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"Latar belakang: Kanker paru menjadi penyebab kematian terbanyak di dunia.Prevalensi kanker paru terus meningkat seiring dengan peningkatan angka harapanhidup dan menyebarkan faktor risiko kanker. Pasien kanker paru yang sebagianbesar berupa KPKBSK rentan untuk mengalami infeksi oportunistik yang terjadipada saat sistem imun tubuh rendah. Salah satu jamur oportunistik yang dapatmenginfeksi adalah Pneumosistis jirovecii yang menyebabkan PneumosistisPneumonia (PCP). Deteksi dini pada populasi rentan penting dilakukan untukmencegah keparahan penyakit. Saat ini, insidensi dan prevalensi PCP pada pasienkanker paru di Indonesia belum cukup jelas akibat rendahnya pemantauan danpelaporan kasus.Tujuan: Penelitian ini dilakukan untuk mengetahui prevalensi dan gambaran klinisPCP pada pasien KPKBSK yang belum di kemoterapi di RSUP Persahabatan,Jakarta.Metode: Penelitian merupakan penelitian potong lintang dengan subjek merupakanpasien KPKBSK yang belum di kemoterapi di RSUP Persahabatan. Pasiendilakukan induksi sputum menggunakan NaCl 3% yang kemudian dilakukanprosedur nested-PCR untuk deteksi PCP melalui primer pada gen mtLSU rRNA.Data pasien didapatkan dari rekam medis pasien.Hasil: Total subjek yang mengikuti penelitian sebesar 56 pasien 1 pasien tanpa datahistopatologi. Didapatkan prevalensi PCP pada penelitian sebesar 17,9% (10pasien). Profil klinis pasien KPKBSK di RSUP Persahabatan yang belumdikemoterapi terbanyak pada usia 18-65 tahun sebesar 75,0% (42 pasien), jeniskelamin laki-laki sebesar 62,5% (35 pasien), tampilan status 1 sebesar 39,2% (22pasien), perokok aktif sebesar 62,5% (35 pasien), Indeks Brinkman kategori ringansebesar 44,6% (25 pasien), histopatologi terbanyak berupa adenokarsinoma sebesar78,2% (43 pasien), dan staging terbanyak pada stadium lanjut sebesar 76,8% (43pasien). Tidak terdapat hubungan yang signifikan (p > 0,05) antara karakteristiksosiodemografis, staging, dan kebiasaan merokok dengan koinfeksi PCP padapasien KPKBSK yang belum di kemoterapi.Simpulan: Prevalensi PCP pada pasien KPKBSK yang belum di kemoterapisebesar 17,9%. Karakteristik pasien terbanyak adalah usia 18-65 tahun, laki-laki,tampilan status 1, perokok aktif, Indeks Brinkman kategori ringan, histopatologiadenokarsinoma, serta staging stadium lanjut. Tidak ada hubungan antarakarakteristik tersebut dengan kejadian PCP pada pasien pada penelitian.

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Background: Lung cancer has become the leading cause of mortality in the world.

Lung cancer prevalence and incidence keep growing for the past years attributed by

increased in life expectance and distribution of lung cancer risk factors. Most lung

cancer patients, including NSCLC type, are prone to get opportunistic infections

when the body immune system weakens. Pneumocystis jirovecii is one of fungal

aetiologies to cause this infection in immunocompromised hosts, called

Pneumocystic Pneumonia (PCP). Early detection is crucial in susceptible patients

to prevent disease progression. PCP incidence and prevalence in NSCLC patients

Indonesia is still unknown which could be caused by inadequate case surveillance

and reports

Objectives: This study aimed to determine PCP prevalence in NSCLC patients

without chemotherapy and its clinical profile in Persahabatan Hospital, Jakarta.

Methods: This cross-sectional study included NSCLC patients who had not

undergone chemotherapy treatments (naïve). Sputum induction with 3% NaCl from

patients were tested for PCP with nested-PCR targeting mtLSU rRNA gene.

Patients’ characteristics data were obtained from medical records.

Results: Data from 56 patients with NSCLC were collected including 1 patient

without histology type identified. From this research, about 17,9% patients were

tested positive for PCP. Naïve NSCLC patients in Persahabatan Hospital

characteristics 75,0% (42 patients) were aged between 18 and 65 years, 62,5% (35

patients) were males, 39,2% (22 patients) had score 1 on performance status, 62,5%

(35 patients) were active smokers, 44,6% (25 patients) had mild Brinkman Index,

most common histopathology type were adenocarcinoma attributed for 78,2% cases

(43 patients), and most patients were on advanced stage for about 76,8% (43

patients). There were no significant association (p > 0,05) between

sociodemography, staging, and smoking behaviour and PCP co-infection in naïve

NSCLC patients.

Conclusion: PCP prevalence in naïve NSCLC patients were 17,9%. Most patients

were aged between 18 to 65 years old, male, score 1 on performance status, active

smokers, mild Brinkman Index, adenocarcinoma type, and were on advanced stage.

No significant association between those factors and PCP in patients."

