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Abstrak :
Pendahuluan: Blastosistosis merupakan penyakit infeksi yang disebabkan oleh Blastocystis hominis. Prevalensi di negara berkembang seperti Indonesia mencapai 60%. Kelompok usia yang paling rentan mengalami infeksi B. hominis adalah anak-anak. Parasit ini banyak ditemukan pada hewan, sehingga adanya kontak dengan hewan dapat meningkatkan risiko infeksi. Metode: Penelitian ini menggunakan data sekunder Departemen Parasitologi FKUI. Penelitian dilakukan pada 284 anak berusia 5-10 tahun. Hasil: Hasil pemeriksaan feses menunjukkan bahwa terdapat 87 dari 284 sampel yang terinfeksi B. hominis (30,6%). Sebanyak 41/128 (32%) anak laki-laki positif terinfeksi dan pada anak perempuan sebanyak 46/156 (29,5%) anak. Anak yang terinfeksi pada kelompok usia 5-6 tahun sebanyak 21/80 (26,25%) anak dan pada kelompok usia 7-10 tahun sebanyak 66/204 (32,35%) anak. Hasil penelitian ini tidak menunjukkan adanya hubungan yang signifikan secara statistik antara prevalensi B. hominis dengan keberadaan hewan liar (p = 0,404; OR = 0,723; IK 95% = 0,34 - 1,55) dan hewan peliharaan (p = 0,377; OR = 0,746; IK 95% = 0,39 - 1,43). Diskusi: Tidak terdapat hubungan antara kejadian blastosistosis dengan keberadaan hewan liar dan hewan peliharaan. ......Introduction: Blastocystosis is an infectious disease caused by Blastocystis hominis. The prevalence in developing countries such as Indonesia reaches 60%. The age group that most susceptible to B.hominis infection is children. This parasite is many found in animals, so by contact with animals, it can increase the risk of infection. Method: This study used secondary data from the Departement of Parasitology FKUI. The study was conducted on 284 children aged 5-10 years. Results: The results of faecal examination showed that there were 87 of 284 samples infected by B.hominis (30.6%). As many as 41/128 (32%) boys were positively infected and 46/156 (29.5%) girls were positively infected. Infected children in the 5-6 year age group were 21/80 (26.25%) and in the 7-10 year age group were 66/204 (32.35%). The results of this study statistically did not show a significant relationship between the prevalence of B.hominis with the presence of wild animals (p = 0,404; OR = 0,723; IK 95% = 0,34 - 1,55) and pet (p = 0,377; OR = 0,746; IK 95% = 0,39 - 1,43). Discussion: There is no relationship between blastocystosis with the presence of wild animals and pet.

Abstrak :

Irritable Bowel Syndrome (IBS) merupakan penyakit terbanyak pada anak dan remaja pada gangguan saluran cerna fungsional dengan subtipe diare, konstipasi, campuran dan unclassified. Mekanisme patofisiologi belum jelas dan memerlukan pembuktian adanya keterlibatan organik. Tujuan penelitian ini adalah untuk mengetahui epidemiologi IBS, peran infestasi Blastocystis hominis dan integritas mukosa usus dalam etiopatogenesis IBS, dampak IBS terhadap kualitas hidup, serta membuat sistem model prediksi IBS pada remaja.

Penelitian ini berbasis komunitas dengan pendekatan potong lintang komparatif dua kelompok pada remaja dari enam SMA di Palembang. Kriteria Roma III digunakan untuk menegakkan diagnosis IBS beserta kuesioner untuk menentukan faktor risiko. Secara multistage random sampling dibandingkan 70 subjek IBS dan 70 subjek nonIBS. Dilakukan pencatatan riwayat medis, pemeriksaan fisis, pemeriksaan parasit dan biomarker tinja serta kuesioner IBSQOL. Pemeriksaan tinja segar dengan mikroskop untuk mengetahui infestasi Blastocystis hominis. Pemeriksaan kadar alfa-1 antitripsin dan kalprotektin tinja dengan ELISA untuk melihat adanya gangguan integritas mukosa usus. Dampak IBS terhadap kualitas hidup dinilai dengan kuesioner IBSQOL.

