Slide Session : OS-IFD-08 ; Infectious Disease : West Nile Virus (WNV) as a Potential New Threat to HIV/AIDS Patients in Indonesia

( Nasronudin ),( Bimo Aksono ),( Bimo D Lukito ),( Brian E Rachman ),( Noordiansyah ),( Retno Indrawati ),( Retno P Rahayu ),( M Inge Lusida ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

NASRONUDIN1, Bimo AKSONO1, Bimo D LUKITO4, Brian E RACHMAN2, NOORDIANSYAH7, Retno INDRAWATI1, Retno P RAHAYU1, M Inge LUSIDA1 Institute of Tropical Disease, Airlangga University, Indonesia1, Medical Faculty Airlangga University - Dr Soetomo Hospital, Indonesia2, Medical Faculty Airlangga University - Dr Soetomo Hospital, Indonesia3, Medical Faculty Airlangga University - Dr Soetomo Hospital, Indonesia4, Faculty of Dentistry, Airlangga University, Indonesia5, Faculty of Dentistry, Airlangga University, Indonesia6, Airlangga University Hospital, Indonesia7 Background: WNV is a mosquito-borne zoonotic arbovirus, belongs to the genus Flavivirus in the family Flaviviridae. Although WNV infection in human has been reported for decades in several parts of the world, but it was diagnosed recently in 2014 in Indonesia. Approximately 80% of WNV infections in humans do not develop any symptoms. Elderly or those with immunosuppression, such as HIV/AIDS, are at greater risk for serious illness. Phylogenetic analysis has divided WNV into mainly Lineage 1(L1) and Lineage 2 (L2), which is geographically specifi c. Aims: To determine and phylogenetic analyse of WNV on HIV/AIDS Patients. Methods: The subjects were HIV/AIDS patients in Airlangga University Hospital. Examination of blood samples were performed in Institute of Tropical Disease Airlangga University. This study has been approved by Ethical Committee. A total of 30 HIV/ AIDS patients were enroled after obtainined informed consent, and examined for WNV RNA using RT-PCR in the envelope region (408 bps). Results: The results showed that 8 (25.81%) of 30 HIV/AIDS patients were WNV positive. The phylogenetic of one WNV strain in this study showed that it belongs to the L2. Only recently were those strains of L2 identifi ed outside of Africa. Conclusions: We found WNV as one of the potential coinfections in HIV/AIDS patients in Indonesia, and therefore it may in other countries too. Phylogenetic analysis of one strain revealed that the virus clustered in the lineage 2.

Poster Session : PS 0397 ; Infectious Disease ; Analysis of Japanese Encephalitis Virus (JEV) as Trigger for Secondary Infection in HIV/AIDS Patients in Indonesia

( Brian Eka Rachman ),( Retno P Rahayu ),( Nasronudin Nasronudin ),( Noordiansyah Noordiansyah ),( Bimo D Lukito ),( Retno Indrawati ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The HIV infection is associated with immunecompromised and rising in opportunistic infection. Therefore, it is predicted that death caused by HIV/AIDS would increase. The main problem for HIV/AIDS patients are opportunistic infection caused by Japanese Encephalitis (JEV) which is rarely found and diffi cult to diagnosed in Indonesia nowadays. Methods: This study is an observational descriptive. Cross sectional technique was used in this study. The amount of samples were 30 HIV/AIDS patients. Enzyme-linked Immunosorbent Assay (ELISA) was used to test IgG and IgM, and Real Time Polimerase chain reaction (RT-PCR). The sample was obtained from HIV/AIDS patients` blood, then CD4 and viral load were tested to detect JEV secondary infection. Results: There were 93,54% of HIV/AIDS patients have undergone ARV therapy for 1-3 years. HIV/AIDS is mostly sexually transmitted with 67,74%. The distribution of HIV/AIDS patients in stage I is 41,94%, 35,48% in stage II, and 22,58% in stage III. The HIV>4x102 viral load test revealed 20% of the samples are infected by JEV. The intention of MDGs (Millenium Development Goals) is to achieve no new infection, no discrimination, no death associated to AIDS are expected to contribute in order to decrease death through early detection of secondary infection. This study might be used as new policies in impeding HIV/AIDS, so the MDGs target could be reached. Conclusions: This research shows that ARV therapy is not enough to prevent secondary infection, such as JEV in HIV/AIDS patients. Therefore, it is necessary to give antimicrobes therapy and adequate nutrional supports.

Slide Session : OS-IFD-05 ; Infectious Disease : Displacement of the Predominant Dengue Virus from Type 2 to Type 1 in Surabaya, Indonesia Within March 2012 - April 2013

