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Abstrak :
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. ......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.

Abstrak :
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.

Abstrak :
Latar Belakang: Kanker paru merupakan salah satu kanker yang paling sering terjadi dan menyebabkan angka kematian yang cukup tinggi. Salah satu komplikasi yang dapat timbul adalah infeksi oportunistik berupa mikosis paru. Mikosis paru masih jarang dikenali, padahal menyebabkan beban kesehatan dan peningkatan laju mortalitas. Salah satu penyebabnya adalah diagnosis yang masih menjadi tantangan karena tidak spesifiknya gejala klinis dan uji diagnosis tidak invasif yang ada juga masih belum diketahui kepastian tingkat akurasinya. Tujuan: Penelitian ini bertujuan untuk mengetahui kaitan berupa nilai akurasi hasil diagnosis immunodiffusion test (IDT) dibandingkan dengan profil IgG spesifik Aspergillus. Metode: Metode penelitian ini adalah dengan uji laboratorium IDT dan IgG spesifik Aspergillus dengan desain studi potong lintang. Pemeriksaan IDT menggunakan crude antigen Aspergillus sedangkan pemeriksaan IgG spesifik Aspergillus menggunakan kit komersial Dynamiker dengan hasil positif jika nilai absorbansi di atas 120 AU/mL. Hasil: Berdasarkan 70 subjek didapatkan karakteristik sebagai berikut yaitu subjek umumnya berjenis kelamin laki-laki 61,4% (n=43), berusia di atas 60 tahun 54,3% (n=38), memiliki riwayat merokok 60,0% (n=42) dengan indeks Brinkmann berat 31,4% (n=22). Pasien umumnya memiliki jenis histologi berupa adenokarsinoma 74,3% (n=52) dengan stadium IIIB-IV sebesar 78,6% (n=55) dan tampilan status kategori PS 1 40,0% (n=28). Prevalensi aspergillosis berdasarkan IgG spesifik Aspergillus pada penelitian ini adalah 25,7%, sedangkan prevalensi jika menggunakan IDT sebesar 42,9%. Nilai akurasi IDT dengan IgG spesifik Aspergillus sebagai baku emas menunjukkan tingkat sensitivitas 44,4% (IK95% 21,5%-67,4%), spesifisitas 57,7% (IK95% 44,3%-71,1%), nilai duga positif 26,7% (IK95% 10,8%-42,5%), dan nilai duga negatif 75,0% (IK95% 61,6%-88,4%) dan nilai Kappa sebesar 0.017. Selain itu, terdapat hubungan yang bermakna secara statistik antara jenis kelamin dan indeks brinkmann terhadap hasil pemeriksaan IDT Aspergillus (p<0.05). Kesimpulan: IDT bukan merupakan metode diagnosis yang baik dan perlu adanya validasi terhadap crude antigen yang digunakan. ......Background: Lung cancer is one of the most common cancers and causes a high mortality rate. One of the complications that can arise is an opportunistic infection in the form of pulmonary mycosis. Pulmonary mycosis is rarely recognized, even though it causes a health burden and an increased mortality rate. One of the causes is the method of diagnosis which is still a challenge because the clinical symptoms are not specific and the existing non-invasive diagnostic tests are not yet known for its exact level of accuracy. Aim: This study aims to determine the correlation in the form of accuracy value of the immunodiffusion test (IDT) diagnostic results compared to the Aspergillus-specific IgG profile. Method: The method of this research was laboratory tests in forms of IDT and Aspergillus-specific IgG with cross-sectional study design. IDT test used crude antigen while Aspergillus-specific IgG test used a commercial Dynamiker Kit with a positive result if the absorbance value above 120 AU/mL. Results: Based on 70 subjects, the characteristics of the subjects are mainly male 61.4% (n=42) with age over 60 years old 54.3% (n=43), had a history of smoking 60% (n=42) with a severe Brinkmann index 31.4% (n=22). Subjects generally had a histological type of adenocarcinoma 74.3% (n=52) with stage IIIB-IV 78.6% (n=55) and performance status category PS1 40.0% (n=28). The prevalence of aspergillosis in this study was 25.7% using Aspergillus-specific IgG, while the prevalence when using IDT was 42.9%. The IDT accuracy value with Aspergillus-specific IgG as the gold standard showed a sensitivity level of 0.444 (95%CI 0.215-0.674), a specificity of 0.577 (95% CI 0.443-0.711), a positive predictive value of 0.267 (95% CI 0.108-0.425), and a negative predictive value of 0.750 (95% CI 0.616-0.884) and the Kappa value is 0.017. In addition, there was a statistically significant relationship between gender and the Brinkmann index on the results of the Aspergillus IDT examination (p <0.05). Conclusion: IDT is not a good diagnostic method and it is still necessary to validate the crude antigen used.