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Meiliyana Wijaya

Deteksi antigen histoplasma pada serum pasien dengan Galaktomanan Aspergillus Positif = Histoplasma antigen detection in the Sera of Patient with Positive Aspergillus Galactomannan

"Antigen galaktomanan diproduksi oleh Aspergillus dan tersedia kit komersial Platelia Aspergillus EIA (Bio-Rad, France) yang dapat digunakan untuk diagnostik aspergilosis paru invasif probable. Beberapa laporan menyatakan bahwa dapat terjadi reaksi silang antara histoplasmosis dan aspergilosis karena baik Aspergillus maupun Histoplasma dapat memproduksi galaktomanan. Hal itu memungkinkan pasien dengan kecurigaan histoplasmosis dapat diduga dengan deteksi galaktomanan menggunakan Platelia Aspergillus EIA. Untuk itu, penelitian ini bertujuan untuk mengetahui keberadaan, prevalensi, dan korelasi antigen galaktomanan Histoplasma pada pasien dengan hasil pemeriksaan galaktomanan Aspergillus positif. Penelitian ini menggunakan sampel berupa serum koleksi Laboratorium Mikologi Departemen Parasitologi FKUI sejak tahun 2018 hingga awal tahun 2019 dengan hasil pemeriksaan Platelia Aspergillus positif. Hasil penelitian ini menunjukkan bahwa sebagian serum pasien dengan galaktomanan Aspergillus positif ternyata juga galaktomanan Histoplasma positif dengan prevalensi sebesar 25%. Analisis statistik menunjukkan tidak ada korelasi antara nilai konsentrasi deteksi antigen galaktomanan Histoplasma dengan nilai indeks deteksi antigen galaktomanan Aspergillus. Pada daerah dengan keterbatasan sarana diagnostik histoplasmosis, pemeriksaan Platellia Aspergillus dapat digunakan untuk membantu menegakkan diagnosis histoplasmosis.

Aspergillus produces galactomannan antigens. There is a commercial Platelia Aspergillus EIA kit (Bio-Rad, France) that can be used for diagnostic probable of invasive pulmonary aspergillosis. Some reports state that there can be a cross-reaction between histoplasmosis and aspergillosis because both Aspergillus and Histoplasma can produce galactomannan. This allows patients with suspicion of histoplasmosis to be suspected by galactomannan detection using Platelia Aspergillus EIA. The purpose of this study was to determine the presence, prevalence, and correlation of Histoplasma galactomannan antigens in patients with positive Aspergillus galactomannan. The sample used in this study was a serum collection from the Mycology Laboratory Department of Parasitology FKUI from 2018 until early 2019 with positive Platelia Aspergillus result. The results of this study indicate that the majority of serum patients with positive Aspergillus galactomannan were also positive Histoplasma galactomannan with a prevalence of 25%. Statistical analysis showed that there was no correlation between the concentration of Histoplasma galactomannan antigen with the index of Aspergillus galactomannan antigen. In areas with limited diagnostic facilities for histoplasmosis, Platellia Aspergillus detection can be used to help diagnose of histoplasmosis."

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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020

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UI - Tugas Akhir Universitas Indonesia Library

Indra Marki

Kesesuaian antara gambaran ileoskopi dengan gambaran histopatologis ileum terminal pada pasien diare kronik kolonoskopi normal = Correlation between terminal ileum ileoscopy and histopathology image in patients with chronic diarrhea and normal colonoscopy

"ABSTRACT

Latar belakang: Selama ini pemeriksaan ileum kurang mendapatkan perhatian, padahal seringkali kelainan-kelainan gastrointestinal bawah berasal dari ileum dengan kolonoskopi normal. Oleh karena itu penelitian ini membahas tentang kesesuaian antara hasil pemeriksaan ileoskopi ileum terminal dengan hasil histopatologinya.

Metode: Metode yang digunakan adalah studi potong lintang dan uji diagnostik antara kedua pemeriksaan tersebut, dengan pemeriksaan histopatologi sebagai standar baku emas.

