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"Penelaahan terhadap kandungan Aspergillus spp. pada berbagai contoh dan status Aspergillosis pada unggas di Kalimantan Selatan telah dilakukan. Contoh diperoleh dari lapangan yang berasal dari ayam buras (129), anak itik Alabio (192), telur itik (701), pakan (59), dedak (17), dan alas kandang (2). Contoh dibiakkan ke dalam medium agar glukosa Sabouraud mengandung antibiotika antibateri (penisilin-streptomisin) dan diinkubasikan pada suhu 25 derajat C dan 37 derajat C. Pertumbuhan koloni lapang, khususnya Aspergillus spp., diamati selama 10-14 hari. Hasil penelitian menunjukkan bahwa Aspergillus fumigatus, A.flavus, A.niger, dan sejumlah Aspergillus lain yang belum dapat diidentifikasikan spesiesnya dapat diisolasi dari sebagian besar contoh. "

"Dalam mengevaluasi aspergillos pada unggas selama 11 tahun (1979 – 1989), telah diperiksa 873 spesimen dengan hasil 221 spesimen (25,32%) positif aspergillos. Ada 16 jenis unggas yang diperiksa positif, meliputi ayam (ras dan buras), itik, dan berbagai jenis burung. Hasil positif terbanyak berasal dari ayam 154 spesimen (69,69%), lalu burung kakatua 24 spesimen (10,86%), kemudian itik 9 spesimen (4,0750, selebihnya burung-burung lain kurang dari 4%/ rgan tubuh yang diserang pada umumnya alat pernapasan (paru-paru dan kantong udara), organ tubuh lainnya. Komposisi hasil diagnosis aspergillos pada ayam adalah fumigatus 59,74%, flavus 32,47%, dan niger 7,79%, sedangkan hasil diagnosis pada unggas secara keseluruhan adalah fumigiatus 68,78%, flavus 24,89%, dan niger 6,33%. Selama pengamatan tidak ditemukan infeksi oleh spesies Aspergillos lain."

"Latar Belakang: Aspergilosis paru kronik (APK) dapat menjadi komplikasi infeksi tuberkulosis (TB) paru yang telah diobati. Gejala klinis APK dengan TB paru sangat mirip, sehingga sulit dibedakan. Diagnosis APK ditetapkan sesuai konsensus berdasarkan gejala klinis, hasil pemeriksaan radiologi dan laboratorium mikologi. Pemeriksaan antibodi dengan imunoglobulin G (IgG) spesifik Aspergillus menggunakan metode Enzyme-linked immunosorbent assay (ELISA) dapat membantu diagnosis APK. Penelitian ini bertujuan untuk mengetahui karakteristik klinis, profil IgG spesifik Aspergillus, serta prevalensi APK pada pasien bekas TB di beberapa rumah sakit di Jakarta.Metode: Penelitian prospektif dengan desain potong lintang ini dilakukan pada April 2019 - Februari 2020. Pemilihan subjek dilakukan dengan metode consecutive sampling. Subjek merupakan pasien bekas TB yang berasal dari poli rawat jalan dan rawat inap Rumah Sakit Umum Pusat Rujukan Respirasi Persahabatan Jakarta dan Rumah Sakit Graha Permata Ibu. Pemeriksaan IgG spesifik Aspergillus dan biakan sputum jamur dilakukan di Laboratorium Departemen Parasitologi FKUI.Hasil: Dari 97 pasien yang sesuai dengan kriteria penerimaan, 66 pasien (68%) berjenis kelamin laki-laki dan rerata usia 51,8±13,6 tahun. Gejala klinis lebih dari 3 bulan yang dilaporkan berupa mudah lelah (38,4%), sesak napas (34,02%), batuk (30,93%), hemoptisis (27,84%), penurunan berat badan (23,71%), dan nyeri dada (19,6%). Gambaran radiologi terkait APK berupa ektasis (57,8%), kavitas (27,8%), penebalan pleura (26,8%), fibrosis parakavitas (18,6%), dan bola jamur (6,2%). Hasil pemeriksaan IgG spesifik Aspergillus positif dilaporkan pada 51 pasien (52,6%), sedangkan biakan sputum jamur Aspergillus didapatkan pada 43 pasien (44,3%). Berdasarkan analisis hasil-hasil pemeriksaan tersebut, diagnosis APK ditegakkan pada 28 pasien (28,9%).Kesimpulan: Profil IgG spesifik Aspergillus pada 97 pasien bekas TB dalam penelitian ini menunjukkan hasil positif pada 51 pasien (52,6%). Gejala klinis lebih dari 3 bulan yang dilaporkan berupa batuk lama, hemoptisis, penurunan berat badan, mudah lelah, dan sesak napas. Gambaran radiologi terkait APK berupa ektasis, kavitas, penebalan pleura, fibrosis parakavitas, dan bola jamur. Prevalensi APK berdasarkan hasil-hasil pemeriksaan tersebut adalah 28,9%.

