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"Sifilis adalah penyakit menular seksual kronik yang memiliki manifestasi klinis yang bervariasi dan menetap untuk waktu yang lama. Neurosifilis merupakan salah satu komplikasi sifilis sistemik dengan temuan di cairan serebrospinal dengan atau tanpa gejala yang jelas. Pemeriksaan yang saat ini tersedia dalam mendukung diagnosis hanya tersedia pemeriksaan analisis cairan serebrospinal dan serologi Treponema pallidum. Saat ini belum diketahui prevalensi neurosifilis di rumah sakit peneliti dan profil serologi Treponema pallidum dari bahan cairan serebrospinal. Penelitian ini merupakan penelitian potong lintang, dilakukan November 2017-Maret 2018 terhadap 50 cairan serebrospinal dan darah yang diperiksakan analisis cairan serebrospinal dengan keterangan klinis terduga infeksi intrakranial. Serum dan cairan serebrospinal diperiksakan RPR, TPHA, anti-Treponema pallidum ELISA IgG dan khusus cairan serebrospinal diperiksa pula rapid test Treponema pallidum. Uji statistik menggunakan chi quare and Fisher exact test.Dari penelitian terhadap 50 cairan serebrospinal dan serum didapatkan rapid test Treponema pallidum, RPR dan TPHA cairan serebrospinal reaktif 4(8%). Dari bahan serum didapatkan RPR reaktif 8(16%) dan TPHA reaktif 9(18%). Anti-Treponema pallidum ELISA IgG positif 4 sampel (8%). Dari 50 sampel didapatkan 7 (14%) neurosifilis, 4 confirmed neurosyphilis dan 3 probable neurosyphilis sesuai kriteria Center for Disease Control and Prevention. Profil analisis cairan serebrospinalnya tidak berwarna, jernih, tidak ada bekuan, hitung sel 12.71 ±9.20 sel/μl, dominasi mononuklear 11.57±9.47 sel/μl, Pandy positif, protein cairan 42.29±21.49 mg/dl, glukosa cairan 55±5.16 mg/dl, glukosa serum 101.04±20.10 mg/dl, dan klorida 122.14±2.48 mEq/L. Pemeriksaan RPR, TPHA, dan anti-Treponema pallidum ELISA IgG dengan bahan serum dan cairan serebrospinal memiliki hubungan bermakna. Dari penelitian ini didapatkan 14% sesuai dengan neurosifilis dari populasi penelitian dan didapatkan 85.71% dengan HIV reaktif. Pada pasien HIV disarankan RPR dan TPHA serum untuk pemeriksaan skrining sifilis.

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Syphilis is a chronic sexually transmitted disease that has varying clinical manifestations and persist for a long time. Neurosyphilis is one of the complications of systemic syphilis with findings in cerebrospinal fluid with or without obvious symptoms. Examinations currently available for diagnostic support were cerebrospinal fluid analysis and serology of Treponema pallidum. There is currently no known prevalence of neurosyphilis in the research hospital and serologic profile of Treponema pallidum from cerebrospinal fluid. This study was a cross sectional study, conducted November 2017-March 2018 against 50 cerebrospinal fluid and blood samples that examined cerebrospinal fluid analysis with clinical information of suspected intracranial infection. Serum and cerebrospinal fluid examined by RPR, TPHA, anti-Treponema pallidum ELISA IgG and particulary rapid test Treponema pallidum for cerebrospinal fluid. Statistic tests were chi quare and Fisher exact test.From a total of 50 cerebrospinal fluid and serum, 4(8%) had reactive cerebrospinal fluid T. pallidum rapid tests, RPRs and TPHAs. From serum there were 8(16%) reactive RPRs and 9(18%) reactive TPHAs. Anti-Treponema pallidum ELISA IgG was positif 4 samples (8%). Among the 50 samples, 7 (14%) had neurosyphilis, 4 were confirmed neurosyphilis and 3 were probable neurosyphilis according to Center for Disease Control and Prevention criteria. The cerebrospinal fluid analysis profile is colorless, clear, without clot, cell count 12.71±9.20 cells/μl, mononuclear 11.57±9.47 cells/μl, positive for Pandy, cerebrospinal fluid protein 42.29±21.49 mg/dl, glucose 55±5.16 mg/dl, serum glucose 101.04±20.10 mg/dl, and chloride 122.14±2.48 mEq/L. Rapid Plasma Reagin, TPHA, and anti-Treponema pallidum ELISA IgG were associated between serum specimen and cerebrospinal fuid. Neurosyphilis was found in 14% of our patient population and 85.71% was reactive for HIV. Rapid Plasma Reagin and TPHA in sera were recommended for syphilis screening for HIV patient."

