SummaryA rapid single-step screening method for detection of glucose-6-phosphate dehydrogenase (G6 PD) deficiency was evaluated on Halmahera Island, Maluku Province, Indonesia, and in Shan and Mon States, Myanmar, in combination with a rapid diagnosis of malaria by an acridine orange staining method. Severe deficiency was detected by the rapid test in 45 of 1126 volunteers in Indonesia and 54 of 1079 in Myanmar, but it was difficult to distinguish blood samples with mild deficiency from those with normal activity. 89 of 99 severely deficient cases were later confirmed by formazan ring method in the laboratory, but 5 with mild and 5 with no deficiency were misdiagnosed as severe. Of the samples diagnosed as mild and no deficiency on-site, none was found to be severely deficient by the formazan method. Malaria patients were simultaenously detected on-site in 273 samples on Halmahera island and in 277 samples from Shan and Mon States. In Mon State, primaquine was prescribed safely to G6 PD-normal malaria patients infected with Plasmodium vivax and/or gametocytes of P. falciparum. The new rapid test for G6 PD deficiency may be useful for detecting severe cases under field conditions, and both rapid tests combined are can be useful in malaria-endemic areas, facilitating early diagnosis, prompt and radical treatment of malaria and suppression of malaria transmission.keyword rapid test, glucose-6-phosphate dehydrogenase, G6 PD deficiency, malaria diagnosis, acridine orange staining, field survey, Indonesia, Myanmar correspondence F. Kawamoto,

BackgroundMutations in pfdhfr and pfdhps genes have been shown to associate with sulphadoxine-pyrimethamine (SP) resistance of Plasmodium falciparum parasites. However, pfdhfr, pfdhps genotypes and the correlations to SP treatment outcome in Indonesia has not yet been well analysed.MethodsAfter obtaining informed consent, 61 uncomplicated falciparum malaria patients were recruited in Banjar district, South Kalimantan Province, Indonesia, from October 2009 to August 2010. They were treated by a single oral dose of SP and its effects on clinical and parasitological status were followed until day 28 after treatment. Occasionally, a thick smear blood film for microscopy observation and blood spot on a filter paper for pfdhfr and pfdhps genotype analysis were collected.ResultsPfdhfr and pfdhps genotypes from 24 P. falciparum-infected patients consisting of adequate clinical parasitological response (ACPR) (n = 6; 25.0%) and early treatment failure (ETF) (n = 10; 41.7%) or late parasitological failure (LPF) (n = 8; 33.3%) were obtained by sequencing. Two novel mutations of pfdhps gene, K540T and I588F, were determined in ten and five isolates, respectively. These mutations were present in the pfdhfr/pfdhps combined haplotypes of ANRNI/SGTGA (n = 6), ANRNL/SGTGA (n = 4), and ANRNI/SGEAA(588F) (n = 5), (mutation codons are bold typed); these haplotypes were mostly belonging to parasitological failure (ETF or LPF). The parasites acquiring five mutations in pfdhfr/pfdhps haplotypes and four mutations with additional I588F did not respond adequately to SP treatment.ConclusionMany of Plasmodium falciparum infected patients in Banjar district, South Kalimantan, Indonesia did not respond adequately to SP treatment and these low ineffectiveness of SP in this area was associated with two novel mutations of pfdhps, K540T and I588F.

Blastocystis spp. is the most common enteric parasitic infection found in several community surveys from developing countries. Blastocystis infections may cause gastrointestinal symptoms, but also cause extraintestinal symptoms such as urticaria and joint pain. Blastocystis infection can also be asymptomatic or a carrier. However, the prevalence of Blastocystis infection in children has not yet been fully investigated in Indonesia, particularly in Bali Province. This study aimed to determine the prevalence of Blastocystis and other intestinal parasites in elementary school children stools in Dukuh village, Karangasem regency. A cross sectional study was conducted in September 2016. A total of 103 school children stools were collected by informed consent and parasites were examined by microscopy with wet mounts method using Lugol’s iodine solution. Thirty-five school children were infected with Blastocystis spp. (35/103, 34%) that consisted of a single infection (29/35, 82.9%) and mix infection with other parasites (6/35, 17.1%). The mix infections were Blastocystis spp. and hookworm infection (1/6, 16.7%), Blastocystis spp. and Entamoeba coli (1/6, 16.7%), Blastocystis spp. and Giardia lamblia (2/6, 33.3%), Blastocystis spp. and Entamoeba histolytica/ Entamoeba dispar (1/6, 16.7%) and Blastocystis spp. and Entamoeba histolytica/ Entamoeba dispar and Giardia lamblia (1/6, 16.7%). The vacuolar forms of Blastocystis were dominantly found, in which was non-infectious form, whereas the infectious form is the cyst form and Blastocystis density was observed less than 5 cells per field of view at 400 magnification in all cases. This study concluded that the high prevalence of Blastocystis infection in elementary school children in Dukuh Village, Karangasem District, Bali that were dominantly single infections and several mix infections with other intestinal parasites. The high prevalence of Blastocystis infection in elementary school children suggested that it needs proper prevention measures for the children in this study area.

