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Background: Coronavirus Disease (COVID-19) emerge as a new global health crisis. COVID-19 has a wide range of clinical feature, from mild cough to severe respiratory failure. This study aims to learn more about clinical feature of COVID-19. Methods: This cross sectional analytic descriptive study includes all COVID-19 patients that yield positive result through GeneXpert-SARS-CoV-2 or Polymerase Chain Reaction (PCR). All data was taken from inpatient form March 12th –June 30th 2020. Results: There were 103 patients with 58 men and 45 women. Patients with male sex tend to experience severe pneumonia than women. It was also found that patients exposed to cigarette smoke tended to experience severe pneumonia symptoms. Patients with more than 1 comorbid tend to develop severe pneumonia symptoms. The dominant clinical symptoms in the patient were cough (84.5%), fever / history of fever (70.9%), and shortness of breath (67.9%). Hematological parameters that correlate with the degree of severity are leucocytes, thrombocyts, lymphocytes, neutrophils, CRP, LDH, creatinine, procalcitonin, SGOT, and SOFA Score. The most common radiological picture obtained was bilateral infiltrate (78.2%). The most common complication was sepsis (38.9%). The mortality rate for COVID-19 patients treated at RSSA tends to be high (26.2%). Discussion: clinical characteristics such as gender, smoking history, comorbides, clinical symptoms (fever, shortness of breath and cough), laboratory (leukocytes, % lymphocytes, % neutrophils and neutrophil counts, CRP, LDH, procalcitonin, creatinine, SGOT, and SOFA scores) has a significant effect on the severity of Covid infection 19 Conclusion: The clinical characteristics of COVID-19 patients affects the severity of the disease.

BACKGROUNDPulmonary tuberculosis (TB) is a leading cause of morbidity and mortality, and East Java province is the second largest contributor of co-infection in Indonesia. Asymptomatic helminth infection among pulmonary tuberculosis patients causes another public health problem. Few data relate to helminth infection based on clinical and immunological outcomes of pulmonary TB in highly endemic areas. METHODSThis study was designed as a preliminary study and aimed to determine helminth co-infection among TB patients with a macroscopic assessment. This cross-sectional study was conducted in June-August 2017. RESULTSAmong 16 treated active TB patients from TB cohort data of Tanakali Kedinding health center found that 56% were stool smear-positive for Trichuris trichiura eggs, but had no clinical symptoms. CONCLUSIONWhether or not the helminth infection may have an impact on the diagnosis and treatment of active TB remains to be further investigated. Co-infection could be inhibited by the host immune response and improve the prognosis of TB treatment.

The majority of HIV / AIDS patients have common secondary infections including of oral candidiasis. Fluconazole can be used to treat oral resistance in candidiasis. Management that can reduce risk can be minimized. However, some evidences suggest that the use of fluconazole is not effective for oral candidiasis. A 34-year-old male patient went to Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, with main complaint of discomfort and pain in the tongue. The physical examination showed a white pseudomembrane on the tongue and palate, which could be removed but left reddish and painful marks. The examination from tongue and palate swab found a colony of white Candida albicans and showed resistant to fluconazole, intermediate to ketoconazole, and sensitive to nystatin. The patient received nystatin oral suspension for three times a day as much as 5 ml (500,000 units). The pseudomembrane disappeared on day 10. The medication continued for fourteen days. No sign of recurrent found in two weeks after the treatment. The administration of nystatin can be used as an effective medication for oral candidiasis.

Soil-Transmitted Helminths (STH) infection is the most common intestinal parasite infection in Indonesia. STH infection can interfere with child development and cause cognitive impairment in severe cases. The school-age group is the most susceptible to STH infection because of direct contact with soil in the school yard. STH infection incidence can be avoided by adequate water, healthy latrines, and good hygiene and can be improved by proper interventions. This study aimed to analyze the correlation between Water, Sanitation, and Hygiene (WASH) with STH infection in Aru Islands District, Maluku. This study used a cross-sectional design and was conducted in Elementary Schools in Karangguli and Wokam villages, Aru Islands district, Maluku. One hundred and six stool samples were collected from both villages. The sociodemographic and WASH data were collected using the interview method. Stool samples were collected and examined for STH infection using a direct smear technique on the light microscope. Data statistical analysis was performed by the SPSS program using the Chi-square or Fischer’s Exact test. The examination results showed that 73 students (68.9%) were infected with STH. The bivariate analysis showed that water source (p = 0.000002), defecation place (p = 0.002), and washing hands after defecation (p = 0.048) were all significantly correlated with STH infection. This study concluded that WASH variables which were water source, defecation place, and washing hands after defecation had a significant correlation with STH infection. Keywords: Water, Sanitation, and Hygiene (WASH); soil-transmitted helminths infection; elementary school students.