"ABSTRAKSifilis adalah penyakit menular seksual kronik yang memiliki manifestasi klinis yang bervariasi dan menetap untuk waktu yang lama. Neurosifilis merupakan salah satu komplikasi sifilis sistemik dengan temuan di cairan serebrospinal dengan atau tanpa gejala yang jelas. Pemeriksaan yang saat ini tersedia dalam mendukung diagnosis hanya tersedia pemeriksaan analisis cairan serebrospinal dan serologi Treponema pallidum. Saat ini belum diketahui prevalensi neurosifilis di rumah sakit peneliti dan profil serologi Treponema pallidum dari bahan cairan serebrospinal. Penelitian ini merupakan penelitian potong lintang, dilakukan November 2017-Maret 2018 terhadap 50 cairan serebrospinal dan darah yang diperiksakan analisis cairan serebrospinal dengan keterangan klinis terduga infeksi intrakranial. Serum dan cairan serebrospinal diperiksakan RPR, TPHA, anti-Treponema pallidum ELISA IgG dan khusus cairan serebrospinal diperiksa pula rapid test Treponema pallidum. Uji statistik menggunakan chi quare and Fisher exact test. Dari penelitian terhadap 50 cairan serebrospinal dan serum didapatkan rapid test Treponema pallidum, RPR dan TPHA cairan serebrospinal reaktif 4 8 . Dari bahan serum didapatkan RPR reaktif 8 16 dan TPHA reaktif 9 18 . Anti-Treponema pallidum ELISA IgG positif 4 sampel 8 . Dari 50 sampel didapatkan 7 14 neurosifilis, 4 confirmed neurosyphilis dan 3 probable neurosyphilis sesuai kriteria Center for Disease Control and Prevention. Profil analisis cairan serebrospinalnya tidak berwarna, jernih, tidak ada bekuan, hitung sel 12.71 9.20 sel/ l, dominasi mononuklear 11.57 9.47 sel/ l, Pandy positif, protein cairan 42.29 21.49 mg/dl, glukosa cairan 55 5.16 mg/dl, glukosa serum 101.04 20.10 mg/dl, dan klorida 122.14 2.48 mEq/L. Pemeriksaan RPR, TPHA, dan anti-Treponema pallidum ELISA IgG dengan bahan serum dan cairan serebrospinal memiliki hubungan bermakna. Dari penelitian ini didapatkan 14 sesuai dengan neurosifilis dari populasi penelitian dan didapatkan 85.71 dengan HIV reaktif. Pada pasien HIV disarankan RPR dan TPHA serum untuk pemeriksaan skrining sifilis.

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ABSTRACTSyphilis is a chronic sexually transmitted disease that has varying clinical manifestations and persist for a long time. Neurosyphilis is one of the complications of systemic syphilis with findings in cerebrospinal fluid with or without obvious symptoms. Examinations currently available for diagnostic support were cerebrospinal fluid analysis and serology of Treponema pallidum. There is currently no known prevalence of neurosyphilis in the research hospital and serologic profile of Treponema pallidum from cerebrospinal fluid. This study was a cross sectional study, conducted November 2017-March 2018 against 50 cerebrospinal fluid and blood samples that examined cerebrospinal fluid analysis with clinical information of suspected intracranial infection. Serum and cerebrospinal fluid examined by RPR, TPHA, anti-Treponema pallidum ELISA IgG and particulary rapid test Treponema pallidum for cerebrospinal fluid. Statistic tests were chi quare and Fisher exact test. From a total of 50 cerebrospinal fluid and serum, 4 8 had reactive cerebrospinal fluid T. pallidum rapid tests, RPRs and TPHAs. From serum there were 8 16 reactive RPRs and 9 18 reactive TPHAs. Anti-Treponema pallidum ELISA IgG was positif 4 samples 8 . Among the 50 samples, 7 14 had neurosyphilis, 4 were confirmed neurosyphilis and 3 were probable neurosyphilis according to Center for Disease Control and Prevention criteria. The cerebrospinal fluid analysis profile is colorless, clear, without clot, cell count 12.71 9.20 cells/ l, mononuclear 11.57 9.47 cells/ l, positive for Pandy, cerebrospinal fluid protein 42.29 21.49 mg/dl, glucose 55 5.16 mg/dl, serum glucose 101.04 20.10 mg/dl, and chloride 122.14 2.48 mEq/L. Rapid Plasma Reagin, TPHA, and anti-Treponema pallidum ELISA IgG were associated between serum specimen and cerebrospinal fuid. Neurosyphilis was found in 14 of our patient population and 85.71 was reactive for HIV. Rapid Plasma Reagin and TPHA in sera were recommended for syphilis screening for HIV patient. "

