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"Latar Belakang: Kriptokokosis meningeal merupakan infeksi oportunistik yang muncul pada penderita terinfeksi HIV di Indonesia. Penyebab utama kriptokokosis adalah Cryptococcus neoformans. Laporan terkait karakteristik klinis, mikologis dan laboratorium klinis pada pasien AIDS dengan kriptokokosis meningeal belum ada di Indonesia. Tujuan: Mengetahui karakteristik klinis, mikologis dan laboratoris pasien AIDS dengan kriptokokosis meningeal di Jakarta. Metode: Penelitian deskripsi retrospektif dengan desain potong lintang ini dilakukan di RSCM dan RSKO untuk data klinisnya dan pemeriksaan laboratoriumnya dilakukan di laboratorium departemen Parasitologi FKUI dan Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands. Hasil: Gejala klinis utama adalah sakit kepala. Pasien yang hidup lebih banyak dari yang meninggal di RS. Isolat Cryptococcus sp. seluruhnya memproduksi melanin, membentuk empat fenotipe koloni, memiliki dua jenis mating-type dan empat genotipe (AFLP1, AFLP1 A, AFLP2 dan AFLP3). Terdapat infeksi campur mating-type dan genotipe pada satu pasien. Hitung CD4 mayoritas rendah.Diskusi: Mating-type terbanyak adalah α- α karena lebih virulens. Genotipe yang ditemukan sesuai laporan di dunia. Infeksi campur mating-type dan genotipe diduga karena jamur yang menginfeksi memiliki mating-type dan genotipe yang berbeda.Kesimpulan: Sakit kepala merupakan gejala klinis terbanyak. Genotipe terbanyak adalah AFLP1. Terdapat infeksi campur mating-type dan genotipe pada satu pasien.

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Background: Meningeal cryptococcosis is an opportunistic infection in HIV-infected patients. The main cause of cryptococcosis is Cryptococcus neoformans. Reports related to clinical, Mycological and laboratory characteristics in AIDS patients with meningeal cryptococcosis do not yet exist in Indonesia. Objective: To determine the clinical, Mycological and laboratory characteristics of AIDS patients with meningeal cryptococcosis in Jakarta. Methods: This retrospective description study with cross-sectional design was conducted at RSCM and RSKO for clinical data and laboratory tests were carried out in the laboratory of the department of Parasitology FKUI and Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands. Results: The main symptom is headache. Patients live more than those who died in the hospital. All isolates of Cryptococcus sp. produce melanin, forming four colony phenotypes, having two types of mating-type and four genotypes (AFLP1, AFLP1 A, AFLP2 and AFLP3). There were a mixed mating-type and genotype infection in one patient.

Discussion: Most mating-types are α- α because they are more virulent. Genotype found is the same with reported in the world. The mixed mating-type and the genotype because suspected infecting fungi have different mating-types and genotypes.

Conclusion: Headache is the most symptom. Most genotypes are AFLP1. There was a mixed mating-type and genotype infection in one patient."

"[ABSTRAKToxoplasma gondii merupakan protozoa intraselular obligat yang tersebar di seluruh dunia. Infeksi yang diakibatkannya disebut toksoplasmosis, dan diperkirakan sekitar sepertiga populasi dunia terinfeksi T. gondii. Toksoplasmosis akan menjadi masalah bahkan dapat mengancam jiwa bila infeksi terjadi pada orang imunokompromi. Ensefalitis toksoplasma (ET) terjadi akibat reaktivasi infeksi laten T. gondii, dan merupakan masalah yang sering terjadi pada pasien AIDS, terutama pada stadium akhir.Untuk menegakkan diagnosis pasti penyebab kelainan SSP pada pasien AIDS sangatlah sulit, karena banyaknya kemungkinan penyebab infeksi lain seperti bakteri, virus, dan jamur. Diagnosis ET ditegakkan hanya berdasarkan asumsi dari gejala klinis, gambaran radiologi, dan respons terhadap terapi yang diberikan. Pemeriksaan kadar IgG anti-Toxoplasma pada cairan organ yang terinfeksi T. gondii jarang dilakukan. Selama ini studi-studi lebih banyak yang memeriksa kadar IgG anti-Toxoplasma pada serum. Oleh karena masih jarangnya penelitian yang menggunakan CSS untuk penegakan diagnosis ET dan untuk mengetahui apakah kadar IgG anti-Toxoplasma pada CSS bermakna dalam menegakkan diagnosis ET, maka penelitian mengenai hal tersebut dilakukan pada pasien HIV & AIDS dengan dugaan meningitis.Dari 50 sampel CSS pasien AIDS yang dikirim ke Laboratorium Parasitologi FKUI, 24 (48%) positif dan 26 (52%) negatif IgG anti-Toxoplasma. Dari IgG positif, 5 (20,83%) kadar tinggi, dan 19 (79,17%) kadar rendah. Tidak ada perbedaan bermakna antara kadar IgG anti-Toxoplasma dengan hasil pencitraan maupun diagnosis klinis ET. Tidak ada hubungan antara kadar IgG anti-Toxoplasma dengan riwayat terapi profilaksis ko-trimoksazol.