Soil transmitted helminthiasis are common in the world and cause illness, especially in developing countries. It can cause infection in humans by contact with parasitic eggs or larvae that live in moist and warm soil. Soil-transmitted helminthiasis is often caused by Ascaris lumbricoides, Trichuris trichiura, Ancylostoma duodenale, and Necator americanus. In Indonesia, Soil transmitted helminthiasis prevalence is still high in some places. The tropical climate and high humidity support for the development of worms like in Sorong District, but there was no data. The purpose of this study is to identify the presece of Soil transmitted helminthiasis in primary school children in Sorong District. A cross-sectional study was conducted in two elementary schools located in Sorong District, West Papua, Indonesia. The two elementary schools are SDN 22 in Klain village and SD  Inpres 24 in sub-district Mayamuk. Once collected, the pot that has contained stool is given formalin 10%. Stool examinattion using direct smear method to determine the presence of soil transmitted helminthiasis. Researchers get the subject as many as 147 children. The proportion of elementary school children by sex consists of 72 boys (49%) and 75 girls (51%). The prevalence of Soil transmitted helminthiasis as a whole was 30.6% (45/147) with 40.1% (18/45) single infections and 59.9% (27/45) mixed infections. The single infection that most frequent is Trichuris trichiura, then followed by Ascaris lumbricoides. Soil-transmitted helminthiasis mostly found in girl than boy and mostly found in 6-9 years age group.  The worm species that infect elementary school children in the district is Ascaris lumbricoides, Trichuris trichiura, Hookworm, and Strongyloides stercoralis. This is probably related with the climate and low sanitation level. To eliminate soil transmitted helminthiasis among elementary school children, in addition to routine treatment also needs intensive counseling about the importance of maintaining personal hygiene and the environment.

BackgroundWhile malaria incidence in Indonesia has decreased threefold in the last decade, more than 200,000 cases were reported in 2016. Different endemicity of Plasmodium falciparum malaria among several islands in Indonesia has been recognized and two unique mutations of P. falciparum dihydropteroate synthase (pfdhps) affecting sulfadoxine–pyrimethamine (SP) resistance were detected from the research of SP efficiency and genotype analysis in South Kalimantan. In this study, geographical distribution and origin of these pfdhps K540T and I588F mutations were analysed.MethodsMalaria parasites DNA from several endemic areas in Indonesia; Sumatera, Java, Kalimantan, Lombok, Sumbawa, Timor, Sulawesi, and Papua islands; in two periods, 2004–2006 and 2009–2012 were subjected for pfdhfr and pfdhps sequence analysis.ResultsDifferent genotype polymorphisms of pfdhfr and pfdhps were observed in the parasites from various regions in Indonesia and relatively more divergent genotypes were determined from Kalimantan isolates in both 2004–2006 and 2009–2012. The parasites containing K540T mutation were identified in 2004–2006 isolates from East Kalimantan, East Java and Sumbawa as an SGTGA haplotype. The other I588F mutation was also determined in 2004–2006 parasites, isolated from Lombok and Sumbawa islands as an SGEAA(588F) haplotype. The parasites with pfdhfr/pfdhps quintuple or sextuple mutation, a genotype marker of SP resistance, were determined mostly in Kalimantan in both 2004–2006 and 2009–2012.ConclusionAnalysis of the prevalence and pfdhfr/pfdhps combined genotypes of K540T or I588F mutations suggested that K540T might be origin in Kalimantan Island and I588F in Sumbawa Island and then these were spread to other areas along with people movement. This research indicates regular monitoring of drug efficacy and parasite genotype analysis is important to keep efficiency and prevent the spread of resistance. It is also essential for the latest anti-malarial drug artemisinin-based combination therapy.

