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"Latar belakang: Aspergilosis paru kronik (APK) merupakan komplikasi yang sering menyebabkan munculnya sekuela respiratori pada pasien bekas tuberkulosis (TB) paru. Diagnosis APK dapat dilakukan dengan pemeriksaan serologi IgG spesifik Aspergillus. Metode tersebut memerlukan waktu tertentu, sumber daya, dan fasilitas khusus, sehingga sulit diterapkan di fasilitas kesehatan dengan sumber daya terbatas. Metode baru Immunocromatography Test (ICT) LD Bio Aspergillus dilaporkan lebih mudah digunakan, cepat dan murah; tetapi akurasi diagnostiknya belum diketahui di Indonesia. Tujuan: Penelitian ini bertujuan untuk mengetahui akurasi diagnostik LD Bio ICT Aspergillus dibandingkan dengan IgG spesifik Aspergillus pada pasien bekas TB. Metode: Penelitian dengan desain potong lintang ini dilakukan dari April 2019 – Oktober 2020. Perekrutan subjek dilakukan di RSUP Persahabatan dan prosedur pemeriksaan mikologi dilakukan di Laboratorium Parasitologi FKUI. Serum pasien bekas TB diperiksa menggunakan LD Bio ICT Aspergillus dan IgG spesifik Aspergillus Dynamiker ELISA. Hasil kedua pemeriksaan dibandingkan untuk melihat akurasi diagnosis LD Bio ICT. Hasil: Dari 82 pasien yang sesuai dengan kriteria inklusi, terdapat 57 pasien (69,5%) laki-laki, rerata usia pasien 51,27±12,55 tahun. Median IMT 18,67 (10,38-31,18). Sebanyak 40 pasien (48,7%) menunjukkan hasil positif IgG spesifik Aspergillus. Adapun hasil positif LD Bio ICT Aspergillus didapatkan pada 35 pasien (42,7%). Sensitivitas dan spesifisitas LD Bio ICT dibandingkan dengan pemeriksaan IgG spesifik Aspergillus adalah 50,0% dan 64,3%, sedangkan nilai duga positif dan negatifnya adalah 57,1% dan 57,5%. Simpulan: LD Bio ICT dapat digunakan untuk mendiagnosis APK pada pasien bekas TB Paru di fasilitas kesehatan dengan sumber daya terbatas.

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Background: Chronic pulmonary aspergillosis (CPA) is a common complication following prior pulmonary tuberculosis (TB) causing respiratory sequelae. Although CPA may lead to worse prognosis, it is still underdiagnosed. Serology test such as Aspergillus-specific IgG is the recommended test for CPA diagnosis. However, this diagnostic procedure is time-consuming, require a lot of resources and certain skills, making this procedure not always easy to implement in limited facilities. The LDBio Diagnostic introduced a novel, affordable, and easy to use serology test, LD Bio Immunocromatography Test (ICT). Nevertheless, LD Bio ICT’s diagnostic accuracy in Indonesia is still unknown.

Study aims: This study aimed to determine the diagnostic accuracy of LD Bio ICT with Aspergillus-specific IgG as comparison in previous pulmonary TB patients.

Methods: This cross-sectional study was conducted in April 2019 – October 2020. Subject recrutment was done in National Referral Centre Persahabatan Hospital and serological test was conducted in the Parasitology Laboratory, Faculty of Medicine Universitas Indonesia. Eighty two sera of previous pulmonary TB patients were serologically tested using LD Bio ICT Aspergillus (France) and Aspergillus-specific IgG was tested using Dynamiker ELISA kit. Results of both tests were then compared to determine the diagnostic accuracy of LD Bio ICT.

Results: Of 82 patients met the inclusion criteria, 57 patients (69.5%) were men, the mean age was 51.27±12.55 years old. The BMI median was 18.67 (10.38-31.18). Forty patients (48.7%) showed positive Aspergillus-specific IgG Dynamiker results. Meanwhile, 35 patients (42.7%) showed positive results of LD Bio ICT Aspergillus. Compared to this finding, LD Bio ICT sensitivity and specificity were 50.0% and 64.3% respectively. In addition, the positive and negative prediction value of LD Bio ICT in this study were 57.1% and 57.5%.

Summary: LD Bio ICT is useful for the diagnosis of CPA in previous pulmonary TB patients in resource-limited settings."