Worm infection is one of the health problems in all tropical countries, including Indonesia. The most frequent helminthiasis is the infection caused by the Soil-Transmitted Helminth. Primary school-age children are an age group that is susceptible to helminthiasis. Worm infections can cause a serious impact if left untreated with no clean and healthy lifestyle. This study was conducted to determine the prevalence and risk factors of STH in children of Manusak Village, East Kupang Subdistrict, Kupang District, East Nusa Tenggara Province, followed by the characterization of subjects. The analytic observational design with the cross-sectional study was applied to this research. Research subjects were 130 children aged 6-12 years old. The infection was diagnosed microscopically by the Katokatz method. Ascaris lumbricoides were the only species found infecting a total of 50 children (38.4%.). The distribution of ascariasis was higher in girls (30 or 23.08%) than in boys (20 or 15.38%), in children whose parents have no formal education (41 or 31.54%), and who their professions are a farmer. Poor hygiene and sanitation such as no washing hands with soap (27 or 20.77%) as well as the habit of not wearing footwear (47 or 36.2%) and bowel habit on the open areas (35 or 26.92%) are the risks factors causing the high incidence of A. lumbricoides in the studied area. Enlightenment to the parents regarding good personal and environmental hygiene and sanitation along with chemotherapy from the government and related agencies is needed to achieve a durable reduction of the burden of ascariasis and other STH infection. Keywords : Soil Transmitted Helminth, Ascaris lumbricoides, children, Kupang DistrictCorrespondence : heny-a@fk.unair.ac.id

Objectives Andrographis paniculata tablets (AS201-01) have previously been shown to have potent bioactivity as an antimalarial and to produce no unwanted side effects in animal models. Here, we present the phase 1 clinical trial conducted to evaluate the safety of AS201-01 tablets in healthy volunteers. Methods The study was a randomized, double-blind controlled cross-over, a placebo-controlled design consisting of a 4-day treatment of AS201-01 tablets. A total of 30 healthy human volunteers (16 males and 14 females) were divided into two groups, and each group was given 4 tablets, twice daily for 4 days. Group 1 received AS201-01, while group 2 received placebo tablets. Volunteers were given a physical examination before the treatment. The effects of AS201-01 on random blood glucose, biochemical, and hematological as well as urine profiles were investigated. Results There were no changes in observed parameters as a result of AS201-01 being administered. Statistical analysis showed no significant difference (p>0.05) between the test and control group regarding hematology profile, biochemical profile, and random blood glucose. Increased appetite and better sleep, which categorized as grade 1 adverse event was reported after treatment with AS201-01 tablet Conclusions The outcome supports our previous observation that the AS201-01 tablet, given twice a day for 4 days, is safe and nontoxic.

Background: The urgency generated by drug-resistant strains of malaria parasites has accelerated the need to find a new anti-malarial drug. Recent studies have shown that 80% ethanol extract Acmena acuminatissima has suitable antimalarial activities. Aim: To analyze the inhibitory effect of A. acuminatissima extract at the developmental stage of P. falciparum in infected erythrocytes in vitro. Methods: the synchronized culture of P. falciparum was incubated along with A. acuminatissima extract, and compared with negative controls. The effect on parasite growth was determined by observing the level of parasitemia and accumulation of various infective stages seen on thin blood smears after the incubation period of 12, 24, 36, and 48 hours using a light microscope with 1000 times magnification. Results: Within 48 hours of observation the difference was mainly in the proportion of ring-stage which was 2.75% in culture with the test compound and 41.41% in the negative control which showed that ethanol extract of A. acuminatissima inhibited the growth of parasites at the schizont stage into the ring stage. In trophozoite and schizonts stages of culture with test compounds, enlargement of digestive vacuole and vesiculation is obtained. Conclusion: A. acuminatissima inhibits the development of intraerythrocyt parasites at the schizonts stage and induced morphological changes.

