Diarrheal diseases are the second cause of the high morbidity and mortality in children under five years old. According to the Basic Health Survey 2018 conducted by the Ministry of Health, the prevalence of diarrheal diseases among children under five years old that were diagnosed by healthcare workers was 11.0%. The aim of this study was to describe the enteric pathogen isolated from children with diarrhea. The study was conducted in five cities in Indonesia: Jakarta, Serang, Denpasar, Makassar, and Mataram. The Inclusion criteria were children aged one month to five years old, with diarrhea that was diagnosed by a healthcare worker. The rectal swabs were sent to the Centre for Research and Development for Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health in Jakarta. Virus and Enterotoxigenic Escherichia coli (ETEC) identification by using multiplex PCR from Seegene, meanwhile bacteria identified by conventional method. As many as 2626 children under five years old participated in this study. The highest viral pathogen that causes diarrhea is viral 1.807 (68,81%) and 486 (18,56%). The virus etiology was Rotavirus 982 (54,34%) cases, followed by Adenovirus 916 (50.69) cases, Norovirus II 444 (24,57%) cases, meanwhile the bacteria pathogen were Enterotoxigenic Escherichia coli detected in 262 (9,98%) followed by Campylobacter jejuni and Shigella spp. This study described Rotavirus is the prevalence etiology of diarrhea among children under five years old followed by Adenovirus and Norovirus, some other cases reported the cause of diarrhea were bacteria ETEC E. coli followed Campylobacter jejuni, Shigella spp, etc.
Background: Indonesia is one of the five countries with the highest number of diphtheria cases worldwide. Diphtheria is caused by the toxigenic strains Corynebacterium diphtheriae, C. ulcerans, and C. pseudotuberculosis. The diphtheria-causing bacteria can be identified using conventional and molecular methods, including polymerase chain reaction (PCR) assay. We used the PCR assay as additional testing, because in island countries like Indonesia, specimen transport is a serious challenge to maintaining bacterial survival. Objectives: This study aimed to evaluate the PCR assay as additional testing to identify diphtheria-causing bacteria in the diphtheria laboratory. Methods: In this cross-sectional study, a total of 178 pairs of the throat and nasal swabs from diphtheria suspected cases and close contacts were collected from seven provinces in Indonesia in 2016. All samples were directly identified by the conventional method and multiplex PCR assay. Statistical analysis was conducted using the 2 × 2 tables to determine the sensitivity and specificity of both methods, while the χ2 test was used to examine the correlation between specimen examination delay and the differentiation of results. A P-value < 0.05 was considered as statistically significant. Results: Out of 178 examined samples, eight samples were identified as diphtheria-positive by both the conventional method and PCR assay, while nine samples were only detected by the PCR assay. All diphtheria-causing bacteria found in the positive samples were toxigenic C. diphtheriae. The diphtheria-causing bacteria were found in 27.6% of cases and 6.0% of close contacts using the PCR assay versus 13.8% of cases and 2.7% of close contacts using the conventional method. Statistical analysis showed that the PCR assay is about twice more sensitive than the conventional method. There was a significant correlation between the differentiation of results and > 72 hours’ specimen examination delay with a P-value of 0.04 (< 0.05). Conclusions: The PCR assay is more sensitive than the conventional method to identify diphtheria-causing bacteria and may be applied as additional testing to increase the positivity rate of diphtheria-confirmed cases in Indonesia as an archipelago country where geographical factors and specimen transport are real obstacles.
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