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Abstrak :
Latar Belakang: Masalah diagnostik efusi pleura tuberkulosis (EPTB) merupakan hal yang menjadi dilema di Indonesia. Pewarnaan rutin sering hasilnya negatif. Kultur M. tuberculosis (MTB) mempunyai kendala waktu, PCR masih dirasa mahal. Kadar Adenosine Deaminase (ADA) pada cairan pleura di berbagai studi di luar negeri menunjukkan tingkat sensitivitas dan spesifisitas yang tinggi. Uji diagnostik ADA di Indonesia belum pemah diteliti. Tujuan. Mengetahui karaktreristik cairan pleura pada EPTB dan mengetahui nilai sensitivitas dan spesifisitas ADA. Metodologi. Uji diagnostik yang dilakukan pada pasien dengan EPTB yang datang dan dirawat di RSCM, untuk dilakukan anamnesis, pemeriksaan fisik, foto torah analisa cairan pleura, pemeriksaan kimia dash, sitologi, kultur MTB, PCR TB, ADA dan respons terhadap OAT. Dilakukan pengolahan data dan dimasukkan ke tabel frekuensi dan tabel silang. Hasil. Selama periode April - September 2005 terkumpul 30 pasien namun dua orang dikeluarkan karena dari sitologinya didapati keganasan dan 4 pasien gagal punksi. Dua puluh empat pasien dengan klinis EP TB yang terdiri dari 12 laki-laki (50%) dan 12 perempuan (50%). Kelompok usia terbanyak < 25 tahun (10 prang, 41,6%). Kultur kuman MTB positif (5 orang, 20,83%), pewarnaan kuraan semua negatif (24 orang, 100%), PCR TB positif (16 orang, 66,6%), ADA positif (16 orang, 66,6%), sensitivitas ADA 75%, spesifisitas ADA 50%, nilai prediksi positif 75%, nilai prediksi negatif 50%, rasio kemungkinan positif 1,5, rasio kemungkinan negatif 0,5. Kesimpulan. Seluruh sampel cairan pleura didominasi limfosit. Diagnosis EPTB dengan menggunakan ADA, didapat sensitivitasnya auk-up tinggi namun spesitisitasnya kurang tinggi.

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Backgrounds: Diagnostic problems of Tuberculous Pleural Effusions (TPE) is dilemmatic in Indonesia. Routine smears are almost always negative. M. tuberculosis (MTB) culture has a time problem and PCR TB is very expensive. Study in other countries about ADA levels on pleural effusions had excellent sensitivity and specificity for TPE. The ADA diagnostic test is less expensive and has never been studied before in Indonesia. Objectives. To study TPE characteristics and ADA's sensitivity and specificity for TPE. Methods. Diagnostic test was conducted to TPE clinically patients who were outpatients or inpatients in Cipto Mangunkusumo Hospital_ The patients were interviewed, physically examined, thorax x-ray, blood serum, cytology, MTB culture, PCR TB, ADA levels and response to anti tuberculosis medicine. Data were processed and make available on frequency table and cross table. Results. From April - September 2005, 30 patients were enrolled in this study but two were excluded because they had malignancy and four because of failure on aspiration procedure. 24 TPE patients were available for in depth study. There were 12 males (50%) and 12 females (50%). Majority of the patients were from < 25 years old group (10 subjects, 41.6%). Culture MTB positive (5 subjects, 20.83%), stain totally negative (24 subjects, 100%), PCR TB positive (16 subjects, 66.6%), ADA positive (16 subjects, 66.6%), ADA sensitivity 75%, ADA specificity 50%, positive predictive value 75%, negative predictive value 50%, likelihood ratio positive 1.5, likelihood ratio negative 0.5. Conclusions. All of pleural effusions sample are predominant lymphocytes. To diagnose TPE, ADA has good enough sensitivity but less specificity.

Abstrak :
ABSTRAK
Pleural effusion occurs when abnormal pleural fluid accumulate within pleural cavity. The first step in pleural effusion evaluation is categorising pleural fluids into transudates and exudates using Light rsquo s Criteria, to determine differential diagnoses. Transudative pleural effusions occur when systemic factors influencing hydrostatic and oncotic pressures are imbalanced. Exudative pleural effusions occur due to local factors influencing increased vascular permeability. This research aims to describe profiles of pleural fluid analysed by Department of Clinical Pathology, Dr. Cipto Mangunkusumo National General Hospital RSCM and investigate their diagnostic value.Data were collected between January August 2016 consecutively. In total, 199 pleural fluids were assessed 123 exudative, 72 transudative and 4 transudative exudative transitional pleural fluids. The samples comprised of 56.3 females and 43.2 males. The age ranged from 1 month to 83 years old, averaging at 45.3 years old. Malignancy was the most frequent etiology found 35.7 , followed by Infection 22.1 . Pleural fluids were predominantly yellow 51.7 . Compared to transudates, exudates were more likely to clot, mostly tested positive for Rivalta and appeared more turbid. WBC count, protein fluid, protein ratio, LDH fluid and LDH ratio of exudates were significantly higher than transudates. Exudates exhibited significantly lower glucose fluid levels. Bacteriologically, 13 samples yielded a positive culture.Profiles of transudative and exudative pleural fluids correlated with their respective clinical conditions, reflecting different underlying mechanisms, thus verifying Light rsquo s criteria. Diagnostic values of pleural fluid analyses towards its clinical diagnosis yielded Sensitivity of 66.7 , Specificity of 67.9 , Positive Predictive Value of 90.6 and Negative Predictive Value of 27.1.