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ABSTRACTToxoplasma gondii is obligate intracellular parasite that spread over the world. Toxoplasmosis, infection of this parasite, infected over one third world population. Toxoplasmosis become problem and life threatening in immunocompromised patients. Toxoplasma encephalitis (TE) is reactivation of latent infection of T. gondii, and usually manifest in severe stage of AIDS.Diagnosis of central nervous system infection in AIDS is very difficult, because many possibilities of infection that caused by bacteri, virus, and fungi. TE is only diagnosed by asumption of clinical signs, radiology, and therapeutic respons. The examination of IgG anti-Toxoplasma in organ fluid was rare. Because of this reason and to answer, is IgG anti-Toxoplasma in cerebro spinal fluid has important meaning for diagnosing TE, this study was done in HIV infection & AIDS patients with meningitis.From 50 LCS of AIDS patients that sent to Parasitology Laboratorium FKUI, 24 (48%) were positive, and 26 (52%) were negative of IgG anti-Toxoplasma. From IgG positive samples, 5 (20,83%) were high, and 19 (79,17%) were in low level. There is no difference between IgG anti-Toxoplasma level with radiology appearence, and with clinical diagnose for TE. No difference between IgG anti-Toxoplasma level with history of cotrimoxazole as prophylaxis therapy.;Toxoplasma gondii is obligate intracellular parasite that spread over the world. Toxoplasmosis, infection of this parasite, infected over one third world population. Toxoplasmosis become problem and life threatening in immunocompromised patients. Toxoplasma encephalitis (TE) is reactivation of latent infection of T. gondii, and usually manifest in severe stage of AIDS.Diagnosis of central nervous system infection in AIDS is very difficult, because many possibilities of infection that caused by bacteri, virus, and fungi. TE is only diagnosed by asumption of clinical signs, radiology, and therapeutic respons. The examination of IgG anti-Toxoplasma in organ fluid was rare. Because of this reason and to answer, is IgG anti-Toxoplasma in cerebro spinal fluid has important meaning for diagnosing TE, this study was done in HIV infection & AIDS patients with meningitis.From 50 LCS of AIDS patients that sent to Parasitology Laboratorium FKUI, 24 (48%) were positive, and 26 (52%) were negative of IgG anti-Toxoplasma. From IgG positive samples, 5 (20,83%) were high, and 19 (79,17%) were in low level. There is no difference between IgG anti-Toxoplasma level with radiology appearence, and with clinical diagnose for TE. No difference between IgG anti-Toxoplasma level with history of cotrimoxazole as prophylaxis therapy., Toxoplasma gondii is obligate intracellular parasite that spread over the world. Toxoplasmosis, infection of this parasite, infected over one third world population. Toxoplasmosis become problem and life threatening in immunocompromised patients. Toxoplasma encephalitis (TE) is reactivation of latent infection of T. gondii, and usually manifest in severe stage of AIDS.Diagnosis of central nervous system infection in AIDS is very difficult, because many possibilities of infection that caused by bacteri, virus, and fungi. TE is only diagnosed by asumption of clinical signs, radiology, and therapeutic respons. The examination of IgG anti-Toxoplasma in organ fluid was rare. Because of this reason and to answer, is IgG anti-Toxoplasma in cerebro spinal fluid has important meaning for diagnosing TE, this study was done in HIV infection & AIDS patients with meningitis.From 50 LCS of AIDS patients that sent to Parasitology Laboratorium FKUI, 24 (48%) were positive, and 26 (52%) were negative of IgG anti-Toxoplasma. From IgG positive samples, 5 (20,83%) were high, and 19 (79,17%) were in low level. There is no difference between IgG anti-Toxoplasma level with radiology appearence, and with clinical diagnose for TE. No difference between IgG anti-Toxoplasma level with history of cotrimoxazole as prophylaxis therapy.]"

