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"Latar Belakang. Tuberkulosis (TB) adalah penyakit menular dan merupakan salah satu dari 10 penyebab kematian terbanyak di dunia. Selain paru, TB dapat juga menyerang ekstraparu. Tanpa terapi, mortalitas TB sangat tinggi. Data mengenai TB ekstraparu masih sedikit di Indonesia. Tatalaksana TB ekstraparu serta hasil pengobatannya juga masih jarang diteliti.Tujuan. Mengetahui hasil pengobatan TB ekstraparu di Rumah Sakit Cipto Mangunkusumo (RSCM) yang sudah menggunakan standar pengobatan TB ekstaparu di IndonesiaDesain Penelitian. Penelitian berdesain kohort retrospektif ini dilakukan menggunakan data sekunder dari rekam medik pasien tuberkulosis ekstraparu pada 1 Januari 2014 - 31 Desember 2017 di RSCM.Hasil Penelitian. Dari 78 subjek penelitian yang menderita TB ekstraparu, prevalensi terbanyak adalah TB kelenjar getah bening yakni 27 subjek (34,6%). Sebanyak 62 (79,5%) subjek dinyatakan mengalami keberhasilan pengobatan dan 58 (74,4%) subjek diantaranya diobati sesuai dengan panduan. Pada analisis multivariat terdapat hubungan bermakna antara jenis kelamin dengan keberhasilan pengobatan TB ekstra paru.Simpulan. Keberhasilan pengobatan TB ekstraparu di RSCM 79,5%. Pengobatan TB ekstraparu di RSCM sudah sesuai dengan panduan terapi TB ekstraparu di Indonesia 74,4%. Keberhasilan pengobatan TB Ekstraparu pada wanita lebih besar dibandingkan pria. Background. Tuberculosis (TB) is an infectious disease and also one of 10 prevalent causes of death worldwide. Apart from lungs, TB also affects extra-pumonar organs. Without treatment, TB mortality is very high. There are only limited data on extrapulmonary TB in Indonesia. Extrapulmonary TB treatment and the outcomes are also rarely studied.Objective. To evaluate the results of standardized extrapulmonary TB treatment in Cipto Mangunkusumo Hospital (RSCM) according to extrapulmonary TB standard treatment used in Indonesia.Methods. This is a retrospective cohort was carried out with secondary data from medical records of extrapulmonary tuberculosis patients in between January 1st 2014 - December 31st 2017 at RSCM.Results. Of the 78 subjects who suffered from extrapulmonary, the highest prevalence extrapumonary TB was lymphadenitis TB in 27 subjects (34,6%). A total of 62 subjects (79,5%) were declared cured and 58 (74,4%) subject treated according to the guidelines. There is related between gender to recovery.Conclusion. The success of extrapulmonary TB therapy at RSCM was 79,%. Extrapulmonary TB treatments at RSCM were in accordance with guidelines for extrapulmonary TB therapy in Indonesia 74,4%. The success of extrapulmonary TB treatment in women is greater than men"

"ABSTRACTLatar Belakang: Perbaikan status nutrisi merupakan salah satu indikator penting dalam menilai keberhasilan pengobatan tuberkulosis. Tujuan: Mengetahui hubungan antara jenis tuberkulosis dan penyakit komorbid dengan perbaikan status nutrisi pasien tuberkulosis anak setelah dua bulan pengobatan. Metode: Penelitian potong lintang dilakukan di RSUPN Cipto Mangunkusumo, Jakarta pada Januari-Oktober 2018 dengan melihat data rekam medis dari 207 pasien anak yang terdiagnosis tuberkulosis selama periode 2012-2018. Hasil: Terdapat hubungan bermakna antara jenis tuberkulosis dengan status nutrisi setelah dua bulan pengobatan fase intensif (nilai p = 0,014; IK95% = 0,422-0,914) dengan kesan bahwa pasien TB ekstraparu mengalami peningkatan status nutrisi lebih baik dibanding pasien TB paru. Selain itu, juga didapat hubungan bermakna antara keberadaan penyakit komorbid dengan status nutrisi pasien (nilai p = 0,020; IK95% = 1,063-2,382), pasien tanpa penyakit komorbid mengalami peningkatan status nutrisi lebih baik dibanding pasien TB dengan penyakit komorbid setelah pengobatan fase intensif. Kesimpulan: Jenis TB dan penyakit komorbid berhubungan dengan kondisi status nutrisi pasien selama dua bulan fase intensif pengobatan tuberkulosis. Tatalaksana komprehensif mencakup manajemen terhadap tuberkulosis dan penyakit komorbid, serta suplementasi nutrisi perlu diperhatikan selama fase awal pengobatan pasien tuberkulosis anak.

