ObjectiveTo identify aetiologies of childhood community-acquired pneumonia (CAP) based on a comprehensive diagnostic approach.Design‘Partnerships for Enhanced Engagement in Research-Pneumonia in Paediatrics (PEER-PePPeS)’ study was an observational prospective cohort study conducted from July 2017 to September 2019.SettingGovernment referral teaching hospitals and satellite sites in three cities in Indonesia: Semarang, Yogyakarta and Tangerang.ParticipantsHospitalised children aged 2–59 months who met the criteria for pneumonia were eligible. Children were excluded if they had been hospitalised for >24 hours; had malignancy or history of malignancy; a history of long-term (>2 months) steroid therapy, or conditions that might interfere with compliance with study procedures.Main outcome(s) measure(s)Causative bacterial, viral or mixed pathogen(s) for pneumonia were determined using microbiological, molecular and serological tests from routinely collected specimens (blood, sputum and nasopharyngeal swabs). We applied a previously published algorithm (PEER-PePPeS rules) to determine the causative pathogen(s).Results188 subjects were enrolled. Based on our algorithm, 48 (25.5%) had a bacterial infection, 31 (16.5%) had a viral infection, 76 (40.4%) had mixed bacterial and viral infections, and 33 (17.6%) were unable to be classified. The five most common causative pathogens identified were Haemophilus influenzae non-type B (N=73, 38.8%), respiratory syncytial virus (RSV) (N=51, 27.1%), Klebsiella pneumoniae (N=43, 22.9%), Streptococcus pneumoniae (N=29, 15.4%) and Influenza virus (N=25, 13.3%). RSV and influenza virus diagnoses were highly associated with Indonesia’s rainy season (November–March). The PCR assays on induced sputum (IS) specimens captured most of the pathogens identified in this study.ConclusionsOur study found that H. influenzae non-type B and RSV were the most frequently identified pathogens causing hospitalised CAP among Indonesian children aged 2–59 months old. Our study also highlights the importance of PCR for diagnosis and by extension, appropriate use of antimicrobials.Trail registration numberNCT03366454

Latar belakang Kejadian kasus COVID-19 pada bayi belum banyak dilaporkan dan mekanisme penularan terhadap bayi baru lahir masih belum jelas. Tujuan Melaporkan perbedaan karakteristik bayi baru lahir dari ibu terkait COVID-19 di RSUP Dr. Kariadi Semarang Metode Penelitian retrospektif dengan data sekunder catatan medik bayi baru lahir dari ibu terkait COVID-19 di RSUP dr Kariadi Semarang pada periode April-Mei 2020 dengan kelompok pembanding bayi baru lahir dari ibu tidak terkait COVID-19. Kriteria inklusi semua bayi lahir dari ibu terkait COVID-19 dirawat di rumah sakit dan dilakukan pemeriksaan PCR dengan spesimen swab nasofaring. Data yang dikumpulkan adalah usia kehamilan, jenis kelamin, berat lahir, cara persalinan, usia ibu dan jenis minum yang diberikan pada bayi. Dilakukan uji beda menggunakan uji chi square dan shapiro wilk. Analisis data menggunakan program komputer SPSS. Hasil Dari 46 sampel penelitian terdiri dari 23 bayi lahir dari ibu terkait COVID-19 dan 23 bayi lahir dari ibu tidak terkait COVID-19 dilakukan analisis dengan hasil tidak terdapat perbedaan bermakna dari usia kehamilan, berat lahir, cara persalinan dan usia ibu. Pada kelompok bayi lahir terkait COVID-19 mayoritas lahir dengan jenis kelamin perempuan (74%) dan jenis minum yang diberikan sekitar 86% dengan susu formula. Tidak ada bayi yang mendapat ASI eksklusif pada bayi yang lahir dari ibu terkait COVID-19. Semua bayi yang lahir dari ibu terkait COVID-19 didapatkan hasil swab nasofaring negatif dan tidak menunjukkan gejala apapun sampai dengan pulang. Simpulan Tidak didapatkan perbedaan karakteristik usia kehamilan, berat lahir, cara persalinan dan usia ibu. Terdapat perbedaan karakteristik jenis kelamin dan jenis minum yang diberikan pada kedua kelompok penelitian. Keyword: bayi baru lahir, COVID-19   Background The incidence of COVID-19 cases in newborn has not been widely reported and the mechanism of transmission to the newborn is unclear. Objective To report the characteristics of newborns from mothers related to COVID-19 at Kariadi Hospital Semarang. Method Retrospective study with secondary data on medical records of newborns from mothers related to COVID-19 at Kariadi Hospital in the April-May 2020 period with a comparison group of newborns from mothers not related to COVID-19. Criteria for inclusion of all infants born to mothers associated with COVID-19 were hospitalized and PCR examination carried out with nasopharyngeal swab specimens. Data collected were gestational age, sex, birth weight, mode of delivery, maternal age and type of dietary given to the baby. Analysis tests were performed using chi square test and Shapiro Wilk. Data analysis using SPSS computer programs Result Of the 46 study samples consisting of 23 babies born to mothers related to COVID-19 and 23 babies born to mothers not related to COVID-19 were analyzed with the results that there were no significant differences in gestational age, birth weight, mode of delivery and maternal age. In the group of babies born with COVID-19 the majority were born with a female sex (74%) and the type of dietary given was around 86% with formula milk. No baby gets exclusive breastfeeding for babies born to mothers related to COVID-19. All babies born to mothers related to COVID-19 obtained negative nasopharyngeal swab results and did not show any symptoms until discharge. Conclusion There were no differences in the characteristics of gestational age, birth weight, mode of delivery and maternal age. There were differences in the characteristics of the sexes and types of dietary given in the two study groups. Keyword: newborn, COVID-19

