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"Aspergilosis paru merupakan infeksi oportunistik yang disebabkan oleh jamur Aspergillus spp. Insidensi aspergilosis paru cenderung semakin meningkat seiring dengan peningkatan penggunaan obat-obatan imunosupresan seperti kortikosteroid dan terapi sitotoksik. Sulitnya penegakan diagnosis aspergilosis paru menjadi tantangan disebabkan tanda dan gejala klinis yang tidak spesifik serta biopsi jaringan sebagai baku emas yang bersifat invasif. Pemeriksaan kultur sputum dan deteksi antibodi merupakan pemeriksaan yang rutin dilakukan pada pasien suspek aspergilosis paru yang dikirim ke Laboratorium Mikologi Departemen Parasitologi FKUI, namun belum tersedia data mengenai nilai diagnostik deteksi antibodi dalam mendiagnosis aspergilosis paru. Tujuan penelitian ini adalah membandingkan pemeriksaan deteksi antibodi dengan crude antigen Aspergillus dengan metode imunodifusi dengan kultur sputum sebagai tes rujukan. Penelitian berdesain potong lintang dengan sampel berjumlah 689 rekam medis dari pasien suspek aspergilosis paru yang melakukan pemeriksaan kultur sputum dan deteksi antibodi di Laboratorium Mikologi Departemen Parasitologi FKUI tahun 2008-2015. Dari analisis deskriptif didapatkan prevalensi aspergilosis paru berdasarkan hasil positif kultur sebesar 0,4. Dari uji diagnostik deteksi antibodi dengan tabel 2x2, nilai sensitivitas 33,33 dan spesifisitas 95,62 serta terdapatnya perbedaan yang bermakna.

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Pulmonary aspergillosis is an opportunistic infection caused by Aspergillus spp mold. The incidence of this infection has dramatically increased which is related to the increasing utilization of immunosuppressive drugs such as corticosteroids and cytotoxic therapy. Diagnosis of pulmonary aspergillosis has been challenging since not only the signs and symptoms of the disease are nonspecific, but also tissue biopsy as gold standard is considered invasive. Sputum culture and antibody detection has been routine examinations done to the patient with suspected pulmonary aspergillosis sent to the Mycology Laboratory of Department of Parasitology FMUI, but the diagnostic value of antibody detection is not available.

The aim of this study is to compare antibody detection with immunodiffusion method using crude antigen of Aspergillus with sputum culture as reference test. This cross sectional study used 689 samples obtained from medical records of patients with suspected pulmonary aspergillosis who undergo both sputum culture examination and antibody detection in Mycology Laboratory of Department of Parasitology FMUI in 2008 2015. Descriptive analysis showed the prevalence of pulmonary aspergillosis based on positive culture result is 0,4. The sensitivity and specificity of antibody detection are 33,33 and 95,62 respectively, resulted from diagnostic test using 2x2 table. Statistical analysis using McNemar rsquo. test shows significant difference between mentioned examinations and low level of agreement Kappa 0,026."

"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: Diagnosis tuberkulosis (TB), khususnya pada pasien HIV masih merupakan masalah tersendiri, terutama pada daerah dengan sumber daya terbatas. Pemeriksaan mikroskopis hapusan bakteri tahan asam (BTA) merupakan metode yang sederhana dan cepat tetapi hanya mendeteksi 30% -40% kasus Tb sedangkan kultur (baku emas) membutuhkan waktu pemeriksaan yang berminggu-minggu. Metode genotipe (PCR dan isothermal amplification) memiliki sensitivitas yang tinggi dan kerjanya cepat tetapi metode ini masih sangat kompleks dan membutuhkan peralatan khusus. Cross-priming amplification (CPA) merupakan metode amplifikasi DNA secara isothermal dengan menngunakan multiprimer dan enzim polymerase dengan tehnik pembacaan hasil amplifikasi yang sederhana. Tujuan: Penelitian ini bertujuan untuk mengetahui perbedaanCPA dan PCR TB LMK FKUI dalam mendeteksi M. tuberculosis pada sputum pasien tersangka TB tanpa/dengan HIV. Metode: 20 sputum pasien non-HIV tersangka TB dan 37 sputum pasien HIV tersangka TB diperiksa dengan CPA dan PCR TB LMK FKUI. Hasil: Semua yang terdeteksi positif dengan CPA juga dideteksi positif oleh PCR tetapi 20% hasil yang terdeteksi negatif oleh CPA terdeteksi sebagai positif di PCR dan semua yang terdeteksi negatif oleh PCR terdeteksi negatif juga di CPA sedangkan hasil negatif di CPA (20%) masih terdeteksi positif oleh PCR. Dalam mendeteksi M. tuberculosis pada sputum pasien HIV/AIDS tersangka TB paru Terdapat hubungan bermakna antara CPA dengan PCR TB LMK FKUI, hampir semua hasil positif oleh CPA (94.1%) juga dideteksi positif oleh PCR tetapi 30% hasil negatif oleh CPA terdekteksi sebagai positif oleh PCR dan hampir semua hasil negatif oleh PCR (93.3%) terdeteksi negatif juga oleh CPA. Kesimpulan: Terdapat hubungan bermakna antara CPA dan PCR TB LMK FKUI dalam mendeteksi M. tuberculosis pada sputum pasien tersangka TB paru. PCR TB LMK FKUI lebih sensitif dibanding CPA dalam mendeteksi M.tuberculosis.