Terdapat  454 subjek dengan prevalens IBS 30,2%, terdiri dari subtipe terbanyak yaitu subtipe diare 36,5%, dan yang paling sedikit subtipe konstipasi 18,9%. Uji regresi logistik mendapatkan faktor risiko utama IBS adalah dibully, perempuan, usia 14–16 tahun, riwayat konstipasi, makan tiga jenis kacang, minuman kemasan, dan riwayat diare (kisaran OR 2,86–1,81). Blastocystis hominis ditemukan pada masing-masing grup sebesar 51,4 vs. 28,6%, dengan perbedaan bermakna (p = 0,006). Tidak ada hubungan bermakna untuk kerusakan mukosa (p = 0,734), tetapi bermakna dengan inflamasi usus (p = 0,039). Terbukti IBS secara bermakna menyebabkan rendahnya kualitas hidup (p = 0,001). Didapatkan 2 model prediksi skoring, yaitu model 1 yang dapat diaplikasikan pada layanan kesehatan primer yang bertujuan sebagai uji tapis dengan menilai faktor risiko. Model 2 diperuntukkan sebagai layanan terapi terkait infestasi Blastocystis pada layanan kesehatan tersier.

Simpulan, prevalens IBS pada remaja di Palembang tinggi dan memiliki faktor risiko utama dibully, perempuan, usia 14–16 tahun, riwayat konstipasi, makan 3 jenis kacang, minuman kemasan, riwayat diare. Terdapat hubungan yang bermakna antara Blastocystis hominis dan inflamasi usus dengan kejadian IBS pada remaja, serta dampaknya terhadap kualitas hidup membutuhkan penanganan yang komprehensif.

Kata kunci: Blastocystis hominis, integritas mukosa usus, irritable bowel syndrome, kualitas hidup, remaja

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Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder and commonly present in children and adolescences, presented as diarrhoea, constipation, mixed or unclassified type. The pathophysiological mechanisms of  IBS are unclear, and still challenging to determine organic disorders. The aim of this study was to investigate the epidemiology of IBS, the role of Blastocystis hominis infestation and intestinal mucosal integrity in the etiopathogenesis of IBS, the impact of quality of lifes, and apply a scoring system to predict the occurrence of IBS among adolescences.

A community-based survey with comparative cross sectional approach was done from six high schools in Palembang. Subjects were recruited using the multistage random sampling divided into two groups (70 subjects IBS and 70 subjects nonIBS). The Rome III criteria were used to establish a diagnosis of IBS along with a questionnaire to determine risk factors,  analyzed for association with Blastocystis hominis infestation, intestinal mucosal integrity, and its impact on quality of life. Direct microscopic stool examination to identify single Blastocystis infection was performed, followed by culture in Jones’ medium, PCR and Sequencing of 18S rRNA to determine Blastocystis subtype. Examination of antitrypsin alpha-1 and fecal calprotectin levels by ELISA was done  to determine impaired intestinal mucosal integrity. Impact of IBS on quality of life was done with the IBSQOL questionnaire.

Of the 454 subjects, the prevalence of IBS was 30.2%, consisting of diarrhea subtypes 36.5%, 21.9% mixed, 22.6% Unclassified and 18.9% constipation. The major risk factors for IBS were bullying, girls, ages 14–16 years, history of constipation, eat three kinds of nuts, drink beverages, and history of diarrhea (range OR 2.86–1.81). Blastocystis hominis was detected in each group of 51.4 vs. 28.6% (p = 0.006). There was no significant association for intestinal mucosal permeability (p = 0.734), but it was significant with intestinal inflammation (p = 0.039). Significant impairment of quality of life among IBS adolescences was found (p = 0.001). The IBS prediction score model had 2 models. Model 1 is more applicable in primary health care for sreening IBS based on risk factors. Model 2 only usable for tertiary health care, as management of Blastocystis infestation.

Conclusion, the prevalence IBS among adolescence was high with major risk factors to IBS consisted of bullying, female gender, age between 14–16 years, previous illness of constipation, diet three nuts, drink beverages, previous illness diarrhoea. Significant association with Blastocystis hominis infestation, intestinal inflammation were found, comphrehensive management is needed as for its impact on quality of life.