Hasil: Hasil penelitian memberikan kesesuaian antara kedua pemeriksaan tersebut sebesar 93,33 %. nilai sensitivitas pemeriksaan ileoskopi dibandingkan dengan histopatologi sebagai standar baku emas sebesar 94 %, spesifisitas 90 %, nilai prediksi positif 97,9 %, dan nilai prediksi negatif sebesar 75 %.

Kesimpulan: Dapat disimpulkan bahwa pemeriksaan ileoskopi pada pasien dengan diare kronik dan kolonoskopi normal memberikan hasil yang serupa dengan pemeriksaan histopatologinya.

ABSTRACT

Background: Ileoscopy are still considered less important, whereas many lower gastrointestinal cases originated from this region. Therefore this study discusses the correlation between the results of the terminal ileum ileoscopy with histopathologic results.

Method: The method used was a cross-sectional study and diagnostic test between the two examinations, with histopathologic examination as the gold standard.

Result: The results give the correlation between the two examination is 93.33%. Moreover ileoscopy compared with histopathologic examination as the gold standard also give a sensitivityof 94%, specificity 90%, positive predictive value 97.9%, and negative predictive value of 75%.

Conclusion: Therefore it can be concluded that ileoscopy examination in patients with chronic diarrhea and normal colonoscopy gave similar results with histopathologic examination."

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2013

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UI - Tesis Membership Universitas Indonesia Library

Rizky Farandi Mubasir

Perbandingan hasil pemeriksaan Immunodiffusion Test (IDT) aspergillus dengan deteksi galaktomanan pada pasien terduga aspergilosis paru invasif di Laboratorium Parasitologi FKUI = Comparison of aspergillus Immunodiffusion Test (IDT) to galactomannan detection in suspected invasive pulmonary aspergillosis patients at Parasitology Laboratory, FMUI

"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.

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."

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Depok: Fakultas Kedokteran Universitas Indonesia, 2020

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UI - Skripsi Membership Universitas Indonesia Library

Sresta Azahra

Pola respon IgG dengan profil berat molekul antigen aspergillus spp. pada pasien diduga aspergilosis paru kronik = The IgG responses against Aspergillus spp. antigens in suspected chronic pulmonary aspergilosis patients

"Kasus aspergilosis paru kronik (APK) yang disebabkan Aspergillus sp. semakin meningkat seiring dengan meningkatnya frekuensi infeksi tuberkulosis (TB) paru sebagai faktor risiko. Diagnosis APK masih menjadi tantangan karena gejala klinis, pemeriksaan radiologi, maupun laboratorium tidak khas. Untuk menetapkan diagnosis APK diperlukan pemeriksaan laboratorium mikologi, termasuk uji serologi. Hasil pemeriksaan imuno-diffusion test (IDT) Aspergillus dengan crude antigen kurang optimal dan IgG Aspergillus ELISA menggunakan antigen galaktomanan yang termasuk antigen sel T independent sehingga tidak mendukung switching isotipe antibodi. Oleh sebab itu, diperlukan penelitian lain untuk mendapatkan prosedur yang lebih baik dalam menetapkan diagnosis APK. Tujuan penelitian ialah mengetahui pola respon IgG terhadap kombinasi empat protein 16 kD, 18-20 kD, 22 kD, dan 30 kD antigen Aspergillus dengan metode Western Blot. Potensi diagnostik dari kombinasi protein 16 kD, 18-20 kD, 22 kD, dan 30 kD antigen Aspergillus dengan metode Western Blot terhadap nilai konsensus positif dan negatif APK berdasarkan 2 metode pemeriksaan yaitu biakan jamur dan IgG anti galaktomanan sebagai baku emas didapatkan nilai sensitivitas dan spesifisitas sebesar 74% dan 96%. Deteksi IgG Aspergillus metode Western Blot menunjukkan antigen dominan berat molekul 16 kD dan 18-20 kD. Kesimpulan uji IgG Aspergillus Western Blot memiliki potensi diagnostik lebih baik dibanding uji IgG Aspergillus ELISA.
Chronic pulmonary aspergillosis (CPA) caused by Aspergillus sp. potentially increases with the increasing frequency of pulmonary tuberculosis (TB) as a risk factor. Diagnosis of CPA is still a challenge because clinical symptoms, radiological examination, and laboratory are not specific. The diagnosis of CPA needs to be performed by specific mycological examination, including serology test. The result of the Aspergillus immunodiffusion test (IDT) with crude antigen is sub optimal and Aspergillus IgG ELISA method uses galactomannan antigens that are independent T cell antigens, so cant support switching of isotype antibodies. Therefore, other study is needed to get a better procedure in determine the CPA diagnostic. The study aimed to determine the IgG responses with a combination of Aspergillus proteins (16 kD, 18-20 kD, 22 kD, and 30 kD) with Western Blot method. Diagnostic potential of the Aspergillus protein combination (16 kD, 18-20 kD, 22 kD, and 30 kD) with Western Blot method on positive and negative consensus values of CPA based on two examination methods are fungus culture and anti-galactomannan IgG as gold standard are obtained sensitivity and specificity of 74% and 96%. From the Aspergillus Western Blot IgG test, dominant antigens obtained were molecular weights of 16 kD and 18-20 kD. The conclusion is Aspergillus specific IgG test with Western Blot method has better diagnostic potential than the anti-galactomannan IgG ELISA method."

