M. Yulianto Listiawan, M. Yulianto
Dept. Of Dermatology, School of Medicine, Universitas Airlangga, Surabaya

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Mycobacterium leprae BACILLEMIA IN BOTH TWINS, BUT ONLY MANIFEST AS LEPROSY IN ONE SIBLING Sukmawati, Netty; Agusni, Indropo; Listiawan, M. Yulianto; Prakoeswa, Cita Rosita S.; Adriaty, Dinar; Wahyuni, Ratna; Iswahyudi, Iswahyudi
Indonesian Journal of Tropical and Infectious Disease Vol 5, No 7 (2015)
Publisher : Institute of Topical Disease

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v5i7.1206

Abstract

Leprosy in twins is rarely reported. A 19 years-old male student, from Lamongan district, was diagnosed as Multibacillary (MB) leprosy in the Skin and STD Clinic of Dr. Soetomo General Hospital Surabaya. Multiple anesthetic skin lesions were found, but the bacteriologic examination was negative for Acid Fast Bacilli (AFB). Histopathology examination support the diagnosis of BL type of leprosy. His twin brother that has been lived together since born until present seems healthy without any complaints of skin lesions and have no signs of leprosy. When a serologic examination for leprosy was performed, a high anti PGL-1 antibody level was found in patient (IgM anti PGL-1 2937 and IgG anti PGL-1 3080 unit/ml) while his healthy twin brother showed only low level (IgM 745 and IgG 0 unit/ml). Interestingly when a PCR study was performed to detect M.leprae in the blood, both of them showed positive results. Using the TTC method, a genomic study of for M.leprae, it is revealed that both samples were identic ( 27x TTC repeats). According to patient’s history, he had a traffic accident and got a wound in the knee seven years ago, while the skin lesions seems started from this area around three years ago before it spread to other parts of the body. The patient was treated with Multi-drug therapy (MDT) while his sibling got a prophylactic treatment for leprosy. After 6 months of treatment, the leprosy skin lesions were diminished and the serologic anti PGL-1 has been decreased. His healthy brother also showed a decrease in anti PGL-1 level and no skin signs of leprosy.
Retrospective Study: Type 1 Leprosy Reaction Pratamasari, Meita Ardini; Listiawan, M. Yulianto
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 27, No 2 (2015): BIKKK AGUSTUS 2015
Publisher : Faculty Of Medicine Airlangga University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikkk.V27.2.2015.137-143

Abstract

Background: Type 1 reaction (T1R) of leprosy occurs due toaltered balance between cell mediated immunity and M. leprae bacilli in the skin and nerves, with upgrading/reversal or downgrading as final result. Leprosy subpolar types have unstable immunity, this cause them often experience recurrence T1R, especially BB type.Clinical findings of T1R are inflammation in the skin or nerves, and can lead to disability if not treated properly. Aim: To evaluate the distribution, diagnosis, trigger factors, and therapy of T1R. Methods: Retrospective study using medical record of leprosy new patients in Dermatology and Venereology Outpatient Clinic, Dr Soetomo General Hospital, Surabaya, during 2010 – 2013. Database, anamnesis, examination, and T1R therapy were recorded. Results: The total of new leprosy patients with T1R within 2010-2013 were 117 patients (19,7% of all new leprosy  patients). Most of them were men (70,1%), aged between 15–34 years (42,8%), with BB as the most frequent type (70,9%). Skin symptom of T1R could be thickening of old lesion (52,1%). T1R most occurred when patients still consume MDT (71,8%). NSAID (37,6%) andcorticosteroid (38,5%)were prescribed as T1R therapy. Conclusions: T1R diagnosis should established accurately by history taking and physical examination.For recurrent T1R,trigger factors should be considered.Key words: type 1 reaction, CMI, reversal, downgrading.
Reverse Transcription Polymerase Chain Reaction (RT-PCR) untuk Mendeteksi Viabilitas Mycobacterium leprae pada Pasien Kusta Tipe Multibasiler Pascapengobatan MDT-WHO Gayatri, Lunni; Listiawan, M. Yulianto; Agusni, Indropo
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 26, No 2 (2014): BIKKK AGUSTUS 2014
Publisher : Faculty Of Medicine Airlangga University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikkk.V26.2.2014.1-6

