Enteropathogens associated with acute diarrhea in community and hospital patients in Jakarta, Indonesia.

The prevalence of bacteria, parasite and viral pathogens in 3875 patients with diarrhea in community and hospital settings from March 1997 through August 1999 in Jakarta, Indonesia was determined using routine bacteriology and molecular assay techniques. Bacterial pathogens isolated from hospital patients were, in decreasing frequency, Vibrio cholerae O1, Shigella flexneri, Salmonella spp. and Campylobacter jejuni, while S. flexneri, V. cholerae O1, Salmonella spp. and C. jejuni were isolated from the community patients. V. cholerae O1 was isolated more frequently (P<0.005) from the hospital patients than the community patients. Overall, bacterial pathogens were isolated from 538 of 3875 (14%) enrolled cases of diarrhea. Enterotoxigenic Escherichia coli were detected in 218 (18%) of 1244 rectal swabs. A small percentage of enterohemorrhagic E. coli (1%) and of Clostridium difficile (1.3%) was detected. Parasitic examination of 389 samples resulted in 43 (11%) positives comprising Ascaris lumbricoides (1.5%), Blastocystis hominis (5.7%), Giardia lamblia (0.8%), Trichuris trichiura (2.1%) and Endolimax nana (0.5%). Rotavirus (37.5%), adenovirus (3.3%) and Norwalk-like virus (17.6%) were also detected. Antimicrobial resistance was observed among some isolates. Bacterial isolates were susceptible to quinolones, with the exception of some isolates of C. jejuni which were resistant to ciprofloxacin, nalidixic acid and norfloxacin. Data obtained from this community- and hospital-based study will enable the Indonesian Ministry of Health to plan relevant studies on diarrheal diseases in the archipelago.

Characterization of Norwalk-like virus associated with gastroenteritis in Indonesia.

Norwalk Virus and Norwalk-like viruses (NLVs) are reportedly responsible for 2.5-4.0% of nonbacterial acute gastroenteritis (NBAG) worldwide. To help clarify the impact of NLVs on NBAG in Indonesia, stool specimens from 102 patients, 74 with NBAG and 28 with BAG, were screened for the presence of NLVs, using a reverse transcription-polymerase chain reaction (RT-PCR) assay. The specimens were subtyped using prototype-specific oligonucleotide probes and were sequenced and compared with published NLV sequences. Of the 102 specimens examined, 31 (30%) were found to be positive for NLVs. Type-specific probe analysis of the RT-PCR products indicated that 31 isolates hybridized to UK1 (Taunton agent) and UK3/4 (Hawaii agent/Snow Mountain agent) prototype strains. The results of this study indicate that prototype strains of NV or NLVs co-circulate in Indonesia and contribute to the overall level of acute gastroenteritis throughout the region.

Incidence of Norwalk-like viruses, rotavirus and adenovirus infection in patients with acute gastroenteritis in Jakarta, Indonesia.

Norwalk-like viruses (NLVs), rotavirus and adenovirus are reportedly responsible from 4 to 42% of non-bacterial acute sporadic gastroenteritis. The incidence of NLVs, adenovirus and rotavirus infections in Indonesia is unclear. A total of 402 symptomatic cases from Indonesian patients with acute gastroenteritis and 102 asymptomatic controls that tested negative for bacteria and parasites were screened for the presence of NLVs, rotavirus and adenovirus using the reverse transcriptase-polymerase chain reaction (RT-PCR), Rotaclone kits and Adenoclone kits. Specific prototype probes were used to ascertain which NLV prototypes were present in the area. NLVs were detected in 45/218 (21%), rotavirus was detected in 170/402 (42%) and adenovirus was detected in 11/273 (4%) samples examined. Genetic analysis of the RT-PCR products using specific prototype probes for NLVs indicated that the prototypes were 42% Taunton agent and 58% Hawaii/Snow Mountain agent. Comparative data on patients showed that the incidence of rotavirus infections was two times greater than the NLVs infections, and that adenovirus infections were the least prevalent. All of the control samples tested were negative for NLVs and adenoviruses, however 8/70 (11%) of the samples were positive for rotaviruses. The high incidence of enteric viral-related infections is a threat among acute diarrheic patients in Jakarta, Indonesia.

Enterotoxigenic Escherichia coli and other causes of infectious pediatric diarrheas in Jakarta, Indonesia.

