cryptococcal and tuberculosis meningitis...

Hal. 2 Bulletin CRID-TROPHID | Volume 2 No. 3 Mei-Agustus 2012

Meningitis has been one of significant diseases in Indonesia. Although

there has been a development in the field of diagnosis and treatment, meningitis still poses threats to the patients. Fact showed that the mortality rate of cryptococcal meningitis in Rumah Sakit Cipto Mangunkusumo (Cipto Mangunkusumo General Hospital or RSCM) was still high reaching at 23,1% in 2010. The diagnosis of tuberculosis meningitis was also a diagnostic challenge to many physicians. Knowing these problems, that was why Faculty of Medicine Universitas Indonesia (FMUI), Perkumpulan Dokter Spesialis Syaraf Indonesia (PERDOSSI) or Indonesia Neurologist Association, and CRID-TROPHID was held a guest lecture to discuss meningitis as its topic. In this special occasion, two kinds of meningitis mentioned above were discussed. The first speakers were dr. Darma Imran, SpS (K), discussing about criptococcal meningitis and DR Reinout van Crevel tuberculous meningitis respectively.

Criptococcal Meningitis: Diagnosis and Treatment

The increasing number of patients presenting with cryptococcal meningitis in RSCM had risen from 2003 to 2010, from 2 to 13 respectively.This increase was correlated with the increasing number of HIV infection. Meanwhile, the number of death had been lowered since the introduction of amphotericin B as one of the main antifungal treatment in cryptococcal meningitis (from

Cryptococcal and Tuberculosis Meningitis Update

50% in 2003 to 23,1% in 2010). Based on research in RSCM, one of the most important prognostic factors in predicting the outcome

of this type of meningitis was the density of cryptococcal organism in the CSF after being stained with India ink, with those whose Cryptococcus sp density in CSF was lower had better outcome (OR = 6,3; P = 0,003).

Diagnosing cryptococcal meningitis was a challenge for clinician. The symptoms of headache and fever were not specific for this disease. Thus, lumbar puncture tended to be delayed until the disease had advanced and the prognosis was poor. In cryptococcal meningitis,

it was important to remember that lumbar puncture was not only useful as diagnostic method, but also as a therapeutic modality. The experience in RSCM showed that in cryptococcal meningitis patients with increasing intracranial pressure, lumbar puncture was a life-saving intervention. The golden standard for the diagnosis of cryptococcal meningitis remained visualizing Cryptococcus sp in the CSF with the outward appearance of India ink and doing CSF culture. However, there was a more convenient method that could be used, which is the Dipstick cryptococcal antigen assay that utilized the CrAg lateral flow assay (LFA). The test can be interpreted as whether positive result on CSF confirmed cryptococcal meningitis, or negative result on CSF excluded cryptococcal meningitis. The positive result on blood (plasma or serum) suggested that cryptococcal meningitis was likely and a lumbar puncture was indicated. However, if lumbar puncture became contraindicated then blood culture could be the altnernative diagnostic test.

The treatment of cryptococcal meningitis consisted of combination of two antifungal drugs. The first, and also the superior, is the combination between amphotericin B and flucytosine. However, in most of developing countries, the available combination was amphotericin B and fluconazole. The regimen dose for this combination was induction therapy for two weeks consisted of amphotericin B (0,7 – 1,0 mg/kgBW per day IV) and fluconazole (800 mg per day orally); continued

Reinout van Crevel was presenting the lecture about diagnosis and treatment of TB Meningitis

2 Bulletin CRID-TROPHID | Volume 3 No. 3 September-December 2012

Hal. 3Bulletin CRID-TROPHID | Volume 2 No. 3 Mei-Agustus 2012

by consolidation therapy consisted of fluconazole (800 mg per day orally) for 8 weeks; and as maintenance and prophylaxis, the available antifungal was fluconazole 200 mg per day orally. However, that current therapy still had its own problem. Even the most superior combination still yielded high mortality rate (15% in USA). Finding the high mortality rate, further research in new antifungal therapy was warranted. While waiting for newer and more effective antifungal therapy, a new adjunctive therapy was under trial. One of the adjunctive therapy was adding dexamethasone in the cryptococcal meningitis regimen that might be beneficial. The rationale behind this statement was that when patients were treated with ARV, infections would be unmasked because the immune system had been restored. Immune reconstitution might cause a very detrimental immunologic response to the host, thus the use of steroid might be justified. A trial in Vietnam showed a promising result. A trial in Indonesia was being conducted, called the CryptoDex trial, which had the aim to assess the effect of additional dexamethasone to the outcome of cryptococcal meningitis. The primary outcome in this trial was 10 weeks of survival.

