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"Latar belakang: Eradikasi frambusia tahun 2020 belum tercapai. Penilaian klinis mengacu pada pedoman WHO. Beberapa studi terakhir melaporkan perkembangan gambaran klinis frambusia menjadi tidak khas, dengan skar yang dilaporkan sebagai temuan terbanyak. Lesi yang tidak dikenali menyebabkan konfirmasi serologi akan terlewat. Saat ini skar sudah dicantumkan kembali ke dalam pedoman WHO terkini, namun belum termasuk dalam katerogi lesi kasus suspek berdasarkan Peraturan Menteri Kesehatan (Permenkes) nomor 8 tahun 2017. Diagnosis frambusia diawali dengan penilaian kasus suspek atau probable, dikonfirmasi dengan pemeriksaan rapid diagnostic test dan pemeriksaan rapid plasma reagin jika meragukan. Alat uji baru RDT DPP telah dianjurkan WHO untuk daerah endemis tanpa fasilitas laboratorium lengkap serta dikombinasikan penggunaannya dengan RDT Biosensor. Tujuan: Menilai kesesuaian gambaran klinis frambusia berdasarkan pedoman WHO terhadap RDT STANDARD Q Syphilis AB Biosensor dan RDT CHEMBIO Dual Path Platform (DPP) Syphilis Screen and Confirm dalam mendiagnosis frambusia pada anak usia 2─15 tahun di Kabupaten Alor, Nusa Tenggara Timur. Metode: Setiap satu sampel penelitian dinilai gambaran klinis dugaan frambusia berdasarkan pedoman WHO, diperiksakan RDT Biosensor, serta RDT DPP. Hasil pemeriksaan akan dinilai kesesuaiannya. Hasil: Terdapat 197 subjek penelitian yang diikutsertakan dalam penelitian ini. Lesi kulit terbanyak yaitu skar frambusia (79,7%). Proporsi kesesuaian keseluruhan gambaran klinis terhadap RDT Biosensor yaitu 28,9% (p=1,000) dan terhadap RDT DPP yaitu 26,9% (p=0,202). Kesesuaian antara gambaran klinis suspek frambusia terhadap hasil RDT Biosensor positif sebesar 77,3% dan terhadap hasil RDT DPP positif sebesar 100%. Selain itu terdapat kesesuaian sebesar 22,8% antara gambaran klinis bukan frambusia dengan RDT Biosensor negatif dan 23,8% dengan RDT DPP negatif. Kesimpulan: Kesesuaian antara gambaran klinis dugaan frambusia berdasarkan pedoman WHO terhadap RDT bernilai rendah, sehingga gambaran klinis kurang dapat dijadikan acuan awal dalam menegakkan diagnosis frambusia di daerah endemis.

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Background: Yaws eradication in 2020 has not been achieved. Clinical assessment refers to WHO guidelines. Several recent studies reported the development of the atypical yaws clinical features, scar was reported as the most common finding. Unrecognized lesions cause serological confirmation to be missed. Currently, scar is not included in the suspected cases category based on the Regulation of the Minister of Health (Permenkes) number 8 of 2017. Yaws diagnoses begins with the assessment of suspected or probable cases, confirmed by a rapid diagnostic test and rapid plasma reagin examination if in doubt. The new RDT DPP test kit has been recommended by WHO for endemic areas without complete laboratory facilities and its combined use with the RDT Biosensor. Objective : Assessing the suitability of the clinical features of yaws based on WHO guidelines with the STANDARD Q Syphilis AB Biosensor and CHEMBIO Dual Path Platform (DPP) Syphilis Screen and Confirm in diagnosing yaws in children aged 2-15 years in Alor District, East Nusa Tenggara. Methods: Each study sample was assessed for suspected yaws clinical features based on WHO guidelines, examined for RDT Biosensor, and RDT DPP. Results : There were 197 research subjects who were included in this study. Scar was the clinical feature that mostly found (79,7%). Overall percent agreement between clinical features with the RDT Biosensor was 28.9% (p=1,000) and against the RDT DPP was 26.9% (p=0,202). The concordance between yaws clinical features between the positive RDT Biosensor result was 77.3% and the positive RDT DPP result was 100%. In addition, there is a 22.8% concordance between the clinical features of non yaws with a negative Biosensor RDT and 23.8% with a negative RDT DPP.Conclusion : The concordance between yaws clinical features based on WHO guidelines for RDT is low, so that the clinical features should not be used as an initial reference in establishing a diagnosis of yaws in endemic areas."