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Introduction: Chronic pulmonary aspergillosis (CPA) might become a complication of pulmonary tuberculosis (TB) that has been treated. The clinical symptoms of CPA can resemble with PTB, making it difficult to distinguish. The diagnosis of CPA is determined by the consensus based on clinical symptoms, radiological features, and mycological results. Antibody detection with Aspergillus- specific immunoglobulin G (IgG) using the Enzyme-linked immunosorbent assay (ELISA) method can contribute to CPA diagnosis. This study aims to determine the clinical characteristics, Aspergillus-specific IgG detection, and the prevalence of CPA in prior TB patients at several hospitals in Jakarta.

Method: This prospective cross-sectional study was conducted in April 2019 - February 2020. Patients recruitment was carried out by consecutive sampling method. Subjects were prior TB patients at Persahabatan National Respiratory Referral Hospital and Graha Permata Ibu Hospital. Detection of Aspergillus- specific IgG and fungal cultures from sputum were carried out in the Laboratory of the Parasitology Department, FMUI.

Results: Of 97 patients recruited according to inclusion criteria, 66 patients (68%) were male and the mean age was 51.8 ± 13.6 years. The clinical symptoms of more than 3 months were fatigue (38.4%), shortness of breath (34.02%), cough (30.93%), hemoptysis (27.84%), weight loss (23, 71%), and chest pain (19,6%). Radiological features associated with CPA were ectasis (57.8%), cavity (27.8%), pleural thickening (26.8%), para-cavitary fibrosis (18.6%), and fungal ball (6.2%). The Aspergillus-specific IgG positive were reported in 51 patients (52.6%), whereas Aspergillus sputum cultures were found in 43 patients (44.3%). Based on the analysis of those examinations, the diagnosis of CPA was determined in 28 patients (28.9%).

Conclusion: The detection of Aspergillus-specific IgG in 97 prior TB patients showed the positive results in 51 patients (52.6%). The clinical symptoms more than three months were fatigue, shortness of breath, cough, hemoptysis, and weight loss. The radiological features related to CPA were ectasis, cavitary lesions, pleural thickening, paracavitary fibrosis, and fungal ball. The prevalence of CPA based on those examinations was 28.9%."

"Aspergilosis invasif AI merupakan infeksi jamur invasif disebabkan Aspergillus spp sedangkan aspergilosis paru invasif API merupakan manifestasi AI yang sering ditemukan Gejala klinis laboratorium rutin dan radiologis tidak khas sehingga sering terjadi keterlambatan diagnosis dan tatalaksana Pemeriksaan biopsi tidak selalu dapat dilakukan dan berisiko tinggi sedangkan pemeriksaan biakan memiliki keterbatasan sensitivitas dan waktu Deteksi antigen galaktomanan GM merupakan uji penapis AI yang dinilai baik tetapi di Indonesia kit GM tidak rutin tersedia dan mahal sehingga perlu dicari uji diagnostik alternatif antara lain menggunakan deteksi antibodi anti Aspergillus yang sederhana mudah murah dan terjamin ketersediaannya Tujuan penelitian ini membandingkan hasil pemeriksaan deteksi antibodi anti Aspergillus metode immunodiffusion test IDT menggunakan crude antigen Aspergillus dengan deteksi antigen GM serta mengetahui nilai sensitivitas dan spesifisitasnya Penelitian berdisain potong lintang ini merupakan bagian dari penelitian multisenter sebelumnya mengenai insidens API pada 405 pasien ICU di 6 rumah sakit di Jakarta Selanjutnya ditentukan 125 pasien non neutropenia diduga AI yang bahan klinisnya menjalani pemeriksaan uji diagnostik di atas Biakan Aspergillus sp tumbuh pada bahan klinis ekskreta paru yang dimiliki 26 dari 125 pasien tersebut 20 8 Diagnosis AI putative ditegakkan pada 26 pasien 6 2 dari 405 pasien keseluruhan Dari 125 pasien yang diperiksa uji GM positif ditemukan pada 62 pasien 48 6 sedangkan uji IDT positif pada 74 pasien 59 2 Analisis statistik menunjukkan tidak terdapat perbedaan bermakna antara hasil uji GM dan uji IDT tetapi nilai kesetaraannya sangat lemah nilai kappa 0 169 Uji IDT menggunakan crude antigen Aspergillus mempunyai sensitivitas 67 7 dan spesifisitas 49 1