"Cryptococcus adalah jamur penyebab tersering pada pasien imunokompromi. Pada penelitian ini, 200 isolat yang berasal dari cairan otak 20 pasien terinfeksi HIV ditetapkan spesies dan serotipenya, serta kepekaannya terhadap obat antifungal (amfoterisin B, flukonazol, vorikonazol, ketokonazol, flusitosin). Spesies dan serotipe Cryptococcus ditetapkan menggunakan medium canavanine glycine bromthymol blue (CGB) dan medium creatinine dextrose bromthymol thymine (CDBT), sementara kepekaan terhadap antifungal diuji dengan metode difusi cakram, NCCLS M-44A, approved guidelines. Spesies C. neoformans ditemukan pada 170 isolat (85%), dengan seluruhnya adalah serotipe A dan 30 isolat adalah C. gattii. Infeksi tunggal C. neoformans ditemukan pada 10 pasien, infeksi tunggal C. gattii pada satu pasien, dan infeksi campuran pada 9 pasien. Cryptococcus spp sensitif terhadap amfoterisin B (93,5%), flukonazol (88,5%), vorikonazol (100%) dan ketokonazol (98%). Resistensi primer terhadap flusitosin ditemukan pada semua isolat C. neoformans dan C. gattii (100%) sebelum dan sesudah terapi. Secara keseluruhan, C. gattii kurang peka dibandingkan C. neoformans terhadap seluruh obat antifungal.

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Cryptococcus are common causes of mycoses in imunocompromised patient. In this study, 200 clinical cerebrospinal fluid from 20 HIV patient?s isolates of Cryptococcus were determine their species and serotypes, and their susceptibilities to antifungal (amphotericin B, fluconazole, voriconazole, ketoconazole, flucytosine) were analyzed. Cryptococcus species and serotypes were determined by canavanine glycine bromthymol blue (CGB) medium and creatinine dextrose bromthymol thymine (CDBT) medium, meanwhile antifungal susceptibilities were determined by disk diffusion method, NCCLS M-44A, approved guidelines. Species C. neoformans was found in 170 (85%) isolate with all of them was serotipe A dan 30 isolates (15%) were C. gattii. Single infection of C. neoformans was found in 10 patients, single infection of C. gattii in one patient and mixed infection in nine patients. Cryptococcus spp susceptible to amphotericin B (93,5%), fluconazole (88,5%), voriconazole (100%) and ketoconazole (98%). Primary resistance to flucytosine was found in all isolates C. neoformans and C. gattii (100%) before and after therapy. In general, C.gattii was less susceptible than C. neoformans to all drug tested. "

