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"[ABSTRAKToxoplasma gondii merupakan protozoa intraselular obligat yang tersebar di seluruh dunia. Infeksi yang diakibatkannya disebut toksoplasmosis, dan diperkirakan sekitar sepertiga populasi dunia terinfeksi T. gondii. Toksoplasmosis akan menjadi masalah bahkan dapat mengancam jiwa bila infeksi terjadi pada orang imunokompromi. Ensefalitis toksoplasma (ET) terjadi akibat reaktivasi infeksi laten T. gondii, dan merupakan masalah yang sering terjadi pada pasien AIDS, terutama pada stadium akhir.Untuk menegakkan diagnosis pasti penyebab kelainan SSP pada pasien AIDS sangatlah sulit, karena banyaknya kemungkinan penyebab infeksi lain seperti bakteri, virus, dan jamur. Diagnosis ET ditegakkan hanya berdasarkan asumsi dari gejala klinis, gambaran radiologi, dan respons terhadap terapi yang diberikan. Pemeriksaan kadar IgG anti-Toxoplasma pada cairan organ yang terinfeksi T. gondii jarang dilakukan. Selama ini studi-studi lebih banyak yang memeriksa kadar IgG anti-Toxoplasma pada serum. Oleh karena masih jarangnya penelitian yang menggunakan CSS untuk penegakan diagnosis ET dan untuk mengetahui apakah kadar IgG anti-Toxoplasma pada CSS bermakna dalam menegakkan diagnosis ET, maka penelitian mengenai hal tersebut dilakukan pada pasien HIV & AIDS dengan dugaan meningitis.Dari 50 sampel CSS pasien AIDS yang dikirim ke Laboratorium Parasitologi FKUI, 24 (48%) positif dan 26 (52%) negatif IgG anti-Toxoplasma. Dari IgG positif, 5 (20,83%) kadar tinggi, dan 19 (79,17%) kadar rendah. Tidak ada perbedaan bermakna antara kadar IgG anti-Toxoplasma dengan hasil pencitraan maupun diagnosis klinis ET. Tidak ada hubungan antara kadar IgG anti-Toxoplasma dengan riwayat terapi profilaksis ko-trimoksazol.

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ABSTRACTToxoplasma gondii is obligate intracellular parasite that spread over the world. Toxoplasmosis, infection of this parasite, infected over one third world population. Toxoplasmosis become problem and life threatening in immunocompromised patients. Toxoplasma encephalitis (TE) is reactivation of latent infection of T. gondii, and usually manifest in severe stage of AIDS.Diagnosis of central nervous system infection in AIDS is very difficult, because many possibilities of infection that caused by bacteri, virus, and fungi. TE is only diagnosed by asumption of clinical signs, radiology, and therapeutic respons. The examination of IgG anti-Toxoplasma in organ fluid was rare. Because of this reason and to answer, is IgG anti-Toxoplasma in cerebro spinal fluid has important meaning for diagnosing TE, this study was done in HIV infection & AIDS patients with meningitis.From 50 LCS of AIDS patients that sent to Parasitology Laboratorium FKUI, 24 (48%) were positive, and 26 (52%) were negative of IgG anti-Toxoplasma. From IgG positive samples, 5 (20,83%) were high, and 19 (79,17%) were in low level. There is no difference between IgG anti-Toxoplasma level with radiology appearence, and with clinical diagnose for TE. No difference between IgG anti-Toxoplasma level with history of cotrimoxazole as prophylaxis therapy.;Toxoplasma gondii is obligate intracellular parasite that spread over the world. Toxoplasmosis, infection of this parasite, infected over one third world population. Toxoplasmosis become problem and life threatening in immunocompromised patients. Toxoplasma encephalitis (TE) is reactivation of latent infection of T. gondii, and usually manifest in severe stage of AIDS.Diagnosis of central nervous system infection in AIDS is very difficult, because many possibilities of infection that caused by bacteri, virus, and fungi. TE is only diagnosed by asumption of clinical signs, radiology, and therapeutic respons. The examination of IgG anti-Toxoplasma in organ fluid was rare. Because of this reason and to answer, is IgG anti-Toxoplasma in cerebro spinal fluid has important meaning for diagnosing TE, this study was done in HIV infection & AIDS patients with meningitis.From 50 LCS of AIDS patients that sent to Parasitology Laboratorium FKUI, 24 (48%) were positive, and 26 (52%) were negative of IgG anti-Toxoplasma. From IgG positive samples, 5 (20,83%) were high, and 19 (79,17%) were in low level. There is no difference between IgG anti-Toxoplasma level with radiology appearence, and with clinical diagnose for TE. No difference between IgG anti-Toxoplasma level with history of cotrimoxazole as prophylaxis therapy., Toxoplasma gondii is obligate intracellular parasite that spread over the world. Toxoplasmosis, infection of this parasite, infected over one third world population. Toxoplasmosis become problem and life threatening in immunocompromised patients. Toxoplasma encephalitis (TE) is reactivation of latent infection of T. gondii, and usually manifest in severe stage of AIDS.Diagnosis of central nervous system infection in AIDS is very difficult, because many possibilities of infection that caused by bacteri, virus, and fungi. TE is only diagnosed by asumption of clinical signs, radiology, and therapeutic respons. The examination of IgG anti-Toxoplasma in organ fluid was rare. Because of this reason and to answer, is IgG anti-Toxoplasma in cerebro spinal fluid has important meaning for diagnosing TE, this study was done in HIV infection & AIDS patients with meningitis.From 50 LCS of AIDS patients that sent to Parasitology Laboratorium FKUI, 24 (48%) were positive, and 26 (52%) were negative of IgG anti-Toxoplasma. From IgG positive samples, 5 (20,83%) were high, and 19 (79,17%) were in low level. There is no difference between IgG anti-Toxoplasma level with radiology appearence, and with clinical diagnose for TE. No difference between IgG anti-Toxoplasma level with history of cotrimoxazole as prophylaxis therapy.]"

