13
|
Imran D, Estiasari R, Maharani K, Sucipto, Lestari DC, Yunus RE, Yunihastuti E, Karyadi TH, Oei D, Timan IS, Wulandari D, Wahyuningsih R, Adawiyah R, Kurniawan A, Mulyadi R, Karuniawati A, Jaya UA, Safari D, van Laarhoven A, Alisjahbana B, Dian S, Chaidir L, Ganiem AR, Lastri DN, Aye Myint KS, van Crevel R. Presentation, etiology, and outcome of brain infections in an Indonesian hospital: A cohort study. Neurol Clin Pract 2018; 8:379-388. [PMID: 30564491 DOI: 10.1212/cpj.0000000000000517] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/08/2018] [Indexed: 11/15/2022]
Abstract
Background Little detailed knowledge is available regarding the etiology and outcome of CNS infection, particularly in HIV-infected individuals, in low-resource settings. Methods From January 2015 to April 2016, we prospectively included all adults with suspected CNS infection in a referral hospital in Jakarta, Indonesia. Systematic screening included HIV testing, CSF examination, and neuroimaging. Results A total of 274 patients with suspected CNS infection (median age 26 years) presented after a median of 14 days with headache (77%), fever (78%), seizures (27%), or loss of consciousness (71%). HIV coinfection was common (54%), mostly newly diagnosed (30%) and advanced (median CD4 cell count 30/µL). Diagnosis was established in 167 participants (65%), including definite tuberculous meningitis (TBM) (n = 44), probable TBM (n = 48), cerebral toxoplasmosis (n = 48), cryptococcal meningitis (n = 14), herpes simplex virus/varicella-zoster virus/cytomegalovirus encephalitis (n = 10), cerebral lymphoma (n = 1), neurosyphilis (n = 1), and mucormycosis (n = 1). In-hospital mortality was 32%; 6-month mortality was 57%. The remaining survivors had either moderate or severe disability (36%) according to Glasgow Outcome Scale. Conclusion In this setting, patients with CNS infections present late with severe disease and often associated with advanced HIV infection. Tuberculosis, toxoplasmosis, and cryptococcosis are common. High mortality and long-term morbidity underline the need for service improvements and further study.
Collapse
Affiliation(s)
- Darma Imran
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Riwanti Estiasari
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Kartika Maharani
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Sucipto
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Delly Chipta Lestari
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Reyhan Eddy Yunus
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Evy Yunihastuti
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Teguh Haryono Karyadi
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Diana Oei
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Ina S Timan
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Dewi Wulandari
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Retno Wahyuningsih
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Robiatul Adawiyah
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Agnes Kurniawan
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Rahmad Mulyadi
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Anis Karuniawati
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Ungke Anton Jaya
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Dodi Safari
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Arjan van Laarhoven
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Bachti Alisjahbana
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Sofiati Dian
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Lidya Chaidir
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Ahmad Rizal Ganiem
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Diatri Nari Lastri
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Khin Saw Aye Myint
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| | - Reinout van Crevel
- Departments of Neurology (DI, RE, KM, Sucipto, DO, DNL), Microbiology (DCL, A. Karuniawati), Radiology (REY, RM), Internal Medicine (EY, THK), Clinical Pathology (IST, DW), and Parasitology (RW, RA, A. Kurniawan), Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia; Eijkman Institute for Molecular Biology (UAJ, DS, KSAM); Eijkman-Oxford Clinical Research Unit (UAJ), Jakarta, Indonesia; Department of Internal Medicine and Radboud Center for Infectious Diseases (AvL, RvC), Radboud University Medical Center, Nijmegen, the Netherlands; TB/HIV Research Center (BA, SD, LC, ARG), Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; and Centre for Tropical Medicine and Global Health (RvC), Nuffield Department of Medicine, University of Oxford, UK
| |
Collapse
|