Deadly Tuberculosis Meningitis

Tuberculosis meningitis was a rare complication of tuberculosis infection (2-3% of all tuberculosis cases). This complication was more commonly found in children, HIV patients, and immunocompromised patients. Why we should know about this was because tuberculosis meningitis is still a deadly disease (mortality rate around 30%) and hard to diagnose.

The most basic way to diagnose tuberculosis meningitis was by testing cerebrospinal fluid for protein, cells, glucose, microscopic examination, and culture. However, all these tests mentioned before required large amount of CSF (5-7 mL). Both culture and microscopic

test also proven to be insensitive for diagnosing tuberculosis meningitis that is confirmed in autopsy. Furthermore, culture was going slowly. As a consequence, prompt treatment might be delayed. PCR was proven to be more sensitive. However, RT-PCR was hard to be run routinely. There was a newer diagnostic method that could be used. The microscopic observation for drug susceptibility (MODS) was 5 times more sensitive than ZN, quicker than Ogawa solid culture, and cheaper than MGIT liquid culture. The median time required to yield positive result for MODS test was only 6 days compared to MGIT and LJ (15 and 24 days respectively). It was also important to note that MODS method was considered as affordable diagnostic method in many settings. It was also interesting knowing the fact of patients diagnosed as “probable tuberculosis meningitis” many of them had their condition deteriorated in spite of tuberculosis treatment. Retrospective analysis showed that 33% of 64 patients were positively infected with Toxoplasma, proven by PCR test.

Tuberculosis meningitis was a medical emergency. Treatment delay was strongly associated with death and empirical anti-tuberculosis therapy should be started promptly in all patients in whom the diagnosis was suspected. Recommendation from British guidelines 2009 stated that one should not wait for microbiological or molecular diagnostic confirmation to stard anti tuberculosis therapy. Optimal regimen for tuberculosis meningitis had not yet been defined. So far, current treatment only followed the model that had been used for pulmonary tuberculosis treatment. However, this regimen had its own problem. Rifampicin had low blood-brain barrier penetration and low CSF concentration, while pyrazinamide and INH provided good concentration in CSF. Adding fourth drug to the treatment was still doubted for its efficacy.

Other than standard regimen, another drug had its own potential in treating tuberculosis meningitis, namely moxifloxacin. Moxifloxacin is a group of fluoroquinolone with the highest in-vitro potency and good blood-brain barrier penetration. Current dose of moxifloxacin being used was 400 mg.

There was a trial that evaluated the pharmacokinetic safety and survival outcome in patients with tuberculosis meningitis. The regimen compared was the use of rifampicin 450 mg per oral versus rifampicin 600 mg intravenously, and ethambutol versus moxifloxacin 400 mg and 800 mg orally. The regimen was being combined with standard INH, pyrazinamide treatment, with adjunctive corticosteroid therapy.

The result described was quite convincing, the intensified dose of rifampicin showed higher maximum concentration in plasma and CSF (22,1 mg/L and 0,62 mg/L respectively), compared with the standard dose (plasma and CSF 6,3 mg/L and 0,27 mg/L respectively). Intensified moxifloxacin dose also showed good result with concentration in plasma and CSF (7,4 mg/L and 2,43 mg/L respectively), compared with standard dose (plasma and CSF 3,9 mg/L and 1,52 mg/L respectively). The survival rate was also improved in group given with intensified dose of rifampicin. The survival rate reached 62% with p value of 0,04. The disadvantage of the regimen is that it required rifampicin to be given intravenously. Further study using oral regimen is needed.

In the end, it was true that the diagnosis and treatment of cryptococcal and tuberculosis meningitis were not easy. However, current development showed that it would get easier to diagnose these diseases, and the development of treatment regimen might improve patients’ survival rate.