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Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 ; Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 ; Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 "

"Latar belakang: Tuberkulosis (TB) dapat menimbulkan komplikasi yang disebabkan oleh infeksi Aspergillus spp, yaitu Aspergillosis Paru Kronik (APK) pada kavitasi di paru. Enzyme-linked Immunosorbent Assay (ELISA) otomatis dan Uji Imunokromatografi (ICT) adalah dua dari metode-metode yang menunjang diagnosis klinis APK. Kedua metode tersebut mendeteksi antibodi Aspergillus spp. Keduanya memiliki keunggulan dan kekurangan masing-masing, namun belum ada studi yang membandingkan hasil dari performa diagnosis APK kedua uji tersebut pada pasien akhir pengobatan TB. Metode: Penelitian ini bersifat deskriptif analitik dengan desain potong lintang. Pemeriksaan ELISA otomatis subjek memiliki ambang > 11,5 sebagai hasil positif. Pemeriksaan ICT subjek memiliki hasil positif jika terlihat garis pada masing-masing kolom T dan C, sedangkan hasil positif hanya terlihat satu garis pada kolom C. Hasil: Jumlah subjek keseluruhan adalah 62 subjek dan diperoleh 20 (32,3%) subjek terdiagnosis APK. Hasil positif pemeriksaan ELISA otomatis adalah 27 (43,5%) subjek, sedangkan pemeriksaan ICT adalah 2 (3,2%) subjek. Sensitivitas dan spesifisitas ELISA otomatis masing-masing adalah 75% dan 71,43%, sedangkan ICT adalah 10% dan 100%. Simpulan: ELISA otomatis memiliki performa diagnosis yang lebih baik dibandingkan ICT untuk diagnosis APK, namun ELISA otomatis masih belum tersedia secara adekuat di wilayah Indonesia sehingga penggunaan ICT tetap digunakan sebagai pemeriksaan APK.

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Introduction: Tuberculosis (TB) can cause complications caused by Aspergillus spp infection, namely Chronic Pulmonary Aspergillosis (CPA) in cavitation of the lungs. Automated Enzyme-linked Immunosorbent Assay (ELISA) and Immunochromatography Test (ICT) are two of the methods that support the clinical diagnosis of CPA. Both methods detect Aspergillus spp. antibodies. Both have their advantages and disadvantages, but there is no study that compares the results of the diagnostic performance of the CPA of the two tests in patients at the end of TB treatment.

Methods: This research was analytic descriptive with a cross-sectional design. Automated ELISA examination of subjects had a threshold > 11.5 as a positive result. ICT examination of subjects had positive results if there was a line in each T and C columns, while positive results only showed one line in C column.

Results: The total number of subjects were 62 subjects and 20 (32.3%) subjects diagnosed with CPA. Subjects showed positive results of automated ELISA examination were 27 (43.5%) subjects, while ICT examinations were 2 (3.2%) subjects. The sensitivity and specificity of the automated ELISA were 75% and 71.43%, respectively, while the ICT was 10% and 100%.