"ABSTRAKSifilis merupakan penyakit multistadium kronik yang disebabkan oleh bakteriTreponema pallidum dan ditularkan dari lesi aktif pasangan seksual atau dari ibuhamil yang terinfeksi pada janin yang dikandungnya. Saat ini telah terjadipeningkatan kasus T. pallidum resisten azitromisin akibat mutasi titik A2058Gdan A2059G pada gen 23S rRNA. Di Indonesia belum ada data terkait resistensiT. pallidum terhadap azitromisin sehingga penelitian ini bertujuan untukmendapatkan metode nested multipleks PCR untuk deteksi kedua mutasi yangmenyebabkan resistensi. Tiga pasang primer digunakan pada reaksi nested PCR.Untuk mendapatkan kondisi uji yang optimal dilakukan optimasi parameter yangpenting pada proses PCR. Uji nested multipleks PCR dapat mendeteksi 22.000jumlah copy DNA/ml dan tidak bereaksi silang terhadap mikroorganisme yangpotensial menyebabkan hasil positif palsu. Uji awal 45 sampel klinis darahditemukan 13 sampel positif T. pallidum dan tidak ditemukan mutasi baikA2058G maupun A2059G. Dua sampel positif dikonfirmasi dengan DNAsekuensing dan menunjukkan tidak ada mutasi titik. Uji nested multipleks PCRyang telah dikembangkan pada penelitian ini dapat digunakan untuk deteksimutasi gen 23S rRNA T. pallidum yang menyebabkan resistensi azitromisin pada sampel klinis darah.

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ABSTRACTSyphilis is a chronic, multi-stage infectious disease caused by Treponemapallidum that is usually transmitted sexually by contact with an active lesion of a partner or congenitally from an infected pregnant woman to her fetus.Azithromycin-resistant strains of T. pallidum is associated with a single pointmutation (either A2058G or A2059G) in both copies of the 23S rRNA gene of T.pallidum. These strains are now prevalent in many countries but there is no dataavailable about it in Indonesia. Therefore, in this study we developed a nestedmultiplex PCR to detect A2058G and A2059G 23S rRNA gene point mutations ofT. pallidum. Three primer sets were designed for nested PCR reactions. To obtainoptimal PCR reaction, all parameters were optimized. The assay could detect atleast 22000 DNA copy number/ml and showed no cross reaction with othermicroorganisms that potentially cause false positive result. A total 13 of 45 wholeblood specimens were PCR positive for T. pallidum and no single point mutation(either A2058G or A2059G) were detected by PCR. Two positive specimens wereconfirmed by DNA sequencing and showed no mutation. Thus, nested multiplexPCR developed in this study is potential to detect azithromycin-resistant T.pallidum in whole blood samples."

"ABSTRAKSifilis merupakan penyakit multistadium yang ditularkan terutama melalui hubungan seksual. Saat ini penggunaan uji polymerase chain reaction (PCR) untuk Treponema pallidum telah banyak digunakan dan diharapkan mampu mengurangi masalah dalam uji diagnostik sifilis. Hasil uji PCR Treponema pallidum dipengaruhi oleh jenis spesimen, metode PCR dan gen target. Penelitian ini ditujukan untuk menilai penggunaan darah dan serum untuk uji multiplex nested PCR dengan gen target 23S rRNA Treponema pallidum. Studi potong lintang dilakukan dari bulan April 2015 - April 2016. Pengambilan sampel secara konsekutif dari pasien dengan gambaran klinis sifilis sekunder yang datang ke poliklinik Infeksi Menular Seksual (IMS) di Jakarta. Uji PCR dilakukan terhadap 122 spesimen klinis (61 darah dan 61 serum). Uji serologi rapid plasma reagin (RPR) dan Treponema pallidum Haemagglutination Assay (TPHA) dilakukan pada semua serum. Hasil positif uji PCR darah sebesar 22,95% dan serum sebesar 6,56%, sedangkan hasil positif uji serologi sebesar 68,85%. Pada hasil uji serologi positif, proporsi hasil positif uji multiplex nested PCR Treponema pallidum darah sebesar 30,95% dibandingkan serum 9,52%. Uji PCR terhadap darah mampu mendeteksi 3,25 kali lebih tinggi daripada serum. Penggunaan darah memberikan nilai kepositivan yang lebih tinggi dibandingkan serum pada uji multiplex nested PCR Treponema pallidum menggunakan gen target 23S rRNA

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ABSTRACTSyphilis is a multistage disease transmitted primarily through sexual intercourse. Nowadays, polymerase chain reaction (PCR) test for Treponema pallidum has been widely used and expected to overcome problems in diagnostic test for syphilis. The PCR Treponema pallidum are influenced by type of specimens, PCR methods and gene targets. This study is aim to assess the use of blood and serum using multiplex nested PCR Treponema pallidum targeting 23S rRNA. Cross-sectional study was conducted from April 2015 - April 2016. Sampling was carried out consecutively from patients with clinical features of secondary syphilis who came to sexual transmitted infection (STI) clinics in Jakarta. PCR test performed on 122 clinical specimen ( 61 blood and 61 serum). All serum were tested with RPR and TPHA assay. The positive results of PCR test on blood was 22,95% and serum was 6,56%, while the positive results of serology was 68,85%. On positive serological test results, the proportion of positive results of multiplex nested PCR Treponema pallidum on blood was 30,95% compared to serum 9,52%. PCR test on blood is able to detect 3,25 times higher than serum. The use of blood give a higher positivity compared to serum in multiplex nested PCR Treponema pallidum using 23S rRNA gene target."