Background: Tuberculosis (TB) is a major global health problem and South-East Asia was the leading contributor of TB cases globally. Treatment regimen of TB for an individual patient depends on multiple factors, and one of them was patient’s comorbidities. Comorbidities such as renal failure or concurrent use of immunosuppressant drugs post renal transplantation will influence pharmacological aspect of anti-tuberculosis drugs.Case: A 38-year-old male with a history of chronic renal failure who had undergone routine hemodialysis was diagnosed with pulmonary tuberculosis and was scheduled for a renal transplantation procedure. During the administration of anti-tuberculosis drugs in this patient, the physician mustconsider the kidney function, and possible drug interactions between anti-tuberculosis drugs especially rifampicin with immunosuppressant drugs used after renal transplantation. The initialregimen used in this patient was RHE which was followed by RH, but after using immunosuppressant drugs, rifampicin was replaced with moxifloxacin to avoid suboptimal effect of immunosuppressant drugs to prevent donor rejection, which is the biggest contributor ofmortality in transplant recipients in the first year post-transplantation.

Basic data of this study showing isolates mostlytaken from male than female (77.5% and 22.5%). Themost age group is productive age groups in the agerange of 26-35 years with 20 subjects (50%). In 2017report of the Directorate General of Disease Controland Environmental Health, Ministry of Health Republicof Indonesia, found HIV/AIDS patients more malethan women, and related more common in young adultwhich makes it more likely to engage in unsafe sexualbehavior that is at risk of HIV transmission (8). Thedomicile of HIV / AIDS patients with OC mostly camefrom Surabaya (90%). This is because most patientshave to seek help from the nearest health center withmost patients from within the city. The isolates mostwere taken from HIV / AIDS patients with OC who hadan absolute CD4 count

Background: Oral Candidiasis (OC) still mainly oportunistic infection problem in HIV/AIDS Patients.Due to increasing report of fluconazole resistant as common antifungal drugs nowadays, there have beenmany studies focusing on natural substances and its antifungal properties. In this study, a form of green teaextract, named Epigallocathechingallate (EGCG) 1,25% were examined for their in vitro antifungal activity against Candida sp in comparison to fluconazole (2 mg/ml) as standard antifungal agents.Objective:To evaluate the antifungal activity of EGCG in compare with fluconazole against Candida isolates takenfrom HIV / AIDS patients with OC. Methods: Fourty Candida sp. isolates taken from HIV / AIDS patientswith OC in the Outpatient Unit and Inpatient Installation of the Infectious Disease Intermediate Care Unit(UPIPI) Dr. Soetomo, Surabaya. Antifungal activity were evaluated by using microdilution tests. Results:The microdilution test revealed the MIC of EGCG for all Candida sp. was 0.625%, while the MIC offluconazole was 100% for all Candida sp. There was significant difference (p

Background: Candidasp. is the most common opportunistic pathogen found during the development of Human immunodeficiency virus (HIV) & Acquired immune deficiency syndrome (AIDS) disease. The clinical severity of oral candidiasis and the prevalence profile of Candida species reflect immunological changes in HIV / AIDS patients. Objective: Evaluating the relationship between CD4 T lymphocyte cells counts and the number of Candida species. Methods: A cross-sectional analytical study was carried out at Dr. Soetomo, Surabaya, Indonesia. For identification of Candida species, culture was carried out on Chromagar media followed by culture with vitek 2. Results: There were 114 study subjects who were divided into three groups based on the number of CD4 T lymphocyte cells, with 158 isolates of Candidaspecies growing in culture. The highest number of Candida species was Candida albicans with a total of 107 isolates (67.7%). Candida non-albicans were 51 isolates (32.3%). Statistical test results showed a significant correlation between the number of CD4 T lymphocyte cells and the number of Candida species (p

Dengue is a severe health problem. In recent decades, the number of infections has increased significantly worldwide, and approximately 70% of cases were found in Asia. To predict local mosquito distribution and estimate the local risk, a combination of ecological factors has been widely used. However, it is not easy to control the dengue transmission because the transmission is influenced by several ecological factors that might have complex interactions among the factors. In addition, ecological information is commonly limited. The elevation is an important weather proxy for the Aedes Aegypti life cycle because it is correlated to a variety of vital ecological factors, especially temperature. This study evaluated the effect of the elevation and identified high-low dengue risk provinces in Indonesia using the clustering Bayesian spatial hierarchical model. We found that the elevation's effect decreased for the provinces with an elevation higher than 289.44m.