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Depok: Fakultas Kedokteran Universitas Indonesia, 2020

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Indra Andrianto Lesmana

Perbandingan Deteksi Antigen Dari Spesimen Nasal dengan rRT-PCR pada Pasien Kontak dengan Kasus Infeksi SARS-CoV-2 yang Terkonfirmasi (Oktober – Desember 2020) = Comparison of Antigen Detection Using Nasal Specimens with rRT- PCR in Patient Contacted with Confirmed Cases of SARS-CoV-2 (October-December 2020)

"Latar Belakang. SARS-CoV-2 sebagai penyebab COVID-19 pertama kali terdeteksi pada sampel klaster pasien di Provinsi Hubei, China pada Desember 2019. Pada mulanya klaster pasien tersebut memiliki gejala seperti demam, batuk, sesak nafas, dan gejala lainnya yang tidak spesifik. Alat uji Rapid Antigen Test (RAT) dapat dijadikan alternatif untuk diagnosis klinis COVID-19. Tujuan. Penelitian ini bertujuan untuk mendapatkan rekomendasi mengenai alternatif spesimen dan metode deteksi SARS-CoV-2. Metode. Desain penelitian ini merupakan uji diagnostik studi potong lintang dengan pengumpulan spesimen secara consecutive sampling. Subjek penelitian yaitu pasien yang memiliki kontak dengan kasus infeksi SARS-CoV-2 yang terkonfirmasi dengan atau tanpa gejala klinis COVID-19 di Fasilitas Pelayanan Kesehatan (Fasyankes) dan Laboratorium Mikrobiologi Klinik (LMK) FKUI dengan jumlah sampel 221. Analisis data dengan tabulasi silang dan perhitungan sensitivitas, spesifisitas, PPV, dan NPV. Hasil. Deteksi antigen menggunakan spesimen nasal memiliki nilai sensitivitas 32,35%, spesifisitas 99,35%, PPV 95,65%, NPV 76,77%, akurasi 78,73%. Tingkat positifitas pada spesimen nasofaring 34,84%, spesimen orofaring 30,32%, dan nasal 30,77%. Kesimpulan. Hasil uji rRT-PCR pada beberapa jenis spesimen menunjukkan bahwa spesimen nasal dan orofaring dapat dijadikan pilihan selain spesimen nasofaring. Penggunaan kit deteksi antigen dapat dilakukan untuk pelacakan kontak COVID-19 atau untuk diagnosis, terutama untuk daerah yang memiliki keterbatasan akses diagnosis menggunakan rRT-PCR.