"Infeksi sistem saraf pusat SSP merupakan masalah yang sangat serius dalam bidang neurologi di seluruh dunia. Infeksi SSP biasanya diduga atas dasar presentasi klinis pasien, namun diagnosis berdasarkan gejala dan tanda klinis memiliki kelemahan, sehingga deteksi dan penatalaksanaan yang tidak tepat menyebabkan infeksi SSP berkembang cepat dengan morbiditas dan mortalitas yang tinggi. Pada penelitian ini, dari bahan cairan serebrospinal CSS akan dilakukan deteksi dan identifikasi bakteri dan virus guna mengetahui penyebab infeksi SSP. Penelitian ini menggunakan sisa sampel CSS dari pasien yang diperiksakan di laboratorium Departemen Patologi Klinik RSUPN CM dengan diagnosis berhubungan dengan infeksi/inflamasi. Spesimen CSS diperiksakan pewarnaan Gram langsung, biakan pada media agar, dan pendekatan molekular menggunakan primer gen 16S rRNA, lytA dan sebelas panel spesifik virus. Koloni yang tumbuh pada agar darah dilanjutkan dengan pemeriksaan pewarnaan Gram dan uji biokimia, serta MALDI-TOF-MS. Untuk bakteri, hasil kemudian dibandingkan, sedangkan untuk virus dilakukan analisis genomik.Dari 147 spesimen CSS, proporsi bakteri Streptococcus pneumoniae sebagai penyebab infeksi SSP dengan metode Gram langsung, biakan, dan qPCR adalah 0,7 dan dengan metode qPCR terget gen lytA saja adalah 2 , sedangkan proporsi virus dengan metode PCR adalah 4,1 . Berdasarkan identifikasi morfologi dan biokimia dari biakan yang tumbuh, berhasil didapatkan 1 isolat Streptococcus pneumoniae, 5 isolat Staphylococcus epidermidis, 1 isolat Staphylococcus saprophyticus, dan 1 isolat Streptococcus dysgalactiae. Berdasarkan hasil uji biokimia dan MALDI-TOF-MS, terdapat 1 isolat memiliki kesamaan jenis bakteri sampai tingkat spesies dan 8 isolat memiliki kesamaan pada tingkat genus. Streptococcus pneumoniae yang ditemukan adalah serotipe 6B, dan bersifat resistan terhadap oxacillin dan trimetoprim-sulfametoxazole. Untuk virus, terdeteksi 1 spesimen positif virus Influenza A dan 5 Herpes virus dari pemeriksaan terhadap 147 spesimen CSS. Analisis sekuens yang diperoleh menunjukkan bahwa virus Influenza tersebut adalah virus Influenza A subtipe H1N1, dan 5 Herpes virus adalah Human betaherpesvirus 5 strain HANSCTR2.Peran diagnostik 16S rRNA dalam deteksi infeksi bakteri pada CSS tidak dapat dinilai, namun penggunaan gen lytA untuk mendeteksi infeksi Streptococcus pneumoniae adalah lebih sensitif dibandingkan dengan biakan. Identifikasi bakteri menggunakan metode biakan-uji biokimia dan biakan-MALDI-TOF-MS memiliki tingkat kesesuaian yang baik sampai pada tingkat genus. Penggunaan primer spesifik virus mampu mendeteksi virus dari bahan CSS. Gambaran analisis CSS pada infeksi bakteri memiliki kesamaan dengan non-infeksi.

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Central nervous system CNS infection is a very serious problem worldwide. The disesase is usually suspected based on patient 39;s clinical presentation, however this diagnosis has weaknesses, whereas an inaccuracy detection and management can cause high morbidity and mortality risk. This study aimed to detect and identify bacteria and virus from cerebrospinal fluid CSF, in order to determine the causes of CNS infection. This study investigated the remained CSF samples from patients examined at the laboratory of Clinical Pathology Department, Cipto Mangunkusumo hospital. The diagnosis or clinical information was related to infection or inflammation. The CSF specimens were examined by direct Gram staining, inoculated on blood agar media, and extracted for amplification using 16S rRNA, lytA and eleven viral specific primers. Colonies that grew on blood agar were stained and tested by biochemical tests, as well as MALDI-TOF-MS. For bacteria, all results were compared, and for the virus, the genomic sequence was analyzed. From 147 cerebrospinal fluid specimens, the proportion of Streptococcus pneumoniae as the etiology of CNS infection by using 3 methods direct Gram, culture, and qPCR lytA gene target was 0,7, while using qPCR lytA the proportion was 2. The proportion of virus by using PCR method was 4.1. Bacterial species isolated during culture on blood agar were Streptococcus pneumoniae 1 isolate, Staphylococcus epidermidis 5 isolates, Staphylococcus saprophyticus 1 isolate , and Streptococcus dysgalactiae 1 isolate. Based on biochemical and MALDI-TOF-MS test results, 1 isolate had the same type of bacteria to the species level and 8 isolates had similarity at the genus level. The serotypes of Streptococcus pneumoniae isolated from CSF were serotype 6B, and non-susceptible to oxacillin and trimethoprim-sulfamethoxazole. For the virus, 1 positive specimen of Influenza virus and 5 Herpes virus were detected. The sequence analysis of Influenza virus showed that the virus was Influenza A virus, subtype H1N1, and for 5 Herpes virus were Human betaherpesvirus 5 strain HANSCTR2. The use of 16S rRNA in the detection of bacterial infections in CSF could not be assessed, but the use of lytA gene in detecting Streptococcus pneumoniae showed higher senstivity compare to culture. Bacterial identification using biochemical methods and MALDI-TOF-MS had a reliable identification up to the genus level. The use of virus-specific primers was capable of detecting viruses from CSF materials. The CSF analysis on bacterial infections had similarities with non-infections."

