Conclusion. GBS patients with evidence of ZIKV infection were clinically similar to those without... more Conclusion. GBS patients with evidence of ZIKV infection were clinically similar to those without evidence of ZIKV infection, but more likely to have facial weakness and paresthesia during acute neurologic illness and report abnormal tear production at 6 months post neurologic onset. Pathophysiologic investigations should examine potential ZIKV autoimmune response preferential effect of cranial nerves among GBS patients. Disclosures. C. Luciano, Sanofi-Genzyme Corporation: Speaker's Bureau, Speaker honorarium.
In response to the COVID-19 pandemic, COVID-19 vaccines have been developed, and the World Health... more In response to the COVID-19 pandemic, COVID-19 vaccines have been developed, and the World Health Oraganization (WHO) has granted emergency use listing to multiple vaccines. Studies of vaccine immunogenicity data from implementing COVID-19 vaccines by national immunization programs in single studies spanning multiple countries and continents are limited but critically needed to answer public health questions on vaccines, such as comparing immune responses to different vaccines and among different populations.
BackgroundReinfection with SARS-CoV-2 has been well documented, yet little is known about the deg... more BackgroundReinfection with SARS-CoV-2 has been well documented, yet little is known about the degree of protection a previous infection provides against reinfection, especially against Variants of Concern (VOC).Case presentationHere we describe a case of an unvaccinated 49-year-old man who experienced two sequential SARS-CoV-2 infections with two different variants, as evidenced by genomic sequencing. The first episode was caused by the Pango lineage B.1.466.2 and resulted in severe COVID-19 with 5 days in an intensive care unit (ICU). The second episode occurred approximately 6 months later, during the Delta surge in Indonesia. Genomic analysis showed that the second infection was caused by the Delta variant (Pango lineage B.1.617.2) and resulted in mild disease that did not require hospitalization. No SARS-CoV-2 nucleic acid was detected between the two episodes, but both binding and neutralizing antibodies to SARS-CoV-2 were detected prior to the reinfection, with the second infe...
Determining the causative pathogen(s) of community-acquired pneumonia (CAP) in children remains a... more Determining the causative pathogen(s) of community-acquired pneumonia (CAP) in children remains a challenge despite advances in diagnostic methods. Currently available guidelines generally recommend empiric antimicrobial therapy when the specific etiology is unknown. However, shifts in epidemiology, emergence of new pathogens, and increasing antimicrobial resistance underscore the importance of identifying causative pathogen(s). Although viral CAP among children is increasingly recognized, distinguishing viral from bacterial etiologies remains difficult. Obtaining high quality samples from infected lung tissue is typically the limiting factor. Additionally, interpretation of results from routinely collected specimens (blood, sputum, and nasopharyngeal swabs) is complicated by bacterial colonization and prolonged shedding of incidental respiratory viruses. Using current literature on assessment of CAP causes in children, we developed an approach for identifying the most likely causat...
Additional file 1: Table S1. Diagnostic tests to confirm rickettsia infection and to exclude S. t... more Additional file 1: Table S1. Diagnostic tests to confirm rickettsia infection and to exclude S. typhi, Dengue, Leptospira, and Chikungunya infections and diagnostic tests to confirm rickettsia infection in an HIV patient and 31 patients with non-rickettsial clinical diagnoses.
The American Journal of Tropical Medicine and Hygiene, 2021
ABSTRACT. HIV prevalence in Indonesia is increasing, and only 64% of infected individuals know th... more ABSTRACT. HIV prevalence in Indonesia is increasing, and only 64% of infected individuals know their status. In a prospective cohort of 1,453 hospitalized patients with unexplained fever, 46 (3.2%) had HIV, including 15 (1.1%) patients without a prior HIV diagnosis. Among 31 subjects previously known to have HIV, 21 (68%) had been receiving combination antiretroviral therapy (cART) at the time of enrollment. Of 39 HIV cases with HIV RNA levels ≥ 100 copies/mL, sequencing for genotype analysis and resistance testing was successful in 30 (77%) subjects. The most common HIV subtypes were AE (90%) and B (10%). Five (16.7%) subjects had resistance mutations to nucleoside and non-nucleoside reverse transcriptase inhibitors, and all of them were on cART. No evidence of transmitted drug resistance was found in newly diagnosed individuals. Hospital-based screening may be an efficient method to expand HIV testing and identify a significant number of new cases. Access to care, close monitoring...