( Brian Eka Rachman ),( Maria I Lusida ),( E Bimo Aksono ),( Siswanto Siswanto ),( Musofa Rusli ),( Bramantono ),( Nasronudin ),( Umar F Achmadi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Indonesia is a country with high endemicity of dengue (haemorrhagic) fever (DF/ DHF). It was reported that dengue virus type 2 (DENV2) was the predominant circulating virus in 2003-2005 in Surabaya, Indonesia, while Yamanaka et al., 2011 reported shifting of DENV serotypes between 2008 - 2010 in three times survey. This study was part of the clinical trial phase three of antivirus against dengue, held in year 2012-2013. Methods: A total of 317 serum samples were collected from patients with fever on day-1 or day-2, suspected dengue infection according to WHO criteria, showed positive result either by NS-1, and or IgM - IgG within March 2012 - April 2013. After an RNA extraction, a multiplex DEN 1-4 quantitative Real-Time PCR was applied to each sample. Results: Sixty three (90%) of 70 PCR positive sera collected within March 2012 and May 2012 showed DENV2, then 5(7.2%) DENV1, 1(1.4%) DENV3, and 1mixed of DENV1+3. Surprisingly, it was totally different for those collected since June 2012 until April 2013. Fifty three (50%) of 106 positive samples were DENV1, 5 (4.7%) DENV2, 35 (33%) DENV3, 7 (6.6%) DEN4, and 2, 2, 1 mixed type of DENV 1+3, DENV1+4, DENV 3+4 respectively. Conclusions: There was a displacement of the predominant type of dengue virus circulating in Surabaya within March 2012 - April 2013. Such kind of predominant DENV shifting from type 2 to type 1 has occurred between October and November 2008. This indicates the need for continuous surveillance of the circulating viruses, which may predict the risk of severe DHF and mild DF as reported previously.

Poster Session : PS 0410 ; Infectious Disease ; Melaleuca Alternifolia Concentrate (MAC) as a Causal Therapy of Dengue Infection

( Nasronudin ),( M Inge Lusida ),( Brian Rachman ),( Musofa Rusli ),( Matoillah Isfandiari ),( Evhy Apryani ),( Vitanata Arfijanto ),( Sudibyo ),( Jt Tjahjana ),( Siswanto ),( Mj Reynolds ),( Umar F A 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Dengue infection is distributed throughout the tropical areas around the world, including Indonesia. Dengue fever/ dengue hemorrhagic fever is a mosquito- borne disease caused by dengue virus of any serotype 1 (DEN1) to DEN4. Until now, therapy is based on pathophysiology. Aims: To evaluate the effi cacy and safety of MAC for the treatment of dengue infection. Methods: This clinical trial phase III was designed to study the inhibitory property of MAC against dengue virus (DENV) activity. A double-blind, randomized, controlled trial method was approved by Ethical Committee of Dr. Soetomo Hospital. This study was conducted from January 2012 to November 2013. After a signed informed consent, 530 patients, fever on day-1 or day-2, suspected dengue infection according to WHO criteria, showed positive result either by NS-1, and or IgM - IgG, were recruited. The subjects were divided into 2 groups. Group I received WHO standard treatment and 300 mg - MAC twice daily orally for 7 days. Group II received WHO standard treatment only. History, physical examination and complete blood count were done every day. Laboratory test (liver function, kidney function, CD4, CD8, VCAM, viral load) were performed on the fi rst, fourth and seventh day. Results: The results showed that the quantity of virus signifi cantly decreased in the treatment group (96.67%) compared to the control group (44.79%). Also showed that MAC did improve the immune system by increasing the value of CD8 (6.89%) and CD4 (9.95%). MAC provision does not interfere with the function of liver and kidney, and was well tolerated by the patients. Conclusions: MAC has signifi cant reduction of viral load level, may have immunomodulatory effects, prevent the plasma leakage, no hepatotoxic and nephrotoxic effects. MAC effi cacy as an antiviral agent against DENV infection has been very effectively illustrated.

Poster Session : PS 0421 ; Infectious Disease ; Demographic and Seroepidemiologic Patterns of Dengue Infection in Surabaya, Indonesia

( M Atoillah Isfandiari ),( M Inge Lusida ),( E Bimo Aksono ),( Brian E Rachman ),( Rahayu Anggraini ),( Musofa Rusli ),( M Vitanata Arfijanto ),( Nasronudin ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Dengue infection cases in Surabaya, contributed to more than 25% of cases in the East Java province during 2012-2013. This study was held to determine the patterns of dengue infection in Surabaya based on patient demographic and types of the virus prior to a clinical trial study of herbal medicine for the treatment of dengue infection Methods: A total of 460 patients with dengue infection diagnosed by specific non-structural 1 (NS1) antigen and or IgM/IgG examination, with fi rst or second day of fever, distributed in 10 hospitals and 15 health centers, obtained during January 2012 to November 2013, were included in this cross-sectional study. Strain identifi cation was based on multiplex RT-PCR for DEN1 to DEN4. The level of CD4 molecules on T-Lymphocytes were also quantitatively determined by ELISA Results: Around one third of the patients (34.6%) were aged between 21-60 y.o, with the rests were under 21 y.o. The dengue type was identifi ed in 209 patients. Among them, 77% were single type infection and 19% were double or more type infection, with DEN1 (34,9%) to be the most prevalent. The average level of CD4 molecules among patients was moderate (5.86±9,1 ng/mL), with no signifi cant difference level among each age group. During the two-year of study, the number of incidence per month fi uctuated between 1 to 80 cases, but tended not to follow general seasonal pattern. Conclusions: In Surabaya, Dengue infections are likely to be found widely among adults, with the pattern of incidence per month tend not to follow regular seasonal pattern. Among all strains, DEN 1 was most widely identifi ed, either as single or double infection with other strains during the period of study. Healthcare preparedness to care dengue infection patients should be conducted throughout the year.