"Latar belakang: Metastasis leptomeningeal (ML) merupakan penyebaran sel tumor ke leptomening dan ruang subarakhnoid, dengan insidens yang semakin meningkat dan prognosis yang buruk. Analisis cairan serebrospinal (CSS) merupakan pemeriksaan penting dengan sitologi sebagai standar baku emas untuk deteksi sel tumor di CSS.Metode penelitian: Studi potong lintang retrospektif multisenter untuk mengetahui gambaran analisis rutin dan sitologi CSS pada keganasan dengan kecurigaan ML yang dilakukan pungsi lumbal pada Januari 2018-Desember 2021. Dilakukan pencatatan data klinis, radiologis, jenis tumor, analisis rutin serta frekuensi pungsi lumbal, dan dianalisis hubungannya dengan sitologi CSS.Hasil: Terdapat 153 subjek dengan abnormalitas analisis rutin CSS(75,2%) berupa peningkatan jumlah sel >5/uL(47,1%) dengan median 5(1-3504)/uL; peningkatan protein CSS >45 mg/dl (52,9%) dengan median 50 (5-820)mg/dl serta penurunan glukosa CSS <50 mg(15%) dengan median 68 (3-269)mg/dl. Proporsi sitologi CSS positif sel ganas 20,3%. Proporsi flow cytometry immunophenotyping CSS positif pada keganasan hematologi dengan kecurigaan ML 25,6%. Terdapat hubungan bermakna antara peningkatan sel, jenis keganasan hematologi, dan gambaran MRI dengan sitologi CSS (p<0,001;p=0,03;p=0,03). Tidak terdapat hubungan bermakna antara manifestasi klinis dan frekuensi pungsi lumbal dengan sitologi CSS.Kesimpulan: Abnormalitas analisis rutin CSS didapatkan pada sebagian besar subjek keganasan dengan kecurigaan ML, dengan positivitas sitologi yang rendah. Gejala klinis yang bervariasi dan pengulangan pungsi lumbal tidak signifikan menaikkan kemungkinan sitologi CSS positif.

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Background: Leptomeningeal metastases (LM) is a condition where malignant cells spread to leptomeninges and subarachnoid space, with increasing incidence and poor prognosis. Cerebrospinal fluid (CSF) analysis is an important examination with cytology as the gold standard for malignant cells detection in CSF.

Methods: A multicenter cross-sectional retrospective study to describe CSF routine analysis and cytology in suspected LM on January 2018-December 2021. Clinical manifestations, radiological data, tumor type, CSF routine analysis, and lumbal puncture frequency were recorded, and their correlation with CSF cytology was analyzed.

Results: There were 153 subjects with abnormalities on CSF routine analysis(75,2%), consist of CSF cell count >5/uL(47,1%) with median 5(1-3504)/uL, CSF protein >45 mg/dL(52,9%) with median 50(5-820) mg/dL, and CSF glucose <50 mg/dL(15%) with median 68(3-629)mg/dL. Positive CSF cytology result was 20,3%. Positive CSF flow cytometry immunophenotyping in hematological malignancy with suspected LM was 25,6%. There was significant correlation between the increase in CSF cell count, hematological malignancy, and MRI results with CSF cytology (p<0,001;p=0,03;p=0,03). There was no significant correlation between clinical manifestations and lumbal puncture frequency with CSF cytology.

Conclusion: Abnormalities of CSF routine analysis were found in majority subjects with suspected LM but CSF cytology positivity rate was considered low. The presence of varied clinical symptoms and repeated lumbal punctures didn’t increase the likelihood of positive CSF cytology."

"ABSTRAKPatah dasar tulang tengkorak terjadi sekitar 3,5 ndash; 24 dari cedera kepala. Patah tulang dasar tengkorak menyebabkan robekan duramater sehingga berisiko terjadinya meningitis sekitar 9,2 . Pelayanan pasien patah tulang dasar tengkorak pada perawatan Neurologi RSCM menyarankan pemberian antibiotik profilaksis dalam upaya pencegahan meningitis bakterialis, dimana menggunakan ceftriaxon. Hal ini masih kontroversial. Penggunaan antibiotik tanpa indikasi yang tepat akan mengakibatkan resistensi antibiotik. Tujuan penelitian ini adalah untuk mengetahui manfaat pemberian antibiotik profilaksis selama 7 hari pada pasien patah tulang dasar tengkorak. Penelitian ini merupakan penelitian eksperimental dengan disain Randomized Clinical Trial, untuk mengetahui perbandingan profil cairan otak pada penderita patah tulang dasar tengkorak dengan atau tanpa pemberian antibiotik profilaksis. Analisis data menggunakan SPSS for Windows versi 20.0. Diperoleh 14 sampel, 7 pasien perlakuan yakni diberikan Ceftriaxon, sisanya kontrol. Sebanyak 57,1 pasien perlakuan, memiliki profil cairan otak yang normal, 42.9 lainnya memiliki profil cairan otak abnormal, bukan meningitis. Pada kelompok kontrol, 57,1 pasien memiliki profil cairan otak yang normal, 42.9 memiliki memiliki profil cairan otak abnormal, bukan meningitis. Dengan uji Chi ndash; Square diperoleh perbedaan yang tidak signifikan p=1,000 . Sebagai kesimpulan, terdapat kesamaan profil cairan otak pada pasien patah tulang dasar tengkorak dengan atau tanpa pemberian antibiotik profilaksis.