ABSTRACT. An anopheline mosquito surveillance was conducted in the malaria endemic areas of Utan Rhee and Lunyuk counties, eastern Sumbawa Island, in 2004 and 2005. Eight species of Anopheles were collected, including a new record of An. balabacensis on the island.

Pregnant women are highly vulnerable to malaria infection in its endemic areas, particularly infection by Plasmodium falciparum that can cause premature, low birth weight, severe anemia in pregnant women, and death. Sulfadoxine-pyrimethamine (SP) for Intermittent Preventive Treatment for pregnant (IPTp) is used for malaria control in pregnancy recommended by the World Health Organization that has already been implemented in Africa. The P. falciparum resistance to SP has been reported in several malarial endemic areas, and mutations in the genes of Plasmodium falciparum Dihydrofolate Reductase (Pfdhfr) and Dihydropteroate Synthase (Pfdhps) are shown to be associated with parasite resistance to SP treatment. Genetic analysis of Pfdhfr and Pfdhps genes in pregnant women infected with P. falciparum has not yet been examined in Indonesia. The cross-sectional study was conducted at two subdistricts, Sungai Pinang and Peramasan, in Banjar district of South Kalimantan Province, where 127 pregnant women were recruited from 2008 to April 2010. Two important mutations in Pfdhfr gene (amino acid positions at N51 and S108) and three in Pfdhps gene (A437, K540 and A581) were analyzed by nested PCR-RFLP method. All of the seven pregnant women samples infected with P. falciparum presented PfDHFR 108N and PfDHPS 437G mutations. One of the samples had the additional mutation at PfDHPS 540, in which Lys is substituted by Glu. These results suggested that P. falciparum might present only some resistance to SP at Sungai Pinang and Peramasan subdistricts, Banjar District, South Kalimantan province, Indonesia. Although there were limited number of samples, this study showed only few mutations of Pfdhfr and Pfdhps genes in P. falciparum at Banjar district, South Kalimantan Province, that suggests SP might be effective for IPTp in this area. Thus, further analysis of the other mutation sites in Pfdhfr and Pfdhps genes and in vivo efficacy study of SP with more sufficient sample numbers will be necessary to confirm this preliminarily result .

AbstrakPatogenesis malaria berat masih belum diketahui menyeluruh. Episode malaria berat dapat disebabkan oleh dua keadaan, produksi tinggi pada fase awal IL-10 dan atau kurangnya produksi IL-10 pada fase transisi. Peran IL-10 pada malaria masih belum jelas diketahui. Penelitian ini bertujuan untuk menganalisis ekspresi IL-10 dalam kaitannya dengan patogenesis malaria berat pada mencit strain BALB/c yang diinfeksi P. yoelii 17XL.Penelitian eksperimental laboratoris dengan rancangan “post test only control group design” dilakukan, dan menggunakan 24 mencit strain BALB/c, betina, usia 7-8 minggu, yang dibagi menjadi 4 kelompok. Mencit BALB/c diinfeksi secara intraperitoneal dengan 1x105 P. yoelii 17XL, dan dikorbankan pada hari ke-3 dan ke-6 pasca infeksi. Parasitemia dan kadar hemoglobin diperiksa setiap hari. Jaringan limpa diambil untuk isolasi RNA. Ekspresi mRNA IL-10, TNFα, dan IFNγ dianalisis dengan RT-PCR. Mencit BALB/c dinfeksi dengan 1x105 P. yoelii 17XL menunjukan infeksi letal, yang ditandai dengan peningkatan parasitemia sejalan dengan penurunan kadar hemoglobin, terjadi setelah hari ke-3 pasca infeksi. Ekspresi mRNA IL-10, begitu pula dengan TNFα dan IFNγ pada hari ke-3 paska infeksi menunjukan peningkatan dibandingkan pada kontrol dan hari ke-6 paska infeksi. Tidak adanya ekspresi IL-10 pada H6, menunjukkan kemungkinan adanya kegagalan regulator mengontrol malaria berat pada infeksi P. yoelii 17XL pada mencit BALB/c.   Kata kunci— mRNA IL-10, RT-PCR, patogenesis malaria berat, mencit BALB/c yang diinfeksi P. yoelii 17XL