Abstract

Latar belakang: Kusta masih menjadi masalah besar di Indonesia. Penatalaksanaan dengan MDT-WHO telah menjadi regimen standar untuk pasien kusta sejak lama. Pada pasien kusta tipe multibasiler (MB), indeks bakteriologis (IB) belum mencapai nilai nol, meskipun telah menyelesaikan terapi 12 regimen. Metode Reverse Transcription-Polymerase Chain Reaction (RT-PCR) memiliki sensitivitas tinggi untuk mendeteksi viabilitas M. leprae. Tujuan: Mengevaluasi viabilitas M. leprae dengan metode RT-PCR pada pasien kusta tipe MB yang telah menyelesaikan regimen MDT 12 di RSUD Dr. Soetomo Surabaya. Metode: 15 pasien kusta tipe MB yang telah menyelesaikan pengobatan MDT-WHO 12 regimen dengan IB positif dilakukan biopsi kulit untuk pemeriksaan RT-PCR. Hasil: Terdapat 13 pasien (86,7%) dengan viabilitas M. leprae positif sementara seluruh pasien tersebut (100%) memiliki Indeks Morfologis (IM) 0%. Dua belas pasien (80%) memiliki Indeks Bakteriologis 2+ dan 10 pasien diantaranya adalah pasien kusta tipe Lepromatous Leprosy (LL) polar. Delapan pasien yang memiliki viabilitas positif tidak mendapatkan kortikosteroid oral selama siklus MDT. Simpulan: Pasien kusta yang telah menyelesaikan terapi MDT dengan MI 0%, didapatkan viabilitas M. Leprae positif dengan metode RT-PCR. Spektrum klinis pasien yang ditentukan dari imunitas seluler nampaknya menjadi faktor terpenting dalam viabilitas M. leprae.Katakunci: viabilitas, M. leprae, kusta tipe multibasiler, RT-PCR.
Kesesuaian Gambaran Klinis Patognomonis Infestasi Skabies dengan Kepositifan Pemeriksaan Dermoskop dan Kerokan Kulit Kurniati, Kurniati; Zulkarnain, Iskandar; Listiawan, M. Yulianto
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 26, No 1 (2014): BIKKK APRIL 2014
Publisher : Faculty Of Medicine Airlangga University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikkk.V26.1.2014.1-8

Abstract

Latar belakang: Diagnosis infestasi skabies oleh klinisi umumnya ditegakkan dengan gejala klinis patognomonis skabies. Tetapi gejala skabies seringkali tidak khas akibat adanya kemiripan dengan penyakit lain terutama pada anak-anak dan kondisi imunokompromais, sehingga diagnosis klinis seringkali keliru dan mengakibatkan kesalahan pemberian terapi. Diperlukan penegakan diagnosis definitif untuk menemukan Sarcoptes scabiei (S. scabiei) atau telurnya, yang secara konvensional dapat dilakukan dengan pemeriksaan mikroskopik dari kerokan lesi kulit penderita. Namun metode tersebut tidak praktis, membutuhkan keterampilan khusus, cenderung invasif, seringkali memerlukan beberapa kali kerokan, serta sulit dilakukan pada anak-anak, sehingga diperlukan metode yang mudah, non-invasif, dan akurasi yang baik. Pemeriksaan dermoskop menawarkan solusi tersebut. Tujuan: Mengevaluasi kesesuaian gambaran klinis patognomonis infestasi skabies dengan kepositifan dermoskop dan pemeriksaan kerokan kulit Metode: Studi analitik observasional cross sectional, total sampling dalam satu kali observasi pada 243 populasi terjangkau yang berusia 5-14 tahun di satu pondok pesantren. Terdapat 44 sampel yang memenuhi kriteria penerimaan sampel yang dilakukan anamnesis dan pemeriksaan fisik untuk menentukan gejala klinis patognomonis skabies, selanjutnya diperiksa dengan dermoskop dan mikroskop dari kerokan kulit pada lesi. Analisis hasil dengan menghitung kappa agreement dan nilai prediksi positif. Hasil: Dari 44 sampel didapatkan 25 sampel klinis patognomonis skabies dan 19 sampel klinis non patognomonis skabies. Pemeriksaan dermoskopi ditemukan positif pada 25 sampel dan mikroskopik kerokan kulit positif pada 18 sampel. Kesesuaian dermoskopi dan kerokan kulit adalah 79,5%, kappa 0,601. Simpulan: Dermoskop berpotensi digunakan sebagai alat diagnostik definitif skabies pada lingkungan dengan prevalensi tinggi skabies. Kata kunci: skabies, dermoskop, kerokan kulit.
Dermoscopic Features of Alopecia Patient Paramita, Kartika; Listiawan, M. Yulianto; Rahmadewi, Rahmadewi
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 27, No 3 (2015): BIKKK DESEMBER 2015
Publisher : Faculty Of Medicine Airlangga University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikkk.V27.3.2015.163-169

