Aspergillus fumigatus as an agent of cutaneous aspergillosis in immunocompetent patient: A rare case

Cutaneous aspergillosis occurs relatively less frequent and therefore remains poorly characterized. Previous reports have described cutaneous aspergillosis as primary or secondary infection. Primary cutaneous aspergillosis usually involves sites of skin injury, at or near intravenous access catheter sites, at sites of traumatic inoculation, and at sites associated with occlusive dressings, burns, or surgery. Primary cutaneous aspergillosis almost always seen in immunocompromised patients and the skin involvement occurs due to hematogenous dissemination from a primary focus or contiguous spread from underlying infected tissues. This is a rare case of an-56-years-old-immunocompetence man with chief complaint of wound and swelling at left leg since 1 year ago that worsen in last 2 months. He got a history of scalded by hot water at his left leg 1 year ago and became swollen with multiple wound on its surface. Examination on regio pedis sinistra there is tumor with verrucous surface 10 cm in diameter, hard with multiple uneven edge ulcer 5 cm in diameter and hyperpigmentation macule unsharply marginated arround. Potassium hydroxide examination showed conidiophores dichotomously branching and septated hyphae that suitable with Aspergillosis sp. From cultures there is velvety-dark-green growth. The microscope findings from the culture specimen showed conidophore, metula, vesicle, phialde, and chains of pigmented conidia that suitable with Aspergillus fumigatus. Blood culture examination showed no growth of fungi. HIV rapid test negative results obtained. Patients treated with Itraconazole 2 x 200 mg for 12 weeks and obtained satisfactory result

The Profile of Erythroderma Patients

Background: Erythroderma is a rare, but it is life threatening. By knowing the profile of eritroderma, can expect the management and the cure of the patient more better. Objective: To evaluate the general profile of erythrodermic patients. Methods: This study was conducted retrospectively in erythrodermic patients in Kemuning Ward dr. Soetomo General Hospital Surabaya in 2011- 2014, collecting data from medical records of patients, including the incidence, etiology, clinical features, investigations, treatment, complications, mortality, and return visit. Results: The incidence of erytroderma patient was 83 (5.3%), gender most was men (54.2%) with the highest age range > 60 years (31.3%), the etiology of most was due to drug reactions (39.7%), skin efflorescence highest number was macular erythematous and thin scale, the percentage of each 69 (83.1%) and 65 (78.3%), the majority results of histopathological examination was drug reaction 23 (43.5%) and psoriasis vulgaris 18 (33.9%), patients were receiving oral dexamethasone therapy (80.7%), mostly complications was on the skin (69.9%), mortality rate was 6.1%. Conclusion: The profile of erythroderma patient has already been described, and the management was giving a good outcome with the mortality rate  6,1%

Retrospective Study : Rosacea Profile

Background: Rosacea is a chronic skin disorder which characterized by erythema of the central face that has persisted for months. Primary features of rosacea include flushing, papules, pustules, and telangiectatic. Although rosacea is clearly visible to all, it is largely unknown to misunderstood by the general public. Knowledge relating to the epidemiology, etiology, pathogenesis, and treatment of this facial disorder is limited. Purpose: To evaluate the management of patients with Rosacea in the cosmetic division, dermatovenereology outpatient clinic Dr. Soetomo general hospital period 2010-2012. Methods: Retrospective study of new patients with Rosacea in cosmetic division during 2010-2012. Results: During the period of three years (2010-2012), there were 49 new patients in cosmetic division, dermatovenereology outpatient clinic Dr. Soetomo general hospital. The most common patient was female, with the highest age group of 25-44 years old, and the most clinical feature found were papulopustular rosacea and erythemato-telangiectatic rosacea. The most common treatment were metronidazole for topical treatment and doxycycline for systemic treatment. Conclusions: The most clinical feature were papulopustular and erythematotelangiectatic subtype, only few cases of phymatous subtype, while the ocular subtype was not found. There were so many varieties in the management of rosacea because there was no standard therapy yet for the management of this disease. Key words: rosacea, retrospective study, rosacea subtype