"Antigen galaktomanan diproduksi oleh Aspergillus dan tersedia kit komersial Platelia Aspergillus EIA (Bio-Rad, France) yang dapat digunakan untuk diagnostik aspergilosis paru invasif probable. Beberapa laporan menyatakan bahwa dapat terjadi reaksi silang antara histoplasmosis dan aspergilosis karena baik Aspergillus maupun Histoplasma dapat memproduksi galaktomanan. Hal itu memungkinkan pasien dengan kecurigaan histoplasmosis dapat diduga dengan deteksi galaktomanan menggunakan Platelia Aspergillus EIA. Untuk itu, penelitian ini bertujuan untuk mengetahui keberadaan, prevalensi, dan korelasi antigen galaktomanan Histoplasma pada pasien dengan hasil pemeriksaan galaktomanan Aspergillus positif. Penelitian ini menggunakan sampel berupa serum koleksi Laboratorium Mikologi Departemen Parasitologi FKUI sejak tahun 2018 hingga awal tahun 2019 dengan hasil pemeriksaan Platelia Aspergillus positif. Hasil penelitian ini menunjukkan bahwa sebagian serum pasien dengan galaktomanan Aspergillus positif ternyata juga galaktomanan Histoplasma positif dengan prevalensi sebesar 25%. Analisis statistik menunjukkan tidak ada korelasi antara nilai konsentrasi deteksi antigen galaktomanan Histoplasma dengan nilai indeks deteksi antigen galaktomanan Aspergillus. Pada daerah dengan keterbatasan sarana diagnostik histoplasmosis, pemeriksaan Platellia Aspergillus dapat digunakan untuk membantu menegakkan diagnosis histoplasmosis.

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Aspergillus produces galactomannan antigens. There is a commercial Platelia Aspergillus EIA kit (Bio-Rad, France) that can be used for diagnostic probable of invasive pulmonary aspergillosis. Some reports state that there can be a cross-reaction between histoplasmosis and aspergillosis because both Aspergillus and Histoplasma can produce galactomannan. This allows patients with suspicion of histoplasmosis to be suspected by galactomannan detection using Platelia Aspergillus EIA. The purpose of this study was to determine the presence, prevalence, and correlation of Histoplasma galactomannan antigens in patients with positive Aspergillus galactomannan. The sample used in this study was a serum collection from the Mycology Laboratory Department of Parasitology FKUI from 2018 until early 2019 with positive Platelia Aspergillus result. The results of this study indicate that the majority of serum patients with positive Aspergillus galactomannan were also positive Histoplasma galactomannan with a prevalence of 25%. Statistical analysis showed that there was no correlation between the concentration of Histoplasma galactomannan antigen with the index of Aspergillus galactomannan antigen. In areas with limited diagnostic facilities for histoplasmosis, Platellia Aspergillus detection can be used to help diagnose of histoplasmosis."

"Cryptococcus merupakan khamir bersimpai yang menyebabkan kriptokokosis dan pada era HIV/A1DS jumfah kasus meningkat tajam. Manifestasi klinik kriptokokosis berbeda sesuai dengan spesies dan serotipe, sehingga identifikasi menjadi sangat penting. Selain itu penerapan spesies pe;nting untuk studi epidemiologis kriptokokosis. Penelitian ini merupakan penelltian deskriptif untuk mengidentifikasi spesies dan serotipe serta virulensi jarnur. Seiai itu ingin diketahui penyebaran penyakit di Jabodetabek. Bahan yang diperiksa adalah 40 lsolat koleksi Departemen P.arasitologi FKUI dan 25 isolat dari cairan otak kulit dan darah. Metode pemeriksaan terdiri ata:s uji asimilasi (kit API 20C AUX), uji pembentukan germ tube, biakan pada medium CGB dan CDBT dan NSA. Penyebaran kasus kriptokokosis diadapatkan berdasarkan domisili pasien. Hasil uji asimilasi didapatkan Cr. neoformans (64 isolat), Cr. lat:rentii var. laurentfi (l isolat). Hasil uji pembentukan germ tube didapatkan bahwa jamur yang diteliti bukan golongan Candida. Penetapan spesies dengan medium CGB didapatkan seluruh isolat adaiah Cr. neoformans. Hasil penetapan serotipe dengan median CDBT didapatkan seluruh isoiat adalah Cr. neoformans serotipe A. Uji virulensi dengan medium NSA memperlihatkan pembentukan pigmen melanin pada semua isofat. Data demografis menunjukkan distribusi penderita kriptokokosis di Jim a wilayah DKI,.Bogor dan Bandung.

