An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China has spread rapidly in multiple countries of the world and has become a pandemic. Currently, there is no vaccine or specific antiviral for COVID-19. A study reported 7.3% of critical patients admitted to ICU, 71% of them required mechanical ventilation, and 38.5% of them were survived. Herein, we reported a 54-year-old man with Acute Respiratory Distress Syndrome (ARDS) of COVID-19 who survived the disease. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasopharyngeal and oropharingeal swabs were positive for SARS-CoV-2. Diagnosis of ARDS was also according to clinical symptoms, laboratory, chest radiograph, and chest CT scan. Alcaligenes faecalis and Candida albicans were also identified from sputum culture. Treatment for this patient was causal and supportive therapy, including antibiotic, antiviral, and antifungal therapy according to the culture results, fluid resuscitation, and oxygen supply from the mechanical ventilator. This patient was survived and discharged on hospital day-29. A fibrosis in parenchyma pulmonary and sensory peripheral neuropathy occurred after survived from ARDS. Monitoring of clinical, laboratory, and chest radiograph were continued after the patient discharged from the hospital. This case highlights the importance of early diagnosis and effective treatment to the care of COVID-19 patient.

Introduction: Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis and usually attacks the lungs. Indonesia is in the third rank of TB cases in the world. An important concern regarding TB currently is the case of anti-TB drug resistance, hence research on resistance patterns and risk factors is essential. This study aimed to identify the pattern of first-line anti-TB drug resistance at Dr. Soetomo General Hospital, Surabaya.Methods: A descriptive retrospective study was conducted at Dr. Soetomo General Hospital, Surabaya for the period of 2017-2019. The samples were obtained through total population sampling of 239 pulmonary TB patients with first-line anti-TB drug resistance which were registered at MDR-TB Polyclinic Dr. Soetomo General Hospital, Surabaya. Only complete medical records were included. The variables were first-line anti-TB drug resistance (isoniazid, rifampicin, ethambutol, streptomycin) and patients’ characteristics (age, gender, treatment history, and comorbidities). The drug resistance test was performed using certified culture methods.Results: Among 239 patients, the incidences of resistance to H, R, E, and S were 79.08%, 94.14%, 25.94%, and 20.08%, respectively. The most common patterns were HR (42.26%), R (18.83%), and HRE (12.55%). The largest age group was 45-54 years old (38%). The dominant gender was male (56.49%). The most treatment history category was relapsed patients (48%) and there were more patients with comorbidity (57%).Conclusion: The highest incidence rate of resistance was rifampicin and the most common resistance pattern was HR. Most of the patients were of working age, male, relapse patients, and had comorbidities. An appropriate TB therapy treatment plays an important role in preventing resistance.

An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China has spread rapidly in multiple countries of the world and has become a pandemic. Currently, there is no vaccine or specific antiviral for COVID-19. A study reported 7.3% of critical patients admitted to ICU, 71% of them required mechanical ventilation, and 38.5% of them were survived. Herein, we reported a 54 year old man with Acute Respiratory Distress Syndrome (ARDS) of COVID-19 who survived the disease. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasopharyngeal and oropharingeal swabs were positive for SARS-CoV-2. Diagnosis of ARDS was also according to clinical symptoms, laboratory, chest radiograph, and chest CT scan. Alcaligenes faecalis and Candida albicans were also identified from sputum culture. Treatment for this patient was causal and supportive therapy, including antibiotic, antiviral, and antifungal therapy according to the culture results, fluid resuscitation, and oxygen supply from the mechanical ventilator. This patient was survived and discharged on hospital day-29. A fibrosis in parenchyma pulmonary and sensory peripheral neuropathy occurred after survived from ARDS. Monitoring of clinical, laboratory, and chest radiograph were continued after the patient discharged from the hospital. This case highlights the importance of early diagnosis and effective treatment to the care of COVID-19 patient.

Indonesia is a greatest burden country of H5N1 avian influenza (AI) virus infection in the world, since first outbreak in Central Java 2005 until August 2010 there was 168 confirmed cases and 138 dead cases. The incidence increasing rapidly in widespread area endemic in Java, Sumatera, Bali and Sulawesi, and sporadic outbreaks in other areas. The World Health Organization stated that AI still became a treat in the next pandemic. H5N1 AI virus infection spreads in almost all provinces, but its endemic in Jakarta, Tangerang and Banten and in other area such Surabaya, Bali were sporadic outbreaks. There are 27 confirmed H5N1 AI infection cases in Jakarta from 296 suspected cases, while in Surabaya only 5 confirmed H5N1 AI infection cases from 12 suspected cases. The age of patient mean with H5N1 AI infection was 16.9 ± 11.6 yo in Jakarta and 24 ± 8.51 yo in Surabaya. There was no difference between male and female. Mortality rate was 77.7% in Jakarta and 60% in Surabaya. A large number of case has indirect contact history, predominantly by visiting market or areas where outbreaks of poultry disease. The clinical feature H5N1 AI virus infection could manifest as mild until severe pneumonia that often progress rapidly to ARDS. In Jakarta, 74% case showed abnormality chest radiography as bilateral pneumonia, while in Surabaya showed lobar pneumonia and bilateral pneumonia. Management patient of H5N1 AI infection is supportive therapy and antiviral, whereas a large number of cases needed mechanical ventilator support.