BackgroundDiscrimination of bacterial and viral etiologies of childhood community-acquired pneumonia (CAP) is often challenging. Unnecessary antibiotic administration exposes patients to undue risks and may engender antimicrobial resistance. This study aimed to develop a prediction model using epidemiological, clinical and laboratory data to differentiate between bacterial and viral CAP.MethodsData from 155 children with confirmed bacterial or mixed bacterial and viral infection (N = 124) and viral infection (N = 31) were derived from a comprehensive assessment of causative pathogens [Partnerships for Enhanced Engagement in Research-Pneumonia in Pediatrics (PEER-PePPeS)] conducted in Indonesia. Epidemiologic, clinical and biomarker profiles (hematology and inflammatory markers) were compared between groups. The area under the receiver operating characteristic curve (AUROC) for varying biomarker levels was used to characterize performance and determine cut-off values for discrimination of bacterial and mixed CAP versus viral CAP. Diagnostic predictors of bacterial and mixed CAP were assessed by multivariate logistic regression.ResultsDiarrhea was more frequently reported in bacterial and mixed CAP, while viral infections more frequently occurred during Indonesia’s rainy season. White blood cell counts (WBC), absolute neutrophil counts (ANC), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) were significantly higher in bacterial and mixed cases. After adjusting for covariates, the following were the most important predictors of bacterial or mixed CAP: rainy season (aOR 0.26; 95% CI 0.08–0.90; p = 0.033), CRP ≥5.70 mg/L (aOR 4.71; 95% CI 1.18–18.74; p = 0.028), and presence of fever (aOR 5.26; 95% CI 1.07–25.91; p = 0.041). The model assessed had a low R-squared (Nagelkerke R2 = 0.490) but good calibration (p = 0.610 for Hosmer Lemeshow test). The combination of CRP and fever had moderate predictive value with sensitivity and specificity of 62.28 and 65.52%, respectively.ConclusionCombining clinical and laboratory profiles is potentially valuable for discriminating bacterial and mixed from viral pediatric CAP and may guide antibiotic use. Further studies with a larger sample size should be performed to validate this model.

Latar belakang Kasus COVID-19 pada anak menunjukkan karakteristik klinis yang bervariasi, meskipun umumnya ringan dapat menjadi sumber penularan dan memunyai dampak terhadap kesehatan secara umum. Tujuan Melaporkan karakteristik klinis, laboratorium, gambaran radiologis dan luaran pasien COVID-19 pada anak di RSUP Dr. Kariadi Semarang Metode Penelitian retrospektif, dengan data dari rekam medis pasien terduga COVID-19 di RSUP dr Kariadi Semarang pada periode Maret – April 2020. Kriteria inklusi pasien usia 0-18 tahun terduga COVID dirawat di rumah sakit, dan dilakukan pemeriksaan PCR dengan spesimen swab. Data yang dikumpulkan adalah demografi, manifestasi klinis, laboratorium, gambaran radiologis, penyakit komorbid, dan luaran. Analisis data menggunakan SPPS for window 12.0 version. Hasil Enam puluh satu pasien yang terduga COVID, 41 kasus dilakukan analisis dengan temuan hasil positif pada 5 (12%) kasus, laki-laki 22 (53,7%) dan perempuan 19( 46,3%) dengan median usia 36 bulan (rentang 3-214 bulan), gejala utama batuk 38 (92,7%), demam 37 (90,2%), dan ronkhi 25 (61%). Pada kelompok kasus COVID positif batuk dijumpai pada 5/5 pasien, demam 3/5 pasien, ronkhi 2/5 pasien. Seluruh pasien dari kelompok COVID positif pulang perbaikan, dan 4 kasus dari kelompok COVID negatif meninggal. Kadar lekosit dan limfosit kelompok COVID positif dan negatif berturut-turut dengan nilai signifikansi p 0,62 dan p 0.72, gambaran radiologis antar kelompok p 0,56 Simpulan Tidak didapatkan perbedaan karakteristik riwayat epidemiologis, gejala dan tanda klinis, laboratorium, foto rontgen toraks serta luaran antar kelompok pasien COVID-19 positif dan negatif.