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Background: The diagnosis tuberculosis (TB) especialy in HIV patients remains a major obstacle to global control of TB, especially in resource limited settings. Light microscopy in sputum smears as common method in detection acid-fast bacilli (AFB) is specific but it only detects 30% to 40% of TB patients, while culture methods as gold standart in TB diagnostic require several weeks of incubation time. Genotypic method (polymerase chain reaction (PCR) and isothermal amplification) is known very sensitive and works fast but it requires special equipment and complex protocols in amplifying and detection amplified products. Cross-priming amplification (CPA) principle is isothermal amplification using multiple cross-linked primers (six to eight primers) and detection of amplified products is performed on special design plastic which is easy to performed and identified.

Objective: The study aimed to determine difference of PCR and CPA to detect M. tuberculosis in sputum specimens from suspected pulmonary tuberculosis without/with HIV patients.

Methods: 20 sputum samples suspected pulmonary TB of non-HIV patients and 37 sputum samples suspected pulmonary TB of HIV patients were subjected to CPA and PCR TB LMK FKUI.

Results:. All samples which were positive by CPA were also PCR positive but 20% result that were CPA negative were still positive by PCR and all samples with PCR negative were negative detected by CPA while some samples that were negative by CPA were still positive detected by PCR (20%). In HIV/AIDS population, there were significant correlation between CPA and PCR TB LMK FKUI which all positive result of CPA (94.1%) were also PCR positive but 30% of CPA negative were still CPA positive and almost all of PCR negative (93.3%) were CPA negative.

Conclusion: There were significant correlation between CPA and PCR TB LMK FKUI in ditected of M.tuberculosis in sputum of suspected pulmonary TB in populations of non HIV/AIDS patients and HIV/AIDS patients."

"Infeksi jamur paru dapat disebabkan Aspergillus spp. menyebabkan aspergillosis paru kronik (APK) yang sering mengikuti penyakit kronik lain, termasuk tuberkulosis (TB) paru. Data APK dan metode diagnosisnya pada pasien TB paru di Indonesia masih terbatas. Penelitian ini bertujuan untuk mengetahui perbandingan sensitivitas deteksi antibodi spesifik Aspergillus pada pasien TB paru. Penelitian berdesain nested case-control ini merupakan bagian dari penelitian payung tentang diagnosis APK pada pasien TB paru di Jakarta. Serum pasien yang memenuhi kriteria inklusi diperiksa menggunakan imunokromatografi kit ICT LDBio Aspergillus sebanyak 2 kali, yaitu saat awal dan akhir pengobatan TB. Pemeriksaan dilakukan pada Maret-Oktober 2022 sesuai protokol di Laboratorium Parasitologi FKUI. Dari 71 pasien TB paru yang memenuhi kriteria inklusi, rerata usia 44,35 ± 17,43. Pemeriksaan ICT LDBio Aspergillus pada awal terapi OAT menunjukkan hasil positif pada 4 dari 71 (5,6%) pasien, dengan sensitivitas 11,54%, spesifisitas 97,78%. Pada akhir terapi OAT, pemeriksaan ICT LDBio Aspergillus juga menunjukkan hasil positif pada 5,6% pasien, dengan sensitivitas 25% serta spesifisitas 96,83%. Hasil ICT LD Bio Aspergillus pada 71 pasien TB paru dalam penelitian ini menunjukkan hasil positif yang setara pada awal dan akhir OAT (5,6%), dengan sensitivitas yang lebih rendah pada awal OAT (11,54%) dibandingkan akhir OAT (25%).