3Bulletin CRID-TROPHID | Volume 3 No. 3 September-December 2012


Faculty of Medicine Universitas Indonesia (FMUI) through CRID-TROPHID and Continuing Medi-

cal Education (CME), in collaboration with Japan International Cooperation Agency (JICA) and Japan Science and Technology Agency (JST), held scien-tific meeting on infectious disease on 24th October 2012. The meeting titled “Advance Update on Pathogenesis of Viral Infection: Hepatitis, Dengue, Coxsackie, Epstein Barr, and HIV” was held in FMUI auditoriumwith videocon-ference session linked to five universi-ties in Indonesia

Four people gave opening re-marks, they were dr. Yusuke Fukuda as Chief Representative of JICA, Ms. Yuko Sato as Chief Research Partnership for Sustainable Development Division of JST, Dr. dr. Ratna Sitompul, SpM(K) as dean of FMUI, and Prof. dr. Amin Soe-bandrio, SpMK, PhD from Indonesian Ministry of Research and Technology. The dean of FMUI said that viral infec-tion is one serious cause of morbidity and mortality in Indonesia. Death-re-lated dengue is more than 1% in Indo-nesia, which is the highest in ASEAN. Nasopharyngeal carcinoma caused by Epstein Barr virus (EBV) contributes a significant number among other head and neck tumors to cancer prevalence in Indonesia. HIV and hepatitis num-ber in Indonesia are also quite high in some regions. Therefore, a synergistic approach has to be applied to over-come this burden.

After opening remarks, plenary on “Epidemiology and Pathogenesis of Hand, Foot, and Mouth Diseases (HFMD) caused by Coxsackie” was given by Vincent T.K. Chow DipMicro-biol, MD, FRCPath, MBBS. MSc, PhD from National University of Singapore. This 60 minute-course raised people awareness to HFMD. HFMD leads to severe neurologic complications such

as aseptic meningitis, encephalitis in brainstem region, acute flaccid paraly-sis similar to poliomyelitis, and neuro-genic pulmonary edema. Moreover, HFMD could be an outbreak in Indo-nesia since it had ever happened in Singapore on 2005. HFMD might be a threat for generation in one country as it was commonly infecting children less than 5 years old.

The first seminar started in ad-vance after a relaxing coffee break. It was hosted by Dra. Beti Ernawati Dewi, PhD. This session discussed about dengue infection. First speaker was dr. Tomohiko Takasaki from National Insti-tute of Infectious Disease, Japan. He explained about current development of dengue vaccine. There were sev-eral types of dengue vaccine develop-ing right now. These vaccines were at stage of clinical trial phase 2b and 3. However, there were still a lot of chal-lenges to make dengue vaccine ready to be used. The second speaker, dr. Leonard Nainggolan, SpPD-KPTI from Universitas Indonesia told the audi-ence about “Recent Advanced Patho-physiology of Dengue Infection”. Two theories rose in pathophysiology of dengue infection, which are Antibody Dependent Enhancement (ADE) and antigenic sin theory. These both path-ways produced stronger infectivity and weaker immune reaction.

In the next session, two speakers were delivering materials about hepati-tis infection. First, Prof. Hak Hotta, MD, PhD from Kobe University Japan pre-sented about “Hepatitis C Virus (HCV) Heterogenicity and Responses to Interferon-based Therapy”. Professor Hotta explored pre-treatment predic-tive factors for virological responses to therapy in patients infected with HCV of various genotypes. Host factors, specifically single nucleotide polymor-phism in IL28B gene on chromosome

19 and viral factors, played roles in the responses. He also assessed what fac-tors contributing to the development of hepatocellular carcinoma in patients with HCV infection. Second, Prof. dr. Maria Inge Lusia, Mkes, PhD, SpMK(K) from Universitas Airlangga gave a lec-ture about “HBV Mutations and Their Clinical Relatedness”. Prof. dr. Maria revealed that mutant HBV might evade protection given by vaccine today. Mu-tant viruses could also escape serolog-ical diagnosis using specific anti-HBs antibodies. Accodingly, occult chronic hepatitis B would develop and this was a serious public concern. The modera-tor, Dr. dr. Rino A. Gani, SpPD-KGEH, closed this session.