Keywords. Blastocystis hominis, intestinal integrity, irritable bowel syndrome,   quality of life, Adolescences

 

Abstrak :
Pendahuluan: Imunoregulasi yang terjadi pada kehamilan menyebabkan ibu hamil lebih rentan terhadap infeksi, termasuk infeksi parasit. Salah satu parasit intestinal yang paling sering ditemukan di negara berkembang adalah Blastocystis-terutama banyak dijumpai pada populasi imunosupresi. Belum diketahui apakah infeksi Blastocystis dapat memengaruhi respon imun seluler terhadap infeksi patogen lain. Penelitian ini bertujuan untuk mengetahui hubungan infeksi Blastocystis pada kehamilan dengan respon imun seluler terhadap infeksi tuberkulosis, yang dimodelkan dengan stimulasi purified protein derivative (PPD). Metode: Penelitian ini menggunakan desain studi potong lintang dengan data yang bersumber dari penelitian utama yang telah dilakukan di daerah endemik Blastocystis. Sebanyak 98 ibu hamil trimester ketiga menjadi sampel dalam penelitian ini. Status infeksi Blastocystis ditetapkan berdasarkan pemeriksaan mikroskopis sampel feses. Respon imun seluler yang dinilai adalah kadar sitokin proinflamasi IFN-γ dan sitokin antiinflamasi IL-10 yang diambil dari kultur darah subjek dan diukur dengan Luminex assay. Hasil: Kadar IFN-γ dan IL-10 setelah stimulasi PPD lebih tinggi pada kelompok ibu hamil sehat dibandingkan ibu hamil terinfeksi Blastocystis, tetapi perbedaan kadar ini tidak signifikan untuk IFN-γ (p=0,356) dan signifikan untuk IL-10 (p=0,001). Perbandingan kadar sitokin setelah stimulasi PPD dengan basal yang dihitung dalam bentuk rasio menunjukkan hasil yang lebih tinggi pada kelompok ibu hamil sehat baik untuk IFN-γ dan IL-10, tetapi keduanya tidak bermakna secara statistik (p=0,428 untuk rasio IFN-γ dan p=0,564 untuk rasio IL-10). Rasio keseimbangan sitokin proinflamasi-antiinflamasi (rasio IFN-γ/rasio IL-10) pascastimulasi PPD lebih tinggi pada kelompok terinfeksi Blastocystis, meskipun tidak signifikan secara statistik (p=0,741). Kesimpulan: Infeksi Blastocystis pada ibu hamil tidak menunjukkan perbedaan respons imun terhadap stimulasi PPD dibandingkan dengan ibu hamil sehat.

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Introduction: Predominant immunoregulatory state in pregnancy is associated with higher risk of infection, including parasitic infection. One of the most common intestinal parasites found in developing country is Blastocystis-which mainly found in immunocompromised population. It is not yet known whether Blastocystis infection could influence cellular immune response to other pathogens. Therefore, this research aims to discover the association between Blastocystis infection in pregnancy with cellular immune response to tuberculosis infection, which is modelled by purified protein derivative (PPD) stimulation. Method: This is a cross-sectional study which uses data from primary research that has been done in a Blastocystis-endemic area. Study samples consist of 98 pregnant women in their third trimester. Blastocystis infection was determined from microscopic examination of stool specimen. The cellular immune response is assessed by measuring serum level of IFN-γ and IL-10 as pro- and anti-inflammatory cytokine, respectively. The serum is obtained from a whole blood culture, and its cytokine level will further be measured with Luminex assay. Result: IFN-γ and IL-10 level with PPD-stimulation is higher in healthy pregnant women compared to Blastocystis-infected subjects, but this difference is not statistically significant for IFN-γ (p=0.356) and significant for IL-10 (p=0.001). The PPD-stimulated/basal ratio of both IFN-γ and IL-10 is also higher in healthy pregnant women, but it is not statistically significant (p=0.428 for IFN-γ ratio and p=0.564 for IL-10 ratio). Although not statistically significant, the pro- and anti-inflammatory cytokine balance (IFN-γ ratio/IL-10 ratio) after PPD stimulation is higher in pregnant women infected with Blastocystis (p=0.741). Conclusion: There is no difference in the cellular immune response to PPD stimulation in pregnant women infected with Blastocystis compared to healthy pregnant women.