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Cryptococcus is encapsulated yeast that caused Cryptococcosis in human. In the era of HIV/AIDS there is an increased number of cryptococcosis. Its clinical manifestation varied according to the species, so species idcntif1calion is quite important. Furthermore species identification is also important in epidemiology study. This descriptive study aimed to identify species and stereotype of Cryptococcus and also its virulence. The study also aimed to know the distribution of Cryptococcosis in Jabodetabek. There wex 40 isolates from the collection of Department of Parasitology FKUl. and other 25 isolates were isolated from spinal fluid, blood and skin. The study Vas done using API 20C AUX, germ tube fonnation test, CGB for the differentiation of Cryptococcus. gattii and Cryptococcus neoformans. and, CDBT for serotyping and melanine production by plating the isolates on niger seed agar. The study on the distribution of the disease was based on patients residence. The results were, 64 isolates of Cr. neoformans and 1 Cr. laurentii. Germ tube formation test is negative. Identification of species with CGB agar showed all isolates were Cr. neoformans. Stereotype identification with CDBT were all stereotype A. All isolate were capable of forming melanin when growth on NSA. Demographic data of the patients shows a wide distribution including 5 areas of DKI, Bogor and Bandung."

"Latar Belakang. SARS-CoV-2 sebagai penyebab COVID-19 pertama kali terdeteksi pada sampel klaster pasien di Provinsi Hubei, China pada Desember 2019. Pada mulanya klaster pasien tersebut memiliki gejala seperti demam, batuk, sesak nafas, dan gejala lainnya yang tidak spesifik. Alat uji Rapid Antigen Test (RAT) dapat dijadikan alternatif untuk diagnosis klinis COVID-19. Tujuan. Penelitian ini bertujuan untuk mendapatkan rekomendasi mengenai alternatif spesimen dan metode deteksi SARS-CoV-2. Metode. Desain penelitian ini merupakan uji diagnostik studi potong lintang dengan pengumpulan spesimen secara consecutive sampling. Subjek penelitian yaitu pasien yang memiliki kontak dengan kasus infeksi SARS-CoV-2 yang terkonfirmasi dengan atau tanpa gejala klinis COVID-19 di Fasilitas Pelayanan Kesehatan (Fasyankes) dan Laboratorium Mikrobiologi Klinik (LMK) FKUI dengan jumlah sampel 221. Analisis data dengan tabulasi silang dan perhitungan sensitivitas, spesifisitas, PPV, dan NPV. Hasil. Deteksi antigen menggunakan spesimen nasal memiliki nilai sensitivitas 32,35%, spesifisitas 99,35%, PPV 95,65%, NPV 76,77%, akurasi 78,73%. Tingkat positifitas pada spesimen nasofaring 34,84%, spesimen orofaring 30,32%, dan nasal 30,77%. Kesimpulan. Hasil uji rRT-PCR pada beberapa jenis spesimen menunjukkan bahwa spesimen nasal dan orofaring dapat dijadikan pilihan selain spesimen nasofaring. Penggunaan kit deteksi antigen dapat dilakukan untuk pelacakan kontak COVID-19 atau untuk diagnosis, terutama untuk daerah yang memiliki keterbatasan akses diagnosis menggunakan rRT-PCR.

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Introduction. The SARS-CoV-2 as the cause of COVID-19 was first detected in a cluster sample of patients in Hubei Province, China in December 2019. The first patient had symptoms such as fever, cough, shortness of breath, and other non-specific symptoms. Rapid Antigen Test can be used as an alternative for diagnosis of COVID-19. Aim. This study aims to obtain recommendations alternative specimens and detection methods for SARS-CoV-2. Method. The design of this study is a cross-sectional diagnostic test with consecutive sampling. The research subjects were patients who had contact with confirmed cases of SARS-CoV-2 infection with or without clinical symptoms of COVID-19 at Health Service Facilities (Fasyankes) and Laboratorium Mikrobiologi Klinik (LMK) FKUI with a total sample of 221. Data analysis using cross tabulation to calculate the sensitivity, specificity, PPV, and NPV. Results. The positivity rate for nasopharyngeal specimens was 34.84%, oropharyngeal specimens 30.32%, and nasal specimens 30.77%. Antigen detection using nasal specimens has sensitivity 32.35%, specificity 99.35%, PPV 95.65%, NPV 76.77%, accuracy 78.73%. Conclusion. The results of the rRT-PCR test on several types of specimens indicate that nasal and oropharynx specimens can be used as an alternative to nasopharyngeal specimens. The use of antigen detection kits can be carried out for COVID-19 contact tracing or for diagnosis, especially for areas that have limited access to diagnosis using rRT-PCR."