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Lung fungal infection can be caused by Aspergillus spp. causes chronic pulmonary aspergillosis (CPA) which often follows other chronic diseases, including pulmonary tuberculosis (TB). CPA data and its method of diagnosis in pulmonary TB patients in Indonesia are still limited. This study aims to compare the sensitivity of Aspergillusspecific antibody detection in pulmonary TB patients. This nested case-control design study is part of an umbrella study on the diagnosis of CPA in pulmonary TB patients in Jakarta. Sera of patients who met the inclusion criteria were examined using the ICT LDBio Aspergillus kit 2 times, namely at the beginning and at the end of TB treatment. The examination was carried out in March-October 2022 according to the protocol at the FKUI Parasitology Laboratory. Of the 71 pulmonary TB patients who met the inclusion criteria, the mean age was 44.35 ± 17.43. The result of ICT LDBio Aspergillus examination at the start of anti-tuberculosis therapy showed positive results in 4 of 71 (5.6%) patients, with a sensitivity of 11.54%, a specificity of 97.78%. At the end of antituberculosis therapy, the result of ICT LDBio Aspergillus examination also showed positive results in 5.6% of patients, with a sensitivity of 25% and a specificity of 96.83%. ICT LDBio Aspergillus results in 71 pulmonary TB patients in this study showed equivalent positive results at the beginning and end of anti-tuberculosis (5.6%), with lower sensitivity at the start of anti-tuberculosis (11.54%) than at the end of anti-tuberculosis (25%)."

"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 dan Tujuan: Prevalensi tuberkulosis di Indonesia menduduki peringkat kedua terbanyak setelah India dan peran diagnosis cepat serta akurat sangatlah penting. Sejak tahun 2014 pemeriksaan laboratorium berbasis amplifikasi asam nukleat GenXpert MTB/RIF telah diadopsi dalam pedoman nasional penanggulangan TB paru BTA negatif karena dalam 2 jam dapat lebih akurat mendeteksi basil tahan asam dibandingkan dengan apusan sputum BTA konvensional. Harga yang mahal dan ketersediaan yang terbatas membuat perlunya alternatif lain untuk pemeriksaan ini. Penelitian ini bertujuan untuk membandingkan gambaran radiografi toraks GenXpert MTB/RIF pada pasien tersangka TB paru BTA negatif. Metode: Uji komparasi dengan pendekatan potong lintang membandingkan gambaran radiografi toraks tipikal, atipikal dan bukan TB pada 44 subyek dengan hasil GenXpert MTB/RIF positif dan negatif 22 subyek per kelompok. Analisis berdasarkan adanya komorbiditas HIV, DM, terapi imunosupresan jangka panjang juga dilakukan. Hasil: Terdapat kesesuaian antara gambaran radiografi toraks dengan hasil pemeriksaan genXpert MTB/RIF pada subyek dengan BTA sputum negatif, dengan nilai kappa 0,59 moderate, sensitivitas 81,8 dan spesifisitas 77,3, yang menguat pada kelompok tanpa komorbiditas kappa 0,71l; sensitivitas 87,5, spesifisitas 83,3, serta berkurang pada kelompok dengan komorbiditas kappa 0,464; sensitivitas 81,8 ; spesifisitas 71,4. Lesi radiografi toraks pada kelompok subyek dengan genXpert positif terbanyak adalah infiltrat lapangan atas paru 77,3, nodul 40,9, kavitas 36,4, secara statistik signifikan dengan p<0,05. Kesimpulan: Jika dibandingkan dengan GenXpert MTB/RIF, radiografi toraks memberikan sensitivitas dan spesifisitas yang baik, sehingga dapat dijadikan alternatif modalitas diagnosis yang lebih murah, terutama di daerah perifer Indonesia.

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Background and Purpose: Indonesia rsquo s tuberculosis prevalence is currently ranked second highest in the world after India. Therefore, the role of fast and accurate diagnosis is very important. After 2014, a nucleic acid amplification test GenXpert MTB RIF is implemented for negative sputum smear tuberculosis, due to its ability to diagnose tuberculosis within 2 hours with higher accuracy compared to conventional smear. Due to its high cost and lack of availability, an alternative for diagnostic tools should be sought. This study objective is to compare chest radiography using WHO ISTC criteria based on typical and atypical lesion, with GenXpert MTB RIF on subjects who are suspected tuberculosis, with negative sputum smear.