After that, the audiences were served special lunch in upper lobby of FMUI. Meanwhile, videoconfer-ence was being held on IASTH Build-ing. Universitas Sriwijaya, Universitas Padjajaran, Universitas Tanjungpura, Universitas Airlangga, and Universi-tas Udayana joined the broadcasted lecture given by Prof. Eiji Konishi from Kobe University, Japan. He gave re-cent update on dengue vaccine which is still on trial. He stated that it was compulsory to do trial in more than one country in order to spread the vac-cine. dr. Tjahjani Mirawati Sudiro, PhD closed the session with question and answer from all the universities.

HIV session led by Dr. dr. Evy Yuni-hastuti, SpPD-KAI were begun immedi-ately after lunch. In this session, Prof. dr. Zubairi Dojerban, SpPD-KHOM, FINASIM gave some good reports about HIV treatment using antiretroviral (ARV). He said that there was possibil-ity to cure HIV today. Two people with HIV had been proven to be free from HIV after taking ARV. One of them was Timothy Brown from Berlin. In Wash-ington DC, no children were born with HIV since 2009. In Indonesia, people

Advance Update on Pathogenesis of Viral Infection

Discussing about dengue infection (left to right: dr Leonard Nainggolan, SpPD-KPTI, dr Tomohiko Takasaki, Dra. Beti Ernawati Dewi)



taking ARV medication could reach functional cure in their daily live. Dr. dr. Budiman Bela, SpMK(K) was the sec-ond speaker in the third session. He reported about the “Indonesia Consor-tium for Development of HIV Vaccine, Diagnostic, and Drugs”. The consor-tium was made in the middle of 2012. It was expected that vaccine develop-ment would be accelerated and HIV diagnostic could be cheaper through this consortium.

Last session revealed EBV infec-tion deep down to its biology molecu-lar. Mrs. Jajah Fachiroh, S.P, M.Si, PhD from Universitas Gadjah Mada gave a lecture about “Pathophysiology of EBV infection” while the next speaker, dr. Marlinda Adham, SpTHT-KL from Universitas Indonesia gave a lecture about “Epidemiology and Application of EBV’s Biology Molecular in Naso-pharyngeal Carcinoma Patients”. EBV

was a carcinogenic virus transferred via saliva and Waldeyer rings. The in-fection could occur at any stage of life. dr. Marlinda told that nasopharyngeal brush sampling combined with EBV-DNA load analysis could be done as early detection for nasopharyngeal carcinoma. Both speakers and the moderator, dr. R. Fera Ibrahim, MSc, PhD, SpMK, closed this event with an impressive way to deliver materials.

Global Health Governance; Dissolving Boundaries in the Technological Eras

On Thursday May 24th 2012, the entire participants of guest lec-ture held by CRID-TROPHID

were reminded about two important aspects regarding public health: firstly health is an investment for country de-velopment and secondly the fact that technology has dissolved the boundar-ies of nations, including the boundaries in public health.

Those two aspects were some of the im-portant points that the speakers of this guest lecture, Prof. dr. Firman Lubis, MPH (from Univer-sitas Indonesia) and Prof. Dr. J.S.M. Anja Krumeich (from Maastricht Univer-sity) delivered in this two-hour-lecture. Prof. Firman Lubis, gave an overview regarding public health in Indonesia. He started his lecture by reviewing the short history of pub-lic health in Indonesia, starting from the colonial era, when the government at that time managed the public health through the Volksgezond-heids Dienst (Public Health Agency), to the independence era where the gov-ernment needed foreign aids to sustain the public health system, to our current system.

The reasons why improving the health of the society were plenty, some of which were as the health was one of the basic human rights, for the wel-fare and satisfaction of the people, to achieve social order and justice, and for the importance of productivity and economic development. During his lec-ture, Prof. Firman also reminded us that based on important health indicators (maternal mortality rate, infant mortal-ity rate, etc), the condition of our pub-

lic health were worse compared to our neighboring countries. This fact should encourage us to improve our health-care system to achieve better health standard. How we could achieve it, was the main problem. It was easier to say than to do it, but with good strat-egy, we could always achieve what we desire. The main strategy that we could always rely on was to strengthening our

health care system at the primary level.

