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Article ; Online: Prophylaxis vs. Preemptive Therapy of CMV Disease in High-Risk Kidney Transplantation Patients

Ariani Intan Wardhani / Rahajeng N. Tunjungputri / Erpryta Nurdia Tetrasiwi / Maruhum Bonar Marbun

Jurnal Penyakit Dalam Indonesia, Vol 10, Iss 3, Pp 151-

An Evidence-Based Case Report

2023 Volume 157

Abstract: Kidney transplant recipients require the use of immunosuppressive agents to prevent multiple organ rejection. Administration of immunosuppressive agents triggers an increased risk of impaired immunity and microbial infections, one of which is ... ...

Abstract	Kidney transplant recipients require the use of immunosuppressive agents to prevent multiple organ rejection. Administration of immunosuppressive agents triggers an increased risk of impaired immunity and microbial infections, one of which is cytomegalovirus (CMV). Prevention of cytomegalovirus infection can be given as a prophylaxis or preemptive therapy. However, the efficacy of choosing prophylaxis or preemptive therapy is still under debate, thus we conducted this study to identify current approach in preventing CMV disease in clinical practice. A literature search was carried out using the PubMed, Cochrane Library, Embase and Scopus databases with the keywords “high risk kidney transplant”, “prophylaxis”, “preemptive” and “CMV infection disease”. Inclusion criteria were only studies in adult kidney transplant patients as a population. , prophylaxis as intervention, preemptive therapy as comparison, and cytomegalovirus infection as outcome. The exclusion criteria of this study were the study articles that were not in Bahasa Indonesia or English, case reports and studies with subjects <18 years old. Critical review using Oxford Center for Evidence Based Medicine (CEBM) Critical Appraisal Tools for Prognostic Study And Systematic Review. The total number of articles identified based on the keywords used is 115 articles. Eliminating duplication with EndNote resulted in 92 articles. Furthermore, exclusion was carried out based on title and abstract so that 29 articles were filtered for which the full text was available. Of these, 23 articles did not have appropriate research questions, 3 studies did not have appropriate patient populations, and 3 articles with types that did not meet the inclusion criteria of this study. As a result, there were 4 articles that can be used in this report. Based on those four articles, it can be concluded that prophylaxis is more effective in preventing CMV disease but had more side effects, when compared to preemptive therapy. However, there was no difference in long term ...
Keywords	cytomegalovirus ; preemptive therapy ; prophylaxis ; renal transplant ; Internal medicine ; RC31-1245
Subject code	610
Language	Indonesian
Publishing date	2023-09-01T00:00:00Z
Publisher	Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Hospital-acquired Skin and Skin-structure Infection in COVID-19 Infected Patient with Prolonged Hospitalization.

Nelwan, Erni Juwita / Tunjungputri, Rahajeng N / Tunjung, Narottama / Widodo, Djoko

Acta medica Indonesiana

2021 Volume 53, Issue 1, Page(s) 105–107

Abstract: Acute bacterial skin and skin-structure infections (ABSSSI) is defined in 2013 by the US Food and Drug Administration as a bacterial cellulitis/erysipelas, major skin abscesses, and wound infections. The Infectious Diseases Society of America (IDSA) in ... ...

