Nasopharyngeal carriage rate, serotype distribution, and antimicrobial profiles of Streptococcus pneumoniae among patients with acute respiratory tract infection in Manado, North Sulawesi, Indonesia.

We studied the carriage rate, distribution of serotype, and antimicrobial profile of Streptococcus pneumoniae (S. pneumoniae) among patients with acute respiratory tract infections (ARTI) in two primary health centres and a tertiary referral hospital from 2019 to 2020 in Manado, North Sulawesi, Indonesia before 13-valent pneumococcal conjugate vaccine (PCV13) introduction. A total of 106 nasopharyngeal swab samples were collected from children and adult patients. Serotyping of S. pneumoniae strain was performed by sequential multiplex PCR and Quellung reaction. Antimicrobial profile was performed by the disc diffusion method. We identified thirty-one patients carried S. pneumoniae strains (29 %). The S. pneumoniae carriage rate was found to be higher among children aged 2-5 years (13/32; 40.6 %) than in children under 1 year (8/27; 29.6 %), children and adolescents under 18 years of age (5/20; 25.0 %) and adult patients (5/27; 18.5 %). The distribution of serotypes varied, including 14, 18C, 19A, 23F, 19F and 35B (two strains each) and 1, 3, 6B, 6C, 31, 9V, 15C, 16F, 17F, 23A, 35F (one strain each) and non-typeable (9/31; 29 %). We found S. pneumoniae isolates were susceptible to vancomycin (30/31; 97 %), chloramphenicol (29/31; 94 %), clindamycin (29/31; 94 %), erythromycin (22/31; 71 %), azithromycin (22/31; 71 %), tetracycline (14/31; 45 %), penicillin (11/31; 35 %), and sulfamethoxazole/trimethoprim (10/31; 32 %). This study provides supporting baseline data on distribution of serotype and antimicrobial profile of S. pneumoniae among patients with ARTI before PCV13 introduction in Manado, North Sulawesi, Indonesia.

Multicentre survey of retinopathy of prematurity in Indonesia.

Background: The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants. Objective: To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia. Setting: Data were collected from 34 hospitals with different levels of care: national referral centres, university-based hospitals, and public and private hospitals. Methods: A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight. Results: We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals. Conclusions: In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia.

Association between High-Sensitivity C-Reactive Protein and Blood Pressure among Children with History of Low Birth Weight Appropriate for Gestational Age, Low Birth Weight Small for Gestational Age, and Normal Birth Weight in Manado, North Sulawesi.

Over the past years, low birth weight (LBW) has been proven to be attributed to a wide variety of long-term morbidities, including hypertension. This study aimed to investigate the association between high-sensitivity C-reactive protein (hs-CRP) and blood pressure (BP) in children with a history of LBW appropriate for gestational age (LBW AGA), LBW small for gestational age (LBW SGA), and normal birth weight appropriate for gestational age (NBW AGA). The study cohort comprised children aged 9-12 years who were born in 2007-2010 at Prof. Dr. R. D. Kandou General Hospital Manado and resided in the city of Manado from March to August 2019. The children who met the inclusion criteria were evaluated for BP and hs-CRP level. A total of 120 children who met the inclusion criteria were enrolled in this study. Analysis for the association between LBW and NBW with systolic blood pressure (SBP) showed statistical significance (p=0.007). Linear regression analysis indicated a strongly significant influence of BW on serum hs-CRP level and SBP. Every 1 g increase in BW results in a decrease of serum hs-CRP level of 0.001 mg/L. Every 1 g increase in BW is attributed to 0.004 mmHg decrease in SBP. An increase in hs-CRP by 1 mg/L increases the SBP by 4.99 mmHg and DBP by 2.88 mmHg. LBW significantly correlates with hs-CRP level and higher SBP. A comprehensive education must be undertaken for the families who have children with LBW to reduce the risk of developing hypertension later in their life.

Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis.

PURPOSE: To determine the diagnostic value of eosinopenia and the neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of early onset neonatal sepsis (EONS). METHODS: This cross-sectional study was conducted in the Neonatology Ward of R.D. Kandou General Hospital Manado between July and October 2017. Samples were obtained from all neonates meeting the inclusion criteria for EONS. Data were encoded using logistic regression analysis, the point-biserial correlation coefficient, chi-square test, and receiver operating characteristic curve analysis, with a P value <0.05 considered significant. RESULTS: Of 120 neonates who met the inclusion criteria, 73 (60.8%) were males and 47 (39.2%) were females. Ninety (75%) were included in the sepsis group and 30 (25%) in the nonsepsis group. The mean eosinophil count in EONS and non-EONS groups was 169.8±197.1 cells/mm3 and 405.7±288.9 cells/ mm3 , respectively, with statistically significant difference (P<0.001). The diagnostic value of eosinopenia in the EONS group (cutoff point: 140 cells/mm3 ) showed 60.0% sensitivity and 90.0% specificity. The mean NLR in EONS and non-EONS groups was 2.82±2.29 and 0.82±0.32, respectively, with statistically significant difference (P<0.001). The diagnostic value of NLR in the EONS group (cutoff point, 1.24) showed 83.3% sensitivity and 93.3% specificity. CONCLUSION: Eosinopenia has high specificity as a diagnostic marker for EONS and an increased NLR has high sensitivity and specificity as a diagnostic marker for EONS.

Case Report: Severe Plasmodium vivax Malaria Mimicking Sepsis in a Neonate.

Severe congenital malaria associated with Plasmodium vivax is uncommon. In Indonesia, most congenital malaria cases are due to Plasmodium falciparum infections. Most cases of congenital or neonatal malaria in endemic areas are diagnosed from peripheral smear as part of routine sepsis workup. Differentiating congenital and acquired neonatal malaria is very difficult. The case presented in this study describes severe P. vivax malaria with cholestatic jaundice and sepsis-like signs and symptoms in neonates. The mother was asymptomatic and the neonate was successfully treated with intravenous artesunate. Severe P. vivax malaria with cholestatic jaundice in neonates is an uncommon condition that should be included in the differential diagnosis of infants displaying hemolytic anemia, thrombocytopenia, cholestatic jaundice, and hepatosplenomegaly in malaria-endemic zones. Early diagnosis can prevent the use of unnecessary antibiotics and mortality of neonates.