"ABSTRAKToksoplasmosis merupakan penyakit yang disebabkan oleh Toxoplasma gondii. Penyakit infeksi ini dapat menyebabkan kondisi fatal bila terjadi pada pasien imunokompromis, misalnya adalah toksoplasma ensefalitis (TE) yang menyerang sistem saraf pusat. Untuk menegakkan diagnosis Toxoplasma sebagai penyebab kelainan SSP (sistem saraf pusat) pada pasien HIV sangat sulit, sehingga diperlukan metode pemeriksaan lain sebagai alternatif, salah satunya adalah pemeriksaan PCR mendeteksi gen B1 dari Toxoplasma gondii. Penelitian ini bertujuan untuk mengembangkan metode PCR pada sampel CSS (cairan serebrospinal) yang sesuai untuk menegakkan diagnosis TE dan mengetahui keunggulan dan kelemahan pemeriksaan PCR dibandingkan pemeriksaan IgG anti-Toxoplasma pada cairan serebrospinal. Penelitian dilakukan pada cairan serebrospinal pasien HIV/AIDS dengan gangguan serebral. Hasil pemeriksaan PCR dari 88 sampel CSS pasien HIV yang datang ke Laboratorium Parasitologi FK UI, adalah 23 (26,1%) positif dan 65 (73,9%) negative T. gondii. Ada hubungan postif bermakna antara pemeriksaan PCR dengan pemeriksaan IgG anti-Toxoplasma dari CSS.

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ABSTRACT

Toksoplasmosis is a disease caused by infection of Toxoplasma gondii. This infection can caused a life threatening condition in immunocompromised patients, for example toxoplasma ensefalitis (TE) which attack central nervous system. It is very difficult to diagnose Toxoplasma as a cause of CNS infection in HIV patient, so we need another methods as alternative, one of which is one of which is a PCR detection of Toxoplasma gondii B1 gene. This research aims to develop a PCR method on samples Cerebrospinal Fluid (CSF) that suitable for TE diagnosis and determine the advantages and disadvantages PCR methods compared to detection of anti-Toxoplasma IgG from CSF. The study was conducted in the cerebrospinal fluid of patients with HIV / AIDS with cerebral disorders. PCR examination results of 88 samples CSS HIV patients who came to the Laboratory of Parasitology FK UI, was 23 (26.1%) positive and 65 (73.9%) negative T. gondii. There is a significant positive relationship between PCR and detection anti-Toxoplasma IgG from CSF."

