Cholesterol dependent cytolysins and the brain: Revealing a potential therapeutic avenue for bacterial meningitis

Bacterial meningitis is a catastrophic nervous system disorder with high mortality and wide range of morbidities. Some of the meningitis-causing bacteria occupy cholesterol dependent cytolysins (CDCs) to increase their pathogenicity and arrange immune-evasion strategy. Studies have observed that the relationship between CDCs and pathogenicity in these meningitides is complex and involves interactions between CDC, blood-brain barrier (BBB), glial cells and neurons. In BBB, these CDCs acts on capillary endothelium, tight junction (TJ) proteins and neurovascular unit (NVU). CDCs also observed to elicit intriguing effects on brain inflammation which involves microglia and astrocyte activations, along with neuronal damage as the end-point of pathological pathways in bacterial meningitis. As some studies mentioned potential advantage of CDC-targeted therapeutic mechanisms to combat CNS infections, it might be a fruitful avenue to deepen our understanding of CDC as a candidate for adjuvant therapy to combat bacterial meningitis

Misidentification of S. suis as a Zoonotic Agent

BACKGROUND: Streptococcus suis is an emerging zoonotic pathogen. This bacterium commonly causes meningitis in human and is often associated with hearing and vestibular dysfunction. S. suis tends to be misidentified, leading to under-diagnosis. CASE PRESENTATION: A previously healthy 50-year-old man was admitted to one of the district hospitals in Bali Province, Indonesia, due to meningitis. He had a history of consuming homemade raw pork product two days before the onset of illness. Streptococcus mitis was identified from the cerebrospinal fluid culture by using VITEX 2 COMPACT (Biomeriuex) with a 99% probability score. This patient had clinical symptoms and risk factor identical to S. suis infection. Therefore, we performed confirmation tests for the cerebrospinal fluid by PCR (using primer specific for gdh and recN) and sequencing of those PCR products. Both of the confirmation tests showed a positive result for S. suis. CONCLUSION: There are few reports of S. suis infections in Indonesia, but we believe that the cases in Indonesia, especially Bali, are not uncommon. The under-reported cases are perhaps due to the difficulties in differentiating S. suis from other Streptococcus species by culture method, particularly Streptococcus mitis. Therefore, confirmation by PCR is necessary

POTENSI ANTIMIKROBA EKSTRAK SAMBILOTO (Andrographis paniculata Ness.) DAN KUNYIT (Curcuma longa Linn.) SERTA KOMBINASINYA TERHADAP BAKTERI Escherichia coli IN VITRO

Penggunaan tanaman tradisional sebagai obat telah banyak dikembangkan sebagai solusi pada kasus resistensi antibiotik. Penelitian ini bertujuan untuk menentukan aktivitas antimikroba dari ekstrak sambiloto, kunyit serta kombinasinya terhadap pertumbuhan bakteri gram negatif Esherichia coli. Penelitian ini adalah penelitian eksperimental murni yang dilakukan secara in-vitro. Ekstrak sampel kunyit dan sambiloto diperoleh dari proses ekstraksi menggunakan methanol 95%. Aktivitas antimikroba dinilai dari diameter zona hambat yang terbentuk pada bakteri E. coli dengan metode difusi cakram. Hasil penelitian ini ditemukan bahwa kombinasi ekstrak sambiloto dan kunyit memiliki potensi antimikroba yang bermakna terhadap bakteri E. coli dengan zona hambat sebesar 27,33 mm (p=0,002) pada konsentrasi 15 µg/ml. Ekstrak kunyit tunggal memiliki potensi antimikroba terhadap E. coli pada konsentrasi 15 µg/ml dengan zona hambat 28,67 mm (p=0,004). Ekstrak sambiloto tunggal tidak memiliki potensi antimikroba untuk E. coli. Simpulan penelitian ini yaitu penggunaan kunyit sebagai antimikroba tunggal memiliki potensi yang lebih baik dibandingkan kombinasi ekstrak, sehingga tidak perlu dikombinasi dengan sambiloto.     </p