Abstract	Acute bacterial skin and skin-structure infections (ABSSSI) is defined in 2013 by the US Food and Drug Administration as a bacterial cellulitis/erysipelas, major skin abscesses, and wound infections. The Infectious Diseases Society of America (IDSA) in 2014 classifies skin and soft-tissue infection (SSTI) as either non-purulent (which includes cellulitis, erysipelas, and necrotizing infection) or purulent (including furuncle, carbuncle, and abscess). Among hospitalized patients with SSTI, healthcare-associated infections account for 73.5% of all cases. Notably, skin and skin-structure infections caused by Pseudomonas aeruginosa, a common hospital pathogen, was reported to cause higher total cost and longer hospital length of stay compared to non-P. aeruginosa cases, despite causing only approximately 5.7% of all healthcare-associated SSTIs. Infection with P. aeruginosa should always be considered in non-healing skin infections in patients with prolonged hospitalization and antibiotic exposure. Tissue culture, preferably taken by surgical debridement, should be promptly performed; and when hospital-infection is suspected, appropriate antibiotics should be started along with removal of all devitalized tissue and to promote skin and soft tissue healing. Expedited discharge should be considered when possible, with adequate antibiotic treatment and follow up for definitive wound treatment.
MeSH term(s)	Anti-Bacterial Agents/administration & dosage ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/physiopathology ; Debridement/methods ; Female ; Hospitalization ; Humans ; Iatrogenic Disease ; Linezolid/administration & dosage ; Middle Aged ; SARS-CoV-2/isolation & purification ; Skin/microbiology ; Skin/pathology ; Skin Diseases, Infectious/diagnosis ; Skin Diseases, Infectious/etiology ; Skin Diseases, Infectious/physiopathology ; Skin Diseases, Infectious/therapy ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents ; Linezolid (ISQ9I6J12J)
Language	English
Publishing date	2021-04-05
Publishing country	Indonesia
Document type	Case Reports ; Journal Article
ZDB-ID	2474707-5
ISSN	2338-2732 ; 0125-9326
ISSN (online)	2338-2732
ISSN	0125-9326
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Article: Black Fungus Complicated with COVID-19 in a Man with Underlying Non-Hodgkin's Lymphoma.

Nelwan, Erni J / Tunjungputri, Rahajeng N / Wardani, Retno S / Wahyuningsih, Retno

Acta medica Indonesiana

2021 Volume 53, Issue 3, Page(s) 349–351

Abstract: COVID-19 is a disease reported to suppress cellular immunity. This may lead to the development of opportunistic infections, among others black fungus, or mucormycosis. On the other hand, pre-existing defect in immunity may render patients susceptible to ... ...

Abstract	COVID-19 is a disease reported to suppress cellular immunity. This may lead to the development of opportunistic infections, among others black fungus, or mucormycosis. On the other hand, pre-existing defect in immunity may render patients susceptible to both mucormycosis and COVID-19. Mucormycosis is a relatively rare fungal infection with rapid progression unless diagnosed promptly and treated adequately, and urgent surgical and medical intervention is lifesaving. The manifestation of mucormycosis largely depends on the presence of exposure to the pathogen and the existing risk factor of the host. As black fungus is locally invasive, the majority of cases will involve tissue damage with local destruction and contiguous spread to nearby structure. We here with present a case of black fungus complicated with COVID-19 in a man with underlying non-Hodgkin's lymphoma.
MeSH term(s)	Adult ; Biopsy/methods ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/physiopathology ; COVID-19/therapy ; Debridement/methods ; Disease Progression ; Humans ; Lymphoma, Non-Hodgkin/complications ; Lymphoma, Non-Hodgkin/pathology ; Lymphoma, Non-Hodgkin/physiopathology ; Male ; Mucorales/isolation & purification ; Mucormycosis/complications ; Mucormycosis/microbiology ; Mucormycosis/pathology ; Mucormycosis/physiopathology ; Nasal Septum/pathology ; Nose Diseases/microbiology ; Nose Diseases/pathology ; Patient Isolation/methods ; SARS-CoV-2/isolation & purification ; Time-to-Treatment ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2021-09-30
Publishing country	Indonesia
Document type	Case Reports ; Journal Article
ZDB-ID	2474707-5
ISSN	2338-2732 ; 0125-9326
ISSN (online)	2338-2732
ISSN	0125-9326
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Parenteral and Oral Anticoagulant Treatment for Hospitalized and Post-Discharge COVID-19 Patients: A Systematic Review and Meta-Analysis.