"Latar belakang: Kanker paru menduduki peringkat ketiga sebagai penyebab kematian utama akibat keganasan di Indonesia, 85% di antaranya adalah kanker paru karsinoma bukan sel kecil (KPKBSK). Pasien kanker paru rentan terhadap infeksi oportunistik, termasuk kriptokokosis, yaitu infeksi jamur Cryptococcus. Penelitian tentang data klinis dan keberadaan Cryptococcus pada pasien KPKBSK di Indonesia masih terbatas. Salah satu metode untuk mendeteksi keberadaan Cryptococcus adalah pemeriksaan serologi Lateral Flow Assay (LFA). Tujuan: Penelitian ini bertujuan untuk mengetahui profil klinis pasien KPKBSK dan kaitannya dengan hasil pemeriksaan LFA Cryptococcus di RSUP Persahabatan. Metode: Penelitian dengan disain potong lintang ini dilakukan pada pasien KPKBSK yang belum dikemoterapi di RSUP Persahabatan yang memenuhi kriteria inklusi. Data klinis pasien diperoleh dari anamnesis dan pemeriksaan fisik yang diambil dari rekam medis, selanjutnya dilakukan pemeriksaan LFA Cryptococcus di laboratorium Parasitologi FKUI. Hasil: Dari 77 subjek yang memenuhi kriteri inklusi, terdapat 48 (62,3%) pasien laki-laki, dengan rerata usia 59,4 tahun. Data klinis lain menunjukkan IMT 18,5-22,9 kg/m2 (53,2%), status tampilan 1 (42,9%), perokok aktif (61,0%), Indeks Brinkman ringan (42,9%), adenokarsinoma (75,3%), stadium IIIB-IV (79,2%). Riwayat komorbid yang ditemukan adalah TB (13,0%), asma/PPOK (1,3%), DM (16,9%), dan penyakit lainnya (31,2%). Proporsi hasil pemeriksaan LFA Cryptococcus positif adalah 11,7%. Tidak ditemukan hubungan bermakna antara profil klinis dengan keberadaan Cryptococcus pada pasien KPKBSK. Simpulan: Proporsi keberadaan Cryptococcus pada pasien KPKBSK yang belum dikemoterapi adalah 11,7%. Profil klinis terbanyak berupa IMT 18,5-22,9 kg/m2, status tampilan 1, perokok aktif, Indeks Brinkman ringan, jenis keganasan adenokarsinoma, dan stadium IIIB-IV. Riwayat komorbid meliputi TB, asma/PPOK, DM, dan penyakit lain. Tidak ditemukan hubungan antara profil klinis dengan keberadaan Cryptococcus pada subjek penelitian.

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Background: Lung cancer is the third of leading cause of death due to malignancy in Indonesia. Eighty-five percent of them were non-small cell lung cancer (NSCLC). Lung cancer patients are prone to have the opportunistic infections, such as cryptococcosis. However, the clinical data on the exictance of Cryptococcus in NSCLC patients in Indonesia are scarce. One of the methods to detect Cryptococcus in those patients is the Lateral Flow Assay (LFA) serology test.

Aim: The study aimed to determine the association between the clinical profile of NSCLC patients with the Cryptococcal LFA test results at Persahabatan Hospital, Jakarta.

Methods: This cross-sectional study was conducted on naïve NSCLC patients at Persahabatan Hospital Jakarta, who met the inclusion criteria. The clinical data were obtained from history taking and physical examination from the medical records. Furthermore, the Cryptococcal LFA serology test was conducted at laboratory of Parasitology Department, Faculty of Medicine Universitas Indonesia.

Results: Of the 77 subjects, there were 48 male patients (62.3%), and the mean age was 59.4 years old. The most common clinical profile of NSCLC patients were BMI of 18.5-22.9 kg/m2 (53.2%), performance status 1 (42.9%), active smokers (61.0%), mild Brinkman Index (42.9%), adenocarcinoma (75.3%), and cancer stage of IIIB-IV (79.2%). The comorbidities of those patients were TB (13.0%), asthma/COPD (1.3%), DM (16.9%), and other diseases (31.2%). The proportion of positive Cryptococcal LFA test results was 11.7%. There was no significant association between the clinical profiles and the presence of Cryptococcus.

Conclusion: The proportion of the Cryptococcus existance in naïve NSCLC patients was 11.7%. The most common clinical profiles were BMI of 18.5-22.9 kg/m2, performance status 1, active smokers, mild Brinkman Index, adenocarcinoma histology type, and lung cancer stage at IIIB-IV. The comorbidities of those patients were TB, asthma/COPD, DM, and other diseases. No association was found between the clinical profile of those patients and the presence of Cryptococcus."