Conclusion: Automated ELISA has better diagnostic performance than ICT for CPA diagnosis, but automated ELISA was not adequately available in the Indonesian region so ICT was still used as CPA examination."

"Tingginya kasus TB paru di Indonesia meningkatkan risiko terjadinya infeksi jamur paru, termasuk Aspergillus spp. yang menyebabkan aspergilosis paru kronik (APK). Identifikasi Aspergillus sampai tingkat spesies perlu dilakukan karena setiap spesies memiliki kepekaan yang berbeda terhadap obat antijamur. Identifikasi fenotipik pada beberapa spesies yang berbeda mungkin identik, sehingga identifikasi molekuler diperlukan untuk memastikan identifikasi spesies. Penelitian ini bertujuan untuk mengidentifikasi Aspergillus spp. yang diisolasi dari pasien diduga APK dan kepekaannya terhadap obat antijamur. Identifikasi dilakukan dengan metode fenotipik, dilanjutkan dengan uji kepekaan menggunakan metode difusi cakram. Isolat resisten dikonfirmasi dengan identifikasi molekuler menggunakan teknik PCR pada target daerah ITS rDNA dan gen BenA. Identifikasi fenotipik 49 isolat Aspergillus yang berasal dari 39 sputum pasien menunjukkan 25 (51%) isolat A. fumigatus, 17 (34,6%) isolat A. niger, enam (12,2%) isolat A. flavus dan satu (2%) isolat A. clavatus. Uji kepekaan menunjukkan 15 (30,6%) isolat resisten terhadap vorikonazol dan atau itrakonazol yang selanjutnya dikonfirmasi dengan identifikasi molekuler. Hasil sekuensing menunjukkan 11 (73,3%) isolat A. fumigatus, dua (13,3%) isolat A. flavus, satu (6,7%) isolat A. niger, dan satu (6,7%) isolat A. clavatus . Identifikasi fenotipik dan genotipk isolat resisten menunjukkan kesesuaian.

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The increase number of pulmonary tuberculosis (PTB) can increase the risk to pulmonary fungal infections, including Aspergillus spp. that causes chronic pulmonary aspergillosis (CPA). Aspergillus identification to the species level is necessary because each species has a different sensitivity to antifungal agents. The phenotypic identification in some different species may be identical, therefore, the molecular method is recommended to confirm the species. The study aimed to identify Aspergillus isolated from suspected CPA patients and their susceptibility profile to antifungal drugs. Fungal identification was conducted by phenotypic method, while the susceptibility testing performed with disk-diffusion method. The resistant isolates were confirmed by molecular identification using PCR technique in the target area of the ITS rDNA region and BenA gene. The phenotypic identification of 49 Aspergillus isolated from 39 sputum sample showed 25 (51%) isolates of A. fumigatus, 17 (34,6%) isolates of A. niger, six isolates of A. flavus, and one (2%) isolate A. clavatus. The susceptibility testing showed 15 (30,6%) resistant isolates were resistant to voriconazole and or itraconazole which was further confirmed by molecular identification. The sequencing results obtained 11 (73,3%) isolates of A. fumigatus, two (13,3%) isolates of A. flavus, one (6,7%) isolate of A. niger, and one (6,7%) isolate A. clavatus. The results of phenotypic and molecular examinations showed the congruence of the results."