Abstract

Backgroud: Alopecia is hair loss of the scalp that occurs in mostly men and about 30% of women during their lifetime. Prevalence of alopecia is increased along with age in both men and women. Using of dermoscope can help the diagnostic accuracy and avoid scalp biopsy for diagnosis. Purpose: Identifying dermoscope examination results and determine the pathophysiology of dermoscope features. Methods: Cross sectional and descriptiove observational study to all of alopecia patients who fulfilled the inclusion criteria at outpatient clinic Dr. Soetomo General Hospital Surabaya in December 2014 through February 2015 performed dermoscope examination Result: There were 20 patients who fulfilled the inclusion criteria, consisted of 3 patients with androgenetic alopecia, 8 alopecia areata, 4 tinea capitis, 2 discoid lupus erythematosus, 1 psoriasis vulgaris, 1 seborheic dermatitis, and 1 trichotilomania. Conclusion: Most of all dermoscope features accordance with the description in the literature, the most diagnosis is androgenetic alopecia.Key words: alopecia, dermoscope, zig-zag hair, black dots.
The Effects of Platelet Rich Plasma Topical Gel on Chronic Plantar Ulcer Healing in Leprosy Patient Sari, Diana Kartika; Listiawan, M. Yulianto; Indramaya, Diah Mira
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 28, No 3 (2016): DESEMBER
Publisher : Faculty Of Medicine Airlangga University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikkk.V28.3.2016.175-181

Abstract

Background: Plantar ulcer is a physical disability that most often occurs in approximately 10-20% of leprosy patient. Conventional therapies such as dressings, surgical debridement, and skin graft can not provide satisfactory improvement. Platelet rich plasma (PRP) has a variety of growth factors required in ulcer wound healing. Purpose: To prove the effect of PRP topical gel to the size of wound, macrophage activation, neovascularization, fibrosis, and formation of granulation tissue on chronic plantar ulcer healing in leprosy patients. Methods: The analytic cohort study of 20 leprosy patients with chronic plantar ulcer in Morbus Hansen Division, Dermatology and Venereology Outpatient Clinic, Dr. Soetomo Hospital Surabaya. Biopsies were performed before and after PRP topical gel treatment on leprosy patient with chronic plantar ulcers. Results: After two doses of PRP topical gel, wound size of 9 patients (45%) was reduced <0.5 cm. Statistycal analysis showed significant differences in size of lesions (p = <0.05), the number of macrophages (p = <0.001), number of capillaries (p = 0.003), and the amount of granulation (p = 0.032) before and after PRP topical gel treatment. While the results of the analysis of the number of fibroblasts showed no significant difference (p = <0.05). Conclusion: PRP topical gel treatment gives good results, in terms of improvement in wound size, an increase in macrophages, neovascularization and granulation tissue.
Mycobacterium leprae BACILLEMIA IN BOTH TWINS, BUT ONLY MANIFEST AS LEPROSY IN ONE SIBLING Sukmawati, Netty; Agusni, Indropo; Listiawan, M. Yulianto; Prakoeswa, Cita Rosita S.; Adriaty, Dinar; Wahyuni, Ratna; Iswahyudi, Iswahyudi
Indonesian Journal of Tropical and Infectious Disease Vol 6, No 1 (2016)
Publisher : Institute of Topical Disease

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (785.454 KB) | DOI: 10.20473/ijtid.v6i1.1206

Abstract

Leprosy in twins is rarely reported. A 19 years-old male student, from Lamongan district, was diagnosed as Multibacillary (MB) leprosy in the Skin and STD Clinic of Dr. Soetomo General Hospital Surabaya. Multiple anesthetic skin lesions were found, but the bacteriologic examination was negative for Acid Fast Bacilli (AFB). Histopathology examination support the diagnosis of BL type of leprosy. His twin brother that has been lived together since born until present seems healthy without any complaints of skin lesions and have no signs of leprosy. When a serologic examination for leprosy was performed, a high anti PGL-1 antibody level was found in patient (IgM anti PGL-1 2937 and IgG anti PGL-1 3080 unit/ml) while his healthy twin brother showed only low level (IgM 745 and IgG 0 unit/ml). Interestingly when a PCR study was performed to detect M.leprae in the blood, both of them showed positive results. Using the TTC method, a genomic study of for M.leprae, it is revealed that both samples were identic ( 27x TTC repeats). According to patient’s history, he had a traffic accident and got a wound in the knee seven years ago, while the skin lesions seems started from this area around three years ago before it spread to other parts of the body. The patient was treated with Multi-drug therapy (MDT) while his sibling got a prophylactic treatment for leprosy. After 6 months of treatment, the leprosy skin lesions were diminished and the serologic anti PGL 1 has been decreased. His healthy brother also showed a decrease in anti PGL 1 level and no skin signs of leprosy.
Histoid Leprosy Rinasari, Umi; Sawitri, Sawitri; Listiawan, M. Yulianto; Prakoeswa, Cita Rosita; Agusni, Indropo; Santoso, Rachmat; Izumi, Shinzo
Indonesian Journal of Tropical and Infectious Disease Vol 1, No 1 (2010)
Publisher : Institute of Topical Disease