Background Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Of all TB patients, 40-50% are children. C-reactive protein (CRP) is produced during the inflammation process and is an indicator of active TB disease. High sensitivity CRP (hs-CRP) test has higher accuracy and sensitivity to detect CRP at lower levels. Objective To compare hs-CRP in children with TB infection, pulmonary TB, and extra-pulmonary TB. Methods This cross-sectional study of children with tuberculosis was conducted at Dr. Kariadi Hospital and the Semarang Community Health Center, Semarang, Central Java, from January 2020–February 2021. Inclusion criteria were patients aged 1–18 years with suspected TB (contact with adult TB patient or clinically suspected to have TB). Results From 95 study subjects, 19 had TB infection, 51 had pulmonary TB, and 25 had extra-pulmonary TB. There was a significant increase in hs-CRP level based on prolonged fever (P<0.001), enlarged lymph glands (P=0.004), joint swelling (P=0.006), low WHZ or BMI for age (P=0.048), positive bacteriological evidence (P<0.001), and negative/not done tuberculin skin test (P=0.001). There was a significant difference of hs-CRP level based on TB status, with the highest hs-CRP level in extra-pulmonary TB [14.3 mg/l (0.16–321.5)], followed by pulmonary TB [0.8 mg/l (0.3–129.1)], and TB infection [0.7 mg/l (0.3–20.2)]. The highest hs-CRP level for extra-pulmonary TB was found in abdominal TB [84.5 mg/l (0.6–321.5)]. Conclusion  Children with extra-pulmonary TB have significantly higher hs-CRP than children with TB infection or pulmonary TB.

Background: Asthma is a chronic respiratory disease most often found in children and has the highest prevalence in developing countries. House dust mites are the second most common trigger of asthma whose habitat is influenced by the criteria for a healthy.Objective: Understanding the correlation between sleep density and asthma status in pediatric patients and criteria for a healthy house.Methods: This study was an analytical observational method with a cross sectional study design that took place from June to October 2020. It involved 25 respondents of children with asthma patients aged 3-11 years. There is a confounding variable, namely the criterion score for a healthy house. Dust samples were collected in the bedroom of the respondent diagnosed with bronchial asthma. The identification process using the floating method was carried out at the Parasitology Laboratory, Faculty of Medicine, Diponegoro University, Semarang Indonesia. Respondent data were analyzed using statistical software programs. Non-parametric test with lambda correlation test.Results: The mean of house dust mite’s density in the respondent's house was 3.68 ± 2.32. House dust mite’s density was associated with the criteria for a healthy house (p <0.05), but house dust mite density was not related to the asthma status of pediatric patients (p> 0.05).Conclusion: There is no correlation between pediatric asthma status and house dust mite density.