Background: Amoebiasis, the cause of dysentery and extra-intestinal abscesses, now becomes second fatal parasitic disease in the world. As routine microscopic diagnosis cannot differentiate causative Entamoeba histolytica from non-pathogenic E. dispar and E. moshkovskii, better diagnosis has to be searched.Materials and Methods: Multiplex single round PCR was tested and compared with results of microscopy of wet preparation on 30 samples of diarrheic stools and extra intestinal lesions from amoebiasis suspected patients.Results: Microscopy examination showed that 21 (70%) of the samples were positive for E. histolytica/E. dispar/E. moshkovskii complex and 18 (86%) of them contained hematophagous trophozoites. Multiplex single round PCR showed 12 positive results, from which seven were positive for E. histolytica, two were positive for E. moshkovskii, and three showed mixed of E. histolytica and E. moshkovskii. No samples were positive for E. dispar. High positive rate of microscopy might be related with highly suspected amoebiasis cases, while lower positive PCR might be caused by low parasite density and time-related trophozoite disintegration.Conclusion: The study showed that multiplex single-round PCR is a valuable diagnostic tool for species differentiation, but cannot replace microscopy in the diagnosis of amoebiasis because of its low sensitivity and impossibility to discriminate the form of E. histolytica and whether it is in the disease-causing stage, while microscopic examination is capable to demonstrate the presence of hematophagous trophozoites that indicates it is invasive and at the disease-causing stage of E. histolytica.Keywords: E.histolytica/E.dispar/E.moshkovskii; multiplex single round PCR; microscopic diagnosis; hematophagous; invasive trophozoite

Studies on infectious diseases, especially those transmitted through intermediaries such as dengue fever, are sometimes seen as growth patterns over time. The measurement is repeated over time and hence we have a longitudinal data structure. We are interested in analyzing factors that influencing the dengue fever rate. A Modelling technique is used to determine the effects of covariates, but there are variable where the effects of covariates may also change over time when the effects of covariates change over time. Varying coefficient model is an alternative to model such situation to determine these effects. In general, the model will form a pattern, both linear and non-linear. As the objective function, we propose to use a P-Splines Quantile Objective function such that a flexible dengue pattern can be developed. The proposed technique will be implemented to dengue fever cases in Bandung City. The density of Bandung City is a factor that causes the spread of infectious diseases. In addition, various risk factors for the spread of dengue cases in Bandung are also taken into account, such as rainfall, temperature or temperature and humidity. Another factor that can be a covariate is the lifestyle factor of the people of Bandung, such as clean and healthy living behaviour and healthy house. The result shows existence of a nonlinear pattern, and the fluctuations in the incident value that changes over time. There are changes in the values of the intercept and slope coefficients over time for each level of the quantile.

Studies of the synthesis of composite zinc oxide-silica (ZnO@SiO2) particles remain a great challenge in terms of obtaining a more precise design and suppress the agglomeration of pure ZnO. However, recent methods encounter problems in production, such as time consumption, multistep processes, and agglomeration of the final product. To this end, a one-step process for the production of composite ZnO@SiO2 particles which has good potential as UV-attenuating materials was proposed via the electrospray method for the first time. The results from this study offer, for the first time, new insights into the design of ZnO@SiO2 as a core-shell particles morphology in which ZnO was coated with SiO2 by using the electrospray method with good control of particle agglomeration. A possible core-shell formation mechanism is proposed to offer an in-depth understanding. When tested as ultraviolet (UV) attenuation materials, the obtained core-shell particles exhibited an activation transmission near 30 % in the wavelength range of 280−400 nm under UV A and B light. This activation transmission is better than that of the same composite without a core-shell structure. Another particle with different characteristics (e.g., hollow SiO2) was obtained after the removal of ZnO from the core-shell composite structure. The activation transmission of hollow silica reached approximately 80 % under UV–vis light, indicating that hollow SiO2 has potential applications in future transparent devices.