"ABSTRAKCryptococcus neoformans adalah khamir berkapsul penyebab kriptokokosis, predileksi di SSP terutama pada individu imunokompromi. Cryptococcus hidup bersama mikobiom di alam. Penelitian bertujuan mengetahui hubungan kriptokokosis meningeal pada pasien HIV dengan keberadaan Cryptococcus di alam. Sampel yang diteliti adalah material pepohonan di lubang pohon dan tanah, debu rumah, kotoran burung, dan air dari 22 rumah pasien HIV dengan kriptokokosis (kelompok kasus) dan tanpa kriptokokosis (kelompok kontrol). Identifikasi Cryptococcus dilakukan berdasarkan karakter morfologi dan fisiologi-biokimia. Total 297 isolat jamur ditemukan Cryptococcus, Candida, Saccharomyces, Rhodotorula, Aspergillus, Neurosporium dan Penicillium. Tujuh isolat Cryptococcus neoformans ditemukan dari 120 khamir yang diperiksa berasal dari debu rumah, kotoran burung kenari, lubang pohon mangga, lapukan daun rambutan. Berdasarkan statistik terdapat korelasi positif signifikan antara keberadaan Cryptococcus neoformans di lingkungan dengan kriptokokosis pada pasien HIV (p=0,013; r=0,47) namun tidak ada korelasi positif dengan musim (r=-0,069). Hasil tersebut menunjukkan bahwa terdapat hubungan antara Cryptococcus neoformans di lingkungan rumah pasien HIV dengan kriptokokosis meningeal. Di alam Cryptococcus neoformans ditemukan bersama Cryptococcus albidus dan Aspergillus niger.

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ABSTRACT

Cryptococcus neoformans is an encapsulated yeast cause cryptococcosis with a predilection for the CNS, especially individual with immunocompromise. The fungus lives with other fungi in nature. This study investigates the relationship between meningeal cryptococcosis in HIV patients with the presence of Cryptococcus in nature. The samples studied are decaying wood and leaves, tree hollows, dust, bird droppings, and water from 22 of HIV-infected patients haouse with cryptococcosis (case group) and without cryptococcosis (control Group). Identification of Cryptococcus was based on morphological and fisiologi-biochemistry characters. From total 297 fungal isolates we found Cryptococcus, Candida, Saccharomyces, Rhodotorula, Aspergillus, Neurosporium and Penicillium. From 120 yeast isolates we found seven Cryptococcus neoformans from dust, canary dropping, mango tree hollow, decaying rambutan leaves on the ground. The statistical analysis showed a significant association among cryptococcosis in HIV-infected patients with the environment (p=0.013). Based on statistic there is a significant positive correlation between the presence of Cryptococcus neoformans in the environment with cryptococcosis in HIV-infected patients (r=0.47), but no positive correlation with the season (r=-0.069 ). These results indicate that there is a relationship between Cryptococcus neoformans in the environment of HIV-infected patients house with meningeal cryptococcosis. In nature Cryptococcus neoformans is found along Cryptococcus albidus and Aspergillus niger."