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (210.114 KB) | DOI: 10.20473/ijtid.v1i1.3719

Abstract

Histoid Leprosy is a variant of lepromatous leprosy with characteristic clinical and histopathological features. Usually it is occured in lepromatous patients who relaps after dapsone monotherapy, in those with dapsone resistance , sometimes even after multidrug treatment, or at times, de novo with characteristic clinical and histopathological features. A 36 years old male, originated from Papua, visited to the skin outpatient clinic with translucent shiny nodules on the left elbow and thumb for the last 18 months. The nodules were multiple, painless and firm. There were nasal congestion, tickening of ear lobes and loss of eye brows. Patient did not have any history of previous antileprotic treatment. Routine blood examination was normal. Bacteriological examination of slit skin smear revealed acid-fast bacilli of Bacterial Index 4+ and Morfologic Index 10%. Histopathology of skin suggested lepromatous leprosy of histoid type with characteristic interlacing bundles of spindle shaped cells. Anti-PGL1 antibody (ELISA) revealed high titer of IgM (>5.300 u/ml) and also IgG anti PGL-1 (>5.300 u/ml). Polymerase chain reaction examination test to detect M.leprae was positive and direct sequencing of M.leprae isolate shows no mutation, which means no resistancy to MDT treatment. Treatment with MDTWHO regiment give clinical improvements and the histoid lesions disappered after 3 months treatment.The histoid form of leprosy in this case developed without any prior treatment of anti leprotic drugs ( de novo ). Some theoretical aspects of the patho-mechanism of histoid leprosy are discussed.
Retrospective Study: Type 1 Leprosy Reaction Pratamasari, Meita Ardini; Listiawan, M. Yulianto
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 27, No 2 (2015): BIKKK AGUSTUS 2015
Publisher : Faculty Of Medicine Airlangga University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikkk.V27.2.2015.137-143

Abstract

Background: Type 1 reaction (T1R) of leprosy occurs due toaltered balance between cell mediated immunity and M. leprae bacilli in the skin and nerves, with upgrading/reversal or downgrading as final result. Leprosy subpolar types have unstable immunity, this cause them often experience recurrence T1R, especially BB type.Clinical findings of T1R are inflammation in the skin or nerves, and can lead to disability if not treated properly. Aim: To evaluate the distribution, diagnosis, trigger factors, and therapy of T1R. Methods: Retrospective study using medical record of leprosy new patients in Dermatology and Venereology Outpatient Clinic, Dr Soetomo General Hospital, Surabaya, during 2010 – 2013. Database, anamnesis, examination, and T1R therapy were recorded. Results: The total of new leprosy patients with T1R within 2010-2013 were 117 patients (19,7% of all new leprosy  patients). Most of them were men (70,1%), aged between 15–34 years (42,8%), with BB as the most frequent type (70,9%). Skin symptom of T1R could be thickening of old lesion (52,1%). T1R most occurred when patients still consume MDT (71,8%). NSAID (37,6%) andcorticosteroid (38,5%)were prescribed as T1R therapy. Conclusions: T1R diagnosis should established accurately by history taking and physical examination.For recurrent T1R,trigger factors should be considered.Key words: type 1 reaction, CMI, reversal, downgrading.
Three Different Genotyping of Mycobacterium leprae in a Family: A Case Report Mayangsari, Renata; Listiawan, M. Yulianto
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 27, No 3 (2015): BIKKK DESEMBER 2015
Publisher : Faculty Of Medicine Airlangga University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikkk.V27.3.2015.232-238

Abstract

Background: Indonesia is the third country with the highest prevalence of leprosy worldwide after India and Brazil. The risk of transmission is higher in household contacts, siblings, and neighborhoods. Purpose: Familial leprosy due to household contacts has been considered as the main transmission in leprosy. The aim of the examination is to detect the presence of Mycobacterium leprae and analyze the variation number of TTC repeats. Case: A family, consisted of mother, 35 year-old, was diagnosed with lepromatous leprosy (LL) type and erythema nodosum leprosum (ENL) necroticans. Her husband, 36 year-old, was diagnosed with tuberculoid leprosy. Daughter, 4 year-old, was diagnosed as indeterminate leprosy due to white small patches on her left cheek, arm, and leg, but there was no complain about anesthesia. Case management: Enzyme-linked immunosorbent assay (ELISA), histopathological examination, and polymerase chain reaction (PCR) for detection of M. leprae were performed. All of PCR results were positive. After sequencing of the TTC area, it revealed that the number of TTC repeats were different. Conclusion: Transmission from mother to others was suspected in family with leprosy living in the same house. PCR examination revealed 16 times TTC repeats on mother, 18 times on father, and 13 times on daughter. It was proven that infection of M. leprae originated from different genomes, which means different source of infection.