Background : Dengue virus infection is still a health problem in Surabaya. On 2015 Insidence Rate (IR) for Surabaya is 22.50 and the Case Fatality Rate (CFR) is 2%. This figure has decreased compared to 2014, but has not met the target achievement indicator for the P2DBD target CFR Method : The study was conducted in the rainy season, May 2015 in several Puskesmas areas in Surabaya. Samples were randomly selected as many as 378 houses spread in eight health centers (Pegirian, Krembangan Selatan, Hamlet Wall, Tambak Rejo, Putat Jaya, Simomulyo, Sawahan and Tanahkali Kedinding). The larvae survey was conducted using the single larva method. Larvae were taken from breeding sites and stored in specimen bottles for species identification at the Parasitology Laboratory Faculty of Medicine Universitas Airlangga.Result : The highest House Index (HI) was obtained (60.46%) or the 39.54% larvae free rate in Simomulyo and the lowest HI (33.33%) or 66.67% ABJ in Pegirian Puskesmas. Larvae species identification showed 100% was Aedes aegypti. The high HI value at the Simomulyo Health Center is not in line with the number of cases of dengue virus infection in 2015 which was 4 cases. Whereas in Pegirian Health Center with the lowest HI value found 11 cases.Discussion : These results could be due to the possibility because the study did not calculate larval density and high population mobility in the area.Conclusion: House Index values are linier with container index but not linear with the number of cases of dengue virus infectionKeywords: House Index, larvae free rate, dengue virus infection, single larva method

We examined the mitogenomes of a large global collection of human malaria parasites to explore how and when Plasmodium falciparum and P. vivax entered the Americas. We found evidence of a significant contribution of African and South Asian lineages to present-day New World malaria parasites with additional P. vivax lineages appearing to originate from Melanesia that were putatively carried by the Australasian peoples who contributed genes to Native Americans. Importantly, mitochondrial lineages of the P. vivax-like species P. simium are shared by platyrrhine monkeys and humans in the Atlantic Forest ecosystem, but not across the Amazon, which most likely resulted from one or a few recent human-to-monkey transfers. While enslaved Africans were likely the main carriers of P. falciparum mitochondrial lineages into the Americas after the conquest, additional parasites carried by Australasian peoples in pre-Columbian times may have contributed to the extensive diversity of extant local populations of P. vivax.

Antioxidant compounds from mangosteen pericarps have been extracted with low-transition-temperature mixture (LTTM) assisted hydrothermal method. Extracted antioxidant compounds were determined as xanthone and total phenolic compounds. The effects of temperature, concentration of LTTM, and sonication pretreatment on the recovery of xanthone and total phenolic compounds were investigated. Extraction were carried out in a batch extractor at various temperatures (120 – 160°C), concentrations of LTTM (0.1 – 0.3 mg/mL), and sonication pretreatments (0 – 10 min). LTTM used for extraction was consisted of citric acid as hydrogen bond donor and alanine as hydrogen bond acceptor. Xanthone and total phenolic compounds were analyzed by spectrophotometer. In order to determine the effect of extraction condition on the antioxidant efficiency of the extract, the antioxidant efficiency of extract were analyzed by DPPH assay method. Based on the result, the recovery of xanthone increased as increasing temperature and concentration of LTTM. Inversely, the recovery of total phenolic compounds decreased as increasing temperature. The sonication pretreatment had significantly effect on the recovery of both xanthone and total phenolic compounds, however the optimum condition of sonication pretreatment was at 5 min. The antioxidant efficiency of the extract was affected by the extraction condition, and the highest antioxidant efficiency was 1.395 obtained at temperature of 120°C, LTTM concentration of 0.3 mg/mL, and sonication time of 5 min.Antioxidant compounds from mangosteen pericarps have been extracted with low-transition-temperature mixture (LTTM) assisted hydrothermal method. Extracted antioxidant compounds were determined as xanthone and total phenolic compounds. The effects of temperature, concentration of LTTM, and sonication pretreatment on the recovery of xanthone and total phenolic compounds were investigated. Extraction were carried out in a batch extractor at various temperatures (120 – 160°C), concentrations of LTTM (0.1 – 0.3 mg/mL), and sonication pretreatments (0 – 10 min). LTTM used for extraction was consisted of citric acid as hydrogen bond donor and alanine as hydrogen bond acceptor. Xanthone and total phenolic compounds were analyzed by spectrophotometer. In order to determine the effect of extraction condition on the antioxidant efficiency of the extract, the antioxidant efficiency of extract were analyzed by DPPH assay method. Based on the result, the recovery of xanthone increased as increasing temperature and conc...