The role of primary health care provider was very important since they were who saw the patient first, and had the opportunities to do preven-tive treatment whether primary or sec-ondary prevention. This strategy was also efficient, because 70-80% health problems could be handled in primary carewith affordable cost. Majority of health care service was mainly provid-ing promotion, prevention, and general care service. However, sometimes this strategy was hampered by the qual-ity of the primary healthcare provider. To solve this problem, the government should upgrade general practitioners into family physician and provide ad-ditional training (through continuing medical education, seminars, train-

ing, etc) to improve the quality of the primary healthcare provider. Other strategies to improve our public health quality consisted of strengthening the effectiveness, efficiency and quality of health care system as a whole inte-grated system and providing universal health insurance.

The second speaker, Prof. Anja Krumeich, mainly talked about how the

advancement of technol-ogy had blurred bound-aries of public health between countries and it had caused new prob-lems and emerged old problems. Intensified travelling caused dis-eases to travel faster and easier. Shifting econom-ic interdependencies net effect is to blamed of the redistribution of poverty, wealth and health. The changing climate, as the impact of technology advancement, caused

diseases such as dengue and malaria to spread more widely and natural di-saster such as tsunami, hurricane, and draught occurred more often. The im-proving public health system in many countries enabled people to live lon-ger, however the gap of life expectancy rate increased between and even with-in countries. The opening opportunities for people beyond their previous limit, their country of origin that was, caused health care professionals (and other professional) to move from their coun-try causing brain drain.

All these new conditions or emerg-ing old problems are certain prob-lems we face today. These problems dissolved the boundaries between countries. Questions such as coun-tries who was responsible, who was in


Prof. Dr. J.S.M. Anja Krumeich (middle) and Prof. dr. Firman Lubis, MPH (fourth from left) as speakers


Infectious diseases have been long known as a great burden to any developing countries. Latest survey

proved that it is also a problem faced by Indonesia. National health survey indicates that in many rural and urban areas in Indonesia, the incidents of infectious diseases play a significant role in the diminishing of indonesian people’s health quality , and to make it worse, it is increasing in an alarming rate. It is still a national threat we all must face today, and therefore, a throughout understanding of host’s molecular aspects of infection and immunological response is necessary for any physician in our country.

As the leading force in the field of education, Faculty of Medicine Universitas Indonesia (FMUI) must take the responsibility of taking an action to provide such knowledge, and on March 2nd 2012 it was made possible with the help of Center of Research and Integrated Development of Tropical Health and Infectious Disease (CRID-THROPID) and Utrecht University.

The guest lecture was given by dr. Kaloyanova and Prof. Helms J. Bernd from Utrecht University – both are experts in the field of biology molecular – and was divided in three sessions, each dedicated to molecular aspects of host’s immunologic response to infection, followed by a session of discussion. The role of moderator was

entrusted to the capable hands of our own expert in molecular biology, Prof. Dr. Mohamad Sadikin, Dsc.

Prof. Dr. Mohamad Sadikin, Dsc. also took the chance to give the audience a brief introduction about proteomic identification and lipidomic analysis, a concept that is new for many of us. The proteomic

identification and its predecessor-genomic identification, are both a well-known method in molecular biology, while the idea of lipidomic analysis is a relatively new breakthrough. The idea is that phospholipids in cell membrane are constantly produced and replaced, and that pathogens may disturb the balance of protein and other cell structures in the events of infection. Thus, infection would also impede in the synthesis of cell membrane, and depending on the pathogens involved and the progress of the infection, a

Proteomic Identification and Lipidomic Analysis on Host’s Aspects of Infection and Immunological Response

charge, and who was in control arose. By the end of World War II, there was an increasing anti-government senti-ment. Because they did not need to provide strong public health service to counter communism, breakdown of public health system took place. In the end, new player in public health service started to emerge. Private sec-tors, NGO, and philanthropist started to pour their effort in the public health sector. Although it looked good at the surface, there were several problems arising from these players; they tended to be flexible but unstable and con-stantly shifting. In consequence, they could not provide stable, sustainable service. Their service tended to be not

comprehensive. It was also important to highlight that these players only of-fer technological quick fix rather than structural change. That meant, instead of fixing the currently insufficient sys-tem, they only provided short-term-needs without considering potential harm that might occur in the future. What’s more, these players tended to be not transparent, hence complicat-ing accountability.