"Latar Belakang: Pneumocystis jirovecii (P. jirovecii) adalah patogen jamur oportunistik yang dapat terdeteksi di saluran napas bawah. Kolonisasi P. jirovecii dapat berkembang menjadi infeksi yang disebut sebagai pneumocystis pneumonia (PCP). Infeksi PCP umumnya terdeteksi di pasien HIV. Pasien tanpa HIV juga dapat mengalami infeksi PCP terutama pada pasien keganasan. Penelitian ini bertujuan untuk mendeteksi kolonisasi P. Jirovecii pada sampel bilasan bronkus dengan pemeriksaan polymerase chain reaction (PCR). Metode: Penelitian ini merupakan penelitian potong lintang dengan deskriptif analitik yang pada pasien terduga kanker paru di RSUP Persahabatan. Subjek penelitian adalah pasien terduga kanker paru yang akan menjalani bronkoskopi sesuai kriteria inklusi. Sampel bilasan bronkus dikirim ke Laboratorium Departemen Parasitologi FKUI untuk ekstraksi DNA dan laboratorium BRIN untuk pemeriksaan PCR konvensional. Penelitian ini menggunakan gen MtLSU dan mTSSU. Hasil: Pada penelitian ini terdapat 72 subjek penelitian. Subjek penelitian terdiri atas 51 laki-laki (70,8%). Rerata usia subjek penelitian adalah 56,6 (9,95) tahun. Subjek penelitian sebagian besar memiliki IMT normal (18,5-22,9 kg/m2). Subjek penelitian sebagian besar adalah perokok baik perokok aktif atau bekas perokok yaitu sebanyak 50 orang (69,4%). Sebanyak 23 orang (31,9%) diantaranya memiliki IB berat (IB >600 batang per tahun). Subjek penelitian yang memiliki riwayat pengobatan TB, baik terkonfirmasi bakteriologis maupun diagnosis klinis, sebanyak 23 orang (31,9%). Sebanyak 26 orang (36,1%) memiliki 1 komorbid sedangkan 10 orang (13,9%) memiliki lebih dari 1 komorbid. Berdasarkan pemeriksaan histopatologi atau sitologi bilasan bronkus, dari 72 subjek penelitian terdapat 50 orang (69,4%) terdiagnosis kanker paru, 15 orang (20,9%) bukan kanker paru, dan 7 orang (9,7%) belum diketahui diagnosisnya. Dari 72 sampel yang diperiksa, tidak ada yang menunjukan hasil PCR positif (0%). Kesimpulan: Proporsi P. Jirovecii yang terdeteksi melalui pemeriksaan PCR pada sampel bilasan bronkus pasien terduga kanker paru sebesar 0%. Pemeriksaan PCR untuk mendeteksi P. Jirovecii tidak disarankan untuk pasien kanker yang baru terdiagnosis dan belum dilakukan pengobatan.

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Background: Pneumocystis jirovecii (P. jirovecii) is an opportunistic fungal pathogen that can be detected in the human lower respiratory tract without signs or symptoms of acute pneumonia or colonization. P. jirovecii colonization can develop into an infection known as pneumocystis pneumonia (PCP). PCP infection is commonly detected in HIV patients. However, patients without HIV can also experience PCP infection, especially in malignant patients. This study aims to detect P. Jirovecii colonization in bronchial lavage samples using polymerase chain reaction (PCR). Methods: This research is a cross-sectional study with descriptive analytics on patients suspected of lung cancer at Persahabatan Hospital. The research subjects were patients with suspected lung cancer who were selected according to the inclusion criteria. Data on clinical, radiological, laboratory and histopathological characteristics were taken from medical records. The patient will have a bronchial lavage sample taken during bronchoscopy for diagnostic purposes. The samples will be examined at the Parasitology Department Laboratory Universitas Indonesia for DNA extraction and the BRIN laboratory for PCR examination. Results: In this study there were 72 research subjects. The research subjects consisted of 51 men (70.8%). The mean age of the research subjects was 56.6 (9.95) years. Most of the research subjects had normal BMI (18.5-22.9 kg/m2). Most of the research subjects were smokers, either active smokers or former smokers, namely 50 people (69.4%). A total of 23 people (31.9%) had severe IB (IB >600 cigarettes per year). There were 23 research subjects who had a history of TB treatment, whether confirmed bacteriologically or clinically diagnosed, as many as 23 people (31.9%). A total of 26 people (36.1%) had 1 comorbid while 10 people (13.9%) had more than 1 comorbid. Based on histopathological or cytological examination of bronchial lavage, of the 72 research subjects, 50 people (69.4%) were diagnosed with lung cancer, 15 people (20.9%) had no lung cancer, and 7 people (9.7%) had no known diagnosis. Of the 72 samples examined, none showed positive PCR results (0%). Conclusion: The proportion of P. Jirovecii detected by conventional PCR examination in bronchial lavage samples from patients suspected of lung cancer was 0%. PCR examination to detect P. Jirovecii is not recommended for cancer patients who have just been diagnosed and have not received treatment."

"ABSTRAKPneumocystis jirovecii adalah penyebab infeksi oportunistik di saluran pernapasanbawah pada individu dengan sistem kekebalan tubuh yang lemah, terutama padapasien HIV. Pemeriksaan infeksi P.jirovecii di Indonesia masih berdasarkanpemeriksaan klinis dan mikroskopis, yang memerlukan waktu yang cukup lama,kurang sensitif dan spesifik. Karena alasan tersebut dalam penelitian inidikembangkan uji molekuler real time PCR (rPCR) yang lebih sensitif danspesifik. Uji rPCR telah berhasil dioptimasi dengan kemampuan deteksi minimumDNA 6,55 copy/μl dan tidak bereaksi silang dengan mikroorganisme yang diujipada penelitian ini. Dibandingkan dengan uji mikroskopis, uji rPCR memberikanhasil positif 20% lebih tinggi daripada uji mikroskopis. Uji rPCR dapatmendeteksi P.jirovecii pada sampel klinis sputum dan sputum induksi dari pasienHIV dengan pneumonia dengan jumlah sel CD4+ > 200 maupun ≤ 200. Olehkarena itu, uji rPCR yang telah dioptimasi dalam studi ini dapat mendeteksiP.jirovecii pada sampel klinis sputum dan sputum induksi dari pasien HIV denganpneumonia dengan jumlah sel CD4+ > 200 maupun ≤ 200

