Introduction: A healthy person who contacts people diagnosed with leprosy can be at a high risk of being infected with leprosy with a predominance of the subclinical stage. The MB type infection has a 4-10 times greater risk of developing into a clinical form. Early detection of subclinical leprosy is important so that it can play a role in the process of eliminating leprosy. If it is not screened, most of the subclinical stage leprosy can develop into the clinical stage and can cause physical deformities. Phenolic glycolipid-1 (PGL-1) is a specific antigen for M.leprae and Interleukin-10 (IL-10) is an anti-inflammatory cytokine that shows the body's immune response. Research on the relationship between levels of IL-10 and IgM anti-PGL-1, especially in Bali, has not been carried out, so this study aims to find a relationship between levels of IL-10 and levels of IgM anti-PGL-1 in household contacts of multibacillary leprosy patients. Methods: This research is an analytical observational study with a cross-sectional and was carried out in February-May 2021 at the Dermatology and Venereology Polyclinic and Clinical Pathology Laboratory, Sanglah Hospital Denpasar, and the Leprosy reference laboratory, Tropical Diseases Center, Universitas Airlangga. Samples aged 18-65 years were selected through Consecutive Sampling according to inclusion and exclusion criteria. The sample was taken from venous blood and then checked for levels of PGL-1 and IL-10. Data analysis using SPSS version 23. The results were considered significant if p<0.05. Results: The mean level of IgM anti-PGL-1 in the contact group vs. the non-contact group was 863.07 ± 789.04 u/ml vs 247.75 ± 161.60 u/ml. The mean levels of IL-10 in the contact and non-contact groups were 121.09 ± 144.11 pg/ml and 46.04 ± 11.27 pg/ml. There was a significant difference in levels of IL-10 and IgM anti-PGL-1 in the contact group and non-contact groups (p<0.05) and a weak positive relationship (r=0.296, p=0.02) between levels of IL-10 and anti-PGL-IgM. 1. Conclusion: The levels of IgM anti-PGL-1 and IL-10 in the contacts were higher than in the non-contacts with a significant difference. Pendahuluan: Narakontak merupakan salah satu kelompok dengan risiko tinggi terinfeksi kusta dengan dominansi stadium subklinis. Pada infeksi tipe MB memiliki resiko 4-10 kali lebih besar berkembang menjadi bentuk klinis. Deteksi dini pada penyakit kusta subklinis ini menjadi penting sehingga dapat berperan dalam proses eliminasi kusta. Jika dibiarkan sebagian besar kusta stadium subklinis dapat berkembang menjadi kusta klinis dan dapat menimbulkan deformitas pada fisik. Phenolic glycolipid-1 (PGL-1) merupakan antigen spesifik untuk M. leprae dan Interleukin-10 (IL-10) merupakan sitokin anti-inflamasi yang menunjukkan respon imun tubuh. Penelitian mengenai hubungan antara kadar IL-10 dan IgM anti PGL-1 khusunya di Bali belum dilakukan, sehingga penelitian ini bertujuan mencari hubungan antara kadar IL-10 dengan kadar IgM anti PGL-1 pada narakontak serumah pasien kusta tipe multibasiler. Metode: Penelitian merupakan studi observasional analitik dengan pendekatan potong lintang dan dilaksanakan bulan Februari-Mei 2021 di Poliklinik Kulit dan Kelamin dan Laboratorium Patologi Klinik, RSUP Sanglah Denpasar dan laboratorium rujukan Leprosy, Tropical Diseases Centre, Universitas Airlangga. Sampel berusia 18-65 tahun dipilih melalui Consecutive Sampling sesuai kriteria inklusi dan eksklusi. Sampel dilakukan pengambilan darah vena kemudian diperiksa kadar PGL-1 dan IL-10. Analisis data menggunakan SPSS versi 23. Hasil dianggap signifikan jika p<0,05. Hasil: Rerata kadar IgM anti PGL-1 kelompok narakontak vs bukan narakontak sebesar 863,07 ± 789,04 u/ml vs 247,75 ± 161,60 u/ml. Rerata kadar IL-10 kelompok narakontak dan bukan narakontak sebesar 121,09 ± 144,11 pg/ml dan 46,04 ± 11,27 pg/ml. Terdapat perbedaan signifikan pada kadar IL-10 dan IgM anti PGL-1 pada kelompok narakontak dan bukan narakontak (p<0.05) serta hubungan positif lemah (r=0,296, p=0,02) antara kadar IL-10 dengan IgM anti PGL-1. Simpulan: Kadar IgM anti PGL-1 dan IL-10 pada narakontak lebih tinggi dari non narakontak dengan perbedaan yang signifikan.