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ABSTRACTSkull base fracture is commonly happened in head injury, with 3,5 ndash 4,0 prevalence.The skull base fracture frequently caused meninges tear and risk of meningeal infection. Ceftriaxone is antibiotic of choice in prevention of meningeal infection. Department of Neurology, Cipto Mangunkusumo Hospital had accepted prophylactic Ceftriaxone in skull base fracture. Its use is still a controversy though. Antibiotic rsquo s use without proper indication may cause resistancy. The aim of this study is to find out the benefit of 7 days rsquo prophylactic antibiotic in skull base fracture. It is an experimental study with Randomized Clinical Trial design, to observe the difference of cerebrospinal fluid analysis between two groups, with or without prophylactic antibiotic use. Data analysis using SPSS for Windows Version 20.0. Fourteen patients was included in this study. Seven patients were in antibiotic group, the rest in control group. In antibiotic group, 57,1 of patients had normal cerebrospinal fluid analysis, while 42,9 had abnormal results, but not meningitis. In control group, 57,1 of patients had normal results, while 42,9 had abnormal results, but not meningitis. Chi ndash Square test found no significance difference between two groups p 1,000 . We found similarity of cerebrospinal fluid analysis in skull base fracture patients from both group."

"Cytologic diagnosis by examination of exfoliated cells in serous cavity fluids is one of the most challenging areas in clinical cytopathology. Almost 20% of the effusions examined are directly or indirectly related to the presence of malignant disease, with carcinoma of the lung as the most common underlying culprit. This volume published in the essentials in cytopathology book series will fulfill the need for an easy-to-use and authoritative synopsis of site specific topics in cytopathology. These guide books fit into the lab coat pocket, ideal for portability and quick reference. Each volume is heavily illustrated with a full color art program, while the text follows a user-friendly outline format."

"ABSTRAKToxoplasma gondii merupakan protozoa obligat intraseluler yang memiliki persebaran di alam cukup luas dan dapat menginfeksi berbagai jenis unggas dan mamalia. Informasi genetik mengenai tipe T. gondii yang menyebabkan toksoplasmosis pada manusia masih sangat terbatas. Analisis genetik dari lokus SAG2 digunakan untuk menentukan prevalensi ketiga genotip T. gondii tipe I, II, dan III yang terkait dengan infeksi toksoplasmosis serebral dan okular di Indonesia. Penentuan genotip ini dilakukan secara langsung pada sampel klinis, tanpa terlebih dahulu melalui proses isolasi pada mencit atau kultur sel. Sebanyak 28 sampel cairan serebrospinal dan 8 sampel cairan mata yang telah dinyatakan positif terinfeksi T. gondii melalui PCR gen B1 digunakan pada penelitian ini. Metode restriction fragment length polymorphism RFLP digunakan untuk mengelompokkan setiap isolat ke dalam satu dari tiga genotip T. gondii. Tipe I merupakan strain yang paling banyak didapatkan pada sampel cairan serebrospinal dan cairan mata. Data tersebut menunjukkan bahwa toksoplasmosis serebral dan okular yang terjadi di Indonesia di dominasi oleh tipe I yang merupakan jenis tipe yang virulen.Kata Kunci: cairan mata, cairan serebrospinal, genotip, PCR-RFLP, Toxoplasma gondi.

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ABSTRACTToxoplasma gondii is an obligate intracellular protozoan that has a wide distribution in nature and can infect many kinds of birds and mammals. Genetic information about the type of Toxoplasma gondii that causes toxoplasmosis in humans is still limited. Genetic analysis of the SAG2 locus was performed to determine the prevalence of the three genotypes of T. gondii associated with cerebral and ocular toxoplasmosis infection in Indonesia. This genotyping is performed directly on clinical samples, without passing the isolation process in mice or cell cultures. A total of 28 samples of cerebrospinal fluid and 8 samples of vitreous fluid which had been confirmed positive for T. gondii infection through B1 gene PCR, used in this study. Restriction fragment length polymorphism RFLP was used to determine each isolate into one of the three genotypes of T. gondii. Type I was the predominant strain found in cerebrospinal and ocular fluid. This data showed that cerebral and ocular toxoplasmosis in Indonesia is dominated by a virulant type I strain.Keywords cerebrospinal fluid, genotype, ocular fluid, PCR RFLP, Toxoplasma gondii."