The American Journal of Tropical Medicine and Hygiene, 2020
Emergence of SARS-CoV-2 in dengue virus (DENV)-endemic areas complicates the diagnosis of both in... more Emergence of SARS-CoV-2 in dengue virus (DENV)-endemic areas complicates the diagnosis of both infections. COVID-19 cases may be misdiagnosed as dengue, particularly when relying on DENV IgM, which can remain positive months after infection. To estimate the extent of this problem, we evaluated sera from 42 confirmed COVID-19 patients for evidence of DENV infection. No cases of SARS-CoV-2 and DENV coinfection were identified. However, recent DENV infection, indicated by the presence of DENV IgM and/or high level of IgG antibodies, was found in seven patients. Dengue virus IgM and/or high IgG titer should not exclude COVID-19. SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) testing is appropriate when dengue nonstructural protein 1 (NS1) or RT-PCR is negative. Given the possibility of coinfection, testing for both DENV and SARS-CoV-2 is merited in the setting of the current pandemic.
Background Chikungunya virus (CHIKV) is often overlooked as an etiology of fever in tropical and ... more Background Chikungunya virus (CHIKV) is often overlooked as an etiology of fever in tropical and subtropical regions. Lack of diagnostic testing capacity in these areas combined with co-circulation of clinically similar pathogens such as dengue virus (DENV), hinders CHIKV diagnosis. To better address CHIKV in Indonesia, an improved understanding of epidemiology, clinical presentation, and diagnostic approaches is needed. Methodology/Principal findings Acutely hospitalized febrile patients �1-year-old were enrolled in a multi-site observational cohort study conducted in Indonesia from 2013 to 2016. Demographic and clinical data were collected at enrollment; blood specimens were collected at enrollment, once during days 14 to 28, and three months after enrollment. Plasma samples negative for DENV by serology and/or molecular assays were screened for evidence of acute CHIKV infection (ACI) by serology and molecular assays. To address the co-infection of DENV and CHIKV, DENV cases were selected randomly to be screened for evidence of ACI. ACI was confirmed in 40/1,089 (3.7%) screened subjects, all of whom were DENV negative. All 40 cases initially received other diagnoses, most commonly dengue fever, typhoid fever, and leptospirosis. ACI was found at five of the seven study cities, though evidence of prior CHIKV exposure was observed in 25.2% to 45.9% of subjects across sites. All subjects were assessed during hospitalization as mildly or moderately ill, consistent with the Asian genotype of PLOS NEGLECTED TROPICAL DISEASES
This is an open access article under the terms of the Creative Commons Attribution License, which... more This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Background: Since its emergence in China, SARS-CoV-2 has infected more than 15.5 million people w... more Background: Since its emergence in China, SARS-CoV-2 has infected more than 15.5 million people worldwide, including in regions where dengue virus (DENV) is hyperendemic such as Latin America and Southeast Asia, including Indonesia. Hence, anticipation for simultaneous infection by DENV and SARS-CoV-2 has been raised.Case presentation: We describe a 68-year-old woman with diabetes mellitus type II who was admitted to the Tangerang District Hospital on 14 April 2020. She lived in a neighborhood where a few people were contracting dengue fever. She presented with five days of fever, malaise, anorexia, nausea, myalgia, and arthralgia. Hematology results revealed anemia, thrombocytopenia, normal leukocyte count, increased neutrophil proportion, and decreased lymphocyte proportion and absolute lymphocyte. Her chest X-ray showed right pericardial infiltrates. Although dengue was clinically suspected, as she met COVID-19 screening criteria, she was also tested for SARS-CoV-2 infection. The...