"Latar belakang: Diagnosis aspergilosis paru invasif (API) cukup sulit dilakukan karena karakteristik klinis dan hasil pencitraan yang tidak spesifik. Biopsi tidak bisa dilakukan karena risiko komplikasi Deteksi antigen galaktomanan (GM) digunakan untuk metode noninvasif karena sensitivitas dan spesifisitas yang tinggi, namun mahal dan jarang tersedia. Uji imunodifusi (IDT) bisa menjadi alternatif karena lebih murah dan mudah, namun perlu diketahui akurasi IDT pada pasien terduga API. Tujuan: Mengetahui nilai diagnostik IDT dibandingkan terhadap deteksi GM dalam mendiagnosis API. Metode: Pengumpulan serum dilakukan di Laboratorium Departemen Parasitologi FKUI sejak Oktober 2019—Oktober 2020 pada pasien terduga API yang berasal dari berbagai rumah sakit di Jakarta. Serum diperiksan menggunakan IDT dan deteksi GM. Metode IDT menggunakan antigen crude Aspergillus buatan Laboratorium Departemen Parasitologi FKUI, sedangkan deteksi GM menggunakan kit PlateliaTM (Bio-Rad, Prancis). Hasil: Sebanyak 92 sampel serum pasien diuji. Proporsi hasil deteksi GM dan IDT berturut-turut sebesar 31.5% dan 42.4%. Hasil menunjukkan bahwa sensitivitas dan spesifisitas IDT berturut-turut sebesar 33.33% dan 69.81%. Selain itu, rasio kemungkinan positif dan negatif berturut-turut sebesar 1.10 dan 0.95. Nilai duga positif dan negatif serta akurasi berturut-turut sebesar 44.83%, 58.73%, dan 54.35%. Tidak ada beda proporsi IDT terhadap deteksi GM (P>0.05) Simpulan: Nilai diagnostik IDT sama dibandingkan terhadap deteksi GM.

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Background: The diagnosis of invasive pulmonary aspergillosis (API) is quite challenging because of non-specific clinical characteristics and imaging results. A biopsy cannot be performed because of the risk of complications. Galactomannan antigen (GM) detection is used as a noninvasive method because of its high sensitivity and specificity, but it is expensive and rarely available. Immunodiffusion test (IDT) can be an alternative method, because it is cheaper and easier, but it is necessary to know the accuracy of IDT in patients suspected of API.

Objective: Determine the diagnostic value of Aspergillus IDT compared to GM detection in diagnosing API.

Methods: Serum collection was carried out at the Parasitology Laboratory of FMUI from October 2019-October 2020 in patients suspected of API from various hospitals in Jakarta. The sera were examined using the Aspergillus IDT and GM detection. The IDT method uses crude Aspergillus antigen that was conducted at the Parasitology Laboratory of FMUI, while GM detection uses the PlateliaTM kit (Bio-Rad, France).

Results: A total of 92 patient serum samples were tested. The proportion of detection results for GM and IDT was 31.5% and 42.4%, respectively. The results showed that the sensitivity and specificity of IDT were 33.33% and 69.81%, respectively. Also, the positive and negative likelihood ratios are 1.10 and 0.95, respectively. Positive and negative predictive values and accuracy were 44.83%, 58.73%, and 54.35%, respectively. There was no difference in the proportion of IDT to GM detection (P> 0.05).

Conclusion: IDT diagnostic value is the same as compared to GM detection."

"Latar belakang: Aspergilosis paru kronik (APK) merupakan penyakit paru destruktif yang bersifat progresif terutama disebabkan infeksi Aspergillus fumigatus. Penyakit ini dapat menjadi komplikasi infeksi tuberkulosis (TB) dan menyebabkan morbiditas serta mortalitas signifikan. Diagnosis APK masih menjadi tantangan karena gejala klinis tidak khas, serta belum ada alat diagnosis yang cepat dan akurat. Deteksi IgG Aspergillus berbasis lateral flow assay (LFA) menggunakan metode imunokromatografi (ICT) merupakan uji cepat dan sederhana untuk membantu diagnosis APK. Penelitian ini bertujuan untuk mengetahui hubungan uji ICT Aspergillus dengan karakteristik klinis dan radiologis APK pada pasien terkait TB paru.Metode: Penelitian berdesain potong lintang ini dilaksanakan pada April 2019-Juli 2023 dan merupakan bagian dari penelitian sebelumnya tentang diagnosis APK di Indonesia. Serum pasien APK diperiksa di Laboratorium Mikologi Departemen Parasitologi FKUI untuk deteksi ICT Aspergillus, kemudian dilanjutkan dengan analisis hasil penelitian.Hasil: Sebanyak 29 dari 54 (54%) serum pasien yang diteliti menunjukkan hasil uji ICT Aspergillus positif. Proporsi jenis kelamin perempuan (63%) lebih banyak dibandingkan laki-laki, sedangkan usia terbanyak 30-60 tahun (74%). Gejala klinis terbanyak adalah fatigue (57%), batuk ≥ 3 bulan (42%), hemoptisis (41%) diikuti sesak napas (24%), dan nyeri dada (20%). Adapun penyakit penyerta terbanyak adalah diabetes melitus (20%), penyakit kardiovaskular (11%), dan PPOK (9%). Gambaran radiologi paling dominan adalah kavitas (94%), diikuti infiltrat (72%), dan penebalan pleura (55%). Analisis statistik menunjukkan kaitan bermakna antara hasil ICT Aspergillus positif dengan gambaran radiologi berupa infiltrat, fibrosis parakavitas, fibrosis, efusi pleura, konsolidasi dan bronkiektasis (p <0,005). Hasil ICT Aspergillus tidak menunjukkan kemaknaan statistik dengan karakteristik klinis.Simpulan: Deteksi IgG spesifik Aspergillus metode ICT pada 54 pasien APK pada penelitian ini menunjukkan hasil positif 54%. Pada penelitian ini hasil ICT Aspergillus menunjukkan kaitan bermakna secara statistik dengan gambaran radiologi, tetapi tidak menunjukkan kaitan bermakna dengan karakteristik klinis pasien.