Tunjungputri, Rahajeng N / Tetrasiwi, Erpryta N / Mulansari, Nadia A / Harimurti, Kuntjoro / Nelwan, Erni J

Acta medica Indonesiana

2022 Volume 54, Issue 2, Page(s) 190–209

Abstract: Background: The use of anticoagulants has been endorsed by different hematological societies as coagulation abnormalities are key features of COVID-19 patients. This systematic review and meta-analysis aims to provide the most recent update on available ...

Abstract	Background: The use of anticoagulants has been endorsed by different hematological societies as coagulation abnormalities are key features of COVID-19 patients. This systematic review and meta-analysis aims to provide the most recent update on available evidence on the clinical benefits and risk of oral and parenteral anticoagulants, as well agents with anticoagulant properties, in hospitalized and post-discharge COVID-19 patients. Methods: This systematic review synthesizes data on the outcome of anticoagulation in hospitalized and post-discharge COVID-19 patients. Dichotomous variables from individual studies were pooled by risk ratio (RR) and their 95% confidence interval (95% CI) using the random-effects model. Meta-analyses were performed when feasible. Results: We included 32 studies from 2.815 unique citations, including 7 randomized clinical trials. A total of 33.494 patients were included. Outcomes measured include mortality and survival rates, the requirement for ICU care and mechanical ventilation. A pooled meta-analysis favors anticoagulant compared to no anticoagulant with reduced mortality in hospitalized patients (RR 0,55; 95%CI 0,43-0,66; p<0,001). Higher dose of anticoagulant also showed treatment benefit compared to standard prophylactic dose in selected populations (RR 0,68; 95%CI 0,40-0,96; p<0,001). Regular, pre-hospital anticoagulation prior to hospitalization yielded mixed result. There are currently no data on the benefit of anticoagulation on post-discharge COVID-19 patients. Conclusion: Determination of the presence of thrombosis in COVID-19 is important, as therapeutic dosage of anticoagulants, rather than prophylatic dose, would be indicated in such clinical situation. Anticoagulants were found to decrease the mortality of hospitalized COVID-19. The results from this study are important in the tailored treatment of COVID-19 patients. Further studies on the need for oral anticoagulation for outpatients or post-discharge is warranted. This study has been registered in PROSPERO database (CRD42020201418).
MeSH term(s)	Aftercare ; Anticoagulants/adverse effects ; Anticoagulants/therapeutic use ; COVID-19/drug therapy ; Hospitalization ; Humans ; Patient Discharge ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/prevention & control
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-07-06
Publishing country	Indonesia
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2474707-5
ISSN	2338-2732 ; 0125-9326
ISSN (online)	2338-2732
ISSN	0125-9326
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Extrapulmonary Manifestations COVID-19.

Nelwan, Erni J / Tunjungputri, Rahajeng N / Tetrasiwi, Erpryta N / Lauditta, Richella K / Nainggolan, Leonard

Acta medica Indonesiana

2022 Volume 54, Issue 2, Page(s) 314–315

Abstract: After being declared as a pandemic on March 11, 2020 by the World Health Organization, COVID-19 has affected 497 million people worldwide as of 9 April 2022. COVID-19 is a disease with a plethora of clinical manifestations, which extends to those beyond ... ...