Negative Response of Lymphocyte Transformation Test (LTT) in a Patient Diagnosed as Stevens-Johnson Syndrome: A Case Report

Background: Evidences for the key role of T-lymphocytes in the pathophysiology of Stevens-Johnson syndrome (SJS) may be evaluated by drug patch test (DPT) and lymphocyte transformation test (LTT). Purpose: This LTT technology may reveal the role and function of T-lymphocytes for both diagnostic and research purposes. Case: A 33 year-old woman was admited in Dermatology and Venereology Ward at Dr. Soetomo General Hospital with skin and mucous membrane lesions after taking oral medication. Clinical and laboratory examination were performed, establishing the diagnosis of SJS caused by suspect amoxycillin and paracetamol. Case management: The suspected drug was discontinued immediately. Patient was given appropriate supportive treatment, systemic antibiotic, and intravenous dexamethasone with initial adjusted dose of 0.1-0.2 mg/kg/day daily according to clinical improvement. The DPT and LTT were performed 6 months after the lesions healed completely. Both DPT and LTT revealed negative results. LTT is based on the principle that T-cells proliferate in the presence of a specific-antigen, with sensitivity and specificity of 60-70% and 85%, respectively. The LTT revealed negative response, stimulation index (SI<2). Patients with SJS often show weak positive or even negative LTT response. Conclusions: Negative result of DPT in SJS does not exclude suspected drug. LTT is more objective and specific than DPT, however the clinical severity is not associated with high SI values

Aspergillus fumigatus as an agent of cutaneous aspergillosis in immunocompetent patient: A rare case

Cutaneous aspergillosis occurs relatively less frequent and therefore remains poorly characterized. Previous reports have described cutaneous aspergillosis as primary or secondary infection. Primary cutaneous aspergillosis usually involves sites of skin injury, at or near intravenous access catheter sites, at sites of traumatic inoculation, and at sites associated with occlusive dressings, burns, or surgery. Primary cutaneous aspergillosis almost always seen in immunocompromised patients and the skin involvement occurs due to hematogenous dissemination from a primary focus or contiguous spread from underlying infected tissues. This is a rare case of an-56-years-old-immunocompetence man with chief complaint of wound and swelling at left leg since 1 year ago that worsen in last 2 months. He got a history of scalded by hot water at his left leg 1 year ago and became swollen with multiple wound on its surface. Examination on regio pedis sinistra there is tumor with verrucous surface 10 cm in diameter, hard with multiple uneven edge ulcer 5 cm in diameter and hyperpigmentation macule unsharply marginated arround. Potassium hydroxide examination showed conidiophores dichotomously branching and septated hyphae that suitable with Aspergillosis sp. From cultures there is velvety-dark-green growth. The microscope findings from the culture specimen showed conidophore, metula, vesicle, phialde, and chains of pigmented conidia that suitable with Aspergillus fumigatus. Blood culture examination showed no growth of fungi. HIV rapid test negative results obtained. Patients treated with Itraconazole 2 x 200 mg for 12 weeks and obtained satisfactory result