Introduction. The SARS-CoV-2 as the cause of COVID-19 was first detected in a cluster sample of patients in Hubei Province, China in December 2019. The first patient had symptoms such as fever, cough, shortness of breath, and other non-specific symptoms. Rapid Antigen Test can be used as an alternative for diagnosis of COVID-19. Aim. This study aims to obtain recommendations alternative specimens and detection methods for SARS-CoV-2. Method. The design of this study is a cross-sectional diagnostic test with consecutive sampling. The research subjects were patients who had contact with confirmed cases of SARS-CoV-2 infection with or without clinical symptoms of COVID-19 at Health Service Facilities (Fasyankes) and Laboratorium Mikrobiologi Klinik (LMK) FKUI with a total sample of 221. Data analysis using cross tabulation to calculate the sensitivity, specificity, PPV, and NPV. Results. The positivity rate for nasopharyngeal specimens was 34.84%, oropharyngeal specimens 30.32%, and nasal specimens 30.77%. Antigen detection using nasal specimens has sensitivity 32.35%, specificity 99.35%, PPV 95.65%, NPV 76.77%, accuracy 78.73%. Conclusion. The results of the rRT-PCR test on several types of specimens indicate that nasal and oropharynx specimens can be used as an alternative to nasopharyngeal specimens. The use of antigen detection kits can be carried out for COVID-19 contact tracing or for diagnosis, especially for areas that have limited access to diagnosis using rRT-PCR."

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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021

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UI - Tugas Akhir Universitas Indonesia Library

Robiatul Adawiyah

Diagnosis kriptokokosis meningeal pada penderita AIDS dengan deteksi antigen glucuronoxylomonan pada cairan otak = Diagnosis of meningeal cryptococoosis in AIDS patient by detection of glucuronoxylomanan antigen in spinal fluid

"Cryptococcosis is an infection caused by encapsulated yeast Crypococcus neofonnans, Before AIDS pandemic it was rarely reported, but nowadays its prevalence increasing sharply. The most common clinical manifestation in AIDS is meningitis. Mycology investigation for the diagnosis of cryptococcosis is obscure by the limitation of sensitivity and time consuming. It is necessary to use another method as the alternative. GXM antigen is distributed in body fluids such as spinal fluid, serum and urine. The detection of GXM in those body fluids can be used to support the diagnosis of Cryptococcus. The dilution that can be used for the diagnosis of cryptococcosis meningitis in Jakarta is not yet known. The method used fur GXM detection is latex agglutination test. For the purpose of this study neat, 100, 300 and 500 dilution of spinal fluid were tested. The gold standard of this study is mycology test i.e. india ink examination and culture.

The result of Prevalens Ratio (PR) showed male are more prone to infection (RP; 1,1), while the range of the age is 25 30 value. Sensitivity) specificity, negative predictive value and positive predictive value it can be concluded that 300 dilution of spinal fluid is cut off value fur the diagnosis of cryptoocccal meningitis in AIDS.

Kriptokokosis adalah infeksi yang disebabkan oleh jamur Cryptococcus sp. terutama Crypococcus neoformans. Sebelum pandemi AIDS kriptokokosis hanya berupa kasus sporadis, namun meningkat tajam setelah era AIDS, dengan manifestasi klinis terbanyak meningitis. Pemeriksaan mikofogi untuk diagnosis krlptokokosis memiliki keterbatasan sensitivitas dan waktu, sehingga dipertukan met

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Hasil penelitian menunjukkan bahwa laki-laki lebih banyak daripada perernpuan dan dari perhitungan Rasio Prevalens, diketahui laki-lal.i lebib berisiko mendapat kriptokokosis (RP: 1,1). Usia terbanyak terdapat pada rentang 25-30 tahun. Berdasarkan perhitungan Me Nemar, nilai kappa, sensitivitas, spesifisitas. Nilai Prediksi Positif dan Nilai Prediksi negatif disimpulkan bahwa pengenceran 300x merupakan nilai batas uji deteksi GXM untuk menegakkan diagnosis kriptokokosis."

Depok: Universitas Indonesia, 2008

T32426

UI - Tesis Open Universitas Indonesia Library

Wafa Herviana

Deteksi antibodi IgM dan IgG aspergillus dengan metode immunochromatography (ICT) pada pasien asma persisten = Detection of aspergillus IgM and IgG with immunochromatography in patients with persistent asthma

"Latar belakang: Pasien asma dapat mengalami sensitisasi terhadap Aspergillus sp. yang dapat menyebabkan aspergilosis bronkopulmoner alergika (ABPA). Kondisi ABPA, penggunaan steroid, dan kerusakan fungsi paru dapat meningkatkan risiko aspergilosis paru kronik (APK). Pemeriksaan baku emas mikologi APK adalah kultur jamur, yang memerlukan sumber daya terlatih dan waktu lama. Pemeriksaan imunokromatografi (ICT) Aspergillus dengan mekanisme lateral flow assay yang mudah dilakukan dan memerlukan sampel sedikit dapat menjadi alternatif baru deteksi Aspergillus sp. pada pasien asma persisten.