"ABSTRAKSifilis adalah penyakit menular seksual kronik yang memiliki manifestasi klinis yang bervariasi dan menetap untuk waktu yang lama. Neurosifilis merupakan salah satu komplikasi sifilis sistemik dengan temuan di cairan serebrospinal dengan atau tanpa gejala yang jelas. Pemeriksaan yang saat ini tersedia dalam mendukung diagnosis hanya tersedia pemeriksaan analisis cairan serebrospinal dan serologi Treponema pallidum. Saat ini belum diketahui prevalensi neurosifilis di rumah sakit peneliti dan profil serologi Treponema pallidum dari bahan cairan serebrospinal. Penelitian ini merupakan penelitian potong lintang, dilakukan November 2017-Maret 2018 terhadap 50 cairan serebrospinal dan darah yang diperiksakan analisis cairan serebrospinal dengan keterangan klinis terduga infeksi intrakranial. Serum dan cairan serebrospinal diperiksakan RPR, TPHA, anti-Treponema pallidum ELISA IgG dan khusus cairan serebrospinal diperiksa pula rapid test Treponema pallidum. Uji statistik menggunakan chi quare and Fisher exact test.Dari penelitian terhadap 50 cairan serebrospinal dan serum didapatkan rapid test Treponema pallidum, RPR dan TPHA cairan serebrospinal reaktif 4(8%). Dari bahan serum didapatkan RPR reaktif 8(16%) dan TPHA reaktif 9(18%). Anti-Treponema pallidum ELISA IgG positif 4 sampel (8%). Dari 50 sampel didapatkan 7 (14%) neurosifilis, 4 confirmed neurosyphilis dan 3 probable neurosyphilis sesuai kriteria Center for Disease Control and Prevention. Profil analisis cairan serebrospinalnya tidak berwarna, jernih, tidak ada bekuan, hitung sel 12.71 ±9.20 sel/μl, dominasi mononuklear 11.57±9.47 sel/μl, Pandy positif, protein cairan 42.29±21.49 mg/dl, glukosa cairan 55±5.16 mg/dl, glukosa serum 101.04±20.10 mg/dl, dan klorida 122.14±2.48 mEq/L. Pemeriksaan RPR, TPHA, dan anti-Treponema pallidum ELISA IgG dengan bahan serum dan cairan serebrospinal memiliki hubungan bermakna. Dari penelitian ini didapatkan 14% sesuai dengan neurosifilis dari populasi penelitian dan didapatkan 85.71% dengan HIV reaktif. Pada pasien HIV disarankan RPR dan TPHA serum untuk pemeriksaan skrining sifilis.

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ABSTRACTSyphilis is a chronic sexually transmitted disease that has varying clinical manifestations and persist for a long time. Neurosyphilis is one of the complications of systemic syphilis with findings in cerebrospinal fluid with or without obvious symptoms. Examinations currently available for diagnostic support were cerebrospinal fluid analysis and serology of Treponema pallidum. There is currently no known prevalence of neurosyphilis in the research hospital and serologic profile of Treponema pallidum from cerebrospinal fluid. This study was a cross sectional study, conducted November 2017-March 2018 against 50 cerebrospinal fluid and blood samples that examined cerebrospinal fluid analysis with clinical information of suspected intracranial infection. Serum and cerebrospinal fluid examined by RPR, TPHA, anti-Treponema pallidum ELISA IgG and particulary rapid test Treponema pallidum for cerebrospinal fluid. Statistic tests were chi quare and Fisher exact test.From a total of 50 cerebrospinal fluid and serum, 4(8%) had reactive cerebrospinal fluid T. pallidum rapid tests, RPRs and TPHAs. From serum there were 8(16%) reactive RPRs and 9(18%) reactive TPHAs. Anti-Treponema pallidum ELISA IgG was positif 4 samples (8%). Among the 50 samples, 7 (14%) had neurosyphilis, 4 were confirmed neurosyphilis and 3 were probable neurosyphilis according to Center for Disease Control and Prevention criteria. The cerebrospinal fluid analysis profile is colorless, clear, without clot, cell count 12.71±9.20 cells/μl, mononuclear 11.57±9.47 cells/μl, positive for Pandy, cerebrospinal fluid protein 42.29±21.49 mg/dl, glucose 55±5.16 mg/dl, serum glucose 101.04±20.10 mg/dl, and chloride 122.14±2.48 mEq/L. Rapid Plasma Reagin, TPHA, and anti-Treponema pallidum ELISA IgG were associated between serum specimen and cerebrospinal fuid. Neurosyphilis was found in 14% of our patient population and 85.71% was reactive for HIV. Rapid Plasma Reagin and TPHA in sera were recommended for syphilis screening for HIV patient."

"ABSTRAKToxoplasma gondii merupakan protozoa obligat intraseluler yang memiliki persebaran di alam cukup luas dan dapat menginfeksi berbagai jenis unggas dan mamalia. Informasi genetik mengenai tipe T. gondii yang menyebabkan toksoplasmosis pada manusia masih sangat terbatas. Analisis genetik dari lokus SAG2 digunakan untuk menentukan prevalensi ketiga genotip T. gondii tipe I, II, dan III yang terkait dengan infeksi toksoplasmosis serebral dan okular di Indonesia. Penentuan genotip ini dilakukan secara langsung pada sampel klinis, tanpa terlebih dahulu melalui proses isolasi pada mencit atau kultur sel. Sebanyak 28 sampel cairan serebrospinal dan 8 sampel cairan mata yang telah dinyatakan positif terinfeksi T. gondii melalui PCR gen B1 digunakan pada penelitian ini. Metode restriction fragment length polymorphism RFLP digunakan untuk mengelompokkan setiap isolat ke dalam satu dari tiga genotip T. gondii. Tipe I merupakan strain yang paling banyak didapatkan pada sampel cairan serebrospinal dan cairan mata. Data tersebut menunjukkan bahwa toksoplasmosis serebral dan okular yang terjadi di Indonesia di dominasi oleh tipe I yang merupakan jenis tipe yang virulen.Kata Kunci: cairan mata, cairan serebrospinal, genotip, PCR-RFLP, Toxoplasma gondi.