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Background: Chronic pulmonary aspergillosis (CPA) is a progressive, destructive lung disease mainly caused by Aspergillus fumigatus infection. The disease can be a complication of tuberculosis (TB) infection and cause significant morbidity and mortality. Diagnosis of CPA is still challenging because the clinical symptoms are not typical, and there are no fast and accurate diagnostic tools. Detection of IgG-specific Aspergillus using the immunochromatography (ICT) method is a quick and simple test to assist CPA diagnosis. The study aimed to determine the correlation between the ICT Aspergillus test and the clinical and radiological characteristics of CPA in TB-related patients.

Method: This cross-sectional study was carried out in April 2019-July 2023 and was part of a previous study on CPA diagnosis in Indonesia. All sera of CPA patients were examined at the Clinical Parasitology Laboratory, Faculty of Medicine Universitas Indonesia for ICT Aspergillus detection, followed by analysis of the study results.

Result: Twenty-nine of the 54 patient sera showed positive results of ICT Aspergillus. There were more female (76%) than male patients, with the majority aged 30–60 years (74%). The most common clinical symptoms were fatigue (57%), cough ≥3 months (42%), hemoptysis (41%), shortness of breath (24%), and chest pain (20%). The most common comorbidities were diabetes mellitus (20%), cardiovascular diseases (11%), and COPD (9%). The dominant of radiological features were cavities (94%), followed by infiltrates (72%), and pleural thickening (55%). The statistical analysis showed a significant correlation between positive ICT Aspergillus results and radiological features, including infiltrates, paracavity fibrosis, fibrosis, pleural effusion, consolidation, and bronchiectasis. However, the ICT Aspergillus did not show statistical significance with clinical characteristics.

Conclusion: The ICT Aspergillus detection in this study showed positive results of 54%. There was a significant correlation between ICT Aspergillus positive result with radiology features, but no significant correlation with clinical characteristics."