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ABSTRACTPneumocystis jirovecii is the cause of opportunistic infections in the lowerrespiratory tract in individuals with weakened immune systems, especially inpatients with HIV. Examination P.jirovecii infection in Indonesia was based onclinical and microscopic examination, requiring considerable time, less sensitiveand specific. Because of these reasons in this study developed a molecular testreal time PCR (rPCR) is more sensitive and specific. rPCR test has beensuccessfully optimized with minimum DNA detection capabilities 6.55 copy/μLand do not cross-react with the microorganisms were tested in this study.Compared with microscopic test, test rPCR gives positive result 20% higher thanthe microscopic test. rPCR test can detect P.jirovecii on clinical samples ofsputum and sputum induction of HIV patients with pneumonia with CD4+ cellcounts > 200 or ≤ 200. Therefore, rPCR test which has been optimized in thisstudy can detect P.jirovecii in clinical sputum samples and sputum induction ofHIV patients with pneumonia with CD4+ cell counts > 200 or ≤ 200"

"Identifikasi Pneumocystis jirovecii pada pasien dengan koinfeksi tuberkulosis (TB) paru masih menjadi tantangan karena gambaran klinis maupun radiologis keduanya yang mirip dan P. jirovecii tidak dapat dikultur. Identifikasi P. jirovecii di Indonesia masih berdasarkan pemeriksaan mikroskopik yang seringkali kurang sensitif. Oleh karena itu, dikembangkan teknik real time PCR yang lebih sensitif dan spesifik dengan gen target mitochondrial large subunit (mtLSU) dan mitochondrial small subunit (mtSSU) rRNA. Penelitian ini bertujuan untuk mengoptimasi deteksi gen mitochondrial large dan small subunit rRNA dalam mengidentifikasi P. jirovecii pada pasien terkait TB paru. Penelitian ini menggunakan 26 sampel sputum pasien terkait TB paru. Optimasi teknik real time PCR berupa optimasi konsentrasi primer, probe, suhu penempelan, volume cetakan DNA dan uji reaksi silang dilakukan untuk mendapatkan kondisi yang optimal dalam amplifikasi gen mtLSU dan mtSSU rRNA. Hasil penelitian menunjukkan hasil optimasi deteksi kedua gen tersebut dapat mengidentifikasi P. jirovecii 1 dari 26 sampel (3,84%). Uji real time PCR yang telah di optimasi dalam penelitian ini dapat mendeteksi P. jirovecii pada sampel klinis pasien terkait TB paru.

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Identification of Pneumocystis jirovecii in patients with co-infected pulmonary tuberculosis (TB) is still a challenge because the clinical and radiological features of both are similar and P. jirovecii cannot be cultured. Identification of P. jirovecii in Indonesia is still based on microscopic examination which is often less sensitive. Therefore, a more sensitive and specific real time PCR technique was developed with mitochondrial large subunit (mtLSU) and mitochondrial small subunit (mtSSU) rRNA target genes. This study aimed to optimize the detection of mitochondrial large and small subunit rRNA genes to identify P. jirovecii in pulmonary TB-related patients. A total of 26 sputum samples of pulmonary TB-related patients were collected. Real time PCR technique optimization including the optimization of primer and probe concentrations, annealing temperature, DNA template volume and cross-reaction testing, was carried out to obtain optimal conditions for mtLSU and mtSSU rRNA gene amplification.  The results showed that the optimization of detection for both genes could identify P. jirovecii in 1 out of 26 samples (3.84%). The optimized real time PCR test in this study can detect P. jirovecii in clinical samples of pulmonary TB-related patients."