Background The burden of leptospirosis in Indonesia is poorly understood. Data from an observatio... more Background The burden of leptospirosis in Indonesia is poorly understood. Data from an observational study conducted from 2013 to 2016 in seven cities across Indonesia was used to estimate the incidence of leptospirosis and document its clinical manifestations in patients requiring hospitalization. Methods Specimens from patients hospitalized with acute fever were collected at enrollment, 14–28 days, and 3 months. Demographic and clinical information were collected during study visits and/or retrieved from medical records and double-entered into clinical report forms. After initially screening for dengue virus and other pathogens, specimens were tested at a central Reference Laboratory for anti-Leptospira IgM using commercial ELISA kits and for Leptospira DNA using an in-house quantitative real-time PCR assay. Results Of 1464 patients enrolled, 45 (3.1%) confirmed cases (by PCR and/or sero-coversion or four-fold increase of IgM) and 6 (0.4%) probable cases (by high titer IgM) of lep...
Background: Reports of human rickettsial infection in Indonesia are limited. This study sought to... more Background: Reports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia.Methods: Acute and convalescent blood from 975 hospitalized non-dengue patients was tested for rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for rickettsia IgM and IgG by IFA and rickettsia genomes using primers for Rickettsia (R.) sp, R. typhi, and Orientia tsutsugamushi. Testing was performed retrospectively on stored specimens; results did not inform patient management.Results: Subject tested positive for R. typhi, R. rickettsia, and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of subjects, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea...
Background The epidemiology of acute febrile illness, a common cause of hospitalization in Indone... more Background The epidemiology of acute febrile illness, a common cause of hospitalization in Indonesia, has not been systematically studied. Methodology/Principal findings This prospective observational study enrolled febrile patients (temperature �38˚C) aged �1 year from July 2013 until June 2016 at eight government referral teaching hospitals in seven provincial capitals in Indonesia. Patients were managed according to the hospital standardof-care (SOC), and blood samples were drawn for molecular and serological assays. Clinical data, laboratory results, and specimens for additional tests were collected at enrollment, days 14-28, and at three months. Regular follow-up visits were then scheduled for every three months either until symptoms resolved or until one year. In total, this study included 1,486 adult and pediatric patients presenting with multi-organ (768, 51.7%), gastrointestinal (497, 33.0%), respiratory (114, 7.7%), constitutional (62, 4.2%), skin and soft-tissue (24, 1.6%), central nervous system (17, 1.1%), or genitourinary (4, 0.3%) manifestations. Microbiological diagnoses were found in 1,003/1,486 (67.5%) participants, of which 351/1,003 (35.0%) were not diagnosed during hospitalization using SOC diagnostic tests. Missed diagnoses included all cases caused by Rickettsia spp., chikungunya, influenza, and Seoul virus. The most common etiologic agents identified were dengue virus (467, 46.6%),
Background. Non-Group A Streptococci (NGAS) are common isolates from patients with pharyngitis. F... more Background. Non-Group A Streptococci (NGAS) are common isolates from patients with pharyngitis. Few studies have assessed the epidemiology and clinical features of these infections in children. Methods. The epidemiology, clinical features, and antibiotic prescribing patterns for NGAS among children with throat cultures obtained for pharyngitis were assessed at a large community-based health system over 10 years. Children with NGAS were compared with children with Group A Streptococcus (GAS) and negative cultures using uni-and multi-variate analysis. Antibiotic prescribing patterns were evaluated. Results. A total of 224,328 rapid Streptococcus tests and 116, 578 throat cultures were performed. Clinical analysis was completed for 602 GAS patients, 535 NGAS patients, and 480 patients with negative cultures. Incidence of NGAS did not vary annually or by season, but increased with age from 2% at ≤ 5 years to 7% at 18 years. Patients with NGAS were more likely than those with negative cultures to have exudates (20.3% vs. 13.1%, P = 0.003) and enlarged tonsils (28.6% vs. 19.3%, P < 0.001). Modified Centor scores did not differ between groups (score>2, P = 1.0; score>3, P = 0.50). Patients with GAS were more likely than those with NGAS to have fever (32.6% vs. 24.5%, P = 0.003), petechiae (14.0% vs. 3.1%, P < 0.001) and modified Centor score >2 (47.8% vs. 27.1%; P < 0.001). Of patients with NGAS 65% were prescribed antibiotics. Conclusion. NGAS likely exists in both a carriage and infectious state and the incidence increases with age. When NGAS causes infection the infection is milder than GAS and complications are rare. Laboratory reporting of NGAS results in high antibiotic use, despite current recommendations against treatment. Disclosures. All authors: No reported disclosures.