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

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

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

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

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

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

"Latar belakang: Tuberkulosis paru (TB) merupakan salah satu faktor risiko terjadinya aspergillosis paru kronik (APK). Keduanya sulit dibedakan karena gejala APK tidak spesifik dan mirip dengan TB. Diagnosis APK ditegakkan berdasarkan gejala klinis, pemeriksaan pencitraan dan laboratorium mikologi. Pemeriksaan serologi dengan metode presipitasi atau Immunodiffusion test (IDT) sudah dikembangkan sejak lama, murah dan mudah dilakukan, tetapi dianggap kurang akurat. Pemeriksaan deteksi antibodi immunoglobulin G (IgG) spesifik Aspergillus dengan metode enzyme-linked immunosorbent assay (ELISA) merupakan salah satu metode diagnosis APK. Metode ini cukup mahal dan belum dilakukan rutin di daerah dengan sumber daya terbatas. Tujuan: Penelitian ini bertujuan untuk mengetahui perbandingan hasil pemeriksaan IDT Aspergillus dengan pemeriksaan IgG spesifik Aspergillus pada pasien bekas TB di RSUP Persahabatan. Metode: Penelitian dengan desain uji diagnostik ini dilakukan sejak April 2019 - November 2020 dengan metode consecutive sampling. Pasien yang direkrut merupakan pasien bekas TB dari RSUP Persahabatan Jakarta. Pemeriksaan IDT dan IgG spesifik Aspergillus dilakukan di Laboratorium Departemen Parasitologi FKUI.Hasil: Dari 80 pasien bekas TB di RSUP Persahabatan sesuai kriteria inkulsi, sebanyak 57 pasien laki-laki (71,3%) dan 23 pasien perempuan (28,7%). Rerata usia pasien adalah 50,98±2,79 tahun, median indeks massa tubuh pasien sebesar (IMT) 18,37. Proporsi hasil pemeriksaan IDT pada pasien bekas TB adalah 36,25%, sedangkan IgG spesifik Aspergillus metode ELISA sebesar 48,75%. Nilai akurasi diagnostik IDT dibandingkan terhadap IgG spesifik Aspergillus metode ELISA menunjukkan sensitivitas 30,77%, spesifisitas 58,54%, nilai prediktif positif 41,38%, nilai prediktif negatif 47,06% dan nilai measurement of agreement dengan cohen’s kappa sebesar -0,108.Simpulan: Metode IDT memiliki akurasi lebih rendah dibandingkan IgG spesifik Aspergillus metode ELISA, sehingga penggunaan IgG spesifik Aspergillus lebih direkomendasikan. Teknik IDT dapat digunakan jika sumber daya terbatas, namun perlu dilakukan standarisasi antigen untuk pemeriksaan tersebut.

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Background: Lung Tuberculosis (LTB) is a risk factor of developing chronic pulmonary aspergillosis (CPA). Both diseases are still difficult to differentiate because clinical presentation of CPA is not specific and similar to LTB. Diagnosis of CPA is confirmed by clinical presentation, radiographic examination and mycology laboratory tests. Serological testing using the precipitation method or immunodiffusion test (IDT) has long been conducted. It is a cheap and easy-to-do method, however the accuracy is not satisfied. Detection of the Aspergillus specific immunogobulin G (IgG) using enzyme-linked immunosorbent assay (ELISA) is one of the keys in diagnosing CPA. However, this method is more expensive and has not been conducted routinely in areas with limited resources.

Aim: This study aimed to determine the results of IDT Aspergillus compare to Aspergillus-specific IgG with ELISA in previous TB patients at Persahabatan Hospital.

Method: This diagnostic study was conducted from April 2019 - November 2020 and recruitment was performed by consecutive sampling. Patients recruited were previous TB patients from Persahabatan General Hospital; while IDT and specific Aspegillus IgG tests were conducted at Laboratory of Parasitology Dept, FMUI.

Conclusion: From 80 previous TB patients from the Persahabatan Hospital that met the inclusion criteria, 57 patients were male (71,3%) and 23 were female (28,7). Mean age was 50,98±2,79 years, median of patients body mass index (BMI) was 18,37. The proportion of old TB patients with positive IDT results was 36,25% and patients with positive IgG results was 48,75%. The diagnostic accuracy of IDT compared to IgG ELISA was 30,77% sensitivity, 58,54% spesificity, 41,38% positive predictive value, 47,06% negative predictive value and the measurement of agreement using cohen’s kappa was -0,108.