A hospital stool survey of Indonesian children less than 5 years of age determined the prevalence of diarrhea caused by enterotoxigenic Escherichia coli (ETEC) and other bacterial enteropathogens, compared to non-diarrheic control patients. ETEC were the second most frequent cause of diarrhea, isolated from 16 of 194 (8.2%) of patient's stools compared to 2 of 97 (2.1%) of control stools. The highest prevalence was in infants 12 to 23 months of age (17.9%).

Chloramphenicol resistant strains in salmonellosis in Jakarta.

During an observation period of 20 months (from January 1978 to September 1979) 123 children with clinically suspected salmonellosis were admitted to the Department of Pediatrics, 70 males and 53 females varying in age from 17 days to 14 years. S. typhi or S. enteriditis was isolated from the stool, urine, blood or cerebrospinal fluid in 85% (105/123) of the cases. The results of the microbiologic examination showed that 28 out of the 105 cases (27%) were resistant to chloramphenicol of which the S. sero-group C1 was predominant. It appeared that 28 cases conformed to the clinical data. In all these cases chloramphenicol was replaced by other antibiotics according to the sensitivity test. The mortality rate was 7% (9/123). Four of the fetal cases were from the chloramphenicol resistant group.

Salmonellosis in Indonesia: phage type distribution of Salmonella typhi.

The distribution of phage types was studied among 577 strains of Salmonella typhi from Indonesia. Chemotype, colicinogeny, and tetrathionate reductase activity were also studied for most of these strains. The current phage type formula for Java was determined to be: A, D2, D6, E1a, E2, M1, and 46, but two other large groups of strains were also found, I + IV and degraded Vi+ strains. Significant differences in S. typhi strain distributions were noted between two localities on Java with respect to phage type and tetrathionate reductase activity. Comparisons were made with past phage typing studies in Jakarta as well as with more recent studies in other parts of south-east Asia. Phage types A, D1, D2, and E1 persisted at a rather steady level in Jakarta for 28 years. Evidence was found for epidemiological links to European and Asian areas. Antibiotic resistance among these Indonesian S. typhi strains was rare.

Antimicrobial resistance and enterotoxin production among isolates of Escherichia coli in the Far East.

The frequency of association between transferable extrachromosomal D.N.A. (plasmid) mediated antibiotic resistance and enterotoxin productin is unknown. The antimicrobial susceptibility of 176 enterotoxigenic Escherichia coli from 57 children and adults in the Philippines, Korea, Taiwan, and Indonesia has been examined. 126 isolates (72%) were resistant to one or more antibiotic(s); 77 (44%) were resistant to four or more antibiotics. 43 E. coli which produced both heat-labile and heat-stable toxin, 110 isolates which produced only heat-labile toxin, and 23 which produced only heat-stable toxin were frequently resistant to multiple antibiotics. 25 of 31 resistant isolates tested, 80% transferred antibiotic resistance in bacterial mating experiments. In 35% of the matings transferring antibiotic resistance, the ability to produce enterotoxin was also conferred on the recipients. This in-vitro observation suggests that the widespread use of antibiotics could increase the distribution of enterotoxigenic E. coli, as genes coding for antibiotic resistance and enterotoxin production are frequently transferred together.

Diarrhoeal disorders of bacterial origin in Jakarta.

During a 21-month period from April 1974 to February 1976, 948 children with gastroenteritis were studied. Aetiologic agents were identified in 43% of these patients. Isolates were identified as follows: V. cholera El Tor, 273 (67%); Salmonella enteritidis, 64 (16%); enteropathogenic E. coli, 28 (7%); Shigella, 28 (7%); Vibrio (NAG), 9 (2%): and V. parahaemolyticus, 7,2%). Gastroenteritis with dehydration is a serious continuing pediatric problem in Jakarta, constituting 30% of admissions to Sumber Waras hospital. The incidence of both cholera and salmonellosis increased during the past 2 years, as judged by the distribution of enteric bacteria isolated from the rectal swabs of gastroenteritis patients in Sumber Waras hospital.

Salmonellosis in Indonesia: phage type distribution of Salmonella paratyphi A.

The distribution of phage types among 221 human strains of Salmonella paratyphi A in Indonesia was studied. Approximately 50% were phage type 5, a rare type elsewhere in the world. Most other isolates were the cosmopolitan phage type 1. The ratio of phage type 1-5 was compared for two cities on Java, Jakarta and Yogyakarta. The ratios were significantly different, phage type 5 predominating in Jakarta. The ratio of phage types among 10 S. paratyphi A strains isolated from Jakarta river water was similar to that found in Jakarta patients.