Blurring boundaries also caused genetic expression to vary. The chang-ing temperature, lifestyle, chemical environment, stress, etc. could cause kinds of expression on genes. Thus the complexity increased due to the changes in genetic expression and

cultural conduct.

The interaction between science and social factor also kept on occur-ring. The societal structures, institu-tions, norms and values became the foundation of technological develop-ment. Knowledge, standards and tech-nology developed according to the norms and values of a society could not be implemented in another society without complication and (unexpected) side effects. Stem cell for example. All these challenges arising from the dis-solving boundaries, namely complex-ity, interdependencies, gaps, would have to be answered by physicians and of course, government.

cell may express a membrane that is different from a membrane expressed by a healthy cell. This feature would make it possible for physicians to form a diagnosis based on the examined state of cell membrane.

Following the introduction, dr. Kaloyanova presented the result of her research in quantitative proteomic

identification of host factors involved in the Salmonella typhimurium infection cycle. Using isotope-labeled amino acids, it was possible to investigate protein profiles from Golgi-enriched fractions of the pathogen-infected cells and to compare the result with normal cells. This comparison would lead to the discovery that there was a significant increase or depletion to no less than 105 proteins. The classification of these 105 proteins revealed that increment or depletion was depending on the attribute of

said protein, and further experiments done by adding and removing some of these proteins. These results gave us a new insight on the interactions of Salmonella typhimurium and human epithelial cells.

This guest lecture had provided us with a greater insight and understanding in host’s aspects in infectious diseases. We also hope that this event will encourage a greater breakthrough and collaboration in the future that would assist us in improving this country’s health quality.

dr. Kaloyanova and Prof. Helms J. Bernd were talking about molecular aspects of host’s immunologic response to infection



Increasing Society Awareness of Transmitted Infection (STRAIN)

On Saturday, Septem-ber 22nd 2012, CRID-TROPHID carried out

a meeting concerning sexu-ally transmitted infections (STIs). Collaborating with Prodia labo-ratory as main sponsorship, STRAIN was held in Auditorium Room in Prodia Laboratorium at Kramat Raya 150, Central Jakar-ta. The background of this event was the awareness to improve people’s knowledge on sexually transmitted infections. The as-pects discussed were mainly about the definition, transmis-sion, complication, treatment, and prevention of sexually transmitted infections. Most of the audiences were interested , seen by many questions were asked to the speakers. There were 93 audiences coming from laypersons, academy of obstetrics, midwives, medical students, and general practitioners.

There were four consultants and one representative from Prodia labora-tory who conveyed the material, name-ly dr. Hanny Nilasari, SpKK(K) and Dr. dr. Wresti Indriatmi, SpKK(K), M.Epid from dermatology department, Prof. Dr. dr. Endang Basuki, MPH from com-

munity medicine department, Dr. dr. I. P. G. Kayika, SpOG(K) from obstet-rics and gynecology department, and lastly, Miftakh Nurrakhman S.Si from Prodia laboratory, with the moderator of the discussion was dr. Fadly Nanda Al-Fattah.

dr. Hanny started the material about general knowledge of sexually transmitted infections. Continued by Dr. dr. I.P.G. Kayika who delivered material about complication of sexually trans-mitted infections. The material was giv-en to achieve the understanding of the

audiences about the importance of recognizing the sign and symptoms, treatment, and also the prevention of it. Almost of all the audiences listened to the lec-ture enthusiastically, especially to the material presented by Prof. Dr. dr. Endang about the preven-tion and health promotion related to sexually transmitted infections.

The materials presented were crucial concerns to medi-cal workers, because they are

the primary communicator to the patients. Dr. dr. Wresti had passion to make the society to have better knowledge about the sexually transmitted infec-

tions. She gave lecture about how to diagnose special case and give early treatment. Miftakh from Prodia labora-tory shared about the laboratory as-sessment regarding the sexually trans-mitted infections.

The meeting was closed by dis-cussion with the audiences and the speakers. The committees hoped that this event could be annually held on different locations so that society will be more aware to sexually transmitted infections and have better knowledge about them.