Abstract	After being declared as a pandemic on March 11, 2020 by the World Health Organization, COVID-19 has affected 497 million people worldwide as of 9 April 2022. COVID-19 is a disease with a plethora of clinical manifestations, which extends to those beyond pulmonary signs and symptoms. Studies that report on the clinical presentation of COVID-19 rarely report specifically on cases with only extrapulmonary manifestations of COVID-19. Extrapulmonary clinical presentations of COVID-19 without pulmonary signs and symptoms is rare, and in such cases, COVID-19 is rarely suspected.We herewith describe four patients with extrapulmonary manifestations of COVID-19, with positive SARS-COV-2 PCR when the test was performed for initial patient screening. The first patient is a 44-year-old female who developed painful ulcer with burning sensation at the lateral side of the tongue along with low grade fever. This symptom appeared after the initial complaints of coughing and nasal congestion subsided. The second patient is a 37-year-old male, who complained of red eyes with itchiness and increased tear production for 3 days before seeing an ophthalmologist. The third patient is a 44-year-old female who developed burning sensation and soreness on her throat upon swallowing with fever and chills. These symptoms appear consecutively without any respiratory complaint. The fourth patient is a previously healthy, 30-year-old female, with a normal weight and BMI, and without any comorbidity, cardiovascular risk and neither personal nor family history of cardiovascular disease. In these 4 patients, COVID-19 stomatitis, conjunctivitis, pharyngitis and COVID-19-associated atrial fibrillation was subsequently diagnosed, respectively.In the pandemic stage of COVID-19, COVID-19 screening has often been routinely performed due to the high risk of transmission. However, the decrease in the number of COVID-19 cases may prompt physicians to perform SARS-COV-2 testing based on clinical suspicion. It is imperative to consider the likelihood of COVID-19 and perform SARS-COV-2 PCR in patients with extrapulmonary complaints that have persisting complaints despite treatment.
MeSH term(s)	Adult ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19 Testing ; Female ; Fever/etiology ; Humans ; Male ; Pandemics/prevention & control ; SARS-CoV-2
Language	English
Publishing date	2022-07-06
Publishing country	Indonesia
Document type	Case Reports ; Journal Article
ZDB-ID	2474707-5
ISSN	2338-2732 ; 0125-9326
ISSN (online)	2338-2732
ISSN	0125-9326
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Hospital-acquired Skin and Skin-structure Infection in COVID-19 Infected Patient with Prolonged Hospitalization

Erni Juwita Nelwan / Rahajeng N Tunjungputri / Narottama Tunjung / Djoko Widodo

Acta Medica Indonesiana, Vol 53, Iss

2021 Volume 1

Abstract	Acute bacterial skin and skin-structure infections (ABSSSI) is defined in 2013 by the US Food and Drug Administration as a bacterial cellulitis/erysipelas, major skin abscesses, and wound infections. The Infectious Diseases Society of America (IDSA) in 2014 classifies skin and soft-tissue infection (SSTI) as either non-purulent (which includes cellulitis, erysipelas, and necrotizing infection) or purulent (including furuncle, carbuncle, and abscess). Among hospitalized patients with SSTI, healthcare-associated infections account for 73.5% of all cases. Notably, skin and skin-structure infections caused by Pseudomonas aeruginosa, a common hospital pathogen, was reported to cause higher total cost and longer hospital length of stay compared to non-P. aeruginosa cases, despite causing only approximately 5.7% of all healthcare-associated SSTIs. Infection with P. aeruginosa should always be considered in non-healing skin infections in patients with prolonged hospitalization and antibiotic exposure. Tissue culture, preferably taken by surgical debridement, should be promptly performed; and when hospital-infection is suspected, appropriate antibiotics should be started along with removal of all devitalized tissue and to promote skin and soft tissue healing. Expedited discharge should be considered when possible, with adequate antibiotic treatment and follow up for definitive wound treatment.
Keywords	hospital-acquired skin ; skin-structure infection ; covid-19 ; prolonged hospitalization ; Internal medicine ; RC31-1245
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	Interna Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Vaccine-Associated Disease Enhancement (VADE): Considerations in Postvaccination COVID-19.

Tunjungputri, Rahajeng N / Tetrasiwi, Erpryta Nurdia / Veronica, Merlinda / Pandelaki, Jacub / Ibrahim, Fera / Nelwan, Erni Juwita

Case reports in medicine

2021 Volume 2021, Page(s) 9673453

Abstract: Introduction: The COVID-19 pandemic has entered a new phase with the roll-out of several vaccines worldwide at an accelerated phase. The occurrence of a more severe presentation of COVID-19 after vaccination may affect policymakers' decision-making and ... ...