Summary: IDT Aspergillus is less accurate compared to Aspergillus-specific IgG ELISA. Therefore the use of Aspergillus-specific IgG ELISA is recommended as a serological test. The IDT method can be used at limited resources facilities, but it is necessary to standardize the antigen for the test."

"Latar belakang: Indonesia memiliki beban tuberkulosis (TB) paru tinggi. Aspergilosis paru kronik (APK) sering ditemukan pada pasien TB. Diagnosis APK menjadi tantangan di Indonesia karena keterbatasan sumber daya. Diperlukan alat diagnostik yang mudah, murah, dan memberikan hasil cepat dengan akurasi baik untuk membantu menegakkan diagnosis APK. Penelitian ini bertujuan untuk mengetahui nilai diagnostik ICT Aspergillus pada pasien TB paru.Metode: Penelitian ini berdesain potong lintang dan merupakan bagian dari penelitian payung tentang diagnosis APK pada pasien TB paru di Jakarta. Serum pasien TB paru yang memenuhi kriteria inklusi diperiksa menggunakan ICT Aspergillus (LDBio, Diagnostics, Lyon, France) dan IgG Spesifik Aspergillus ELISA (Bordier affinity products, Crissier, Switzerland) sesuai protokol di Laboratorium Mikologi Departemen Parasitologi FKUI pada Februari-November 2021.Hasil: Dari 105 subjek penelitian yang memenuhi kriteria inklusi, sebanyak 58,1% adalah laki-laki. Rerata usia pasien 47,1617,1 tahun. Proporsi hasil positif ICT Aspergillus adalah 10,5% dan IgG spesifik Aspergillus ELISA 43,8%. Sensitivitas ICT Aspergillus 23,9%, dengan spesifisitas 100%, nilai duga positif 100%, dan nilai duga negatif 62,8%.Kesimpulan: Kemampuan diagnostik ICT Aspergillus belum optimal sebagai alat skrining, tetapi dapat dipertimbangkan sebagai alat diagnosis pasien TB paru suspek APK pada daerah dengan sumber daya terbatas.

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ackground: Indonesia has high pulmonary tuberculosis (TB) burden. Chronic pulmonary aspergillosis (CPA) is common in pulmonary TB patients. Diagnosing CPA is challenging in Indonesia because of the limited resources available. A new rapid and robust diagnostic tool is needed. This research aims to evaluate the diagnostic value of the ICT Aspergillus in pulmonary TB patients.

Methods: This cross-sectional study is a part of the CPA diagnostic research of pulmonary TB patients. Pulmonary TB patients' serum fulfilling the inclusion criteria were assessed using ICT Aspergillus (LDBio, Diagnostics, Lyon, France) and Aspergillus-specific IgG ELISA (Bordier affinity products, Crissier, Switzerland) in Mycology Laboratory of Parasitology Department FMUI in February-November 2021.

Results: From 105 subjects included, the proportion of men 58,1% with 47,1617,1 years age means. The Aspergillus IgG was positive in 10,5% patients with ICT, and 43,8% with ELISA. The sensitivity of ICT Aspergillus was 23,9%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 62,8%.

Conclusion: ICT Aspergillus has a fair diagnostic capacity in pulmonary TB patients as screening tools for CPA. However, the usage of ICT Aspergillus as point-of-care test in limited-resource settings needs to be considered."