Studi Retrospektif: Alopesia Areata

Latar Belakang: Alopesia areata (AA) adalah penyakit yang ditandai dengan kerontokan rambut pada kulit kepala secara tiba-tiba. Penegakan diagnosis AA dengan pemeriksaan fisik dan dermoskopi cukup mudah, namun penatalaksanaan pasien AA cenderung sulit.Terapi hanya merangsang pertumbuhan rambut yang baru, tetapi tidak memengaruhi perjalanan penyakit. Tujuan: Mengevaluasi gambaran umum dan penatalaksanaan pasien AA. Metode: Penelitian ini merupakan penelitian deskriptif retrospektif dalam kurun waktu 5 tahun yaitu tahun 2012-2016 di Divisi Kosmetik URJ Kesehatan Kulit dan Kelamin RSUD Dr. Soetomo Surabaya. Hasil:  Jumlah pasien baru AA di Divisi Kosmetik Medik URJ Kesehatan Kulit dan Kelamin RSUD Dr. Soetomo Surabaya periode 2012-2016 sebesar 0,6% dari 4875 pasien Divisi Kosmetik Medik. Sebesar 70% pasien baru AA adalah pria dan didominasi oleh kelompok usia 25-44 tahun (40%). Keluhan pasien AA terbanyak berupa kerontokan atau kebotakan rambut setempat pada 27 pasien (90%). Lama sakit terbanyak pasien baru AA adalah 0-6 bulan, yaitu sebanyak 20% pasien dengan riwayat tanpa pengobatan sebelumnya sebanyak 76,7%, kriteria diagnosis terbanyak adalah area kecil tidak berambut yang didapatkan pada 90% pasien. Subtipe AA yang paling banyak ditemukan adalah subtipe klasik sebanyak 90% pasien. Terapi AA yang banyak digunakan adalah pemberian topikal minoxidil (96,7%) dan suplemen kombinasi. Sebanyak 46,7% pasien melakukan kontrol ulang. Simpulan: AA banyak menyerang pria pada usia produktif. Terapi pertama yang diberikan adalah topikal minoxidil. Hasil terapi pada pasien yg melakukan kontrol ulang 50% menunjukkan perbaikan yaitu pertumbuhan rambut baru pada lesi AA

Increase of Serum Zinc Levels in Patients with Vitiligo

Background: Vitiligo is a common acquired depigmentary disease characterized by depigmented patches of the skin, hair, and mucous membranes due to selective destruction of melanocytes. Zinc is one of the trace element that suspected to play an important role in pathogenesis of vitiligo. Previous research showed a controversial result in zinc level of vitiligo. Purpose: To compare serum zinc between vitiligo and control in Dermatology and Venereology Outpatient Clinic in Dr. Soetomo General Hospital Surabaya. Methods: Analitic observational case control research was conducted, with 19 vitiligo patients in Dermatology and Venereology Outpatient Clinic Dr. Soetomo hospital and 19 age-sex matched controls (non-vitiligo subjects) that were qualified with inclusion and exclusion criteria. Serum zinc level was measured in both groups using atomic absorbtion spectrophotometer. Results: Mean serum zinc in vitiligo groups were 254.53 µg/dL and 109.53 µg/dL in control groups. This results showed that mean serum zinc in vitiligo group significantly higher compared to control group (p<0,05). There was a statistically significant association between serum zinc level and progressivity of the lesion as patient with active vitiligo lesion showed higher values of serum zinc. Stress is the most common predisposing factors (36%), meanwhile stress can also induce the increasing of serum zinc. Conclusion: Serum zinc in vitiligo patient is higher than control and showed correlation with course of the disease. It is required further research to reveal the role of zink in vitiligo and the connection between the degree of stress and serum zinc

The Profile of Interferon-ɣ and BCG Scar as an Immune Response Reflection in Children with Leprosy

Background: Leprosy in children are commonly found in Madura, Indonesia. Bacillus Calmette-Guerin (BCG) vaccination and interferon--γ (IFN-γ) level associated with severity of leprosy. Purpose: To evaluate IFN-γ level and BCG scar due to leprosy in child. Methods: A descriptive observational cross sectional research, with leprosy in patients in Bangkalan, Madura as subjects. Subjects has been collected through consecutive sampling, then BCG scars were observed and blood vein samples were taken to measure IFN-γ level. Results: IFN-γ level were below normal range in almost all subjects. Mean level in patients with BCG scar (10,07 pg/ml) were higher than patients with non-scar (6,9 pg/ml). Seventy percents patients without BCG scar tend to be MB type based on percentage BCG scar due to type of leprosy. Conclusion: Immunity status as a result of BCG vaccination measured from IFN-γ level has many confounding factor. BCG vaccination seems to have an important role in severity of leprosy. Patients with BCG scar tend to be PB type. BCG vaccination can be benefits to make milder symptoms of leprosy