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ABSTRACTBackground: Nutritional status improvement constitutes one of an indicator to assess anti tuberculosis treatments success. Objective: This research aims to determine whether the diagnosis of tuberculosis (pulmonary or extrapulmonary) and comorbidities are associated with childrens nutritional status during the first 2-month of tuberculosis treatment. Methods: A cross-sectional study conducted in Cipto Mangunkusumo Hospital, Jakarta in January to October 2018 by reviewing 207 medical records of children diagnosed with tuberculosis from 2012-2018 period of time. Results: Type of TB is associated with nutritional status of children after 2-month intensive phase treatment (p value = 0.014; CI95% = 0.422 to 0.914), children with extrapulmonary TB show better improvement in nutritional status rather than children with pulmonary TB. Comorbidities are associated with nutritional status (p value = 0.020; CI95% = 1.063 to 2.382), tuberculosis children without comorbidities experience better nutritional status improvement rather than those with comorbidities after anti tuberculosis intensive phase treatment. Discussion: Type of TB and comorbidities are significantly associated with nutritional status of tuberculosis children during 2-month intensive phase of anti tuberculosis treatment. Comprehensive treatment including management for tuberculosis and those with comorbidities, along with nutritional supplementation are necessarily maintained during the early phase of treatment in children with tuberculosis."

"ABSTRAKLatar Belakang: Status nutrisi seringkali berhubungan dengan infeksi tuberkulosis TB. TB aktif menyebabkan kehilangan berat badan dan berat badan kurang merupakan faktor risiko infeksi TB, baik melalui reaktivasi TB laten maupun penyakit primer yang progresif menjadi TB ekstrapulmonar TBEP. Defisiensi makro dan mikronutrien pada pasien malnutrisi akan mempengaruhi sistem cell-mediated immunity CMI. Selain itu infeksi TB juga meningkatkan kebutuhan energi, penurunan asupan makanan, penurunan berat badan, dan malabsorpsi makro dan mikronutrien sehingga terjadi wasting. Terapi medik gizi pada pasien TB paru dengan komplikasi TBEP dan malnutrisi bertujuan untuk memperbaiki parameter ststus nutrisi, mempertahankan imbang nitrogen dan mencegah proses wasting lebih lanjut. Metode: Pasien pada laporan serial kasus ini berusia antara 8 ndash;28 tahun menderita TB paru dengan komplikasi lesi TBEP yang berbeda-beda, yaitu: 1 limfadenitis TB, skrofuloderma, dan efusi pleura, 2 spondilitis TB, 3 TB intestinal pasca laparotomi dengan fistula enterokutan, serta 4 meningoensefalitis TB dan TB milier. Status gizi keempat pasien adalah 2 pasien malnutrisi berat dan 2 pasien malnutrisi ringan, dengan hasil skrining skor >2. Terapi medik gizi yang diberikan disesuaikan dengan kondisi klinis dan kelainan yang terdapat pada pasien. Keempat pasien diberikan suplementasi mikronutrien. Pemantauan yang dilakukan meliputi keluhan subjektif, tanda vital, analisis dan toleransi asupan, pemeriksaan laboratorium, kapasitas fungsional, serta pada pasien TB intestinal dilakukan pemantauan produksi fistel serta perubahan berat badan. Hasil: Tiga pasien mengalami perbaikan kondisi klinis, asupan makanan dan kapasitas fungsional, satu pasien perburukan dan meninggal. Kesimpulan: Terapi medik gizi yang adekuat pada pasien TB dengan TBEP dan malnutrisi dapat mempercepat pemulihan dan memperbaiki status nutrisi.Kata kunci: Malnutrisi, terapi medik gizi, tuberkulosis ekstrapulmonar, suplementasi mikronutrien, keluaran klinis.