Methods: Comparative cross sectional study to compare chest radiography using WHO ISTC criteria based on typical and non typical TB among 44 subjects suspected tuberculosis infection with negative sputum smear, among groups with positive and negative GenXpert each 22 subjects. Analysis is also performed on subjects with and without comorbidities HIV, DM, long term immunosuppressive therapy.

Results: We found moderate agreement with kappa value 0,59 moderate, sensitivity 81,8 and specificity 77,3, and showing increased value in group without comorbidities kappa 0,71l sensitivity 87,5, specificity 83,3, and decreased value in group with comorbidities kappa 0,464 sensitivity 71,4 specificity 75. Radiographic lesions most frequently found in positive GenXpert group are upper field infiltrate 77,3, nodules 40,9, and cavities 36,4, with greater proportion compared with negative group, and statistically significant p<0,05.

Conclusion: Compared with GenXpert MTB RIF, chest radiography shows good sensitivity and specificity, so it is still potential as cost effective diagnostic modality especially in peripheral areas in Indonesia. "

"Indonesia merupakan negara dengan beban TB terbesar kedua di dunia. Prevalensi infeksi penyerta jamur paru juga tinggi, salah satunya aspergilosis paru kronik (APK). Alat diagnostik yang baik dan mudah digunakan sangat diperlukan untuk menunjang diagnosis APK, namun data terkait hal tersebut di Indonesia masih terbatas. Penelitian ini bertujuan untuk mengetahui nilai performa diagnostik deteksi antibodi spesifik Aspergillus berbasis ELISA manual dan otomatis pada pasien TB paru. Penelitian ini merupakan uji diagnostik untuk membandingkan hasil deteksi antibodi spesifik Aspergillus berbasis ELISA menggunakan metode manual dan otomatis dari sera pasien TB paru yang diperiksa di Laboratorium Parasitologi FKUI. Dari 62 subjek yang memenuhi kriteria inklusi, 56,5% pasien adalah perempuan. Median usia pasien adalah 34 tahun dengan nilai minimum 16 dan nilai maksimum 72. Proporsi hasil positif ELISA manual adalah 12,9%, sedangkan proporsi hasil positif ELISA otomatis adalah 29%. Metode ELISA manual memiliki nilai performa diagnostik 20% untuk sensitivitas, 90,48% untuk spesifisitas, 61,5% untuk nilai duga positif, dan 59,79% untuk nilai duga negatif. Adapun ELISA otomatis memiliki nilai performa diagnostik 70% untuk sensitivitas, 90,48%untuk spesifisitas, 84,83% untuk nilai duga positif, dan 79,86% untuk nilai duga negatif. Kemampuan diagnostik ELISA manual tidak sebaik otomatis, namun dapat dipertimbangkan sebagai alat diagnosis penapisan yang lebih mudah diakses, khususnya di daerah dengan sumber daya terbatas. Perlu dilakukan penelitian lanjutan mengenai cut-off ELISA manual yang sesuai untuk populasi Indonesia.

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Indonesia is a country with the second largest TB burden in the world. The prevalence of pulmonary fungal infections is also high, one of which is chronic pulmonary aspergillosis (CPA). A good and easy-to-use diagnostic tool is needed to aid CPA diagnosis. This study aims to determine the diagnostic performance value of Aspergillus-specific antibody detection based on manual and automatic ELISA on pulmonary TB patient’s serum carried out at Parasitology Laboratory FMUI. This diagnostic test study compared the results of Aspergillus-specific antibody detection in pulmonary TB patient’s sera based on ELISA using manual and automatic methods. Of the 62 subjects who met the inclusion criteria, 56.5% of the patients were women. The median age of the patients was 34 years with a minimum value of 16 and a maximum value of 72. The proportion of positive results for manual ELISA was 12.9%, while the proportion of positive results for automatic ELISA was 29%. Manual ELISA has a diagnostic performance value of 20% for sensitivity, 90.48% for specificity, 61.5% for a positive predictive value, and 59.79% for a negative predictive value. Meanwhile, automatic ELISA has a diagnostic performance value of 70% for sensitivity, 90.48% for specificity, 84.83% for a positive predictive value, and 79.86% for a negative predictive value. Manual ELISA diagnostic capabilities are not as good as automated one but can be considered as a screening diagnostic tool as it is more accessible, especially in areas with limited resources. It is necessary to study the appropriate cut-off on manual ELISA Indonesian population."