"Latar belakang: Pasien asma persisten berisiko mengalami penyakit jamur paru, termasuk aspergilosis bronkopulmoner alergika (ABPA) dan aspergilosis paru kronik (APK). Deteksi IgG spesifik Aspergillus metode enzyme-linked immunosorbent assay (ELISA) merupakan pemeriksaan mikologi yang direkomendasikan untuk diagnosis APK. Metode baru yang lebih praktis adalah immunochromatography test (ICT) Aspergillus, tetapi data hasil pemeriksaan tersebut masih terbatas di Indonesia. Penelitian ini bertujuan untuk mengetahui nilai diagnostik ICT Aspergillus dibandingkan dengan metode ELISA pada pasien asma persisten.Metode: Uji diagnostik dilakukan untuk mengetahui nilai diagnostik ICT Aspergillus dibandingkan dengan IgG spesifik Aspergillus metode ELISA. Bahan klinis berasal dari serum pasien asma persisten di RSUP Persahabatan pada tahun 2021 yang memenuhi kriteria inklusi. Deteksi antibodi kedua metode tersebut dilaksanakan di laboratorium Departemen Parasitologi FKUI untuk mengetahui proporsi, sensitivitas, spesifisitas, nilai duga positif dan negatif.Hasil: Deteksi antibodi spesifik Aspergillus kedua metode dilakukan terhadap 50 serum pasien. Proporsi hasil positif ICT Aspergillus 16%, sedangkan ELISA 32%. Nilai diagnostik ICT Aspergillus dibandingkan ELISA menunjukkan sensitivitas 25%, spesifisitas 88,24%, nilai duga positif 50%, dan nilai duga negatif 71,43%.Kesimpulan: Pemeriksaan ICT Aspergillus belum dapat direkomendasikan sebagai pemeriksaan standar diagnosis APK pada pasien asma persisten karena memiliki sensitivitas rendah

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Introduction: Patients with persistent asthma are at risk of developing pulmonary mycoses, including allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA). Aspergillus immunochromatography test (ICT) is a new practical method to detect Aspergillus-specific antibodies, but data on ICT results are still limited in Indonesia. This study aims to determine the diagnostic value of Aspergillus ICT compared to ELISA in persistent asthma patients.

Methods: Diagnostic tests were carried out to determine the diagnostic value of Aspergillus ICT. The antibody detection on the sera of persistent asthma patients at Persahabatan General Hospital in 2021 who met inclusion criteria was carried out in the laboratory of Parasitology Department, FMUI to determine the proportion, sensitivity, specificity, positive and negative predictive values.

Results: Detection of Aspergillus-specific antibodies was performed on 50 patient sera using ICT and ELISA. The proportion of positive results for Aspergillus ICT revealed 16%, while the ELISA 32%. The diagnostic value of Aspergillus ICT compared to ELISA showed a sensitivity of 25%, specificity of 88.24%, a positive predictive value of 50%, and a negative predictive value of 71.43%.

Conclusion: Aspergillus ICT could not be recommended as a standard examination for CPA diagnosis in persistent asthma patients due to its low sensitivity."

"Latar belakang: Indonesia memiliki beban tuberkulosis yang tinggi. Kerusakan paru yang ditimbulkan mendasari terjadinya aspergillosis paru kronik (APK). Salah satu kriteria diagnosis APK ialah bukti keterlibatan Aspergillus. Mempertimbangkan keterbatasan kultur, deteksi antibodi ELISA menjadi modalitas alternatif. Penelitian ini bertujuan membandingkan performa diagnostik pemeriksaan IgG spesifik Aspergillus ELISA manual dan otomatis pada pasien riwayat TB paru. Metode: Penelitian potong lintang ini membandingkan pemeriksaan IgG spesifik Aspergillus ELISA manual Bordier dan ELISA otomatis Immulite menggunakan serum pasien dengan riwayat TB. Performa diagnostik dibandingkan dalam bentuk proporsi hasil positif, sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif. Hasil: Terdapat total 68 subjek, dengan median usia 34,5 tahun, proporsi lansia 11,76% dan proporsi laki-laki 42,65%. Proporsi hasil positif pemeriksaan IgG spesifik Aspergillus ELISA manual dan ELISA otomatis masing-masing 13,24% dan 48,53%. Pemeriksaan IgG spesifik Aspergillus ELISA manual memiliki sensitivitas 20,83%, spesifisitas 90,91%, nilai duga positif 55,56%, dan nilai duga negatif 67,80%. Pemeriksaan IgG spesifik Aspergillus ELISA otomatis menunjukkan sensitivitas 91,67%, spesifisitas 75%, nilai duga positif 66,67%, dan nilai duga negatif 94,29%. Kesimpulan: Performa diagnostik dan teknis pemeriksaan IgG spesifik Aspergillus ELISA otomatis lebih baik dibandingkan ELISA manual, tetapi pemilihan modalitas diagnosis perlu mempertimbangkan faktor keterjangkauan, aksesibilitas, dan akurasi sesuai kebutuhan dan ketersediaan sumber daya.