"ABSTRAK Latar belakang : Cytomegalovirus (CMV) merupakan salah satu infeksi oportunistikpada pasien dengan sindrom immunodefisiensi (AIDS). Gejala klinis dan CT scantidak dapat menegakkan diagnosa definitif ensefalitis CMV. Oleh karena itudiperlukan uji alternatif untuk menegakkan diagnosis infeksi CMV pada pasien HIVdengan infeksi otak. Salah satu uji yang sensitif dan spesifik adalah Real TimePolymerase Chain Reaction (rPCR).Tujuan : Mendapatkan uji deteksi molekular CMV pada pasien HIV dengantersangka infeksi otak.Metode : Penelitian dilakukan dalam 3 tahap. Tahap 1 adalah optimasi konsentrasiprimer, probe, suhu annealing, volume elusi ekstraksi DNA, dan volume cetakan.Tahap 2 adalah uji spesifisitas (reaksi silang) dan uji sensitivitas (ambang batasdeteksi DNA) rPCR dan tahap 3 adalah penerapan uji rPCR yang sudah dioptimasiterhadap sampel plasma, urin, dan LCS.Hasil : Kondisi optimal uji rPCR telah diperoleh dengan konsentrasi primer danprobe 0,1 μM, dengan kondisi suhu reaksi rPCR: aktivasi enzim pada 950C selama 3menit; 45 siklus pada 950C selama 15 detik (denaturasi) dan 560C selama 1 menit(annealing dan ekstensi). Volume elusi ekstraksi DNA yang optimal untuk ketigajenis sampel (LCS, plasma dan urin) adalah 40 μL, dan volume cetakan rPCR untukLCS, plasma, dan urin, masing-masing adalah 5, 4, dan 3 μL. Uji rPCR mampumendeteksi DNA pada 50.000 jumlah kopi/mL dan tidak bereaksi silang denganStaphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacteriumtuberculosis, Candida spp, Toxoplasma gondii, EBV,HSV,dan VZV. Penerapan ujirPCR pada sampel klinis memberikan hasil negatif pada semua sampel LCS, 72,22%positif pada sampel plasma, dan 72,22% positif pada sampel urin.Kesimpulan: Telah dilakukan optimasi uji rPCR dengan minimal deteksi DNACMV 50.000 jumlah kopi/mL dan tidak bereaksi silang dengan mikroorganisme yangberpotensi menyebabkan positif palsu (false positive).ABSTRACT Background: Cytomegalovirus (CMV) is one of opportunistic infections in patientswith Aquired Immunodeficiency Syndrome (AIDS). Clinical manifestations are nottypical, and CT scans can not define encephalitis CMV specifically. Therefore, it isimportant to apply an alternative assay for sensitive and specific detection of CMVinfection in HIV patients with suspected central nervous system (CNS) infections.One of the assays is real time polymerase chain reaction (rPCR).Objective: To obtain a molecular assay for detection of CMV in HIV patients withsuspect CNS infections.Methods: This study was conducted in three phases. The first is optimization ofconcentrations of primers, probe, annealing temperature, final elution of DNAextraction, and volume of PCR template. The second is determinations of sensitivity(minimal detection of DNA) and specificity (cross-reaction) of the optimized rPCR,and the third is application of the rPCR for clinical samples of plasma, urine, andliquor cerebrospinal (LCS).Results: The rPCR reaction showed optimal concentrations of primers and probe at0.1 μM, with thermal cycler: 950C for 3 min (enzyme activation), followed by 45cycles of 950C for 15 sec (denaturation) and 560C for 1 min (annealing andextension). Final elution of DNA extraction was 40 μL and volume of PCR templatesfor urine, plasma, and LCS was 3, 4, and 5 μL, respectively. The rPCR had minimaldetection of DNA at 50,000 copies/mL and was not cross-reacted withStaphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacteriumtuberculosis, Candida spp, Toxoplasma gondii, Epstein-Bar Virus (EBV), HerpesSimplex Virus (HSV) and Varicella Zoster Virus (VZV). Application of rPCR forclinical samples showed that the rPCR yielded 72.22% positive for plasma or urine,and negative for all LCS samples.Conclusion: The rPCR has been optimized in this study with minimal DNA detectionat 50,000 copies/mL and was not cross-reacted with other microorganisms that arepotential to cause false positive results.;Background: Cytomegalovirus (CMV) is one of opportunistic infections in patientswith Aquired Immunodeficiency Syndrome (AIDS). Clinical manifestations are nottypical, and CT scans can not define encephalitis CMV specifically. Therefore, it isimportant to apply an alternative assay for sensitive and specific detection of CMVinfection in HIV patients with suspected central nervous system (CNS) infections.One of the assays is real time polymerase chain reaction (rPCR).Objective: To obtain a molecular assay for detection of CMV in HIV patients withsuspect CNS infections.Methods: This study was conducted in three phases. The first is optimization ofconcentrations of primers, probe, annealing temperature, final elution of DNAextraction, and volume of PCR template. The second is determinations of sensitivity(minimal detection of DNA) and specificity (cross-reaction) of the optimized rPCR,and the third is application of the rPCR for clinical samples of plasma, urine, andliquor cerebrospinal (LCS).Results: The rPCR reaction showed optimal concentrations of primers and