Abstrak :
Latar Belakang: Blastocystis hominis merupakan salah satu protozoa yang paling sering ditemukan di saluran intestinal manusia dengan distribusi di seluruh dunia, dengan prevalensi yang lebih besar di negara berkembang. Di Indonesia prevalensinya mencapai 60%. Prevalensi pada anak usia di bawah 6 tahun cukup tinggi, yaitu 25%. Terdapat literatur yang melaporkankan efek infeksi B. hominis terhadap rendahnya status nutrisi pada anak. Tujuan: Untuk mengetahui prevalensi infeksi B. hominis pada balita di kecamatan Jatinegara, serta hubungannya dengan status gizi pada balita. Metode: Studi cross-sectional dengan menggunakan data sekunder hasil pemeriksaan tinja parasit usus dan pengukuran tinggi badan dan berat badan pada balita di Kecamatan Jatinegara pada tahun 2006. Dari hasil consecutive sampling didapatkan 386 sampel, kemudian dirandom menjadi 2 kelompok, yaitu kelompok yang hanya terinfeksi B. hominis (n = 227) dan kelompok tanpa infeksi parasit usus (n = 159). Kemudian dibandingkan keadaan status nutrisi antara kedua kelompok ini. Penilaian status nutrisi dalam penelitian ini menggunakan indeks antropometri, yaitu berat berdasarkan usia (WAZ), yang menunjukkan tingkat underweight, tinggi berdasarkan usia (HAZ), yang menunjukkan tingkat stunting, dan berat berdasarkan tinggi (WHZ), yang menunjukkan tingkat wasting. Masingmasing indeks antropometri ini diperlihatkan dalam standar deviasi unit (z-score) dari median populasi referensi World Health Organization-National Center for Health Statistics (WHO-NCHS). Z-score dengan nilai -2 SD digunakan sebagai cut-off point malnutrisi. Hasil: Prevalensi B. hominis sebesar 58, 7%. Analisis statistik menunjukkan tidak terdapat perbedaan yang bermakna secara statistik (p > 0, 05) pada indeks antropometri untuk status nutrisi (WAZ, HAZ, WHZ) antara kedua kelompok. Kesimpulan: Pada studi ini memperlihatkan bahwa prevalensi B. hominis tinggi, serta tidak terdapat hubungan antara infeksi B. hominis dengan status nutrisi anak balita pada daerah ini. ......Background: Blastocystis hominis is one of the most common protozoa found in human intestinal tract with distribution throughout the world, with a greater prevalence in developing countries. In Indonesia, prevalence reaches 60%. Prevalence in children aged under 6 years old is quite high at 25%. There is literature that shows effect Blastocystis hominis infection on nutritional status in a child. Objectives: To investigate the prevalence of Blastocystis Hominis Infection among Preschool Children in Jatinegara and the relationship between Blastocystis hominis infection and nutritional status among children under 5 years old. Methods: Cross-sectional study using secondary data review for stool analysis of intestinal parasites and measurement of height and weight, which was carried out among children in Jatinegara district in 2006. Consecutive sampling of the results obtained 386 samples, then randomized into 2 groups: groups that were infected with only B. hominis (n = 227) and groups without intestinal parasitic infection (n = 159). Then compared the nutritional status between the two groups. Assessment of nutritional status in this research using anthropometry indexes, weight for age (WAZ), which indicates the level of underweight, height for age (HAZ), which indicates the level of stunting, and weight for height (WHZ), which indicates the level of wasting. Each of the three nutritional status indexes are expressed in standard deviation units (z-scores) from the median of this reference population World Health Organization-National Center for Health Statistics (WHO-NCHS). Z score of -2 SD was used as cut off point of malnutrition. Results: Prevalence of Blastocystis Hominis infection was 58, 7%. Statisical analysis revealed that the antropometric indexs for nutritional status (WAZ, HAZ, and WHZ) did not differ significantly (p > 0, 05) between the infected group and the control group. Conclusions: Prevalence of Blastocystis Hominis among Preschool Children in Jatinegara Distric is high. In this study showed that there is no relationship between infections of B. hominis with the nutritional status of children under five years old in this area.