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Introduction: Indonesia has high tuberculosis (TB) burden. The resulting lung damage underlies chronic pulmonary aspergillosis (CPA) development. CPA is diagnosed in patients with evidence of Aspergillus involvement as one of its criteria. Taking into account the limitations of culture, ELISA antibody detection becomes alternative modality. This study aims to compare diagnostic performance between manual and automated ELISA for Aspergillus-specific IgG in patients with treated TB. Method: This cross-sectional study compares Aspergillus-specific IgG test using Bordier manual ELISA and Immulite automated ELISA on sera from patients with treated TB. Diagnostic performance was compared in positive test proportion, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). Result: There are 68 subjects, with median age of 34,5 years, elderly subjects proportion of 11,76%, male proportion of 42,65%. Positive results proportion from Aspergillus-specific IgG manual and automated ELISA are 13,24% and 48,53%, respectively. Manual ELISA shows 20,83% sensitivity, 90,91% specificity, 55,56% PPV, 67,80% NPV. Automated ELISA shows 91,67% sensitivity, 75% specificity, 66,67% PPV, 94,29% NPV. Conclusion: Technical and diagnostic performance of automated ELISA Aspergillus-specific IgG test is better than manual ELISA, but choosing diagnostic modality needs consideration on factors such as affordability, accessibility, and accuracy according to the needs and available resources."

"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."

"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 tuberkulosis (TB) paru sering mendasari aspergilosis paru kronis (APK). Diagnosis APK masih menjadi tantangan karena gejala klinis dan hasil pemeriksaan yang tidak khas serta data penelitian yang terbatas. Pemeriksaan immunochromatography test (ICT) Aspergillus dilaporkan bermanfaat dalam diagnosis cepat APK. Tujuan penelitian ini adalah mengetahui kaitan hasil ICT Aspergillus dengan karakteristik klinis pasien TB paru. Penelitian dengan desain potong lintang ini merupakan bagian penelitian sebelumnya tentang diagnosis APK di Indonesia dan berlangsung pada Februari–November 2021. Pemeriksaan ICT Aspergillus dilakukan di laboratorium Departemen Parasitologi FKUI sesuai protokol (LD Bio Diagnostics, Lyon, France). Dari 89 pasien TB paru yang memenuhi kriteria inklusi, terdapat 50 pasien (56,2%) laki-laki. Sebanyak 42,6% pasien dalam rentang usia 45-64 tahun, 56,2% berpendidikan akhir SMP/SMA, dan 53,9% merupakan pekerja. Karakteristik klinis pasien TB paru dalam penelitian ini menunjukkan indeks massa tubuh (IMT) normal pada 36 pasien (40,4%). Penyakit asma didapatkan pada 3,4% pasien, penyakit paru obstruktif kronis (PPOK) 4,5%, diabetes mellitus (DM) 16,9%, hipertensi 6,7%, dan kanker paru 1,1%. Hasil pemeriksaan ICT Aspergillusmenunjukkan hasil positif pada 11 pasien (12,4%). Pada penelitian ini, didapatkan hubungan bermakna antara hasil pemeriksaan ICT Aspergillus dengan penyakit penyerta pada pasien TB paru, yaitu asma (p = 0,039).

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Pulmonary tuberculosis (TB) is the most common underlying disease of chronic pulmonary aspergillosis (CPA). Diagnosing CPA is still a challenge because of no typical pathognomonic clinical symptoms and examination result. Aspergillus Immunochromatography Test (ICT) is reported to be useful for rapid diagnosis of CPA. This study was used to determine relation between the results of Aspergillus ICT and the clinical characteristics of pulmonary TB patients. This cross-sectional study was part of the previous research on CPA diagnosis in Indonesia. Aspergillus ICT examination was carried out in FKUI Department of Parasitology laboratory according to the protocol (LD Bio Diagnostics, Lyon, France).

From the 89 pulmonary TB patients who met the inclusion criteria, there were 56,2% male patients, 42,6% of patients are within 45-64 years old age range, 56,2% have a final education of middle/high school, and 53,9% are workers, and normal body mass index (BMI) in 36 patients (40,4%). Asthma was found in 3,4% of patients, 4.5% of chronic obstructive pulmonary disease (COPD), 16.9% of diabetes mellitus (DM), 6.7% of hypertension, and 1.1% of lung cancer. Aspergillus ICT showed positive results in 11 patients (12,4%) and were related to the asthma variable (p = 0,039) in statistical analysis."

"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%."