"Latar belakang: Aspergilosis paru kronik (APK) merupakan komplikasi yang sering ditemukan pada pasien dengan riwayat tuberkulosis (TB) paru. Pemeriksaan serologi Aspergillus yang cepat dan sensitif dibutuhkan untuk mendiagnosis APK. Penelitian ini membandingkan pemeriksaan serologi ELISA otomatis dan tes imunokromatografi pada dalam mendeteksi antibodi spesifik Aspergillus pada pasien dengan riwayat TB paru.Metode: Studi potong-lintang ini merupakan bagian dari penelitian payung tentang diagnosis APK pada pasien TB. Serum pasien diperiksa menggunakan ELISA otomatis dan tes imunokromatografi. Performa diagnosis diperoleh melalui perbandingan hasil pemeriksaan dengan diagnosis APK. Agreement antar tes dianalisis dengan Hasil: Didapatkan 68 pasien pasca TB dengan median usia 34,5 (17-72) tahun. Sebanyak 24 pasien diadiagnosis APK (35,3%). Proporsi positif ELISA otomatis dan tes imunokromatografi sebesar 48,5% dan 2,9%. ELISA otomatis memiliki sensitivitas 91,7%, spesifisitas 75%, nilai duga positif 66,7%, dan nilai duga negatif  94,3%. Tes imunokromatografi memiliki sensitivitas 8,3%, spesifisitas  dan nilai duga positif 100%, serta nilai duga negatif 66,7%. Agreement antara kedua tes sangat rendah (kappa score: 0,062).Kesimpulan: Pada pasien dengan riwayat TB paru, ELISA otomatis IgG spesifik Aspergillus dapat digunakan sebagai pemeriksaan penunjang APK di area dengan sumber daya mendukung. Sedangkan tes imunokromatografi dapat digunakan sebagai uji penapisan awal APK di daerah dengan keterbatasan sumber daya.

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Introduction: Chronic pulmonary aspergillosis (CPA) is common in post TB patients. Faster and more sensitive Aspergillus serological examination is necessary for CPA diagnosis. This study compared automated ELISA and immunochromatography test for Aspergillus specific antibody detection in post pulmonary TB patients.

Method: This cross-sectional study is part of previous research on CPA diagnosis in tuberculosis. Patient’s sera were tested with automated ELISA and immunochromatography test. The results were compared to CPA diagnosis to obtain diagnostic performances. The agreement between tests was analyzed with Cohen’s kappa.

Result: There were 68 previous TB patients with median age 34,5 (17-72) years old. CPA was diagnosed in 24 patients (35,3%). The positive result of automated ELISA and immunochromatography test were 48,5% and 2,9%. Automated ELISA showed sensitivity of 97%, specificity of 75%, PPV of 66,7%, and NPV of 94,3%. The immunochromatography test showed sensitivity of 8,3%, specificity and PPV of 100%, and NPV of 66,7%. There was very low agreement between tests (kappa score: 0,062).

Conclusion: Automated ELISA Aspergillus specific IgG could be utilized for supporting CPA diagnosis in post TB patients, mainly in settings where resources are available. Immunochromatography test is applicable as an early screening tool for CPA detection in resource-constrained areas."

"Penyakit TB MDR merupakan salah satu penyakit infeksi yang prevalensinya semakin meningkat dari tahun ke tahun di Indonesia dengan angka keberhasilan pengobatan 45%. Konversi kultur sputum merupakan suatu prediktor kuat dari awal keberhasilan terapi. Waktu konversi yang lambat akan memperpanjang periode penularan dan memprediksi tingkat kegagalan pengobatan yang tinggi. Terdapat beberapa faktor risiko yang berhubungan dengan konversi kultur sputum pasien TB MDR. Penelitian terkait faktor risiko kadar albumin dengan waktu konversi kultur sputum masih sangat terbatas. Tujuan penelitian ini adalah untuk mengetahui hubungan kadar albumin dengan waktu konversi kultur sputum di poli MDR terpadu RS Paru Dr M Goenawan Partowidigdo tahun 2022. Penelitian ini menggunakan studi cohort retrospektif dengan sampel yang diambil dari catatan rekam medis dan SITB pasien poli MDR. Variabel yang diteliti adalah kadar albumin < 3,5 gram/dl dan ≥ 3,5 gram/dl dengan variabel covariat usia, jenis kelamin, pendidikan, index masa tubuh, status merokok, gradasi sputum bta, komorbid, regimen pengobatan, dan kepatuhan minum obat . Hasil penelitian berdasarkan analisis multivariat menunjukkan kadar albumin < 3,5 mg/dl memiliki kecepatan waktu konversi 41,8% lebih lambat dengan (HR=0,582, 95% CI 0.344-0.984) untuk mengalami konversi dibanding dengan pasien TB MDR dengan kadar albumin ≥ 3,5 mg/dl setelah memperhitungkan status merokok dan kepatuhan minum obat. Perlunya memperbaiki kadar albumin yang rendah pada pasien TB MDR di rumah sakit dan memberikan penyuluhan kepada keluarga pasien agar turut berpartisipasi memantau asupan makan pasien yaitu makanan yang mengandung tinggi protein seperti ikan gabus serta ekstra putih telur untuk membantu meningkatkan kadar albumin pasien yang dapat berguna untuk terjadinya konversi kultur sputum.