"Latar Belakang: Prevalensi penderita HIV/AIDS masih tinggi dan masih menjadi masalah kesehatan di Indonesia, apabila terkena infeksi Toxoplasma gondii bisa memperberat kondisi klinis. Manifestasi klinis yang sering muncul adalah Toxoplasma ensefalitis (TE). T. gondii memiliki tipe tertentu dan terdapat hubungan antara manifestasi klinis yang muncul dengan tipe T. gondii. Sampai saat ini belum ditemukan adanya laporan tipe T. gondii pada TE di Indonesia. Penentuan tipe memerlukan penanda genetik, sehingga penelitian ini bertujuan untuk mencari penanda genetik pada cairan serebrospinal untuk penentuan tipe T. gondii serta melihat proporsi tipe T. gondii pada penderita TE.Metode: Sebanyak 160 sampel cairan serebrospinal yang tersimpan di laboratorium Parasitologi FKUI dan telah dikarakterisasi positif IgG anti T. gondii dan 69 diantaranya positif pada pemeriksaan PCR, dilakukan penentuan tipe T. gondii dengan penanda genetik yaitu SAG2 3’ dan SAG2 5’, GRA6, GRA7 dan BTUB. Hasil PCR yang positif dari keempat gen tersebut selanjutnya disekuensing; hasil sekuensing diolah menggunakan MEGA XI, dibuat analisis filogenetik dengan sekuens rujukan T. gondii tipe I,II,III dan atipikal dari NCBI genbank. Penentuan tipe T. gondii sampel TE ditentukan berdasarkan konsensus dari hasil analisis filogenetik gen SAG2 3’, SAG2 5’, GRA6, GRA7 dan BTUB.Hasil: Penanda genetik yang digunakan untuk penentuan tipe T. gondii adalah SAG2 3’, SAG2 5’, GRA6, GRA7, dan BTUB. Hasil positif nested PCR gen GRA7 sebanyak 34/69 (50.7%). Sebanyak 6 sampel positif pada PCR gen SAG2 3’ dan SAG2 5’ dari 34 sampel positif GRA7 . PCR gen GRA 6 dan BTUB tidak memberikan hasil positif pada sampel kecuali kontrol positif yang berasal dari isolat T. gondii hasil kultur. Hasil konsensus dari 6 sampel berdasarkan 3 gen penanda SAG2 5’, SAG2 3’ dan GRA7 adalah 3/6 tipe I, 2/6 tipe I varian dan 1/6 tipe I/III.Kesimpulan: Toxoplasma gondii tipe I/tipe I varian dan tipe III merupakan tipe T. gondii penyebab toxoplasma ensefalitis pada HIV/AIDS di Indonesia. Gen SAG2 5’, SAG2 3’, dan GRA7 dapat digunakan sebagai penanda genetik untuk penentuan tipe T. gondii dari sampel klinis langsung.

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Background: The prevalence of HIV/AIDS in Indonesia remains high and continues to be a significant health concern. Infection with Toxoplasma gondii can exacerbate clinical conditions for these patients. Toxoplasma encephalitis (TE) is a common clinical manifestation. Different types of T. gondii are associated with distinct clinical manifestations. Currently, there are no reports of T. gondii types in TE in Indonesia. However, determining the type requires genetic markers. Therefore, this study aimed to identify genetic markers in cerebrospinal fluid to determine T. gondii type and assess the proportion of T. gondii types in TE patients.

Methods: A total of 160 cerebrospinal fluid samples deposited in the FKUI Parasitology laboratory and had been tested positive for anti T. gondii IgG and sixty-nine out of one hundred and sixty were positive in the PCR examination. Toxoplasma gondii genotype was determined using genetic markers, namely SAG2 3' and SAG2 5', GRA6, GRA7 and BTUB. Positive nested PCR results from these four genes were then sequenced; the sequencing results were processed using MEGA-XI. Phylogenetic analysis was made with reference sequences were T. gondii type I, II, III and atypical from NCBI GenBank. Determination of the type of T. gondii was determined based on the consensus from the results of phylogenetic analysis of the SAG2 3', SAG2 5', GRA6, GRA7 and BTUB genes.

Results: The genetic markers used for T. gondii type determination were SAG2 3', SAG2 5', GRA6, GRA7, and BTUB. Positive PCR results for the GRA7 gene were 34/69 (50.7%), furthermore 6/34 were positive for PCR of the SAG2 3' and SAG2 5' genes. PCR for the GRA6 and BTUB genes did not give any positive results with the LCS samples except the positive control which came from cultured T. gondii isolate. The consensus results of T. gondii type determination from 6 samples based on the 3 marker genes SAG2 5', SAG2 3' and GRA7 are 3/6 type I, 2/6 type I variant and 1/6 type I/III.