"Latar Belakang: Kanker paru merupakan salah satu kanker yang paling sering terjadidan menyebabkan angka kematian yang cukup tinggi. Salah satu komplikasi yang dapattimbul adalah infeksi oportunistik berupa mikosis paru. Mikosis paru masih jarangdikenali, padahal menyebabkan beban kesehatan dan peningkatan laju mortalitas. Salahsatu penyebabnya adalah diagnosis yang masih menjadi tantangan karena tidakspesifiknya gejala klinis dan uji diagnosis tidak invasif yang ada juga masih belumdiketahui kepastian tingkat akurasinya.Tujuan: Penelitian ini bertujuan untuk mengetahui kaitan berupa nilai akurasi hasildiagnosis immunodiffusion test (IDT) dibandingkan dengan profil IgG spesifikAspergillus.Metode: Metode penelitian ini adalah dengan uji laboratorium IDT dan IgG spesifikAspergillus dengan desain studi potong lintang. Pemeriksaan IDT menggunakan crudeantigen Aspergillus sedangkan pemeriksaan IgG spesifik Aspergillus menggunakan kitkomersial Dynamiker dengan hasil positif jika nilai absorbansi di atas 120 AU/mL.Hasil: Berdasarkan 70 subjek didapatkan karakteristik sebagai berikut yaitu subjekumumnya berjenis kelamin laki-laki 61,4% (n=43), berusia di atas 60 tahun 54,3%(n=38), memiliki riwayat merokok 60,0% (n=42) dengan indeks Brinkmann berat31,4% (n=22). Pasien umumnya memiliki jenis histologi berupa adenokarsinoma 74,3%(n=52) dengan stadium IIIB-IV sebesar 78,6% (n=55) dan tampilan status kategori PS 140,0% (n=28). Prevalensi aspergillosis berdasarkan IgG spesifik Aspergillus padapenelitian ini adalah 25,7%, sedangkan prevalensi jika menggunakan IDT sebesar 42,9%. Nilai akurasi IDT dengan IgG spesifik Aspergillus sebagai baku emas menunjukkan tingkat sensitivitas 44,4% (IK95% 21,5%-67,4%), spesifisitas 57,7% (IK95% 44,3%-71,1%), nilai duga positif 26,7% (IK95% 10,8%-42,5%), dan nilai duganegatif 75,0% (IK95% 61,6%-88,4%) dan nilai Kappa sebesar 0.017. Selain itu, terdapat hubungan yang bermakna secara statistik antara jenis kelamin dan indeks brinkmann terhadap hasil pemeriksaan IDT Aspergillus (p<0.05).Kesimpulan: IDT bukan merupakan metode diagnosis yang baik dan perlu adanya validasi terhadap crude antigen yang digunakan.

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Background: Lung cancer is one of the most common cancers and causes a high

mortality rate. One of the complications that can arise is an opportunistic infection in

the form of pulmonary mycosis. Pulmonary mycosis is rarely recognized, even though it

causes a health burden and an increased mortality rate. One of the causes is the method

of diagnosis which is still a challenge because the clinical symptoms are not specific

and the existing non-invasive diagnostic tests are not yet known for its exact level of

accuracy.

Aim: This study aims to determine the correlation in the form of accuracy value of the

immunodiffusion test (IDT) diagnostic results compared to the Aspergillus-specific IgG

profile.

Method: The method of this research was laboratory tests in forms of IDT and

Aspergillus-specific IgG with cross-sectional study design. IDT test used crude antigen

while Aspergillus-specific IgG test used a commercial Dynamiker Kit with a positive

result if the absorbance value above 120 AU/mL.

Results: Based on 70 subjects, the characteristics of the subjects are mainly male 61.4%

(n=42) with age over 60 years old 54.3% (n=43), had a history of smoking 60% (n=42)

with a severe Brinkmann index 31.4% (n=22). Subjects generally had a histological

type of adenocarcinoma 74.3% (n=52) with stage IIIB-IV 78.6% (n=55) and

performance status category PS1 40.0% (n=28). The prevalence of aspergillosis in this

study was 25.7% using Aspergillus-specific IgG, while the prevalence when using IDT

was 42.9%. The IDT accuracy value with Aspergillus-specific IgG as the gold standard

showed a sensitivity level of 0.444 (95%CI 0.215-0.674), a specificity of 0.577 (95% CI

0.443-0.711), a positive predictive value of 0.267 (95% CI 0.108-0.425), and a negative

predictive value of 0.750 (95% CI 0.616-0.884) and the Kappa value is 0.017. In

addition, there was a statistically significant relationship between gender and the

Brinkmann index on the results of the Aspergillus IDT examination (p <0.05).

Conclusion: IDT is not a good diagnostic method and it is still necessary to validate the

crude antigen used."

"Kanker paru sebagai salah satu kanker terbanyak di dunia merupakan faktor risiko dari infeksi oportunistik, seperti mikosis paru. Mikosis paru masih jarang dikenali akibat diagnosis yang masih menjadi tantangan karena gejala dan radiologis yang tidak spesifik dan uji diagnosis yang tidak invasif masih belum diketahui kepastian tingkat akurasinya. Studi ini dilakukan untuk mengetahui nilai akurasi hasil pemeriksaan immunodiffusion test (IDT) yang menggunakan crude antigen dibandingkan dengan profil immunoglobulin G (IgG) spesifik Aspergillus sebagai baku emas yang menggunakan kit Dynamiker dengan hasil positif jika absorbansi di atas 120 AU/mL. Penelitian dilakukan melalui uji laboratorium dengan desain studi potong lintang. Prevalensi aspergillosis berdasarkan IgG spesifik Aspergillus didapatkan 25,7% dan nilai akurasi IDT didapatkan sensitivitas 44,4% (IK95% 21,5%-67,4%), spesifisitas 57,7% (IK95% 44,3%-71,1%), nilai duga positif 26,7% (IK95% 10,8%-42,5%), dan nilai duga negatif 75,0% (IK95% 61,6%-88,4%) dengan nilai Kappa sebesar 0.017. Selain itu, terdapat perbedaan yang bermakna secara statistik antara jenis kelamin dan indeks Brinkmann terhadap hasil pemeriksaan IDT Aspergillus (p<0,05). Oleh karena itu, IDT bukan merupakan metode diagnosis yang baik dan perlu adanya perbaikan terhadap antigen yang digunakan.