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ABSTRACT<>br>Objective Nutritional status and tuberculosis TB infections are frequently related. Active TB leads to weight loss and undernutrition is a risk factor for TB infection, either through the reactivation of latent TB or progressive primary disease into extrapulmonary TB EPTB. Macro and micronutrient deficiencies in malnourished patients will affect the cell mediated immunity CMI system. TB infection also increases energy demand, decreased food intake, induced weight loss, and macro and micronutrient malabsorption resulting in wasting. The aims of nutritional medical therapy in pulmonary tuberculosis patients complicated by EPTB and malnutrition are to improve the parameters of nutritional status, maintain nitrogen balance and prevent further wasting. Methods Patients age on this case series report between 8 and 28 years old, have pulmonary tuberculosis with complications of different EPTB lesions 1 TB lymphadenitis, scrofuloderma, and pleural effusion, 2 spondylitis TB, 3 post laparotomy intestinal TB with enterocutaneous fistula, and 4 TB meningoencephalitis and miliary TB. The nutritional status of all patients was 2 patient had severe malnutrition and 2 patients had mild malnutrition. All patient had screening score 2. Nutritional therapy which was given to all patients, was adjusted to the clinical conditions and abnormalities suffered by the patient. All patients received micronutrient supplementation. Monitoring included subjective complaints, vital signs, analysis and intake tolerance, laboratory examination, functional capacity, and in one patient with intestinal TB, fistel production and weight changes. Results Three patients showed improved clinical conditions, dietary intake and functional capacity, one patient suffered deteriorated and died. Conclusion Adequate medical nutrition therapy in malnourished and EPTB patients can improve recovery and improve nutritional status.Keywords Malnutrition, medical nutrition therapy, extrapulmonary tuberculosis, micronutrient supplementation, clinical outcome."

"Dilakukan penelitian untuk memperoleh bukti tentang basil tahan asam (BTA) dalam sumsum tulang (ST) pada pasien dengan tuberkulosis ekstrapulmoner. Pada 50 kasus yang diduga tuberkulosis ekstrapulmoner dilakukan aspirasi ST dari sternum/crista iliaca dan dimasukkan dalam uji klinik pengobatan anti tuberkulosis. Hasilnya menunjukkan bahwa semua kasus yang diteliti bereaksi terhadap pengobatan anti tuberkulosis. Gambaran jangkitan penyakit adalah sebagai berikut: abdomen (20), susunan saraf pusat (19), pericard (5), limfadenopati leher (2), PUO (2), spina (1) dan milier (1). Lima puluh dua persen kasus menunjukkan BTA dalam ST (pada pewarnaan Zn), sedangkan hanya 4% kasus yang menunjukkan BTA pada cairan tubuh lain (cairan serebro spinal/pericardium/ peritoneum). Di samping itu, perubahan sitomorfologik dari ST menunjukkan terjadinya limfositosis (22%), peningkatan sel plasma (80%) dan makrofag (88%), sesuai dengan patologi infeksi yang disertai aktifitas makrofag yang berlebihan. Disimpulkan bahwa aspirasi sumsum tulang mempunyai nilai diagnostik yang definitif dan mungkin berguna apabila pemeriksaan lain belum cukup. (Med J Indones 2002; 11: 148-52)

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This study was undertaken to look for evidence of acid fast bacilli (AFB) in bone marrow (BM) in patients of extrapulmonary tuberculosis. Fifty cases suspected of extrapulmonary tuberculosis underwent bone marrow aspiration from sternum/illiac crest and were put on a therapeutic trial of antituberculosis therapy. All cases taken in the study responded to the therapy. The pattern of involvement were ? abdominal (20), CNS (19), pericardial involvement (5), cervical lymphadenopathy (2), PUO (2), spinal (1) and miliary (1). 52% cases showed evidence of AFB in BM (on Ziehl Neelsen?s (ZN) staining) whereas only 4% of cases showed evidence of AFB in any other body fluid (CSF/pericardium/peritonium). Besides this, cytomorphological changes of BM showed evidence of lymphocytosis (22%), increased plasma cells (80%) and prominence of macrophages (88%), thus signifying infective pathology with macrophage overactivity. So we conclude that bone marrow aspiration has a definite diagnostic value and may prove useful when other investigations are unrewarding. (Med J Indones 2002; 11: 148-52)"

"BACKGROUND: there are many researches about IGRA in extrapulmonary Tuberculosis (TB), but there only few data from developing countries. This was the first research about the utility of IGRA in extrapulmonary TB performed in Indonesia as developing country with the 2nd most frequent of TB cases in the world. This study aimed to identify the advantage of IGRA examination in diagnosing extrapulmonary TB.METHODS:eighty-four patients, presumed to have extrapulmonary TB were examined with IGRA and gold standard examination. The gold standard examination was performed by histopathologic examination, and tissue smear for acid-fast bacilli.RESULTS:among 84 patients included in the study, 57 patients were tested positive with gold standard, where 50 patients among them were also tested positive with IGRA. Among 27 patients tested negative with gold standard, IGRA positive was found in 10 patients. Lymphadenitis was the most common manifestation of the extrapulmonary TB. Diagnostic test from IGRA for extrapulmonary TB found as follows: sensitivity 87,71%, specificity 63%, positive predictive value 83,33%, and negative predictive value 70,83%.CONCLUSION:IGRA could be used as supporting tool in the diagnosis of extrapulmonary TB. The negative result, however, does not indicate absence of TB infection"