We have previously developed the WST-8 method as a simple and rapid screening test for detection of glucose-6-phosphate dehydrogenase (G6PD) deficiency accomplished by the naked eye. However, it was little difficult to distinguish between faint orange colors developed by heterozygous females and pink colors of normal hemolyzed blood, since both have similar tones. To solve this problem, we established a new and simple screening method that utilizes another formazan substrate, MTT (3-(4,5-dimethyl-2- thiazolyl)-2,5-diphenyl-2H tetrazolium bromide) in combination with a hydrogen carrier, 1-methoxy phenazine methosulfate. MTT formazan exhibits a purple color, thus allowing for the ability to easily distinguish the pink colors of hemolyzed blood. However, MTT has been reported to react with hemoglobin non-specifically and to interfere with the interpretation of the color reaction. In our examinations by mixing MTT with hemolyzed blood, we found that the non-specific reaction was very slow, and that the addition of a small amount of blood (5~10 μl) into a reaction mixture (800 μl) did not interfere with the reaction of G6PD activity. In this new MTT method, a strong purple color was generated in normal blood samples at 20~30 min after incubation, which could be distinguished by the naked eye from G6PD-deficient blood samples with less than 50% residual activity. In addition, quantitative measurement using a spectrophotometer was also possible despite the fact that MTT formazan is water-insoluble.

Longitudinal data have a complex structure. Unlike cross-sectional data, there are more associated features with longitudinal data. Associated features to longitudinal data including the heterogeneity between subjects, the serial correlation and the characteristics of changes over time. Therefore exploring longitudinal data is more complicated than that of cross-sectional data. Various methods were developed by many researchers to explore longitudinal data. In general, there are at least three things that could be described from longitudinal data: mean structure, variance structure, and correlation structure. Visual methods and subject-specific profile were studied for such datasets to detect these structures. Methods were applied to data sets from upper respiratory tract infection data in Bandung City. From the result, we can describe the growth patterns at both group and individual level and then selecting suitable statistical models which contain within and between groups variations.

Wild isolates of malaria parasites were preserved in wet ice for 2–12 days and cultivated by a candle jar method. In four isolates of Plasmodium falciparum collected from Myanmar and preserved for 12 days, all failed to grow. In 31 isolates preserved for 5–10 days, nine were transformed to young gametocytes, but 22 isolates grew well. From Ranong, Thailand, nine isolates preserved for 7 days were examined, and six grew well. On the other hand, all of the 59 isolates collected from eastern Indonesian islands failed to establish as culture-adapted isolates, even most of them were preserved only for 2–3 days: 10 isolates stopped to grow, and 49 isolates were transformed to sexual stages by Day 10. These results indicated that a great difference in adaptation to in vitro culture may exist between wild isolates distributed in continental Southeast Asia and in eastern Indonesia and that gametocytogenesis might be easily switched on in Indonesian isolates. In wild isolates of P. vivax, P. malariae and P. ovale preserved for 2–9 days, ring forms or young trophozoites survived, but adaptation to in vitro culture failed. These results indicate that wild isolates can be preserved in wet ice for 9–10 days.

Malaria persists as an undiminished global problem and still is the cause of much human morbidity and mortality. Although the disease has been eradicated in many temperate zones, it continues to be endemic throughout much of the tropics and subtropics. Many tools for understanding its biology and epidemiology are well developed, with a particular richness of comparative genome sequences. Studies of the epidemiology, prevention, and treatment of human malaria methods, and analyses of parasite polymorphisms have long had have already been influenced by the availability of molecular useful and highly informative applications. The molecular epidemiology of malaria is currently undergoing its most substantial revolution as a result of the genomic information and technologiesthat are available in well-resourced centers. However, great progress in malaria control has been made in some highly endemic countries. Vector control is assuming a new importance with the significant reductions in malaria burden achieved using combined malaria control interventions. Education of health workers and communities about malaria prevention, diagnosis and treatment is a vital component of effective case management, especially as diagnostic policies change.