Conclusion:

Toxoplasma gondii type I/ type I variant and type I/III is a type of T. gondii associated with toxoplasma encephalitis in HIV/AIDS in Indonesia. The SAG2 5', SAG2 3', and GRA7 genes can be used as genetic markers for T. gondii type determination directly from clinical samples."

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Kriptokokosis adalah infeki jamur yang disebabkan olehCryptococcus. Manifestasi klinis utama pada pasien terinfeksi HIV adalah kriptokokosis meningeal.  Angka kematian masih tinggi, walaupun pasien telah mendapatkan obat anti-retroviral (ARV). Tujuan penelitian ini adalah untuk mengetahui prevalensi, profil klinis-mikologis dan prediktor yang mempengaruhi luaran klinis. Penelitian ini bersifat retrospektif dengan menelusuri rekam medik pasien RSCM yang bahan kliniknya diperiksa di Departemen Parasitologi FKUI pada Januari 2013 – Oktober  2018. Prevalensi kriptokokosis meningeal pada 161 pasien HIV yang diteliti adalah 24,2% (39 pasien). Pemeriksaan cairan otak  dengan tinta india menunjukan hasil positif pada 47 dari 50 pasien (94%). Pemeriksaan lateral flow assay(LFA) menunjukkan hasil positif pada 27 dari 28 pasien (96,4%) dan biakan pada 29 dari 30 pasien (96,7%). Profil klinis pada 46 pasien yang diteliti menunjukkan gejala klinis terbanyak  sakit kepala (93,5%), diikuti demam (65,2%), muntah (65,2%) dan penurunan berat badan (47,8%). Pencitraan otak pada 38 pasien, menunjukkan hasil normal pada 20 pasien (52,6%), lesi fokal pada 5 pasien dan penyangatan meningen pada 5 pasien (13,1%). Analisis statistik menunjukkan  pemeriksaaan fisis tekanan darah >130/90 mmHg, kaku kuduk dan papiledema didapatkan berhubungan dengan kematian (p<0,05). Dari 46 pasien setelah keluar dari RSCM, luaran hidup ditemukan sebanyak 21 orang (45,7%). Pada tindak lanjut 20 pasien setelah enam bulan keluar RSCM, luaran hidup ditemukan pada 13 orang (65%). Prediktor yang berhubungan dengan luaran klinis mati pada penelitian ini adalah penurunan berat badan, status HIV baru dan papiledema (p<0,05). 

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Cryptococcosis is a fungal infection caused by Cryptococcus. The main clinical manifestation in HIV-infected patients is meningeal cryptococcosis. The mortality rate is still high, despite the use of anti-retroviral drugs (ARVs). The purpose of this study was to determine the prevalence, clinical-mycological profile and predictors for clinical outcomes. This study was retrospective, the data was retrieved  from medical records at Cipto Mangunkusumo hospitalwhose clinical materials were examined in the Parasitology Department faculty of medicine University of Indonesia in January 2013 - October 2018. The prevalence of meningeal cryptococcosis in 161 HIV patients studied was 24.2% (39 patients). Examination of brain fluids with Indian ink showed positive results in 47 of  50 patients (94%). Lateral flow assay (LFA) positive in 27 of 28 patients (96.4%) and from culture the result was positive in 29 out of 30 (96,7%). The clinical profile in 46 patients studied showed the most clinical symptoms is headache (93.5%), followed by fever (65.2%), vomiting (65.2%) and weight loss (47.8%). Brain imaging in 38 patients showed normal results in 20 patients (52.6%), focal lesions in 5 patients and meningeal enhancement in 5 patients (13.1%). Physical examination of blood pressure >130/90 mmHg, neck stiffness and papilledema was found to be associated with death (p<0.05). Of the 46 patients after leaving the Cipto Mangunkusumo hospital, live outcomes were found in 21 patients (45.7%). Live outcomes at follow-up of 20 patients after six months out of the Cipto Mangunkusumo hospitalwere found in 13 patients (65%). Predictors related to dead clinical outcomes in this study were weight loss, new HIV status and papilledema (p <0.05).

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