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Lung cancer as one of the most common cancers in the world is a risk factor for opportunistic infections, such as pulmonary mycoses. Pulmonary mycoses is still rarely recognized due to the challenging diagnosis because the symptoms and radiology are not specific and the accuracy value of diagnostic tests that are not invasive is still not yet known. This study was conducted to determine the accuracy of immunodiffusion test (IDT) using crude antigen compared to the Aspergillus-specific immunoglobulin G (IgG) as the gold standard using Dynamiker kit with the positive result if the absorbance value is above 120 AU/mL. The method of this research is laboratory test with a cross-sectional study design. The prevalence of aspergillosis based on Aspergillus-specific IgG is 25.7% and the accuracy values of IDT are sensitivity 44.4% (95% CI 21.5%-67.4%), specificity 57.7% (95% CI 44.3%-71.1%), positive predictive value 26.7% (95% CI 10.8%-42.5%), and negative predictive value 75.0% (95% CI 61.6%-88.4%) with Kappa value 0.017. Besides, there was a statistically significant difference between gender and the Brinkmann Index on the results of IDT examination (p>0.05). Therefore, IDT is not a good or reliable diagnostic method and there is a need for improvement or correction of the antigen used."

"Latar Belakang: Pajanan terhadap jamur telah diketahui berperan dalam perburukan gejala asma, fungsi paru yang buruk, rawat inap dan kematian. Kolonisasi atau pajanan jamur dapat mencetuskan respons alergi dan inflamasi paru. Sensititasi jamur oleh Aspergillus dapat menyebabkan Allergic Bronchopulmonary Aspergillosis (ABPA) maupun Severe Asthma with Fungal Sensitization (SAFS). Pemeriksaan Immunodiffusion test (IDT) merupakan uji serologi untuk mengetahui terdapatnya antibodi anti-Aspergillus, namun pemeriksaan ini belum banyak digunakan di Indonesia dan perannya terhadap pasien asma belum diketahui.Metode: Penelitian ini adalah penelitian prospektif dengan metode consecutive sampling dan desain potong lintang. Subjek penelitian ini adalah pasien asma yang berobat di Poliklinik Asma Rumah Sakit Persahabatan, Jakarta. Subjek penelitian menjalani pemeriksaan spirometri, Asthma Control Test (ACT) dan serologi antibodi anti-Aspergillus dengan metode IDT Aspergillus menggunakan crude antigen Aspergillus.Hasil: Subjek penelitian ini sebanyak 59 pasien. Sejumlah 49 subjek (83,1%) berjenis kelamin perempuan, 37 subjek (62,7%) berusia ≥50 tahun, 45 subjek (76,3%) berpendidikan SLTA atau lebih, 25 subjek (42,4%) obesitas I, 5 subjek (8,5%) obesitas II dan 11 subjek (18,6%) bekas perokok. Sebagian besar subjek (62,71%) merupakan pasien asma persisten sedang. Asma terkontrol penuh ditemukan pada 7 subjek (11,86%), sedangkan asma tidak terkontrol pada 32 subjek (54,24%). Derajat obstruksi yang terbanyak ditemukan adalah obstruksi sedang pada 31 subjek (52,5%). Nilai %VEP1 ≥80% prediksi setelah uji bronkodilator ditemukan pada 24 subjek (40,7%). Dari 59 sampel darah yang diperiksa, tidak ada yang menunjukkan hasil IDT positif (0%), termasuk subjek yang datang dalam keadaan eksaserbasi dan subjek dengan asma persisten berat.Kesimpulan: Hasil positif pemeriksaan IDT Aspergillus pada pasien asma sebesar 0%. Pemeriksaan IDT Aspergillus tidak dapat digunakan secara tunggal tanpa pemeriksaan lain untuk mendeteksi sensititasi terhadap Aspergillus pada pasien asma dan tanpa validasi terhadap crude antigen Aspergillus yang digunakan.

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Background: Exposure to fungi has been known to play a role in worsening symptoms of asthma, poor lung function, hospitalization and death. Fungal colonization or exposure can trigger an allergic response and lung inflammation. Fungal sensitization by Aspergillus spp. can cause allergic bronchopulmonary aspergillosis (ABPA) or severe asthma with fungal sensitization (SAFS). Immunodiffusion test (IDT) is a serological test to determine the presence of anti-Aspergillus antibodies, but this examination has not been widely used in Indonesia and its role in asthma patients is unknown.Method: This study was a prospective study with consecutive sampling method and cross-sectional design. The subjects were asthma patients treated at Asthma Outpatient Clinic at Persahabatan Hospital Jakarta, Indonesia. Subjects underwent spirometry, Asthma Control Test (ACT) and serology of anti-Aspergillus antibodies examination with the IDT Aspergillus method using crude antigen Aspergillus.Results: The subjects of this study were 59 patients. A total of 49 subjects (83.1%) were females, 37 subjects (62.7%) were ≥50 years old, 45 subjects (76.3%) had high school education level or higher, 25 subjects (42.4%) were obese I, 5 subjects (8.5%) were obese II and 11 subjects (18.6%) were former smokers. Most subjects (62.71%) were moderate persistent asthma patients. Fully-controlled asthma was found in 7 subjects (11.86%), while uncontrolled asthma was found in 32 subjects (54.24%). The highest degree of obstruction found was moderate obstruction in 31 subjects (52.5%). The %VEP1 ≥80% predicted after the bronchodilator test was found in 24 subjects (40.7%). Of the 59 blood samples examined, none showed positive IDT results (0%), including subjects who came in exacerbations and subjects with severe persistent asthma.Conclusion: Positive results of IDT Aspergillus examination in asthma patients were 0%. The Aspergillus IDT examination cannot be used singly without other examinations to detect Aspergillus sensitization in asthmatic patients and without validation of the crude antigen Aspergillus used."