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ABSTRACTToxoplasma gondii is an obligate intracellular protozoan that has a wide distribution in nature and can infect many kinds of birds and mammals. Genetic information about the type of Toxoplasma gondii that causes toxoplasmosis in humans is still limited. Genetic analysis of the SAG2 locus was performed to determine the prevalence of the three genotypes of T. gondii associated with cerebral and ocular toxoplasmosis infection in Indonesia. This genotyping is performed directly on clinical samples, without passing the isolation process in mice or cell cultures. A total of 28 samples of cerebrospinal fluid and 8 samples of vitreous fluid which had been confirmed positive for T. gondii infection through B1 gene PCR, used in this study. Restriction fragment length polymorphism RFLP was used to determine each isolate into one of the three genotypes of T. gondii. Type I was the predominant strain found in cerebrospinal and ocular fluid. This data showed that cerebral and ocular toxoplasmosis in Indonesia is dominated by a virulant type I strain.Keywords cerebrospinal fluid, genotype, ocular fluid, PCR RFLP, Toxoplasma gondii."

"Latar belakang: Metastasis leptomeningeal (ML) merupakan penyebaran sel tumor ke leptomening dan ruang subarakhnoid, dengan insidens yang semakin meningkat dan prognosis yang buruk. Analisis cairan serebrospinal (CSS) merupakan pemeriksaan penting dengan sitologi sebagai standar baku emas untuk deteksi sel tumor di CSS.Metode penelitian: Studi potong lintang retrospektif multisenter untuk mengetahui gambaran analisis rutin dan sitologi CSS pada keganasan dengan kecurigaan ML yang dilakukan pungsi lumbal pada Januari 2018-Desember 2021. Dilakukan pencatatan data klinis, radiologis, jenis tumor, analisis rutin serta frekuensi pungsi lumbal, dan dianalisis hubungannya dengan sitologi CSS.Hasil: Terdapat 153 subjek dengan abnormalitas analisis rutin CSS(75,2%) berupa peningkatan jumlah sel >5/uL(47,1%) dengan median 5(1-3504)/uL; peningkatan protein CSS >45 mg/dl (52,9%) dengan median 50 (5-820)mg/dl serta penurunan glukosa CSS <50 mg(15%) dengan median 68 (3-269)mg/dl. Proporsi sitologi CSS positif sel ganas 20,3%. Proporsi flow cytometry immunophenotyping CSS positif pada keganasan hematologi dengan kecurigaan ML 25,6%. Terdapat hubungan bermakna antara peningkatan sel, jenis keganasan hematologi, dan gambaran MRI dengan sitologi CSS (p<0,001;p=0,03;p=0,03). Tidak terdapat hubungan bermakna antara manifestasi klinis dan frekuensi pungsi lumbal dengan sitologi CSS.Kesimpulan: Abnormalitas analisis rutin CSS didapatkan pada sebagian besar subjek keganasan dengan kecurigaan ML, dengan positivitas sitologi yang rendah. Gejala klinis yang bervariasi dan pengulangan pungsi lumbal tidak signifikan menaikkan kemungkinan sitologi CSS positif.

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Background: Leptomeningeal metastases (LM) is a condition where malignant cells spread to leptomeninges and subarachnoid space, with increasing incidence and poor prognosis. Cerebrospinal fluid (CSF) analysis is an important examination with cytology as the gold standard for malignant cells detection in CSF.

Methods: A multicenter cross-sectional retrospective study to describe CSF routine analysis and cytology in suspected LM on January 2018-December 2021. Clinical manifestations, radiological data, tumor type, CSF routine analysis, and lumbal puncture frequency were recorded, and their correlation with CSF cytology was analyzed.

Results: There were 153 subjects with abnormalities on CSF routine analysis(75,2%), consist of CSF cell count >5/uL(47,1%) with median 5(1-3504)/uL, CSF protein >45 mg/dL(52,9%) with median 50(5-820) mg/dL, and CSF glucose <50 mg/dL(15%) with median 68(3-629)mg/dL. Positive CSF cytology result was 20,3%. Positive CSF flow cytometry immunophenotyping in hematological malignancy with suspected LM was 25,6%. There was significant correlation between the increase in CSF cell count, hematological malignancy, and MRI results with CSF cytology (p<0,001;p=0,03;p=0,03). There was no significant correlation between clinical manifestations and lumbal puncture frequency with CSF cytology.

Conclusion: Abnormalities of CSF routine analysis were found in majority subjects with suspected LM but CSF cytology positivity rate was considered low. The presence of varied clinical symptoms and repeated lumbal punctures didn’t increase the likelihood of positive CSF cytology."