Abstrak :
Stunting merupakan manifestasi kondisi gizi buruk atau malnutrisi yang parah dan berisiko tertularnya penyakit infeksi protozoa. Infeksi Blastocystis hominis dan Giardia duodenalis pada kondisi immunokompromis dapat menimbulkan morbiditas lebih tinggi, termasuk pada keadaan stunting. Penelitian ini bertujuan untuk mengetahui karakteristik infeksi B.hominis dan G.duodenalis usus pada populasi anak stunting di Kabupaten Bandung. Penelitian ini merupakan penelitian cross-sectional yang dilakukan pada bulan Januari-Maret 2020 Sampel penelitian berupa sampel feses dengan preservasi formalin dan RNA later. Data mengenai faktor risiko dan demografis didapatkan melalui wawancara. Total sampel dalam penelitian ini sebanyak 230 sampel. Metode pemeriksaan dilakukan menggunakan metode mikroskopik untuk sampel dengan preservasi formalin, dan metode molekuler (PCR) untuk sampel dengan preservasi RNA later. Analisis data dilakukan uji bivariat dan multivariat. Terdapat 13 sampel positif G. duodenalis dan 128 sampel positif B. hominis dari jumlah total 230 sampel. Variabel jenis kelamin, pendidikan ayah tamat SD dan SMP, pendidikan ibu tidak sekolah, penghasilan di bawah UMR, sumber air menggunakan sumur pompa tangan, jarak sumber air dengan septic tank dan ketidaktersediaan septic tank memiliki nilai risk ratio >1 terhadap infeksi G. duodenalis dan B. hominis. Variabel umur (p-value 0,033), gejala lemas (p-value 0,018), dan keberadaan septic tank (p-value 0,013) memiliki korelasi signifikan terhadap kejadian infeksi G.duodenalis berdasarkan uji m ultivariat. Variabel jenis kelamin memiliki (p-value 0,037) korelasi signifikan terhadap kejadian infeksi B. hominis berdasarkan uji multivariat. Usia, jenis kelamin, dan keberadaan septic tank di rumah merupakan faktor yang berpengaruh terhadap infeksi B. hominis dan G. duodenalis. Diperlukan penelitian lanjutan menggunakan kontrol balita non-stunting untuk melihat perbandingan dan korelasi lebih dalam antara stunting dan kejadian infeksi. ......Stunting is a manifestation of poor nutritional conditions or severe malnutrition and risk infection of protozoa. Blastocystis hominis and Giardia duodenalis infections in immunocompromised conditions can cause higher morbidity, including stunting. This study aims to determine the characteristics of intestinal protozoan parasite infections in the stunting child population in Bandung Regency. This study is a cross-sectional study in Bandung Regency which was carried out in January-March 2020 and the sample was examined at the Parasitology Laboratory of RSP Unpad. The research samples were feces samples with preservation of formalin and RNA later. Data regarding risk factors and demographic data were obtained through interviews. The total sample in this study was 230 samples. The examination method was carried out using a microscopic method for samples with formalin preservation, and molecular methods (PCR) for samples with later RNA preservation. Data analysis was carried out by bivariate and multivariate tests. There were 13 positive samples for G. duodenalis and 128 positive samples for B. hominis out of a total of 230 samples. The variables of gender, father's education graduated from elementary and junior high school, mother's education is not in school, income below the minimum wage, water source using hand pump wells, distance from water source to septic tank and unavailability of septic tank has a risk ratio value >1 for G.duodenalis and B. hominis infections. Variable age (p-value 0.033), symptoms of weakness (p-value 0.018), and the presence of a septic tank (p-value 0.013) had a significant correlation to the incidence of G. duodenalis infection based on multivariate tests. The gender variable (p-value 0.037) was significantly correlated with the incidence of B. hominis infection based on a multivariate test. Age, gender, and the presence of a septic tank at home are factors that influence B. hominis and G. duodenalis infections. Further research is needed using control of non-stunting toddlers to see deeper comparisons and correlations between stunting and the incidence of infection.

Abstrak :
The present book evaluates in chapters contributed by renowned researchers the latest findings on, landmarks in the discovery of blastocystis, epidemiology, transmission and zoonotic potential, morphology of human and animal blastocystis isolates, clinical aspects of blastocystis infections, behavioral decision analysis : what makes us sick?, blastocystis-host interactions, molecular approaches on the systematical position, genetic polymorphism, blastocystis from a statistical point of view, diarrheas due to different agents of disease, zoonotic diseases in comparison.