"Latar belakang. Meskipun vaksin Bacille Calemette-Guerin telah menjadi program vaksinasi wajib di Indonesia, TB pada anak tetap prevalen sehingga penelitian ini akan mengevaluasi jaringan parut BCG dan hubungannya dengan kejadian TB ekstraparu (TB-EP) pada anak. Metode Penelitian. Pengambilan data dilakukan di Rumah Sakit Cipto Mangunkusumo Kiara dengan metode potong-lintang pada populasi anak terdiagnosis TB berdasarkan kriteria WHO dan konsensus IDAI. Hasil. Sebanyak 246 pasien anak dengan jangkauan usia 2 bulan -18 tahun terdiagnosis TB. Sebesar 127 anak (51,6%) mengalami TB-EP, dengan prevalensi TB tulang, KGB dan abdomen secara berurutan 13%, 10,9%, dan 6,6%. Mayoritas pasien TB EP adalah laki-laki (55,2%) dan berada dalam kelompok usia 6-14 tahun (60%). Riwayat kontak dengan kasus TB-EP ditemukan pada 49 kasus (51,5%). Penyakit komorbid penyerta dengan mayoritas keganasan (25,6%) dan infeksi HIV (23,1%) ditemukan pada 21 kasus TB-EP (35%). Status jaringan parut BCG positif ditemukan pada 140 kasus (56,9%). Dari 106 anak tanpa jaringan parut BCG, sebanyak 38 anak (35,8%) memiliki TB paru dan sebanyak 68 anak (64,2 %) memiliki TB-EP. Tidak adanya jaringan parut BCG memiliki hubungan yang bermakna dengan kejadian TB-EP pada anak (p < 0.01) dengan OR: 2,457 (IK95% : 1,46 - 4,131). Kesimpulan. Tingginya kejadian TB-EP pada anak pada proporsi tanpa jaringan parut BCG berhubungan signifikan secara statistik. Upaya vaksinasi BCG yang optimal diperlukan untuk mengurangi morbiditas dan mortalitas TB-EP pada anak di Indonesia.

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Objectives. Although the Bacille Calmette-Guerin vaccination program is already implemented nationally, childhood TB remains prevalent particularly in Indonesia so this study will evaluate the relationship between BCG vaccination scar and extra pulmonary TB in children.

Methods. Data collection was conducted at Cipto Mangunkusumo Kiara Hospital by cross-sectional method. Children diagnosed with TB according to WHO criteria and IDAI consensus are included in this study.

Results. A total of 246 pediatric patients with a-2 months to 18 years-age range were diagnosed with TB. Extra pulmonary TB was found in 127 children (51.6%), with the most prevalent type: bone, lymph node and abdomen TB sequentially are 13%, 10.9%, and 6.6%. The majority of patients with extrapulmonary TB are male (55.2%) and are in the age group 6-14 years (60%). History of contact with active TB cases was found in 49 out of 95 extrapulmonary cases (51.5%). Comorbidities, predominantly malignancies (25.6%) and HIV infection (23.1%), were found in 21 of 60 extrapulmonary cases (35%). BCG scar was found in 140 cases (56.9%). Of 140 children with BCG scar, 81 children (68.1%) had pulmonary TB and 59 children (42.1%) had extra-pulmonary TB. Of the 106 children without BCG scar, 38 (35.8%) had pulmonary TB and 68 (64.2%) had extra-pulmonary TB. The absence of BCG scar tissue has a significant relationship with extra-pulmonary TB incidence in children (p <0.01) with OR :2.457 (CI95% : 1.46 - 4.131).

Conclusion: The high incidence of extra-pulmonary TB in children in the proportion lacking BCG scar was statistically significant.Thus, an optimal BCG vaccination effort is required to reduce the morbidity and mortality of childhood extrapulmonary TB in Indonesia."

"Latar Belakang: Uji tuberkulin merupakan pemeriksaan penunjang utama yang membantu diagnosis tuberkulosis anak di Indonesia. Jenis TB yang diderita pasien ternyata dapat mempengaruhi hasil negatif palsu dari uji tuberkulin. Tujuan: Menganalisis hubungan antara hasil uji tuberkulin dan jenis tuberkulosis pasien TB paru dan ekstraparu pada pasien tuberkulosis anak. Metode: Penelitian potong lintang yang dilakukan di Rumah Sakit Cipto Mangunkusumo, Jakarta pada Januari-Oktober 2018 dengan melihat data usia, jenis kelamin, penyakit komorbid, hasil uji tuberkulin, dan jenis tuberkulosis dari formulir TB-01 dan rekam medis dari 230 pasien anak yang terdiagnosis tuberkulosis selama periode 2014-2018. Hasil: Tidak terdapat hubungan bermakna antara hasil uji tuberkulin dengan jenis tuberkulosis (nilai p = 0,607; RR = 0,937; IK95% = 0,729 sampai 1,203). Kesimpulan: Hasil uji tuberkulin tidak berhubungan dengan jenis tuberkulosis yang dimiliki pasien anak. Pada kasus yang diduga mengalami anergi, diagnosis tuberkulosis dapat ditegakkan dengan gambaran klinis pasien, pemeriksaan radiologis, dan hasil uji bakteriologis.