Introduction: Syphilis is one of the most common sexually transmitted infections worldwide. Syphilis can be acute to chronic. Syphilis is caused by the parasite Treponema pallidum (T. pallidum). Transmitted through sexual contact and blood. In this case, we report a case of secondary syphilis in an adolescent girl.Case report: an 18-year-old girl came with complaints of red spots on the palms of the hands and soles of the feet, with a history of sores in the pubic area that were painless and odorless and then healed on their own so no treatment was given. A history of positive sexual contact approximately one week before the patient came for examination. On dermatological status, right and left palmar and plantar locations found erythematous macules, round to geographical in shape with diameters of 0.5 cm - 1.5 cm and 0.5 cm x 0.7 cm - 0.7 cm x 1 cm, scattered discrete and localized distributions. The patient was differentially diagnosed with secondary syphilis with syphilitic roseola, pityriasis rosea and palmoplantar psoriasis. To confirm the diagnosis, a serological examination was carried out on June 10th 2020, Venereal disease research laboratory test (VDRL) examination with reactive results with a titer of 1:32 and reactive treponema pallidum hemagglutination assay (TPHA) with a TPHA titer of 1:2560. He was given a single dose of intramuscular (IM) injection of benzathine penicillin G 2.4 million international units (IU) and education on further follow up for VDRL laboratory test.Conclusion: A case of secondary syphilis with manifestations of syphilitic roseola has been reported in an 18-year-old teenager. The patient's has a generally good prognosis because in general the patient's condition is good, but considering the patient is still a teenager, it is possible to have irresponsible sexual relations later in life. Pendahuluan: Sifilis merupakan salah satu penyakit infeksi menular seksual yang sering ditemukan. Sifilis dapat berbentuk akut hingga kronis. Sifilis disebabkan oleh parasit Treponema pallidum (T. pallidum). Menular melalui kontak seksual dan darah. Pada kasus ini dilaporkan sebuah kasus sifilis sekunder pada remaja perempuan.Laporan kasus: remaja perempuan 18 tahun datang dengan keluhan bercak-bercak kemerahan pada telapak tangan dan telapak kaki, dengan riwayat luka pada daerah kemaluan tidak nyeri dan tidak berbau kemudian sembuh sendiri sehingga tidak dilakukan pengobatan. Riwayat kontak seksual positif kurang lebih satu minggu sebelum pasien datang melakukan pemeriksaan. Pada status dermatologi, lokasi palmar dan plantar dekstra et sinistra ditemukan makula eritema, berbentuk bulat hingga geografika dengan ukuran diameter 0,5 cm - 1,5 cm dan 0,5 cm x 0,7 cm – 0,7 cm x 1 cm, tersebar diskret dan distribusi lokalisata. Pasien didiagnosis banding dengan sifilis sekunder dengan roseola sifilitika, pitiriasis rosea dan palmoplantar psoriasis. Untuk menegakkan diagnosis dilakukan pemeriksaan serologis pada tanggal 10 Juni 2020 yakni pemeriksaan VDRL dengan hasil reaktif dengan titer 1:32 dan TPHA reaktif dengan titer TPHA 1:2560. Diberikan terapi injeksi benzatin penisilin G 2,4 juta international unit (IU) intramuskular (IM) dosis tunggal dan edukasi pemantauan pengobatan yang akan dilakukan yakni pemeriksaan VDRL ulang pada bulan ke-1 setelah terapi.Simpulan: Telah dilaporkan satu kasus sifilis sekunder dengan manifestasi roseola sifilitika pada remaja berusia 18 tahun. Prognosis pasien adalah dubia ad bonam karena pada umumnya kondisi pasien baik, namun mengingat pasien masih remaja, ada kemungkinan untuk melakukan hubungan seksual yang tidak bertanggung jawab di kemudian hari.
Stevens-Johnson syndrome (SJS) is systemic immune reactions (type IV hypersensitivity) that are usually present by blistering and erosions of skin and mucous membranes with involvement of multiple organ systems. The incidence of SJS is rare, with the common comorbidities are diabetes mellitus, epilepsy, hypertension, and stroke. This condition is associated with systemic proinflammatory state. Diabetes mellitus is a metabolic disorder that is characterized by abnormally elevated levels of blood glucose due to glucose intolerance, hyperglycemia, and impaired insulin secretion. Nowadays, pathogenesis of diabetes is considered to be dysregulation of immune factors that are recognized as important etiological components in the development of insulin resistance. We report a case of a 30-years-old man with fever and sore throat, who had type 2 diabetes mellitus (T2DM) and used carbamazepine and amitriptyline for diabetic neuropathy, then followed by redness and blistering on his lips, palates, face, and trunk which subsequently diagnosed with SJS.
Background: Neurofibromatosis is a genetic disorder which manifests as a tumor that surrounds the nerves and several other pathologic presentations.Case: Female, 11 years old, according to history, physical examination and supporting investigation was consistent with the diagnostic criteria of type 1 neurofibromatosis (NF-1). Patient also has intellectual disability. On the patient, a tumor on the foot region that was functionally disabling was found and a surgical treatment was performed.Discussion: Cognitive disorder is the most common neurological complication in individuals with NF-1 and usually present with low intelligence quotient (IQ). There is no specific treatment to prevent the development of NF-1. However, early treatment can minimize and prevent further complication. Treatment for the patient involve multiple clinical discipline.Conclusion: A neurofibromatosis case can be diagnosed clinically alone, however, since there are many other systemic involvements that require multi-disciplinary approach.
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