Introduction: The epidemiology of novel H1N1 Influenza virus infection in tropical countries is n... more Introduction: The epidemiology of novel H1N1 Influenza virus infection in tropical countries is not well described. To characterize the epidemiology of nH1N1 in Indonesia, we implemented enhanced surveillance for hospitalized patients with severe acute respiratory infection (SARI) in 12 Hospitals Tangerang, Indonesia in June 2009. Methods: We identified all hospitals that manage patients with respiratory illness and trained clinicians to identify SARI patients, collect clinical specimens and complete a standardized case investigation form. Throat and nasal swabs were tested by RT-PCR using primers from the US CDC. Results: Between June 28 and September 3, 2009, we identified 216 patients with SARI including 19 patients (9%) with nH1N1 infection. Patient with nH1N1 infection were identified in 7 hospitals and ranged in age from 11 months to 54 years (median age 20 years); 59% were male. The age specific rate for hospitalization 5.7 per 100,000 population. The number of patients with nH1N1 infection peaked in mid July which is the low season for seasonal influenza transmission in Tangerang, Indonesia. The median time from symptom onset to hospital admission was 2 days, ranging from 1 to 8 days. Six nH1N1 patients had complicated course of illness including 2 patients who died. Among the 19 nH1N1, 6 had underlying medical conditions. All patients with nH1N1 infection were treated with Oseltamivir. Conclusion: We observed a rapid rise in the number of SARI patients with nH1N1 infection shortly after introduction of this virus in Indonesia. The age distribution, clinical features, and mortality of hospitalized patients is similar to that observed in other countries.
Tujuan: Mengetahui proporsi kasus SARI yang disebabkan oleh virus infl uenza. Metode yang digunak... more Tujuan: Mengetahui proporsi kasus SARI yang disebabkan oleh virus infl uenza. Metode yang digunakan untuk mendeteksi keberadaan virus infl uenza adalah metode Reverse Transkriptase-Polymerase Chain Reaction (RT-PCR). Metode: Usap tenggorok yang diambil dari pasien yang memiliki simptom mengarah ke SARI di ekstrak untuk memperoleh RNA, kemudian diamplifi kasi menggunakan 5 pasang primer dan probe (infl uenza A, Infl uenza B, A/H1N1, A/H3N2 dan A/H5N1) dengan metode real-time RT-PCR. Hasil: Dari 549 sampel diketahui bahwa 6% pasien SARI disebabkan oleh virus Infl uenza, dan 4% disebabkan oleh virus Infl uenza A, 2% disebabkan oleh virus Infl uenza B. Virus infl uenza A yang paling banyak menyebabkan SARI adalah virus A/H3N2. Sedangkan 94% dari keseluruhan sampel SARI yang diterima menunjukan hasil negatif terhadap Infl uenza. Kesimpulan: Sebagian besar kasus SARI tidak disebabkan oleh virus infl uenza. Virus infl uenza A yang paling sering menyebabkan SARI adalah A/H3N2. Kondisi bahwa Kasus fl u burung A/H5N1 sudah pernah diidentifi kasi di Indonesia serta penyebaran virus baru infl uenza A/H1N1 pada tahun 2009 meningkatkan kembali pentingnya survelians SARI.
Conclusion. GBS patients with evidence of ZIKV infection were clinically similar to those without... more Conclusion. GBS patients with evidence of ZIKV infection were clinically similar to those without evidence of ZIKV infection, but more likely to have facial weakness and paresthesia during acute neurologic illness and report abnormal tear production at 6 months post neurologic onset. Pathophysiologic investigations should examine potential ZIKV autoimmune response preferential effect of cranial nerves among GBS patients. Disclosures. C. Luciano, Sanofi-Genzyme Corporation: Speaker's Bureau, Speaker honorarium.