Metode: Penelitian ini dilaksanakan pada Juni-November 2021, menyertakan 50 pasien asma persisten di RS Persahabatan yang direkrut pada penelitian sebelumnya. Bahan klinis terdiri atas 50 serum pasien untuk pemeriksaan ICT Aspergillus dan 15 sampel sputum untuk kultur jamur. Pemeriksaan dilakukan di laboratorium Departemen Parasitologi FKUI.

Hasil: Demografi 50 subjek didominasi perempuan (78%) dan rerata usia subjek 55,8 tahun (SD±13,14). Hasil positif ICT Aspergillus ditemukan pada 16% (8 subjek). Pertumbuhan 17 isolat Aspergillus didapatkan pada sputum yang berasal dari 11 pasien, terdiri atas: Aspergillus niger (8 isolat), Aspergillus sp. (5 isolat), Aspergillus flavus (3 isolat), dan Aspergillus terreus (1 isolat). Tiga pasien memiliki hasil positif pada kultur dan ICT Aspergillus. Delapan dari pasien dengan hasil kultur positif memiliki hasil ICT negatif, meski 4 di antaranya memiliki 2 isolat Aspergillus.

Kesimpulan: Pemeriksaan ICT Aspergillus menunjukkan hasil positif 16% pada 50 pasien asma yang diteliti. Kultur jamur pada sputum 11 dari 15 pasien menunjukkan pertumbuhan Aspergillus sebanyak 17 isolat, dengan spesies terbanyak A. niger. Tidak terdapat kaitan bermakna antara pemeriksaan ICT Aspergillus dengan hasil kultur jamur Aspergillus pada pasien asma persisten.

Introduction: Asthma patients can be sensitized to fungi, including Aspergillus sp. which can cause allergic bronchopulmonary aspergillosis (ABPA). The certain conditions such as ABPA, steroid consumption, and lung function disturbance can increase the risk of chronic pulmonary aspergillosis (CPA). The gold standard for mycology examination for CPA diagnosis is fungal culture, which is time-consumed and need special resources. Immunochromatography test (ICT) Aspergillus could be a new alternative for CPA diagnosis, including for asthma patients.
Method: There were 50 persistent asthma patients from Persahabatan General Hospital who were recruited in previous study. Fifty sera were tested for ICT Aspergillus and 15 sputum samples for fungal culture.
Result: Demography of 50 subjects was dominated by women (78%) and mean age was 55.8 years (SD±13.14). Positive ICT test result was 16%, and 17 Aspergillus isolated from sputum of 11 out of 15 patients, consisted of Aspergillus niger (8 isolates), diikuti Aspergillus sp. (5 isolates), Aspergillus flavus (3 isolates), and Aspergillus terreus (1 isolate). There were 3 patients with positive results in both ICT and Aspergillus culture. Eight patients with Aspergillus confirmation had negative ICT results, despite 4 out of 8 had 2 Aspergillus isolates.
Conclusion: Aspergillus ICT in this study showed a positivity rate of 16%. There were 17 Aspergillus isolates from the sputum of 11 out of 15 patients, with A. niger as the most common species. There was no significant relationship between Aspergillus ICT examination and fungal culture results in persistent asthmatic patients."

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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021

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UI - Skripsi Membership Universitas Indonesia Library

Agnes Immanuela Toemon

Deteksi Antigen Cryptococcus sp. pada Sekreta Paru Pasien dengan Gejala Pneumonia Menggunakan Lateral Flow Assay = Cryptococcus sp. Antigen Detection of Pulmonary Secreta from Patients with Pneumonia Symptoms using Lateral Flow Assay