Abstract	Introduction: The COVID-19 pandemic has entered a new phase with the roll-out of several vaccines worldwide at an accelerated phase. The occurrence of a more severe presentation of COVID-19 after vaccination may affect policymakers' decision-making and vaccine uptake by the public. Vaccine-associated disease enhancement (VADE) is the modified presentation of infections in individuals after having received a prior vaccination. Currently, little is known about the potential of vaccine-associated disease enhancement (VADE) following COVID-19 immunization. Conclusion: We report two cases of patients developing COVID-19 shortly after CoronaVac vaccination in which VADE is likely. We recommend that current vaccination strategies consider the measurement of neutralizing antibody titer as a guide in ensuring the safest strategy for mass immunization. Studies are needed to investigate the true incidence of VADE on vaccinated individuals as well as on how to differentiate between VADE and severe manifestations of COVID-19 that are unrelated to vaccination.
Language	English
Publishing date	2021-10-29
Publishing country	United States
Document type	Case Reports
ZDB-ID	2502642-2
ISSN	1687-9635 ; 1687-9627
ISSN (online)	1687-9635
ISSN	1687-9627
DOI	10.1155/2021/9673453
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Article ; Online: Black Fungus Complicated with COVID-19 in a Man with Underlying Non-Hodgkin’s Lymphoma

Erni J Nelwan / Rahajeng N Tunjungputri / Retno S Wardani / Retno Wahyuningsih

Acta Medica Indonesiana, Vol 53, Iss

2021 Volume 3

Abstract	COVID-19 is a disease reported to suppress cellular immunity. This may lead to the development of opportunistic infections, among others black fungus, or mucormycosis. On the other hand, pre-existing defect in immunity may render patients susceptible to both mucormycosis and COVID-19. Mucormycosis is a relatively rare fungal infection with rapid progression unless diagnosed promptly and treated adequately, and urgent surgical and medical intervention is lifesaving. The manifestation of mucormycosis largely depends on the presence of exposure to the pathogen and the existing risk factor of the host. As black fungus is locally invasive, the majority of cases will involve tissue damage with local destruction and contiguous spread to nearby structure. We here with present a case of black fungus complicated with COVID-19 in a man with underlying non-Hodgkin’s lymphoma.
Keywords	black fungus ; covid-19 ; non-hodgkin lymphoma ; Internal medicine ; RC31-1245
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	Interna Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Longitudinal proteomic profiling of the inflammatory response in dengue patients.

Garishah, Fadel Muhammad / Boahen, Collins K / Vadaq, Nadira / Pramudo, Setyo G / Tunjungputri, Rahajeng N / Riswari, Silvita Fitri / van Rij, Ronald P / Alisjahbana, Bachti / Gasem, Muhammad Hussein / van der Ven, André J A M / de Mast, Quirijn

PLoS neglected tropical diseases

2023 Volume 17, Issue 1, Page(s) e0011041

Abstract: ... samples from hospitalized patients with non-severe DENV infection in the acute (n = 43) and convalescence ... n = 35) phase of the infection and samples of healthy controls (n = 10).: Results: We identified ...

