberapa faktor, diantaranya beban jamur, penyakit dasar, status imun pasien, diagnosis dini, serta ketersediaan obat. Kata Kunci: Cryptococcus, kriptokokosis, spesies, aspek klinik. Abstract Cryptococcus sp. as the cause of meningeal cryptococcosis had been widely studied around the world. But its molecular epidemiology with clinical manifestations, diagnostic procedures and clinical outcomes have not been comprehensively discussed. Seven new names for Cryptococcus sp. have been proposed and the distribution varies in several countries. However, C. gattii is still more restricted in area than C. neoformans. Genotype diversity was obtained in both one country and in one patient meningeal cryptococcosis. The clinical manifestations that appear are different, however the main ones are headache, fever and decreased consciousness. Diagnosis procedures could be carried out from conventional to molecular and protein-based. Clinical outcomes are influenced by several factors, including fungal load, underlying disease, patient’s immune status and early doagnosis as well as the availability of drugs.Key words: Cryptococcus, molecular epidemiology, clinical aspects &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

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

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

Whole genome sequencing data of Candida krusei, the pathogen causing Candidaemia, from Department of Parasitology Culture Collection, Faculty of Medicine Universitas Indonesia [version 2; peer review: 2 approved]

Candida krusei is a Candida non-albicans species with a high prevalence, which causes candidaemia. Current treatment guidelines include fluconazole as a primary therapeutic option for the treatment of these infections; however, it is only a fungistatic against Candida spp., and both inherent and acquired resistance to fluconazole have been reported. C. krusei species is also reported as the only Candida sp. which has an intrinsic resistance factor to fluconazole. Therefore, in dealing with antifungal resistance, it is necessary to develop new antifungal agents that are efficient in the treatment of fungal infections, especially those caused by C. krusei. The purpose of this study was to investigate the genome of clinical C. krusei isolates and correlate the resistant phenotypes with mutations in resistance genes. A total of 16 samples of C. krusei from clinical samples from hospitals in Jakarta were used in the experiment. All colonies were extracted using the QIAamp DNA Mini Kit. The library was prepared using the Illumina DNA Prep Kit. The sequencing process was carried out on the Illumina MiSeq Platform using a 2x301 paired-end configuration. FASTQ raw files are available under the BioProject Accession Number PRJNA819536 and Sequence Read Archive Accession Numbers SRR18739949 and SRR18739964