Latar belakang: Kasus Probable Covid-19 adalah kasus penderita  dengan gambaran klinis dan pemeriksaan penunjang yang meyakinkan Covid-19 namun tidak terkonfirmasi dengan  pemeriksaan real-time polymerase chain reaction (RT-PCR). Kasus probable  banyak menimbulkan  kekhawatiran karena risiko penularan dan keraguan  dalam tata laksana baik bagi dokter, perawat, dan  penanggung jawab  pasien. Tujuan penulisan artikel ini adalah untuk melaporkan kasus seorang anak dengan probable Covid-19  dan mendiskusikan  kemungkinan diagnosis banding lain sebagai pemikiran di tengah pandemi Covid-19 guna pengelolaan pasien yang lebih optimal. Kasus:  Anak perempuan 14 tahun 5 bulan dengan keluhan utama batuk selama dua minggu sebelum masuk rumah sakit,  disertai demam, diare dan sesak. Selama perawatan, sesak makin bertambah. Tiga hari perawatan ditemukan oliguria, proteinuria, anemia, leukositosis, trombositopenia, hipersegmentasi neutrofil, limfopenia, peningkatan prokalsitonin, hipoalbuminemia dan penurunan fungsi ginjal (51 ml/menit/1,73 m2). Gambaran rontgen dada menunjukkan bronkopneumonia dan kardiomegali. MSCT dada terdapat gambaran konsolidasi dan ground glass appearance (GGO) di kedua paru mendukung ke arah Covid-19. Pada hari perawatan ke 16 anak mengalami gagal nafas, hemoptoe, penurunan kesadaran  hingga meninggal.   Swab RT-PCR 3 kali negatif (selama perawatan dan post mortem). Ringkasan : Infeksi Covid-19 adalah penyebab infeksi saluran nafas yang serius dan berat. Telah dilaporkan seorang anak perempuan 14 tahun 5 bulan yang meninggal karena Probable Covid-19. Di tengah pandemi Covid-19 ini seorang dokter  perlu meningkatkan kewaspadaan yang tinggi terhadap infeksi virus atau bakteri lain untuk memperbaiki tata laksana dan luaran  pada penderita. Kata kunci: Covid-19, probable, ground glass opacity, RT-PCR   Background: Probable Covid-19 cases are patients with clinical features and convincing investigations for covid-19 but there is  not confirmed by real time polymerase chain reaction (RT-PCR). Probable cases raise many concerns because of the risk of transmission and doubt in good management for the doctor / nurse in charge of the patient. The purpose of writing was to report the child with probable Covid-19 and provide a discussion of possible other differential diagnoses as thoughts in the midst of the Covid-19 pandemic for optimal management of sufferers. Case: A girl 14 years 5 months old had a cough for two weeks before admission, accompanied by fever, diarrhea and breathlessness. During treatment, the shortness of breath increased, three days of treatment found oliguria, proteinuria, hematuria, anemia, leukocytosis, thrombocytopenia, neutrophil hypersegmentation, lymphopenia, increased procalcitonin, hypoalbuminemia and decreased renal function (51 ml / min / 1.73 m2). Chest x-ray of bronchopneumonia and cardiomegaly. In the finding of  chest computed tomography scan showed consolidation and ground glass appearance (GGO) in both lungs supporting the diagnose  of Covid-19. On the 16th day of treatment, the child suffered respiratory failure, hemoptoes, decreased consciousness until death. RT-PCR swabs were 3 times negative (during treatment and post mortem). Summary: Covid-19 is a serious and severe cause of respiratory tract infection. It has been reported that a girl of 14 years and 5 months who died of Probable Covid-19 has been reported. During the Covid-19 pandemic, a doctor  may need  to increase high awareness of other viral or bacterial infections to improve management  and outcome of patients in the future. Key word: Covid-19,  Children,  Ground Glass Opacity, RT_PCR

BackgroundPneumonia remains the leading killer with an estimated of 922,000 fatalities or 15% of all deaths in <5-year-old children in 2013. Mortality can be reduced by providing appropriate treatment to the pathogens. The objectives of this study were to describe the causes of pneumonia that may change after the introduction of vaccines and to identify biomarkers to differentiate between bacterial and viral infection.MethodsA 2-year multicenter cohort study of children between 2-month–5-year old with pneumonia has been conducted in three hospitals in Indonesia since July 2017. Demographics, clinical, laboratory, radiology, treatment data, have been recorded. Blood, urine, nasopharyngeal swab, sputum/induced sputum, specimens have been collected for biomarkers, culture, molecular and serological tests.ResultsThree-thirty from 99 pneumonia subjects screened were enrolled in this study since July 2017. 20 (60.6%) subjects had bacterial and viral coinfection, 10 (30.3%) subjects with bacterial infection, two (6.0%) subjects with viral infection, and one (3.0%) subject had unknown etiology. Demography, clinical signs and symptoms, disease and vaccination history, laboratory, and radiological evaluation are shown in Table 1. The etiologies of pneumonia are described in Figure 1.ConclusionMixed viral and bacterial infection were predominant. Several atypical pathogens were identified. No significant different in biomarkers between viral, bacterial and mixed infection groups was found. This finding highlights the need to improve diagnostic capacity to aid clinicians in pneumonia management. Disclosures All authors: No reported disclosures.