Sensitivity Difussion Test of Cefixime against Neisseria gonorrhoeae from Female Sex Worker with Cervicitis Gonorrhea without Complication who Follow Periodic Presumptive Treatment (PPT)

Background: Neisseria gonorrhoeae as etiology of gonorrhoeae infection is considered to be most concerned because of emerging antibiotic resistant strains that compromise the effectiveness of treatment. The emergence of antibiotic resistance has remained a challenge for a few decades. The third generation cephalosporins such as cefixime and ceftriaxone are now the first-line therapy in many region, however, the reduction of the susceptibility to cephalosporins is likely to emerge and spread. Purpose: To evaluate susceptibility of cefixime to Neisseria gonorrhoeae with diffusion test in uncomplicated cervicitis gonorrheae of female sex worker who following Periodic Presumptive Treatment’s program. Methods: The study design was descriptive observational cross sectional for 3.5 months from November 2012-February 2013 in Putat Jaya Public Health Center Surabaya. Results: There were 21 isolates of N. gonorrhoeae from 86 cervical secretions which were performed cefixime diffusion susceptibility test. Based on in vitro cefixime diffusion susceptibility test against N. gonorrhoeae isolates obtained 7 isolates (33.3%) were resistant to cefixime and 14 isolates (66.7%) sensitive to cefixime. From sensitive isolates, 5 of 14 isolates (35.7%) had inhibition zone with a diameter of 31 mm which is the minimum limit of cefixime ability to inhibit the growth rate of N. gonorrhoeae. Conclusions: There were found N. gonorrhoeae isolates that resistant to cefixime and some isolates with near of concentration maximal inhibition of cefixime with diffusion test. Thus it’s necessary to perform sentivity test of cefixime to N. gonorrhoeae using dilution test to obtain the resistance of N. gonorrhoeae to cefixime

Profil Pasien Urtikaria

Latar Belakang: Sebanyak 15-20% manusia pernah mengalami episode urtikaria satu kali selama hidupnya. Urtikaria adalah erupsi pada kulit, berwarna merah, berbatas tegas, dan memutih bila ditekan. Prevalensi urtikaria di dunia berkisar antara 0,3%-11,3% tergantung besar populasi yang diteliti. Tujuan: Mengevaluasi profil dan gambaran umum pasien baru urtikaria. Metode: Penelitian ini dilakukan di Instalasi Rawat Jalan Ilmu Kesehatan Kulit dan Kelamin dan Ilmu Penyakit Dalam RSUD Dr. Soetomo Surabaya periode 2015-2017. Metode yang digunakan adalah deskriptif retrospektif dengan mengevaluasi rekam medis pasien berupa umur, jenis kelamin, klasifikasi International Classification of Diseases (ICD) urtikaria, durasi urtikaria, dan pengobatan. Hasil: Didapatkan 463 pasien urtikaria. Pasien didominasi oleh rentang umur antara 12-25 tahun. Diagnosis terbanyak adalah urtikaria alergi sebanyak 36% pada tahun 2015, 34% tahun 2016, dan meningkat menjadi 40% pada tahun 2017. Pengobatan yang paling sering dilakukan adalah golongan obat antihistamin H1 generasi kedua. Kombinasi antihistamin H1 dan H2 juga masih banyak digunakan untuk terapi urtikaria. Simpulan: Pasien urtikaria di RSUD Dr. Soetomo tidak mengalami banyak perubahan bila dibandingkan dengan data profil urtikaria yang dilakukan tahun sebelumnya. Pengobatan urtikaria yang dilakukan kurang sesuai dengan guideline urtikaria terbaru tahun 2014