In response to the COVID-19 pandemic, COVID-19 vaccines have been developed, and the World Health... more In response to the COVID-19 pandemic, COVID-19 vaccines have been developed, and the World Health Oraganization (WHO) has granted emergency use listing to multiple vaccines. Studies of vaccine immunogenicity data from implementing COVID-19 vaccines by national immunization programs in single studies spanning multiple countries and continents are limited but critically needed to answer public health questions on vaccines, such as comparing immune responses to different vaccines and among different populations.
BackgroundReinfection with SARS-CoV-2 has been well documented, yet little is known about the deg... more BackgroundReinfection with SARS-CoV-2 has been well documented, yet little is known about the degree of protection a previous infection provides against reinfection, especially against Variants of Concern (VOC).Case presentationHere we describe a case of an unvaccinated 49-year-old man who experienced two sequential SARS-CoV-2 infections with two different variants, as evidenced by genomic sequencing. The first episode was caused by the Pango lineage B.1.466.2 and resulted in severe COVID-19 with 5 days in an intensive care unit (ICU). The second episode occurred approximately 6 months later, during the Delta surge in Indonesia. Genomic analysis showed that the second infection was caused by the Delta variant (Pango lineage B.1.617.2) and resulted in mild disease that did not require hospitalization. No SARS-CoV-2 nucleic acid was detected between the two episodes, but both binding and neutralizing antibodies to SARS-CoV-2 were detected prior to the reinfection, with the second infe...
Determining the causative pathogen(s) of community-acquired pneumonia (CAP) in children remains a... more Determining the causative pathogen(s) of community-acquired pneumonia (CAP) in children remains a challenge despite advances in diagnostic methods. Currently available guidelines generally recommend empiric antimicrobial therapy when the specific etiology is unknown. However, shifts in epidemiology, emergence of new pathogens, and increasing antimicrobial resistance underscore the importance of identifying causative pathogen(s). Although viral CAP among children is increasingly recognized, distinguishing viral from bacterial etiologies remains difficult. Obtaining high quality samples from infected lung tissue is typically the limiting factor. Additionally, interpretation of results from routinely collected specimens (blood, sputum, and nasopharyngeal swabs) is complicated by bacterial colonization and prolonged shedding of incidental respiratory viruses. Using current literature on assessment of CAP causes in children, we developed an approach for identifying the most likely causat...
Additional file 1: Table S1. Diagnostic tests to confirm rickettsia infection and to exclude S. t... more Additional file 1: Table S1. Diagnostic tests to confirm rickettsia infection and to exclude S. typhi, Dengue, Leptospira, and Chikungunya infections and diagnostic tests to confirm rickettsia infection in an HIV patient and 31 patients with non-rickettsial clinical diagnoses.
The American Journal of Tropical Medicine and Hygiene, 2021
ABSTRACT. HIV prevalence in Indonesia is increasing, and only 64% of infected individuals know th... more ABSTRACT. HIV prevalence in Indonesia is increasing, and only 64% of infected individuals know their status. In a prospective cohort of 1,453 hospitalized patients with unexplained fever, 46 (3.2%) had HIV, including 15 (1.1%) patients without a prior HIV diagnosis. Among 31 subjects previously known to have HIV, 21 (68%) had been receiving combination antiretroviral therapy (cART) at the time of enrollment. Of 39 HIV cases with HIV RNA levels ≥ 100 copies/mL, sequencing for genotype analysis and resistance testing was successful in 30 (77%) subjects. The most common HIV subtypes were AE (90%) and B (10%). Five (16.7%) subjects had resistance mutations to nucleoside and non-nucleoside reverse transcriptase inhibitors, and all of them were on cART. No evidence of transmitted drug resistance was found in newly diagnosed individuals. Hospital-based screening may be an efficient method to expand HIV testing and identify a significant number of new cases. Access to care, close monitoring...