"Latar Belakang : Asma merupakan penyakit inflamasi kronik saluran napas dengan fungsi bersihan mukosilier yang menurun, maka itu bentuk matur dari spora Aspergillus fumigatus bisa tumbuh dan membuat sensitisasi Aspergillus yang merupakan kondisi awal aspergillosis paru pada asma dan dapat berkembang menjadi Allergic Bronchopulmonary Aspergillosis (ABPA). Penegakkan diagnosis aspergillosis paru didapatkan jika reaksi hipersensitisasi terhadap antigen A.fumigatus positif.Metode : Penelitian ini menggunakan metode potong lintang pada 86 pasien asma yang berobat ke RSUP Persahabatan dengan nilai Asthma Control Test (ACT) ≤ 24. Subjek penelitian dibagi 2 kelompok berdasarkan sensitisasi Aspergillus. Penilaian aspergillosis paru menggunakan pemeriksaan Imunoglobulin E (IgE) spesifik A.fumigatus. Kriteria diagnosis ABPA yang digunakan pada penelitian ini menggunakan kriteria International Society of Human and Animal Mycology (ISHAM) yaitu dua kriteria obligatory (IgE spesifik A.fumigatus dan IgE total) serta 3 kriteria tambahan (IgG spesifik A.fumigatus, eosinofil total, gambaran foto toraks). Pemeriksaan fungsi paru dilakukan pada penelitian ini termasuk spirometri, kapasitas difusi paru karbon monoksida (DLCO) dan nitrit oksida udara ekspirasi (FeNO).Hasil : Proporsi pasien asma tidak terkontrol yang memiliki aspergillosis paru didapatkan 3,5% (3/86) sedangkan proporsi ABPA didapatkan 1,1% (1/86). Terdapat faktor-faktor yang memengaruhi aspergillosis paru pada asma tidak terkontrol, diantaranya adalah nilai IMT (p=0,77), riwayat merokok (p=0,86) dan riwayat TB paru (p=0,03).. Karakteristik imunologi didapatkan nilai median IgE total pada subjek dengan aspergillosis paru 465(22-1690) IU/ml dan nilai median hitung total eosinofil 380 (0-770) sel/µl. Dari penilaian spirometri pada subjek aspergillosis paru didapatkan nilai median KVP 1630(950-2150) ml, nilai rerata KVP%prediksi 70±33,71%, nilai VEP1 1150(470-1240) ml, nilai median VEP1% prediksi 54(24-76)%, nilai rerata VEP1/KVP 59,33±14,57)% serta nilai rerata DLCO 84,67±24,66%. Nilai median FeNO pada asma tidak terkontrol dengan aspergillosis paru pada penelitian ini didapatkan 32 (12-45) ppb.Kesimpulan : Penegakkan diagnosis aspergillosis paru pada pasien asma tidak terkontrol harus dilakukan sejak awal, terutama pada pasien dengan riwayat TB  paru. Hal tersebut dapat mencegah aspergillosis paru pada asma tidak terkontrol berkembang menjadi penyakit ABPA serta kerusakan paru yang permanen.

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Background: Asthma is a chronic airway inflammation with decrease of mucocilliary clearance. The mature form of Aspergillus fumigatus spores could grow in this condition and caused an Aspergillus sensitization as an early progression to allergic bronchopulmonary aspergillosis (ABPA). Pulmonary aspergillosis could be diagnosed from a hypersensitivity reaction to the A. fumigatus antigen.

Methods : This cross-sectional study included 86 asthma patients with Asthma Control Test ACT score ≤ 24 and treated at Persahabatan Hospital Jakarta, Indonesia. Pulmonary aspergillosis was examined using specific immunoglobulin E (IgE) assay of A. fumigatus. The ABPA diagnostic in this study used the International Society of Human and Animal Mycology (ISHAM) criteria, which included two obligatory criteria (A. fumigatus-specific IgE and total IgE) and three additional criteria (A. fumigatus-specific IgG, blood eosinophil count, and thoracic x-ray). Lung function were examined using spirometry, diffusing capacity for carbon monoxide (DLCO), and fraction of exhaled nitric oxide (FeNO).

Results: Uncontrolled asthma patients who had pulmonary aspergillosis was 3.5% (3/86) while the proportion of ABPA was 1.1% (1/86).  A history of prior pulmonary tuberculosis (TB) was correlated with aspergillosis in uncontrolled asthma patients (p=0.03). The median value of total IgE and blood eosinophil count in pulmonary aspergillosis subjects was 465 (22-1690) IU/mL and 380 (0-770) cells/µL, respectively. Spirometry results of pulmonary aspergillosis subjects were median FVC 1630 (950-2150) ml, mean predicted FVC% predicted value 70±33.71%, mean FEV1 1150 (470-1240) ml, median predicted FEV1% 54 (24-24)%, mean FEV1/FVC 59.33±14.57%, and mean DLCO 84.67±24.66%. The median FeNO in uncontrolled asthma with pulmonary aspergillosis in this study was 32 (12-45) ppb.

Conclusion: Diagnosis of pulmonary aspergillosis in patients with uncontrolled asthma should be carried out early, especially in patients with a history of pulmonary TB. This would prevent pulmonary aspergillosis in uncontrolled asthma from developing into ABPA disease and permanent lung damage."