"Latar belakang. Meningkatnya kasus HIV-AIDS human immunodeficiency virus-acquired immunodeficiency syndrome secara global memicu kewaspadaan akan peningkatan infeksi oportunistik, salah satunya infeksi Pneumocystis jirovecii yang mengakibatkan pneumonia PjP. Infeksi PjP merupakan kasus yang sulit ditangani terkait rendahnya sensitivitas uji diagnostik diiringi dengan peningkatan kasus resistensi terhadap antibiotik. Di Indonesia belum terdapat data demografis, epidemiologi molekuler maupun data resistensi mengenai kasus infeksi PjP. Mengantisipasi masalah tersebut, dalam penelitian ini dikembangkan uji diagnostik PjP pada ODHA Orang Dengan HIV-AIDS terduga pneumonia melalui pendekatan molekular terhadap gen MSG Major Surface Glycoprotein disertai dengan karakterisasi gen DHPS dihidropteroat sintase dan gen mtLSU mitochondrial large subunit yang berkorelasi dengan genotipe resisten dan virulensi P. jirovecii. Tujuan penelitian. Memperoleh suatu uji deteksi infeksi PjP, data genotipe resistensi dan virulensi PjP melalui pendekatan secara molekuler yang dapat dimanfaatkan sebagai dasar data demografi dan epidemiologi molekuler PjP di Indonesia. Metode penelitian. Pengembangan uji diagnosis molekuler PjP terhadap gen MSG dilakukan dengan metode real- time PCR yang diujikan terhadap 100 sampel sputum. Pola genotipe resistensi dilakukan melalui amplifikasi gen DHPS dilanjutkan dengan restriction fragment length polymorphism RFLP . Virulensi daerah hot spot gen mtLSU dianalisis dengan metode PCR dan sekuensing DNA. Hasil. Secara demografi, diketahui prevalensi PjP pada ODHA terduga pneumonia di Jakarta mencapai 20,0, laki-laki 75, rentang usia terbanyak 31-40 tahun 35, dominan 80 pada kisaran sel limfosit T CD4 200-349 sel/L. Sebanyak 12 pasien menunjukkan gen DHPS positif, lima pasien 41,66 merupakan genotipe wild type WT dan 7 pasien lainnya 58,32 merupakan genotipe resisten, terdiri dari 16,67 genotipe-3 dan 41,66 genotipe campuran WT dan genotipe 1. Analisis virulensi berdasarkan gen mtLSU diperoleh 30 strain PjP positif yang didominasi oleh variasi-3. Status imun pasien lebih berkaitan dengan genotipe resistensi dibandingkan dengan jenis varian. Kesimpulan. Uji real-time PCR yang dikembangkan mampu memberikan nilai diagnostik yang lebih baik dibandingkan pewarnaan Giemsa. Terdapat 3 genotipe gen resistensi WT, genotipe 1 dan 3 dan 7 varian P. jirovecii yang bersirkulasi di Jakarta. Genotipe resistensi lebih berkaitan terhadap kondisi klinis pasien dibandingkan dengan jenis varian.

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Background. The global rise of HIV-AIDS cases increase the alertness against oportunistic infections, one of them is Pneumocystic jirovecii pneumonia PjP. PjP infection is a one of a tough infection to be cured due to low sensitivity of its diagnostic method following the escalation of PjP resistance against antibiotics. There is no demografic, molecular epidemiology nor antibiotics resistance data were available related to PjP infection in Indonesia. Thus, this study was conducted to develop a molecular test to diagnose PjP infection in HIV-AIDS suspected pneumonia patients based on MSG Major Surface Glycoprotein gene detection, followed by characterization of DHPS dihydropteroat syinthetase and mtLSU mitochondrial large subunit genes represent genoype resistance and P. jirovecii virulence. Research objective. To obtain a molecular test in diagnosing PjP infection and information of P. jirovecii genotype resistance and virulence based on molecular characteristics, which can be used further as demographic and molecular epidemiology basis data of PjP in Indonesia. Research methods. Molecular diagnostic test aimed for MSG gene of P. jirovecii detection was done through real-time PCR against 100 sputum samples. Genotype resistance and P. jirovecii polymorphism patterns was done through DHPS and mtLSU genes amplification followed by restriction fragment length polymorphism RFLP and DNA sequencing analysis. Virulence of the hot spot area are of the mtLSU gene was analyzed by PCR method and DNA sequencing. Results. The prevalence of PjP infection in HIV-AIDS suspected pneumonia patients in Jakarta was 20.0, male 75 within 31-40 y.o 35, dominant 80 from patients with CD4 T-lymphocytes of 200-349 cells/L. Molecular real-time PCR methods give five times sensitivity higher than Giemsa stain. Twelve patients showed positive DHPS gene, five patients 41.67 were wild type WT genotypes and 7 other patients 58.32 were resistant genotypes, with 16.66 was genotype-3 and other 41.66 was mixed genotypes WT and genotype 1. Virulence analysis based on mtLSU gene show 30 positive strains which dominated by variant-3. The patients immune status is more related to the resistance genotype compared to the variant type. Conclusion. The developed real-time PCR method is proven to able to give better diagnostic value than Giemsa stain. There are 3 genotypes of resistance genes WT, genotypes 1 and 3 and 7 variants of P. jirovecii circulating in Jakarta. Resistance genotypes are more related to the clinical condition of patients compared to variant types. "