The American Journal of Tropical Medicine and Hygiene, 2020
Emergence of SARS-CoV-2 in dengue virus (DENV)-endemic areas complicates the diagnosis of both in... more Emergence of SARS-CoV-2 in dengue virus (DENV)-endemic areas complicates the diagnosis of both infections. COVID-19 cases may be misdiagnosed as dengue, particularly when relying on DENV IgM, which can remain positive months after infection. To estimate the extent of this problem, we evaluated sera from 42 confirmed COVID-19 patients for evidence of DENV infection. No cases of SARS-CoV-2 and DENV coinfection were identified. However, recent DENV infection, indicated by the presence of DENV IgM and/or high level of IgG antibodies, was found in seven patients. Dengue virus IgM and/or high IgG titer should not exclude COVID-19. SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) testing is appropriate when dengue nonstructural protein 1 (NS1) or RT-PCR is negative. Given the possibility of coinfection, testing for both DENV and SARS-CoV-2 is merited in the setting of the current pandemic.
Background Chikungunya virus (CHIKV) is often overlooked as an etiology of fever in tropical and ... more Background Chikungunya virus (CHIKV) is often overlooked as an etiology of fever in tropical and subtropical regions. Lack of diagnostic testing capacity in these areas combined with co-circulation of clinically similar pathogens such as dengue virus (DENV), hinders CHIKV diagnosis. To better address CHIKV in Indonesia, an improved understanding of epidemiology, clinical presentation, and diagnostic approaches is needed. Methodology/Principal findings Acutely hospitalized febrile patients �1-year-old were enrolled in a multi-site observational cohort study conducted in Indonesia from 2013 to 2016. Demographic and clinical data were collected at enrollment; blood specimens were collected at enrollment, once during days 14 to 28, and three months after enrollment. Plasma samples negative for DENV by serology and/or molecular assays were screened for evidence of acute CHIKV infection (ACI) by serology and molecular assays. To address the co-infection of DENV and CHIKV, DENV cases were selected randomly to be screened for evidence of ACI. ACI was confirmed in 40/1,089 (3.7%) screened subjects, all of whom were DENV negative. All 40 cases initially received other diagnoses, most commonly dengue fever, typhoid fever, and leptospirosis. ACI was found at five of the seven study cities, though evidence of prior CHIKV exposure was observed in 25.2% to 45.9% of subjects across sites. All subjects were assessed during hospitalization as mildly or moderately ill, consistent with the Asian genotype of PLOS NEGLECTED TROPICAL DISEASES
This is an open access article under the terms of the Creative Commons Attribution License, which... more This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Background: Since its emergence in China, SARS-CoV-2 has infected more than 15.5 million people w... more Background: Since its emergence in China, SARS-CoV-2 has infected more than 15.5 million people worldwide, including in regions where dengue virus (DENV) is hyperendemic such as Latin America and Southeast Asia, including Indonesia. Hence, anticipation for simultaneous infection by DENV and SARS-CoV-2 has been raised.Case presentation: We describe a 68-year-old woman with diabetes mellitus type II who was admitted to the Tangerang District Hospital on 14 April 2020. She lived in a neighborhood where a few people were contracting dengue fever. She presented with five days of fever, malaise, anorexia, nausea, myalgia, and arthralgia. Hematology results revealed anemia, thrombocytopenia, normal leukocyte count, increased neutrophil proportion, and decreased lymphocyte proportion and absolute lymphocyte. Her chest X-ray showed right pericardial infiltrates. Although dengue was clinically suspected, as she met COVID-19 screening criteria, she was also tested for SARS-CoV-2 infection. The...
