Korelasi Temuan Limfosit Plasma Biru dengan Kadar C-Reaktif Protein sebagai Penunjang dalam Diagnosis Demam Berdarah Dengue

Dengue Hemorrhagic Fever diagnosis is supported by examining Blue Plasma Lymphocytes and C-Reactive Protein, in which Blue Plasma Lymphocytes can distinguish Dengue and Non-Dengue infections. At the same time, the C-Reactive Proteins are used to see the presence of inflammation due to infections such as Dengue Virus infection. Objectives: To analyzed the correlation of the number of Blue Plasma Lymphocytes with C-Reactive Protein (CRP) levels in Dengue Hemorrhagic Fever patients. Methods: This study was analytical observational research with a cross-sectional design. The sample used was a patient diagnosed with DHF with a positive Nonstructural protein 1 (NS1) or Rapid Diagnostic Test (RDT) IgG/IgM result. The data was collected and analyzed using Spearman's rank statistical test. Results: The average number of Blue Plasma Lymphocytes in positive samples was 8%, with the number of negative results, namely 4 (13.33%) samples and 26 (86.67%) samples with positive Blue Plasma Lymphocyte results. The average level of C–Reactive Protein in the positive samples was 29.36 mg/L, with results that had normal levels were 11 (36.67%) samples and 19 (63.33%) samples with abnormal C-Reactive Protein levels. Spearman's Rank statistical test results obtained a value of p = 0.000 < 0.05, indicating a correlation between the number of Blue Plasma Lymphocytes and C–Reactive  Protein levels in Dengue Hemorrhagic Fever patients. Conclusion: The more Blue Plasma Lymphocytes, the higher C–Reactive Protein levels in Dengue Hemorrhagic Fever.Keywords: blue plasma lymphocytes, C–reactive protein, dengue hemorrhagic fever

Origins and spread of novel genetic variants of sulfadoxine-pyrimethamine resistance in Plasmodium falciparum isolates in Indonesia

Background

While malaria incidence in Indonesia has decreased threefold in the last decade, more than 200,000 cases were reported in 2016. Different endemicity of Plasmodium falciparum malaria among several islands in Indonesia has been recognized and two unique mutations of P. falciparum dihydropteroate synthase (pfdhps) affecting sulfadoxine–pyrimethamine (SP) resistance were detected from the research of SP efficiency and genotype analysis in South Kalimantan. In this study, geographical distribution and origin of these pfdhps K540T and I588F mutations were analysed.

Methods

Malaria parasites DNA from several endemic areas in Indonesia; Sumatera, Java, Kalimantan, Lombok, Sumbawa, Timor, Sulawesi, and Papua islands; in two periods, 2004–2006 and 2009–2012 were subjected for pfdhfr and pfdhps sequence analysis.

Results

Different genotype polymorphisms of pfdhfr and pfdhps were observed in the parasites from various regions in Indonesia and relatively more divergent genotypes were determined from Kalimantan isolates in both 2004–2006 and 2009–2012. The parasites containing K540T mutation were identified in 2004–2006 isolates from East Kalimantan, East Java and Sumbawa as an SGTGA haplotype. The other I588F mutation was also determined in 2004–2006 parasites, isolated from Lombok and Sumbawa islands as an SGEAA(588F) haplotype. The parasites with pfdhfr/pfdhps quintuple or sextuple mutation, a genotype marker of SP resistance, were determined mostly in Kalimantan in both 2004–2006 and 2009–2012.

Conclusion

Analysis of the prevalence and pfdhfr/pfdhps combined genotypes of K540T or I588F mutations suggested that K540T might be origin in Kalimantan Island and I588F in Sumbawa Island and then these were spread to other areas along with people movement. This research indicates regular monitoring of drug efficacy and parasite genotype analysis is important to keep efficiency and prevent the spread of resistance. It is also essential for the latest anti-malarial drug artemisinin-based combination therapy.