We conducted a survey for malaria diagnosis and treatment in four primary schools in Flores Island, one of the Indonesian Islands with an area of 17,000 km2 and a population of 1.8 million. Of those examined, 24.4% were diagnosed as having malaria (90/363) and administered medicine immediately. A glucose-6-phophate dehydrogenase (G6PD) test was performed at the same time, and 16 persons (4.4%) were diagnosed as G6PD deficient. Eleven persons consented to analysis of the G6PD genome. We analyzed these subjects and found one case of G6PD Vanua Lava (383T>C), five cases of G6PD Coimbra (592C>T), one case of G6PD Viangchan (871G>A), one case of G6PD Chatham (1003G>A), and three cases of G6PD Kaiping (1388G>A). These were unexpected findings because five different G6PD variants were found in such a small population. This suggests that people of Flores Island are derived from various ancestries.

The presence of Plasmodium ovale has never been previously reported in Myanmar. Using blood samples obtained in many villages across the country between 1996 and 2000, molecular diagnosis of Plasmodium species was made with semi- or full-nested polymerase chain reaction (PCR) with species-specific primers, followed by agarose gel electrophoresis to detect amplification products. The presence of P. ovale was also confirmed with the another PCR-based diagnosis, the microtiterplate hybridization (MPH) method using species-specific probes. Both methods target the A type of the small subunit ribosomal RNA gene of the four human malaria parasites. Plasmodium ovale DNA was amplified in samples from 65 (4.9%) of 1323 PCR-positive patients, with perfect agreement between results obtained by nested PCR and MPH. Only four P. ovale-infected patients had single-species infection; all others were coinfected with P. falciparum, P. vivax and/or P. malariae. Quadruple infections were observed in six subjects. Parasites with typical P. ovale morphology were found in only 19 patients by conventional microscopy of Giemsa-stained thin smears or fluorescence microscopy of acridine orange-stained thin smears. Plasmodium ovale infections were found in villages situated in the southern, central and western regions of Myanmar, suggesting that P. ovale may be widely distributed in this country.

A rapid single-step screening method for detection of glucose-6-phosphate dehydrogenase (G6 PD) deficiency was evaluated on Halmahera Island, Maluku Province, Indonesia, and in Shan and Mon States, Myanmar, in combination with a rapid diagnosis of malaria by an acridine orange staining method. Severe deficiency was detected by the rapid test in 45 of 1126 volunteers in Indonesia and 54 of 1079 in Myanmar, but it was difficult to distinguish blood samples with mild deficiency from those with normal activity. 89 of 99 severely deficient cases were later confirmed by formazan ring method in the laboratory, but 5 with mild and 5 with no deficiency were misdiagnosed as severe. Of the samples diagnosed as mild and no deficiency on-site, none was found to be severely deficient by the formazan method. Malaria patients were simultaenously++ detected on-site in 273 samples on Halmahera island and 277 samples from Shan and Mon States. In Mon State, primaquine was prescribed safely to G6 PD-normal malaria patients infected with Plasmodium vivax and/or gametocytes of P. falciparum. The new rapid test for G6 PD deficiency may be useful for detecting severe cases under field conditions, and both rapid tests combined are can be useful in malaria-endemic areas, facilitating early diagnosis, prompt and radical treatment of malaria and suppression of malaria transmission.

We recently reported a new rapid screening method for glucose-6-phosphate dehydrogenase (G6PD) deficiency. This method incorporates a new formazan substrate (WST-8) and is capable of detecting heterozygous females both qualitatively and quantitatively. Here, we report its evaluation during field surveys at three malaria centres and in malaria-endemic villages of Myanmar and Indonesia, either alone or in combination with a rapid on-site diagnosis of malaria. A total of 57 severe (45 males and 12 females) and 34 mild (five males and 29 females) cases of G6PD deficiency were detected among 855 subjects in Myanmar whilst 30 severe (25 males and five females) and 23 mild (six males and 17 females) cases were found among 1286 subjects in Indonesia. In all cases, severe deficiency was confirmed with another formazan method but due to limitations in its detection threshold, mild cases were misdiagnosed as G6PD-normal by this latter method. Our results indicate that the novel method can qualitatively detect both severely deficient subjects as well as heterozygous females in the field. The antimalarial drug, primaquine, was safely prescribed to Plasmodium vivax-infected patients in Myanmar. Our new, rapid screening method may be essential for the diagnosis of G6PD deficiency particularly in rural areas without electricity, and can be recommended for use in malaria control programmes.