Background The burden of leptospirosis in Indonesia is poorly understood. Data from an observatio... more Background The burden of leptospirosis in Indonesia is poorly understood. Data from an observational study conducted from 2013 to 2016 in seven cities across Indonesia was used to estimate the incidence of leptospirosis and document its clinical manifestations in patients requiring hospitalization. Methods Specimens from patients hospitalized with acute fever were collected at enrollment, 14–28 days, and 3 months. Demographic and clinical information were collected during study visits and/or retrieved from medical records and double-entered into clinical report forms. After initially screening for dengue virus and other pathogens, specimens were tested at a central Reference Laboratory for anti-Leptospira IgM using commercial ELISA kits and for Leptospira DNA using an in-house quantitative real-time PCR assay. Results Of 1464 patients enrolled, 45 (3.1%) confirmed cases (by PCR and/or sero-coversion or four-fold increase of IgM) and 6 (0.4%) probable cases (by high titer IgM) of lep...
Background: Reports of human rickettsial infection in Indonesia are limited. This study sought to... more Background: Reports of human rickettsial infection in Indonesia are limited. This study sought to characterize the epidemiology of human rickettsioses amongst patients hospitalized with fever at 8 tertiary hospitals in Indonesia.Methods: Acute and convalescent blood from 975 hospitalized non-dengue patients was tested for rickettsia IgM and IgG by ELISA. Specimens from cases with seroconversion or increasing IgM and/or IgG titers were tested for rickettsia IgM and IgG by IFA and rickettsia genomes using primers for Rickettsia (R.) sp, R. typhi, and Orientia tsutsugamushi. Testing was performed retrospectively on stored specimens; results did not inform patient management.Results: Subject tested positive for R. typhi, R. rickettsia, and O. tsutsugamushi IgG antibodies were identified in 269/872 (30.8%), 36/634 (5.7%), and 19/504 (3.8%) of subjects, respectively. For the 103/975 (10.6%) non-dengue patients diagnosed with acute rickettsial infection, presenting symptoms included nausea...
Background The epidemiology of acute febrile illness, a common cause of hospitalization in Indone... more Background The epidemiology of acute febrile illness, a common cause of hospitalization in Indonesia, has not been systematically studied. Methodology/Principal findings This prospective observational study enrolled febrile patients (temperature �38˚C) aged �1 year from July 2013 until June 2016 at eight government referral teaching hospitals in seven provincial capitals in Indonesia. Patients were managed according to the hospital standardof-care (SOC), and blood samples were drawn for molecular and serological assays. Clinical data, laboratory results, and specimens for additional tests were collected at enrollment, days 14-28, and at three months. Regular follow-up visits were then scheduled for every three months either until symptoms resolved or until one year. In total, this study included 1,486 adult and pediatric patients presenting with multi-organ (768, 51.7%), gastrointestinal (497, 33.0%), respiratory (114, 7.7%), constitutional (62, 4.2%), skin and soft-tissue (24, 1.6%), central nervous system (17, 1.1%), or genitourinary (4, 0.3%) manifestations. Microbiological diagnoses were found in 1,003/1,486 (67.5%) participants, of which 351/1,003 (35.0%) were not diagnosed during hospitalization using SOC diagnostic tests. Missed diagnoses included all cases caused by Rickettsia spp., chikungunya, influenza, and Seoul virus. The most common etiologic agents identified were dengue virus (467, 46.6%),
Background. Non-Group A Streptococci (NGAS) are common isolates from patients with pharyngitis. F... more Background. Non-Group A Streptococci (NGAS) are common isolates from patients with pharyngitis. Few studies have assessed the epidemiology and clinical features of these infections in children. Methods. The epidemiology, clinical features, and antibiotic prescribing patterns for NGAS among children with throat cultures obtained for pharyngitis were assessed at a large community-based health system over 10 years. Children with NGAS were compared with children with Group A Streptococcus (GAS) and negative cultures using uni-and multi-variate analysis. Antibiotic prescribing patterns were evaluated. Results. A total of 224,328 rapid Streptococcus tests and 116, 578 throat cultures were performed. Clinical analysis was completed for 602 GAS patients, 535 NGAS patients, and 480 patients with negative cultures. Incidence of NGAS did not vary annually or by season, but increased with age from 2% at ≤ 5 years to 7% at 18 years. Patients with NGAS were more likely than those with negative cultures to have exudates (20.3% vs. 13.1%, P = 0.003) and enlarged tonsils (28.6% vs. 19.3%, P < 0.001). Modified Centor scores did not differ between groups (score>2, P = 1.0; score>3, P = 0.50). Patients with GAS were more likely than those with NGAS to have fever (32.6% vs. 24.5%, P = 0.003), petechiae (14.0% vs. 3.1%, P < 0.001) and modified Centor score >2 (47.8% vs. 27.1%; P < 0.001). Of patients with NGAS 65% were prescribed antibiotics. Conclusion. NGAS likely exists in both a carriage and infectious state and the incidence increases with age. When NGAS causes infection the infection is milder than GAS and complications are rare. Laboratory reporting of NGAS results in high antibiotic use, despite current recommendations against treatment. Disclosures. All authors: No reported disclosures.