"ABSTRAKLatar belakang: Frambusia atau yaws merupakan penyakit akibat infeksi Treponema pallidum subspecies pertenue yang menahun dan terutama mengenai kulit serta tulang. Penegakkan diagnosis berdasarkan klinis dan serologis. Program temuan kasus frambusia didasarkan atas temuan klinis menurut World Health Organization WHO , kemungkinan terdapat frambusia tanpa lesi klinis yang tidak terdiagnosis masih belum dapat disingkirkan. Belum ada penelitian proporsi di suatu desa yang dinyatakan endemis. Tujuan: Mengetahui proporsi kasus frambusia berdasarkan kriteria klinis WHO dan pemeriksaan serologis di desa Sei Berombang pada anak usia 1-12 tahun periode 22-27 Agustus 2016. Metode: Studi potong lintang ini dilakukan pada tanggal 22-27 Agustus 2016 di desa Sei Berombang, Sumatera Utara. Pemilihan sampel dilakukan secara consecutive sampling. Subjek kemudian dilakukan anamnesis, pemeriksaan fisis, dan pemeriksaan rapid diagnostic test RDT . Hasil : Didapatkan total 129 subjek dengan median usia 9 tahun termuda 1 tahun dan tertua 12 tahun . Sebanyak 14 anak dengan lesi klinis suspek frambusia, sedangkan 4 anak dengan RDT yang positif. Hanya 3 anak dari RDT yang positif memiliki temuan klinis. Lesi klinis suspek frambusia yang paling banyak ditemukan adalah makula hipopigmentasi dan skar atrofik, sedangkan lokasi tersering adalah tungkai bawah. Simpulan: Ditemukan proporsi suspek frambusia berdasarkan klinis adalah 10,85 , sedangkan proporsi frambusia konfirmasi berdasarkan klinis dan serologis adalah 2,33 . Dua subjek didiagnosis frambusia laten, sedangkan satu subjek didiagnosis sebagai frambusia primer. Kata kunci: frambusia, proporsi, anak

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ABSTRACTBackground Yaws is a chronic infectious disease caused by Treponema pallidum subspecies pertenue, mainly affecting skin and bone. Diagnosis of yaws is based on clinical manifestation and serologic test. According to WHO, yaws detection program is focused on clinical manifestation. Thus, it is possible that latent yaws without any clinical manifestation is still under diagnosed. Until recently, there is no proportion study performed in remote endemic village.Objective To determine the proportion of yaws based on WHO clinical criteria and serologic test in children age 1 12 years old in Sei Berombang village.Methods This cross sectional study was conducted on 22nd 27th August 2016 in Sei Berombang village, North Sumatra. We recruited the subjects consecutively and performed anamnesis, clinical examination, and rapid diagnostic test RDT .Results A total of 129 subjects were examined with median age of 9 years old 1 12 years old . Yaws was suspected in 14 subjects, but only 4 subjects were reactive to RDT. Three subjects had clinical manifestation and RDT reactive. Hypopigmentation patch and atrophic scar were the most common clinical findings in this study. Most lesions were found in lower extremities. Conclusion Proportion of suspected yaws based on clinical manifestation is 10,85 in this study. Proportion of confirmed yaws based on clinical manifestation and serology is 2,33 . Two subjects diagnosed with latent yaws and one subject was diagnosed with primary yaws. "

"Kasus frambusia yang tercatat di Puskesmas Bondo Kodi Kabupaten Sumba Barat Daya, Nusa Tenggara Timur (NTT) terus meningkat dari 174 kasus tahun 2009 menjadi 327 kasus pada tahun 2010 dan 369 kasus pada tahun 2011. Pada tahun 2012, frambusia tertinggi terjadi di Desa Mali Iha di Kecamatan Bondo Kodi dengan 43 kasus. Penelitian ini bertujuan untuk mengetahui faktor-faktor lingkungan, perilaku, dan pengetahuan masyarakat yang berhubungan dengan kejadian penyakit frambusia pada anak-anak.Penelitian observasional ini menggunakan rancangan studi kasus-kontrol, dengan kondisi sarana air bersih (SAB), perilaku hidup bersih dan sehat (PHBS), dan pengetahuan masyarakat tentang frambusia sebagai variabel bebas. Sampel penelitian adalah 30 orang anak yang menderita frambusia (kasus) dan 30 orang anak sehat (kontrol) yang diambil dengan metode purposive sampling. Data dan informasi mengenai SAB, praktik PHBS, dan pengetahuan masyarakat tentang frambusia didapatkan dengan observasi dan wawancara, kemudian dianalisis dengan uji kai kuadrat.Ditemukan, secara statistik kejadian frambusia berhubungan bermakna dengan kondisi SAB (OR = 15,16 dan nilai p = 0,035) dan PHBS (OR = 7 dan nilai p = 0,048), tetapi tidak berhubungan dengan pengetahuan masyarakat tentang frambusia (nilai p = 0,283). Penelitian ini menyimpulkan bahwa kondisi SAB dan PHBS merupakan faktor risiko frambusia.