Kriptokokosis merupakan infeksi jamur Cryptococcus sp. yang sering ditemukan pada individu imunokompromi. Infeksi tersebut dapat menyerang berbagai organ, termasuk otak, susunan saraf pusat dan paru.. Pemeriksaan langsung dan biakan dari bahan klinis memiliki sensitivitas rendah. Deteksi antigen glucuronoxylomannan (GXM) merupakan alternatif pemeriksaan untuk diagnosis kriptokokosis, biasanya dilakukan pada cairan otak dan serum. Pemeriksaan antigen GXM dengan metode lateral flow assay (LFA) telah menjadi uji point-of-care dalam diagnosis kriptokokosis otak dan diseminata. Penggunaan LFA untuk diagnosis kriptokokosis paru belum pernah dilakukan sebelumnya. Penelitian ini bertujuan untuk mengetahui kegunaan uji LFA untuk diagnosis kriptokokosis paru. Penelitian berdisain potong lintang ini menyertakan pasien dengan gejala pneumonia pada beberapa rumah sakit di Jakarta dan sekitarnya sejak Maret-Oktober 2018. Pemeriksaan mikologi dilakukan di laboratorium Departemen Parasitologi FKUI menggunakan LFA IMMY dan LFA Dynamiker, serta pemeriksaan klasik. Dari 30 pasien yang diteliti, hasil pemeriksaan bahan sekreta paru (sputum/cairan pleura/BAL) menunjukkan semua hasilnya negatif dengan LFA IMMY. Adapun pemeriksaan LFA Dynamiker menunjukkan hasil positif pada empat pasien (13,3%). Profil klinis empat pasien dengan dugaan kriptokokosis paru pada penelitian ini menunjukkan batuk berdahak, nyeri dada, dan nodul paru. Hasil pemeriksaan pewarnaan tinta India menunjukkan hasil negatif, sedangkan biakan tidak ditemukan pertumbuhan Cryptococcus.

Kata kunci : pneumonia, Cryptococcus¸ lateral flow assay

Cryptococcosis is a fungal infection caused by Cryptococcus sp. and often found in immune-compromised patients. Cryptococcus sp. can infect various organs such as brain, central nervous system and lung. Direct examination and culture of clinical samples are not sensitive in detecting pulmonary cryptococcosis. Detection of antigen glucuronoxylomannan (GXM) is an alternative to confirm the diagnosis of cryptococcosis, mostly examine from brain and sera. The detection of GXM antigen using lateral flow assay (LFA) is recommended as point-of-care testing for the diagnosis of meningeal and disseminated cryptococcosis. However, diagnosis of pulmonary cryptococcosis using LFA has never been reported. Therefore, this research aimed to investigate the usefulness of the LFA test for the diagnosis of pulmonary cryptococcosis

This cross-sectional study involved patients with pneumonia in several hospitals in Jakarta and its surrounding, from March-October 2018. All mycology tests, including LFA IMMY and LFA Dynamiker, were performed in the laboratory of Parasitology Department, Faculty of Medicine, Universitas Indonesia. Thirty pulmonary secreta including sputum and bronchoalveolar lavage (BAL) were collected from 30 patients. None of the samples showed positive result on LFA IMMY testing, whereas using LFA Dynamiker four samples (13,3%) were shown to be Cryptococcus antigen positive. The clinical manifestations of four suspected cryptococcosis patients were cough, chest pain, and pulmonary nodule. The fungal cultures using bird seed agar (BSA) did not show any positive result.

Keywords: pneumonia, Cryptococcus, lateral flow assay

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2018

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UI - Tesis Membership Universitas Indonesia Library

Aydan Jalil Rancakbudi

Deteksi Antibodi Spesifik Aspergillus Berbasis Enzyme Linked Immunosorbent Assay (ELISA) Metode Manual Dibandingkan dengan Otomatis pada Pasien Tuberkulosis Paru = Detection of Aspergillus-Specific Antibody Based on Enzyme Linked Immunosorbent Assay (ELISA) Manual Method Compared to Automatic in Pulmonary Tuberculosis Patients

"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.

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."

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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022

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Deteksi Antibodi Anti-Aspergillus dalam Diagnosis Aspergilosis Invasif pada Pasien di Unit Perawatan Intensif = Detection of Anti-Aspergillus Antibody in Invasive Aspergillosis for Intensive Care Unit Patients

"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

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 "

Lengkap +

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

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UI - Tugas Akhir Universitas Indonesia Library

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