"Latar belakang: Pasien kanker paru lebih rentan mengalami infeksi, termasuk infeksi jamur paru (mikosis paru) yang dapat memperburuk prognosis pasien. Aspergillus merupakan jamur penyebab mikosis paru yang paling sering, termasuk aspergilosis paru kronik (APK). Deteksi IgG spesifik Aspergillus berbasis enzyme-linked immunosorbent assay (ELISA) sering digunakan untuk diagnosis APK, tetapi penggunaannya masih terbatas karena berbagai kendala. Uji diagnosis APK dengan metode sederhana tetapi dengan hasil akurat diharapkan dapat mengatasi kendala tersebut, sekaligus meningkatkan kualitas tata laksana. Tujuan: Penelitian ini bertujuan untuk mengetahui hasil pemeriksaan ICT LD Bio Aspergillus dibandingkan dengan IgG-spesifik Aspergillus Dynamiker pada pasien kanker paru bukan sel kecil (KPKBSK) di RSUP Persahabatan. Metode: Penelitian ini merupakan uji diagnostik untuk membandingkan dua metode pemeriksaan APK yang lebih akurat. Rangkaian penelitian dilaksanakan sejak April 2019–Oktober 2020. Subjek penelitian adalah pasien KPKBSK di RSUP Persahabatan yang memenuhi kriteria inklusi. Pemeriksaan IgG spesifik Aspergillus Dynamiker dan ICT LD Bio Aspergillus dilakukan di laboratorium Departemen Parasitologi FKUI. Analisis statistik hasil perbandingan kedua metode tersebut dilakukan untuk mengetahui proporsi, sensitivitas, spesisifisitas, nilai duga positif & nilai duga negatif. Hasil: Dari 77 pasien yang memenuhi kriteria inklusi, proporsi hasil positif ICT LD Bio Aspergillus 14,3%, sedangkan IgG spesifik Aspergillus Dynamiker 22,1%. Sensitivitas ICT LD Bio Aspergillus dibandingkan dengan IgG spesifik Aspergillus Dynamiker 23,5%, sedangkan spesifisitasnya 88,3%. Nilai duga positif ICT LD Bio Aspergillus dibandingkan dengan IgG spesifik Aspergillus Dynamiker adalah 36,4%; sedangkan nilai duga negatifnya 80,3%. Kesimpulan: Hasil pemeriksaan ICT LD Bio ICT Aspergillus lebih baik dibandingkan dengan IgG spesifik Aspergillus pada pasien KPKBSK di RSUP Persahabatan.

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Background: Lung cancer patients are more susceptible to infections, including pulmonary mycosis, which can worsen the prognosis. Aspergillus is the most common cause of pulmonary mycosis, including chronic pulmonary aspergillosis (CPA). Detection of Aspergillus-specific IgG with enzyme-linked immunosorbent assay (ELISA) is often used for diagnosis of CPA, but it is still a challenge. The CPA diagnosis with a simple method and accurate results is needed to improve the quality of patient’s management.

Aims: The study aimed to determine the results of ICT LD Bio Aspergillus compared with Aspergillus-specific IgG Dynamiker's in NSCLC patients at Persahabatan General Hospital.

Methods: This study is a diagnostic test to compare the ICT LD Bio Aspergillus with Aspergillus-specific IgG Dynamiker's which is more accurate for CPA diagnosis. The study was conducted from April 2019 to October 2020. The subjects were NSCLC patients at Persahabatan General Hospital who met the inclusion criteria. The serology tests were carried out at the laboratory of Parasitology Department, FKUI. The statistical analysis was performed to determine the proportion, sensitivity, specificity, positive and negative predictive values of the two tests.

Results: Of the 77 patients who met the inclusion criteria, the proportion of positive results for ICT LD Bio Aspergillus was 14.3%, while for Aspergillus-specific IgG Dynamiker's was 22.1%. The sensitivity of ICT LD Bio Aspergillus compared to Aspergillus-specific IgG Dynamiker was 23.5%, while the specificity was 88.3%. The positive predictive value of ICT LD Bio Aspergillus compared to Aspergillus-specific IgG Dynamiker was 36.4%; while the negative predictive value was 80.3%.

Conclusion: The ICT LD Bio Aspergillus is more accurate than Aspergillus-specific IgG in NSCLC patients at Persahabatan General Hospital."