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Frambusia cases recorded at Bondo Kodi Primary Health Care in Sumba Barat Daya District, East Nusa Tenggara (NTT) were continously increasing from 174 in 2009 to 327 in 2010 and 369 in 2011. In 2012, the highest frambusia occurred in Mali Iha Village with 43 cases. The present research was to define environmental, behavioural, and knowledge factors associated with the frambusia in children.

This observational study employed case-control design with condition of clean water source, practices of personal hygiene and health behavior, and community knowledge about frambusia as independent variables. Samples were 30 children with frambusia (cases) and 30 healthy children (control) who were selected using purposive sampling. Data and information on environmental condition, behavioral practices, and community knowledge were collected by interview and direct observation and were analyzed using chi-square test.

It was found that statistically the frambusia cases were associated significantly with the condition of clean water source (OR = 15.16, p value = 0.035) and personal hygiene and healthy behavior (OR = 7, p value = 0.048), but were not associated with community knowledge (p value = 0.283). It concludes that condition of clean water sources and personal hygiene and healthy behavior are risk factors of frambusia in children."

"Indonesia saat ini merupakan penyumbang terbesar kasus frambusia di Asia Tenggara. Untuk mendukung eliminasi frambusia di Indonesia dibutuhkan uji diagnosik yang dapat mendiagnosis frambusia secara cepat, mudah, akurat sehingga uji tersebut dapat dipakai sebagai bagian dari survei komunitas. Uji diagnostik yang ada saat ini membutuhkan pemeriksaan serologi rapid plasma reagin (RPR)/veneral disease research laboratory (VDRL) sehingga akan menimbulkan kesulitan karena mayoritas kasus frambusia ditemukan di daerah terpencil yang tidak memiliki fasilitas laboratorium lengkap. Penelitian ini bertujuan untuk menentukan nilai diagnostik dari rapid diagnostic test (RDT) Chembio Dual Path Platform® (DPP) Syphilis Screen and Confirm dalam mendiagnosis frambusia pada anak usia 2 - 15 tahun di Kabupaten Alor, Nusa Tenggara Timur. Pemeriksaan RDT DPPÒ, RPR, dan treponema pallidum haemagglutination assay (TPHA) dilakukan pada setiap subjek penelitian. Sebanyak 197 subjek berpartisipasi dalam penelitian ini. Nilai sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif garis non-treponemal RDT DPPÒ adalah tidak dapat dinilai, 73.6% (IK 95% 66.87- 79.61), 0%, dan 100%. Nilai sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif garis treponemal RDT DPPÒ adalah 0%, 94.7% (IK 95% 90.63-97.47), 0%, dan 97.3% (IK 95% 97.24-97.41). Proporsi kasus frambusia, baik kasus konfirmasi maupun laten, berdasarkan pemeriksaan RPR dan TPHA adalah 0%. Berdasarkan hasil penelitian ini, kemampuan RDT DPPÒ untuk diagnosis kasus frambusia tidak dapat disimpulkan karena tidak ditemukan kasus aktif frambusia.

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Indonesia is currently the largest contributor to yaws cases in Southeast Asia. To support yaws elimination in Indonesia, a diagnostic test that can diagnose yaws quick, easy, and accurate is needed so that the test can be used as part of a community survey. Current diagnostic tests require serologic rapid plasma reagin (RPR)/veneral disease research laboratory (VDRL) test, which will cause difficulties because the majority of yaws cases are found in remote areas that do not have complete laboratory facilities. This research aims to determine the diagnostic value of the rapid diagnostic test (RDT) Chembio Dual Path Platform® (DPP) Syphilis Screen and Confirm for diagnosing yaws in children aged 2 - 15 years in Alor, East Nusa Tenggara. RDT DPPÒ, RPR, and treponema pallidum haemagglutination assay (TPHA) test were performed on each subject. Total of 197 subjects participated in this study. The sensitivity, specificity, positive predictive value, and negative predictive value of the non-treponemal RDT DPPÒ line were unassessable, 73,6% (95% CI 66,87-79,61), 0%, and 100%. The sensitivity, specificity, positive predictive value, and negative predictive value of the treponemal RDT DPPÒ line were 0%, 94,7% (95% CI 90,63-97,47), 0%, and 97,3% (95% CI 97,24-97,41). The proportion of confirmed cases of yaws based on RPR and TPHA test was 0%. Based on the results of this study, the ability of RDT DPPÒ for the diagnosis of yaws cases cannot be concluded because there was no active yaws cases were found."