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Background: Tuberculin skin test is one of the primary diagnostic tools for diagnosing tuberculosis in children. Objective: This research analyse the association between the result of tuberculin skin test and the type of tuberculosis in children with pulmonary and extrapulmonary tuberculosis.

Methods: This research is a cross-sectional study conducted in Cipto Mangunkusomo Hospital, Jakarta in January to October 2018 by reviewing 230 data of age, gender, comorbidities, result of tuberculin skin test, and type of tuberculosis from TB-01 form and medical records of children diagnosed with tuberculosis from 2014 until 2018.

Result: There is no significant correlation between the result of tuberculin skin test and type of tuberculosis in children with pulmonary and extrapulmonary tuberculosis (p value = 0.607; RR = 0.937; CI 95% = 0.729 to 1.203).

Discussion: The result of tuberculin skin test does not have significant correlation with the type of tuberculosis in children with pulmonary and extrapulmonary tuberculosis. In cases with suspected anergy, the diagnosis can be formed by patients clinical features, radiology examination and the result of biological testing."

"Anak merupakan populasi yang memiliki risiko lebih tinggi untuk terjadinya tuberkulosis ekstraparu (TBC-EP). Namun demikian, sampai saat ini data mengenai keberhasilan pengobatan TBC ekstraparu pada anak dan faktor yang memengaruhinya di Indonesia masih sangat terbatas. Penelitian ini bertujuan untuk mengetahui keberhasilan pengobatan TBC-EP pada anak dan mengidentifikasi faktor-faktor yang memengaruhinya. Pengambilan data dilakukan di Rumah Sakit Cipto Mangunkusumo Kiara dengan metode kohor retrospektif pada populasi anak terdiagnosis TBC ekstraparu. Dari 953 pasien anak usia 0 bulan-17 tahun yang terdiagnosis TBC, 458 (48%) anak mengalami TBC-EP dengan tiga bentuk yang paling sering bertutur-turut adalah TBC osteoartikular (21,7%), limfadenitis (21,1%) dan sistem saraf pusat (16,3%). Sebanyak 70,6% pasien TBC ekstraparu anak dinyatakan sembuh selama 2015-2021. Mayoritas pasien TBC-EP berusia 11-18 tahun (46%) dengan sebaran jenis kelamin yang seimbang, laki-laki (49,3%) dan perempuan (50,7%). Riwayat kontak dengan pasien TBC ditemukan pada 41,1% dan jaringan parut BCG ditemukan pada 34,7% kasus. Komorbiditas TBC ekstraparu dan TBC paru ditemukan pada 45,7% pasien. Analisis multivariat pada faktor prediktor keberhasilan pengobatan TBC ekstraparu mendapati hasil yang bermakna pada status gizi baik (RR 1,285, IK 95% 1,135-1,456) dan jenis TBC ekstraparu yang dialami bukanlah TBC ekstraparu berat (RR 1,330, IK 95% 1,094-1,616).

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Children is highly susceptible to extrapulmonary tuberculosis (EPTB). However, knowledge about childhood EPTB in Indonesia and its treatment success is limited. This study aimed to determine treatment success rate of EPTB and factors affecting successful treatment outcome in children. We conducted a retrospective cohort study in Cipto-Mangunkusumo Kiara Hospital. A total of 953 pediatric patients below 18 years old were diagnosed with TBC. Extrapulmonary TB was found in 458 children (48%), with the most prevalent type: bone and joint (21.7%), lymph node (21.1%), and central nervous system (16.3%). There were 70.6% EPTB pediatric patients successfully treated during 2015-2021. The majority of patient with EPTB were in the age group of 11-18 years (46%) with balanced sex distribution, male (49.3%) and female (50.7%). Comorbidity of pulmonary TBC and EPTB was found in 45.7% patients. Multivariate analysis in factors predicting successful treatment outcome with significant results were good nutritional status (RR 1.285, 95% CI 1.135-1.456) and suffered from non-severe EPTB form (RR     1.330, 95% CI 1.094-1.616)."