probe at0.1 μM, with thermal cycler: 950C for 3 min (enzyme activation), followed by 45cycles of 950C for 15 sec (denaturation) and 560C for 1 min (annealing andextension). Final elution of DNA extraction was 40 μL and volume of PCR templatesfor urine, plasma, and LCS was 3, 4, and 5 μL, respectively. The rPCR had minimaldetection of DNA at 50,000 copies/mL and was not cross-reacted withStaphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacteriumtuberculosis, Candida spp, Toxoplasma gondii, Epstein-Bar Virus (EBV), HerpesSimplex Virus (HSV) and Varicella Zoster Virus (VZV). Application of rPCR forclinical samples showed that the rPCR yielded 72.22% positive for plasma or urine,and negative for all LCS samples.Conclusion: The rPCR has been optimized in this study with minimal DNA detectionat 50,000 copies/mL and was not cross-reacted with other microorganisms that arepotential to cause false positive results.;Background: Cytomegalovirus (CMV) is one of opportunistic infections in patientswith Aquired Immunodeficiency Syndrome (AIDS). Clinical manifestations are nottypical, and CT scans can not define encephalitis CMV specifically. Therefore, it isimportant to apply an alternative assay for sensitive and specific detection of CMVinfection in HIV patients with suspected central nervous system (CNS) infections.One of the assays is real time polymerase chain reaction (rPCR).Objective: To obtain a molecular assay for detection of CMV in HIV patients withsuspect CNS infections.Methods: This study was conducted in three phases. The first is optimization ofconcentrations of primers, probe, annealing temperature, final elution of DNAextraction, and volume of PCR template. The second is determinations of sensitivity(minimal detection of DNA) and specificity (cross-reaction) of the optimized rPCR,and the third is application of the rPCR for clinical samples of plasma, urine, andliquor cerebrospinal (LCS).Results: The rPCR reaction showed optimal concentrations of primers and probe at0.1 μM, with thermal cycler: 950C for 3 min (enzyme activation), followed by 45cycles of 950C for 15 sec (denaturation) and 560C for 1 min (annealing andextension). Final elution of DNA extraction was 40 μL and volume of PCR templatesfor urine, plasma, and LCS was 3, 4, and 5 μL, respectively. The rPCR had minimaldetection of DNA at 50,000 copies/mL and was not cross-reacted withStaphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacteriumtuberculosis, Candida spp, Toxoplasma gondii, Epstein-Bar Virus (EBV), HerpesSimplex Virus (HSV) and Varicella Zoster Virus (VZV). Application of rPCR forclinical samples showed that the rPCR yielded 72.22% positive for plasma or urine,and negative for all LCS samples.Conclusion: The rPCR has been optimized in this study with minimal DNA detectionat 50,000 copies/mL and was not cross-reacted with other microorganisms that arepotential to cause false positive results.;Background: Cytomegalovirus (CMV) is one of opportunistic infections in patientswith Aquired Immunodeficiency Syndrome (AIDS). Clinical manifestations are nottypical, and CT scans can not define encephalitis CMV specifically. Therefore, it isimportant to apply an alternative assay for sensitive and specific detection of CMVinfection in HIV patients with suspected central nervous system (CNS) infections.One of the assays is real time polymerase chain reaction (rPCR).Objective: To obtain a molecular assay for detection of CMV in HIV patients withsuspect CNS infections.Methods: This study was conducted in three phases. The first is optimization ofconcentrations of primers, probe, annealing temperature, final elution of DNAextraction, and volume of PCR template. The second is determinations of sensitivity(minimal detection of DNA) and specificity (cross-reaction) of the optimized rPCR,and the third is application of the rPCR for clinical samples of plasma, urine, andliquor cerebrospinal (LCS).Results: The rPCR reaction showed optimal concentrations of primers and probe at0.1 μM, with thermal cycler: 950C for 3 min (enzyme activation), followed by 45cycles of 950C for 15 sec (denaturation) and 560C for 1 min (annealing andextension). Final elution of DNA extraction was 40 μL and volume of PCR templatesfor urine, plasma, and LCS was 3, 4, and 5 μL, respectively. The rPCR had minimaldetection of DNA at 50,000 copies/mL and was not cross-reacted withStaphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus,Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Mycobacteriumtuberculosis, Candida spp, Toxoplasma gondii, Epstein-Bar Virus (EBV), HerpesSimplex Virus (HSV) and Varicella Zoster Virus (VZV). Application of rPCR forclinical samples showed that the rPCR yielded 72.22% positive for plasma or urine,and negative for all LCS samples.Conclusion: The rPCR has been optimized in this study with minimal DNA detectionat 50,000 copies/mL and was not cross-reacted with other microorganisms that arepotential to cause false positive results."