Introduction: The epidemiology of novel H1N1 Influenza virus infection in tropical countries is n... more Introduction: The epidemiology of novel H1N1 Influenza virus infection in tropical countries is not well described. To characterize the epidemiology of nH1N1 in Indonesia, we implemented enhanced surveillance for hospitalized patients with severe acute respiratory infection (SARI) in 12 Hospitals Tangerang, Indonesia in June 2009. Methods: We identified all hospitals that manage patients with respiratory illness and trained clinicians to identify SARI patients, collect clinical specimens and complete a standardized case investigation form. Throat and nasal swabs were tested by RT-PCR using primers from the US CDC. Results: Between June 28 and September 3, 2009, we identified 216 patients with SARI including 19 patients (9%) with nH1N1 infection. Patient with nH1N1 infection were identified in 7 hospitals and ranged in age from 11 months to 54 years (median age 20 years); 59% were male. The age specific rate for hospitalization 5.7 per 100,000 population. The number of patients with nH1N1 infection peaked in mid July which is the low season for seasonal influenza transmission in Tangerang, Indonesia. The median time from symptom onset to hospital admission was 2 days, ranging from 1 to 8 days. Six nH1N1 patients had complicated course of illness including 2 patients who died. Among the 19 nH1N1, 6 had underlying medical conditions. All patients with nH1N1 infection were treated with Oseltamivir. Conclusion: We observed a rapid rise in the number of SARI patients with nH1N1 infection shortly after introduction of this virus in Indonesia. The age distribution, clinical features, and mortality of hospitalized patients is similar to that observed in other countries.
Tujuan: Mengetahui proporsi kasus SARI yang disebabkan oleh virus infl uenza. Metode yang digunak... more Tujuan: Mengetahui proporsi kasus SARI yang disebabkan oleh virus infl uenza. Metode yang digunakan untuk mendeteksi keberadaan virus infl uenza adalah metode Reverse Transkriptase-Polymerase Chain Reaction (RT-PCR). Metode: Usap tenggorok yang diambil dari pasien yang memiliki simptom mengarah ke SARI di ekstrak untuk memperoleh RNA, kemudian diamplifi kasi menggunakan 5 pasang primer dan probe (infl uenza A, Infl uenza B, A/H1N1, A/H3N2 dan A/H5N1) dengan metode real-time RT-PCR. Hasil: Dari 549 sampel diketahui bahwa 6% pasien SARI disebabkan oleh virus Infl uenza, dan 4% disebabkan oleh virus Infl uenza A, 2% disebabkan oleh virus Infl uenza B. Virus infl uenza A yang paling banyak menyebabkan SARI adalah virus A/H3N2. Sedangkan 94% dari keseluruhan sampel SARI yang diterima menunjukan hasil negatif terhadap Infl uenza. Kesimpulan: Sebagian besar kasus SARI tidak disebabkan oleh virus infl uenza. Virus infl uenza A yang paling sering menyebabkan SARI adalah A/H3N2. Kondisi bahwa Kasus fl u burung A/H5N1 sudah pernah diidentifi kasi di Indonesia serta penyebaran virus baru infl uenza A/H1N1 pada tahun 2009 meningkatkan kembali pentingnya survelians SARI.
Uploads
Papers by Dewi Lokida