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MDR TB disease is an infectious disease whose prevalence is increasing from year to year in Indonesia with a treatment success rate of 45%. Sputum culture conversion is a strong predictor of initial therapeutic success. Slow conversion time will prolong the period of transmission and predict a high rate of treatment failure. There are several risk factors associated with sputum culture conversion in MDR TB patients. Research related to risk factors for albumin levels and sputum culture conversion time is still very limited. The aim of this study was to determine the relationship between albumin levels and sputum culture conversion time at the integrated MDR polyclinic at Dr M Goenawan Partowidigdo Pulmonary Hospital in 2022. This study used a retrospective cohort study with samples taken from medical records and SITB patients at poly MDR. The variables studied were albumin levels < 3.5 mg/dl and ≥ 3.5 mg/dl with the covariate variables age, sex, education, body mass index, smoking status, sputum gradation, co-morbidities, medication regimens, and drinking adherence drug . The results of the study based on multivariate analysis showed that albumin levels < 3.5 mg/dl had a 41.8% slower conversion time (HR=0.582, 95% CI 0.344-0.984) to experience conversion compared to MDR TB patients with albumin levels ≥ 3.5 mg/dl after taking into account smoking status and medication adherence. It is necessary to improve low albumin levels in MDR TB patients at the hospital and provide counseling to the patient's family to participate in monitoring the patient's food intake, namely foods that contain high protein such as snakehead fish and extra egg whites to help increase the patient's albumin levels which can be useful for the occurrence of sputum culture conversion."

"Tuberkulosis merupakan salah satu masalah kesehatan global. Terdapat banyak pasien tuberkulosis memiliki status gizi kurang saat awal diagnosis yang berdampak pada penurunan daya tahan tubuh pasien tersebut, sehingga meningkatkan risiko terjadinya kegagala dapn konversi. Penelitian ini bertujuan untuk mengetahui hubungan antara status gizi pasien tuberkulosis pada awal diagnosis dengan keberhasilan konversi sputum. Penelitian ini menggunakan desain kohort retrospektif dengan menggunakan data sekunder yang didapat dari Kartu Pasien TB.01 di UPT Puskesmas Sukmajaya, UPF Puskesmas Villa Pertiwi dan UPF Puskesmas Abadi Jaya n=131. Pada penelitian ini didapatkan 93,2 pasien dengan status gizi kurang BMI0,05 antara status gizi pasien tuberkulosis saat awal diagnosis dengan keberhasilan konversi sputum setelah pengobatan fase intensif dilakukan RR 1,016 ,95 CI,0,932-1,108.

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Tuberculosis is one of global health problem. There is many tuberculosis patients who have low nutritional status in the initial of diagnosis that can lower the immune system of the patients and increase the risk of conversion failure. The aim of this study is to evaluate the correlation between the nutritional status of tuberculosis patient in the initial of diagnosis and the success of sputum conversion after an intensive phase of treatment been performed.

This study used a retrospective cohort design using secondary data which obtained from Kartu Pasien TB.01 in UPT Puskesmas Sukmajaya, UPF Puskemas Villa Pertiwi and UPF Puskesmas Abadi Jaya n 131. In this study, 93,2 patients with low nutritional status BMI 0,05 between the nutritional status of tuberculosis patients in the initial of diagnosis and the success of sputum conversion after an intensive phase of treatment been performed RR 1.016, 95 CI, 0.932 to 1.108."