Prof. Dr. dr. Endang Basuki MPH was explaining about the behavior to prevent and health promotion related to sexually transmitted infection


On Tuesday, July 3rd 2012, once again CRID-TROPHID held a research grants’ presentation in

the meeting room, first floor of the library of Faculty of Medicine Universitas Indonesia (FMUI). Unilever Indonesia had given the grants to CRID-TROPHID for a three-year research on healthy behavior through their products. The meeting discussed the progress from the first year of the researc.h The researcher is expected to report their result to the representatives of Unilever Indonesia. The event started at 12.30 pm by dr. Pradana Soewondo, SpPD-KEMD, who moderated the sessions.. Executive editor of CRID-TROPHID,

dr. Muchtarudin Mansyur, MS, SpOK, PhD, his staffs, and two presenters from other departments made a presentation. First, dr. Ahmad Fuad from Community Medicine Department presented the result of a study on : “Peran Modul Edukasi terhadap Perubahan Pengetahuan, Sikap, dan Perilaku Hidup Bersih dan Sehat Pelajar SD dan Faktor-faktor yang Berhubungan”. The metod of the study is cross-sectional and experimental study, which was conducted in two different elementary schools. The first school was represented by students of 4th to 6th grade as a control group. Meanwhile, the other school was

represented by students from 3rd to 6th grade as an intervention group. The sample in intervention group used more classes than the control group in order to mantain an equal number of population. The intervention group was received a training on the healthy living habits module.

The result was divided into five sections. From the variable knowledge and behavior, there was an inconsistency of knowledge from the pretest and posttest result between the control and intervention groups. This was because the students did not take this test seriously so that there was a possibility of not doing

Healthy Lifestyle in Eradicating Scabies


Prof. dr. Saleha Sungkar, DAP&E, MS, SpPark (middle), and dr. Ahmad Fuad (right) were answering questions from Unilever representative.


well and as a result of the intervention that was carried out in big classes. Other possible factors, such as the access of information, school facilities, school health unit, and socialization program of healthy behavior also influenced the resultd. Regarding the behavior aspect, there was an increasing result after the students were given the education module. The majority of students were successful to do 21-day-program launched and using the products from Unilever.

From the germ-hand pattern, there were an increasing number of non-pathogenic germs, namely E. coli and Klebsiella after washing hand. This might be the result of Picking up the bar soap from the floor, as all water sources had met the standard water requirement. From the whole sample, fecal parasites (1 to 3 parasites) were found in 89 out of 146 students observed. In the meantime, from the anthropometry indicator, the weight of students in control school was heavier than students in intervention school. However, the height of students in control school happened to be vice versa. More than 80% of the students in intervention school were classified as underweight based on Body Mass Index (BMI).

The last indicator was from skin disease. Pediculosis capitis had been found as the most problem among the students. It was related to healthy

behavior. There were also some other skin diseases found on some students there, for example hyperpigmentation postinflammation, xerosis cutis, and also insect bites.

The second research was presented by Prof. dr. Saleha Sungkar, DAP&E, MS, SpPark with the title “Efektivitas Permetrin dalam Pemberantasan Skabies”. As we know, scabies is the third commonest skin diseases among twelve others occurred in society. The most predisposition sites are fingers, wrist, abdomen, buttock, and male genitalia. The research was accomplished in Pesantren X, East Jakarta. The result

revealed that 60% children living there suffered from scabies due to the lack of healthy behavior such as bedding together, borrowing clothes

to each other, etc. Then, Saleha and team ran the treatment with dividing it into three groups; first group was treated by standard protocol and soap was given, second group by topical treatment only on lesions and soap was given too, and the last one by topical treatment only on lesions and received “Lifebuoy” soap (antiseptic soap) sponsored by Unilever. All groups were evaluated every week during four weeks. The result

showed that on the first and second week, standard protocol gave better result than other. Nevertheless, on the third week, there were no statistically differences among the groups. Lastly, on the fourth week, recurrence was found among the groups but there were no statistically differences.

In the end, the representative from Unilever gave comments and suggestions about the results and they would like to discuss for the future research grants. After that, Pradana ended the event with his closing statement to maintain the cooperation between FMUI represented by CRID-TROPHID and Unilever Indonesia.

cryptococcal and tuberculosis meningitis...

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