POTENSI ANTIMIKROBA EKSTRAK SAMBILOTO (ANDROGRAPHIS PANICULATA NESS.) DAN KUNYIT (CURCUMA LONGA LINN.) SERTA KOMBINASINYA TERHADAP BAKTERI ESCHERICHIA COLI IN VITRO

Penggunaan tanaman tradisional sebagai obat telah banyak dikembangkan sebagai solusi pada kasus resistensi antibiotik. Penelitian ini bertujuan untuk menentukan aktivitas antimikroba dari ekstrak sambiloto, kunyit serta kombinasinya terhadap pertumbuhan bakteri gram negatif Esherichia coli. Penelitian ini adalah penelitian eksperimental murni yang dilakukan secara in-vitro. Ekstrak sampel kunyit dan sambiloto diperoleh dari proses ekstraksi menggunakan methanol 95%. Aktivitas antimikroba dinilai dari diameter zona hambat yang terbentuk pada bakteri E. coli dengan metode difusi cakram. Hasil penelitian ini ditemukan bahwa kombinasi ekstrak sambiloto dan kunyit memiliki potensi antimikroba yang bermakna terhadap bakteri E. coli dengan zona hambat sebesar 27,33 mm (p=0,002) pada konsentrasi 15 µg/ml. Ekstrak kunyit tunggal memiliki potensi antimikroba terhadap E. coli pada konsentrasi 15 µg/ml dengan zona hambat 28,67 mm (p=0,004). Ekstrak sambiloto tunggal tidak memiliki potensi antimikroba untuk E. coli. Simpulan penelitian ini yaitu penggunaan kunyit sebagai antimikroba tunggal memiliki potensi yang lebih baik dibandingkan kombinasi ekstrak, sehingga tidak perlu dikombinasi dengan sambiloto.     </p

Surveilan Pneumokokus dan Dampak Pneumonia pada Anak Balita

Latar belakang. Streptococcus pneumonia (SP) adalah penyebab utama meningitis, pneumonia, dan bakteremia pada bayi dan anak. Mikroorganisme tersebut adalah penyebab utama kematian yang dapat dicegah dengan imunisasi pada anak usia di bawah lima tahun. Data tentang insiden invasive pneumococcal disease (IPD) di Indonesia masih terbatas. Tujuan. Mengetahui dampak pneumonia dan IPD pada populasi target di Rumah Sakit Umum Pusat Sanglah Denpasar, Bali, Indonesia. Metode. Surveilan aktif berbasis rumah sakit, prospektif selama satu tahun pada anak usia 28 hari sampai 60 bulan. Seluruh anak yang tinggal dalam area cakupan penelitian, usia 28 hari sampai 36 bulan mengalami demam 39°C atau menderita pneumonia, menunjukkan gejala IPD Hasil. Subjek 736 anak dengan median usia 10 bulan (79,2% usia 28 hari sampai <24 bulan). S. pneumonia tidak terdeteksi dari seluruh subjek. Biakan darah dilakukan pada 736 subjek, 125 di antaranya (17,19%) menunjukkan pertumbuhan bakteri. Bakteri yang diisolasi dari biakan darah antara lain Staphylococcus sp 58 (46,4%), S. aureus 45 (36,0%), Pseudomonas sp 9 (7,2%), E. coli 3 (2,4%). Diagnosis awal terbanyak adalah pneumonia, 439 (59,7%). Insiden pneumonia 534,2/100000, usia 28 hari - <6 bulan 167,1/100000, dan usia 28 hari - <24 bulan 839/100000. Angka insiden tertinggi pneumonia dengan foto dada usia 28 hari - <6 bulan yaitu 10,9/100000, dan kelompok usia 28 hari - <24 bulan 19,4/100000. Angka insiden pneumonia dan foto dada dengan CRP 40 mg/L tertinggi pada kelompok usia 12 bulan - <24 bulan, 82,9/100000. Dilakukan pemeriksaan PCR S. pneumoniae terhadap 106 sampel, terdiri dari kasus meninggal, meningitis, sepsis dan pneumonia berat tidak terdeteksi S. pneumoniae Kesimpulan. Pneumonia mempunyai dampak yang cukup berarti bagi daerah cakupan RSUP Sanglah yang disebabkan oleh pneumokokus, dan saat ini masih merupakan tantangan