Plasmodium ovale and Plasmodium malariae, two of the four human malaria parasites, are usually found at very low prevalence in East Asia, even in areas with intense malaria transmission. In this article, Fumihiko Kawamoto, Qing Liu, Marcelo Ferreira and Indah Tantular review data obtained in recent field surveys, using alternative diagnostic methods such as acridine orange staining and PCR-based methods, to evaluate the prevalence of these two malaria species in East Asia. They argue that these species might be much more prevalent in East Asia than reported previously. In addition, they discuss the implications of sequence variations found in the small subunit ribosomal RNA genes of the two species targeted by diagnostic PCR and compare morphological criteria for speciation of malaria parasites stained with Giemsa and acridine orange.

During malaria surveys in Myanmar, 2 peculiar forms of Plasmodium malariae-like parasites were found. The morphologies of their early trophozoite stages were distinct from that of the typical P. malariae, resembling instead that of Plasmodium vivax, var. minuta, reported by Emin, and Plasmodium tenue, reported by Stephens, both in 1914. Two polymerase chain reaction (PCR)-based diagnoses, which target the same regions in the small subunit ribosomal RNA (SSUrRNA) genes, indicated that these parasites were new variant forms of P. malariae and that they could be separated into 2 genetic types that correlated with the 2 morphological types. Sequence analysis of the SSUrRNA and the circumsporozoite protein genes revealed that they were distinct both from each other and from other known P. malariae isolates and that the P. tenue-like type was closer to a monkey quartan malaria parasite, Plasmodium brasilianum. These results illustrate that the microscopic appearance of human P. malariae parasites may be more varied than previously assumed and suggest the value of molecular tools in the evaluation of malaria morphological variants.

Sequence analyses of six isolates from Southeast Asia supports dividing species into types, Complete DNA sequences of the small subunit ribosomal RNA (SSUrRNA) gene and partial sequences of three other loci were obtained from three variant-type and three classic-type Plasmodium ovale isolates from Southeast Asia and compared with GenBank-available data. Three different SSUrRNA sequences (Pov 1–3) were found in each variant-type isolate, and two different SSUrRNA sequences (Poc 1–2) in each classic-type isolate. Pov 1–3 were closer to sequences previously found in the Cameroon and MAL/MAI isolates, whereas Poc 1–2 were closer to sequences previously found in two clones of the Nigerian I/CDC strain. The 3´ half of Pov 1–3 was identical to the partial sequence of the SSUrRNA gene from the London School (LS) strain. Results support grouping P. ovale into two groups, the classic type (including the Nigerian I/CDC strain) and the variant type (Cameroon, MAL/MAI, and LS isolates).

Background Sulawesi in Indonesia has a unique geographical profile with assumed separation from Sundaland. Studies of Helicobacter pylori in this region are rare due to the region’s rural location and lack of endoscopy equipment. Indirect methods are, therefore, the most appropriate for measuring H. pylori infection in these areas; with the disposable gastric brush test, we can obtain gastric juice as well as small gastric tissue samples for H. pylori culture. We investigated the prevalence of H. pylori infection and evaluated human migration patterns in the remote areas of North Sulawesi. Methods We recruited a total of 251 consecutive adult volunteers and 131 elementary school children. H. pylori infection was determined by urine antibody test. A gastric brush test was used to culture H. pylori. We used next-generation and polymerase chain reaction based sequencing to determine virulence factors and multi-locus sequence typing (MLST). Results The overall H. pylori prevalence was only 14.3% for adults and 3.8% for children, and 13.6% and 16.7% in Minahasanese and Mongondownese participants, respectively. We isolated a single H. pylori strain, termed -Manado-1. Manado-1 was East Asian type cagA (ABD type), vacA s1c-m1b, iceA1 positive/iceA2 negative, jhp0562-positive/β-(1,3) galT-negative, oipA “on”, and dupA-negative. Phylogenetic analyses showed the strain to be hspMaori type, a major type observed in native Taiwanese and Maori tribes. Conclusions Our data support that very low H. pylori infection prevalence in Indonesia. Identification of hspMaori type H. pylori in North Sulawesi may support the hypothesis that North Sulawesi people migrated from north.