BackgroundBacteriological confirmation of tuberculous (TB) meningitis is difficult. Culture is slow and microscopy has insufficient sensitivity. We evaluated real time PCR targeting insertion sequence IS6110 among 230 consecutive adult patients with subacute meningitis in a referral hospital in Indonesia.MethodsCerebrospinal fluid (CSF) samples were examined using microscopy, solid and liquid culture, and real time IS6110-PCR with a fluorescence-labeled probe using DNA extracted from CSF. CSF samples from 40 non-infectious neurology patients were used as negative controls. IS6110-PCR results were linked with clinical and CSF characteristics.ResultsMost patients presented with subacute meningitis, after a median of 14 days of symptoms (range 7–30). After exclusion of cryptococcal and bacterial meningitis, 207 patients were classified as definite or probable TB meningitis; 17.9% with HIV infection. Among this group IS6110-PCR gave the highest positivity rate (68%, 95% CI 62–74%) compared with microscopy of ZN-stained slides (11%, 95% CI 7–15%), and mycobacterial culture using solid (36%, 95% CI 29–42%) and liquid (44%, 95% CI 37–51%) media. IS6110-PCR was positive in 92% of patients with culture-positive and 42% of patients with culture-negative probable TB meningitis. Among culture-negative patients, a positive PCR was associated with a history of TB treatment, a longer duration of illness, a higher CSF cell count and protein, and a lower CSF glucose. IS6110-PCR was negative in all CSF samples from non-meningitis control patients.ConclusionsReal time IS6110-PCR is a quick, sensitive, and specific test for diagnosing of TB meningitis in this setting. Its performance in other (less-developed) settings needs further study.
BackgroundFluorescence microscopy (FM) has not been implemented widely in TB endemic settings and little evaluation has been done in HIV-infected patients. We evaluated diagnostic performance, time and costs of FM with light-emitting diodes technology (LED-FM), compared with conventional (Zieh-Neelsen) microscopy in a hospital in Indonesia which acts as referral centre for HIV-infected patients.MethodWe included pulmonary tuberculosis suspects from the outpatient and HIV clinic. Direct and concentrated sputum smears were examined using LED-FM and ZN microscopy by two technicians who were blinded for the HIV-status and the result of the comparative test. Mean reading time per slide was recorded and cost of each slide was calculated. Mycobacteria culture served as the reference standard.ResultsAmong 404 tuberculosis suspects from the outpatient clinic and 256 from the HIV clinic, mycobacteria culture was positive in 12.6% and 27%, respectively. The optimal sensitivity of LED-FM was achieved by using a threshold of ≥2 AFB/length. LED-FM had a higher sensitivity (75.5% vs. 54.9%, P<0.01) but lower specificity (90.0% vs 96.6%, P<0.01) compared to ZN microscopy. HIV was associated with a lower sensitivity but similar specificity. The average reading time using LED-FM was significantly shorter (2.23±0.78 vs 5.82±1.60 minutes, P<0.01), while costs per slide were similar.ConclusionHigh sensitivity of LED-FM combined with shorter reading time of sputum smear slides make this method a potential alternative to ZN microscopy. Additional data on specificity are needed for effective implementation of this technique in high burden TB laboratories.
INCREASING OF HOUSEWIVES POTENTIAL IN PROCESSING DOMESTIC ORGANIC WASTE BY USING TAKAKURA METHOD IN CIBIRU WETAN VILLAGE, BANDUNG REGENCY. Domestic waste (DW) is a major environmental challenge for many urban local bodies in Indonesia both in the village and in the city, where urbanization, industrialization and economic growth have resulted in increased waste generation per person. One way to solve this waste is to turn organic domestic into compost. Composting, the recycling of organic waste such as vegetation and food waste reduces the amount of waste going to landfill and is, therefore, a rapidly growing sector. Desa Cibiru Wetan, Kab. Bandung, West Java is one of the villages that has learned about how to process organic waste into compost and become a pilot project but because of the distance between raw materials and management with compost incubator so that compost production is disturbed. Therefore, the purpose of the project activity was to produce compost from domestic organic waste by the Takakura method. In this method, a small incubator was used and placed at the home of the community. Although on a small scale but with many multipliers, it able to produce an abundant compost and can be an alternative for the existing compost incubator method. The stage included counseling and socialization, training in making incubator Takakura, training in production compos,t and monitoring and evaluation. The results showed a good understanding of both groups for both the socialization and counseling stages as well as for the practice of production of compost. In conclusion, the activity on the production of compost by using Takakura method able was to solved for domestic organic waste and remind set the interest of the community in producing compost.
PARTNER VILLAGE IN FAMILY MEDICINE PLANT CULTIVATION TOWARDS CIBIRU WETAN VILLAGE AS A HERBAL CENTER. The area of Cibiru Wetan Village is a farming area because besides the limited water supply, the land is hilly. With the initiative and participation of women farmer groups which had so many achievements and skills, it was necessary to explore the potential that could provide a new icon for Cibiru Wetan Village. The purpose of the activity was to socialize and practice the cultivating of the medicinal plants carried out by a group of women farmers with simple and effective technology and finally able to become a center of dried herbs production. The method used in the cultivation program for medicinal plants was divided into three stages. The first stage was to provide material counseling on family medicinal plants including the understanding of the benefits of the plant, the second stage was to provide an explanation or training in planting family medicinal plants and the last stage or third stage was to practice directly in planting these medicinal plants. The results showed a positive understanding of both groups for both the socialization and counseling stages as well as for the practice of medicinal plants cultivation. It could be concluded, the partner village activities in medicinal plants cultivation could improve the understanding of the target group.
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