Abstract	Background: The immunopathogenesis of dengue virus (DENV) infection remains incompletely understood. To increase our understanding of inflammatory response in non-severe dengue, we assessed longitudinal changes in the inflammatory proteome in patients with an acute DENV infection. Methods: Using a multiplex proximity extension assay (PEA), we measured relative levels of 368 inflammatory markers in plasma samples from hospitalized patients with non-severe DENV infection in the acute (n = 43) and convalescence (n = 35) phase of the infection and samples of healthy controls (n = 10). Results: We identified 203 upregulated and 39 downregulated proteins in acute versus convalescent plasma samples. The upregulated proteins had a strong representation of interferon (IFN) and IFN-inducible effector proteins, cytokines (e.g. IL-10, IL-33) and cytokine receptors, chemokines, pro-apoptotic proteins (e.g. granzymes) and endothelial markers. A number of differentially expressed proteins (DEPs) have not been reported in previous studies. Functional network analysis highlighted a central role for IFNγ, IL-10, IL-33 and chemokines. We identified different novel associations between inflammatory proteins and circulating concentrations of the endothelial glycocalyx disruption surrogate marker syndecan-1. Conclusion: This unbiased proteome analysis provides a comprehensive insight in the inflammatory response in DENV infection and its association with glycocalyx disruption.
MeSH term(s)	Humans ; Interleukin-10 ; Interleukin-33 ; Dengue ; Proteome ; Proteomics ; Cytokines/metabolism ; Chemokines
Chemical Substances	Interleukin-10 (130068-27-8) ; Interleukin-33 ; Proteome ; Cytokines ; Chemokines
Language	English
Publishing date	2023-01-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2429704-5
ISSN	1935-2735 ; 1935-2735
ISSN (online)	1935-2735
ISSN	1935-2735
DOI	10.1371/journal.pntd.0011041
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Article ; Online: Effect of oseltamivir phosphate versus placebo on platelet recovery and plasma leakage in adults with dengue and thrombocytopenia; a phase 2, multicenter, double-blind, randomized trial.

Tunjungputri, Rahajeng N / Riswari, Silvita Fitri / Pramudo, Setyo G / Kuntjoro, Lydia / Alisjahbana, Bachti / Nugraha, Harry Galuh / van der Ven, Andre / Gasem, Muhammad Hussein / de Mast, Quirijn

PLoS neglected tropical diseases

2022 Volume 16, Issue 1, Page(s) e0010051

Abstract: ... in 64 patients (31 oseltamivir; 33 placebo). Time to platelet count ≥100,000/μl (n = 55) or discharge (n ...

Abstract	Background: Thrombocytopenia, bleeding and plasma leakage are major complications of dengue. Activation of endogenous sialidases with desialylation of platelets and endothelial cells may underlie these complications. We aimed to assess the effects of the neuraminidase inhibitor oseltamivir on platelet recovery and plasma leakage in dengue. Methods: We performed a phase 2, double-blind, multicenter, randomized trial in adult dengue patients with thrombocytopenia (<70,000/μl) and a duration of illness ≤ 6 days. Oseltamivir phosphate 75mg BID or placebo were given for a maximum of five days. Primary outcomes were the time to platelet recovery (≥ 100,000/μl) or discharge from hospital and the course of measures of plasma leakage. Results: A total of 70 patients were enrolled; the primary outcome could be assessed in 64 patients (31 oseltamivir; 33 placebo). Time to platelet count ≥100,000/μl (n = 55) or discharge (n = 9) were similar in the oseltamivir and placebo group (3.0 days [95% confidence interval, 2.7 to 3.3] vs. 2.9 days [2.5 to 3.3], P = 0.055). The kinetics of platelet count and parameters of plasma leakage (gall bladder thickness, hematocrit, plasma albumin, syndecan-1) were also similar between the groups. Discussion: In this trial, adjunctive therapy with oseltamivir phosphate had no effect on platelet recovery or plasma leakage parameters. Trial registration: ISRCTN35227717.
MeSH term(s)	Adolescent ; Adult ; Antiviral Agents ; Blood Platelets ; Dengue/drug therapy ; Double-Blind Method ; Female ; Humans ; Male ; Oseltamivir ; Young Adult
Chemical Substances	Antiviral Agents ; Oseltamivir (20O93L6F9H)
Language	English
Publishing date	2022-01-07
Publishing country	United States
Document type	Clinical Trial, Phase II ; Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	2429704-5
ISSN	1935-2735 ; 1935-2735
ISSN (online)	1935-2735
ISSN	1935-2735
DOI	10.1371/journal.pntd.0010051
Database	MEDical Literature Analysis and Retrieval System OnLINE

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