Effect of Hypervirulent Strains, Antibiotic Resistance, and Host Characteristics on Mortality of Klebsiella pneumoniae Bacteremia Patients at a Tertiary Referral Hospital in Denpasar, Indonesia

Klebsiella pneumoniae bacteremia is one of the leading causes of sepsis that has a high mortality rate. The effect of multidrug resistance and different virulence of Klebsiella pneumoniae on mortality is still controversial. This study aimed to determine the impact of hypervirulent K. pneumoniae (hvKp), MDR, and clinical characteristics on mortality of K. pneumoniae bacteremia patients. A retrospective cross-sectional study was conducted on  K.  pneumoniae bacteremia cases of patients hospitalized at Professor dr. I.G.N.G Ngoerah General Hospital from December 1, 2020, to May 31, 2021. A positive PCR of rmpA, iucA genes, and/or a positive string test was identified as hvKp. The mortality rate of 51 K. pneumoniae bacteremia patients samples (aged 0-74 years) was 72.5%, in which 9.8% (5/51) of them were hvKp and 51% of the isolates (26/51) produced the Extended Spectrum Beta Lactamase (ESBL). Furthermore, 9.8% (5/51) of the cases were carbapenem-resistant. Thus, hvKp, MDR, gender characteristics, and comorbidities do not significantly affect the mortality of K. pneumoniae bacteremia patients. Multivariate logistic regression analysis showed that sepsis (odds ratio (OR) 4.29; p=0.038) and adult age group (mean 50 years) (OR 3.75; p=0.039) are independent predictors with a significant effect on mortality of  K. pneumoniae bacteremia patients. Careful and integrated management of K. pneumoniae bacteremia patients is essential for better outcomes, especially in sepsis and elderly patients. Although hvKp prevalence is low, emerging MDR-hvKp in health facilities is a severe concern for further actions and research

Effect of Hypervirulent Strains, Antibiotic Resistance, and Host Characteristics on Mortality of Klebsiella pneumoniae Bacteremia Patients at a Tertiary Referral Hospital in Denpasar, Indonesia

Klebsiella pneumoniae bacteremia is one of the leading causes of sepsis that has a high mortality rate. The effect of multidrug resistance and different virulence of Klebsiella pneumoniae on mortality is still controversial. This study aimed to determine the impact of hypervirulent K. pneumoniae (hvKp), MDR, and clinical characteristics on mortality of K. pneumoniae bacteremia patients. A retrospective cross-sectional study was conducted on  K.  pneumoniae bacteremia cases of patients hospitalized at Professor dr. I.G.N.G Ngoerah General Hospital from December 1, 2020, to May 31, 2021. A positive PCR of rmpA, iucA genes, and/or a positive string test was identified as hvKp. The mortality rate of 51 K. pneumoniae bacteremia patients samples (aged 0-74 years) was 72.5%, in which 9.8% (5/51) of them were hvKp and 51% of the isolates (26/51) produced the Extended Spectrum Beta Lactamase (ESBL). Furthermore, 9.8% (5/51) of the cases were carbapenem-resistant. Thus, hvKp, MDR, gender characteristics, and comorbidities do not significantly affect the mortality of K. pneumoniae bacteremia patients. Multivariate logistic regression analysis showed that sepsis (odds ratio (OR) 4.29; p=0.038) and adult age group (mean 50 years) (OR 3.75; p=0.039) are independent predictors with a significant effect on mortality of  K. pneumoniae bacteremia patients. Careful and integrated management of K. pneumoniae bacteremia patients is essential for better outcomes, especially in sepsis and elderly patients. Although hvKp prevalence is low, emerging MDR-hvKp in health facilities is a severe concern for further actions and research