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ABSTRAK
Pada Pleura Effusi terdapat akumulasi cairan pleura abnormal pada rongga pleura. Langkah pertama pada algoritme pleura effusi adalah kategorisasi cairan pleura menjadi transudat dan eksudat untuk menentukan diagnosis differensial. Cairan pleura transudat ditemukan pada etiologi sistemik dimana terdapat ketidakseimbangan tekanan hidrostatik dan onkotik. Cairan pleura eksudat ditemukan pada etiologi lokal dimana terdapat peningkatan permeabilitas. Cairan transudat dan eksudat dapat dibedakan menggunakan kriteria Light rsquo;s. Penelitian ini bertujuan untuk mendeskripsikan profil analisis cairan pleura di Departemen Patologi Klinik, Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo RSCM dan untuk menginvestigasi nilai diagnostik analisis cairan pleura.Penelitian ini menggunakan sampel cairan pleura dari Departemen Patologi Klinik yang dipilih antara bulan Januari-Agustus 2016 secara konsekutif. Sampel berjumlah 199; 72 transudat, 127 eksudat dan 4 peralihan transudate ke eksudat. Demografik sampel adalah 56.3 perempuan dan 43.2 laki-laki. Umur berkisar antara 1 bulan-83 tahun dan rerata 45.3 tahun. Etiologi paling sering adalah keganasan 35.7 , diikuti dengan infeksi 22.1 . Dibandingkan dengan transudat, eksudat lebih banyak terdapat bekuan, hasil Rivalta positif dan lebih keruh. Leukosit, protein cairan, protein rasio, LDH cairan dan LDH rasio lebih tinggi pada eksudat. Glukosa cairan lebih rendah pada eksudat. 13 sampel menunjukkan kultur positif.Terdapat korelasi antara profil cairan pleura transudat dan eksudat dengan diagnosis klinis, menunjukkan adanya perbedaan mekanisme dan menggambarkan efektifitas kriteria Light rsquo;s. Nilai diagnostik analisis cairan pleura berupa sensitivitas 66.7 , spesifisitas 67.9 , nilai prediksi positif 90.6 dan nilai prediksi negatif 27.1

Abstrak :
Pendahuluan: Tuberkulosis pleura merupakan bentuk TB ekstra paru paling umum kedua setelah TB kelenjar dan merupakan penyebab utama efusi pleura di daerah endemik TB. Diagnosis dan pengobatan cepat dan tepat sangat penting dalam pengelolaan TB pleura karena dapat menjadi progresif dan mengenai organ lain. Sampai saat ini, penegakkan diagnosis TB pleura masih menjadi tantangan. Tujuan: Mendapatkan model prediksi diagnosis TB pleura berdasarkan klinis, radiologi thoraks, analisa cairan pleura, ADA dan BTA metode sitosentrifugasi dan melakukan uji diagnostik pemeriksaan analisa cairan pleura, ADA dan BTA metode sitosentrifugasi pada pasien terduga TB pleura dengan biakan TB MGIT sebagai baku emas. Metode: Desain penelitian potong lintang. Subjek penelitian terdiri dari 50 pasien efusi pleura terduga TB. Dilakukan pemeriksaan analisa cairan pleura, ADA dan BTA metode sitosentrifugasi. Klinis pasien dan radiologi thoraks diperoleh dari rekam medik pasien. Analisis data dilakukan untuk uji diagnosis, analisis bivariat, multivariat, dan Receiving Characteristics Operator (ROC), dan analisis bootstrapping pada Kalibrasi Hosmer-Lemeshow. Hasil: Uji diagnosis analisa cairan pleura yaitu eksudat dengan MN>50% yaitu sensitivitas 83,3%, spesifisitas 38,6%, NPP 15,6%, NPN 94,4%. Pemeriksaan ADA yaitu sensitivitas 66,7%, spesifisitas 95,5%, NPP 66,7%, NPN 95,5%. Pemeriksaan BTA metode sitosentrifugasi yaitu sensitivitas 50%, spesifisitas 97,7%, NPP 75%, NPN 93,5%. Model prediksi diagnosis TB pleura adalah Logit (y) = -4,872+(2,025xEksudat dengan MN>50% +3,308xADA +2,438xBTA). Kesimpulan: Determinan diagnosis dan komponen sistem skor TB pleura adalah eksudat dengan MN>50%, ADA dan BTA metode sitosentrifugasi. Sistem skor diharapkan menjadi alat bantu diagnosis TB pleura. Berdasarkan uji diagnosis, pemeriksaan analisa cairan pleura yaitu eksudat dengan MN >50% baik untuk penapisan, sedangkan pemeriksaan ADA dan BTA metode sitosentrifugasi baik untuk menegakkan diagnosis. ...... Introduction: Pleural tuberculosis is the second commonest form of extrapulmonary TB after Lymph node and the main cause of pleural effusion in TB endemic areas. Early diagnosis and treatment is important because of its progressivity and spread to other organs. Until now, diagnosis of pleural TB remains a challenge. Objective: This study aims to obtain prediction model based on clinical data, chest x-ray, pleural fluid analysis, ADA, and cytocentrifuged AFB, and perform diagnostic study on pleural fluid analysis, ADA, and cytocentrifuged AFB in suspected TB patients with TB MGIT culture as the gold standard. Methods: This is a cross-sectional study on 50 pleural effusion patients suspected with TB. Pleural fluid analysis, ADA, and cytocentrifuged AFB tests were performed. Clincal data and x-rays were obtained from patient records. Statistical analysis include bivariate and multivariate analysis, ROC analysis, and bootstrapping in Hosmer-Lemeshow calibration test. Results: The result of exudate and MN > 50% in pleural fluid analysis yielded 83.3% sensitivity, 38.6% specificity, 15.6% PPV, and 94.4% NPV. The result of > 40 U/L in ADA test showed 66.7% sensitivity, 95.5% specificity, 66.7% PPV, and 95.5% NPV. Cytocentrifuged AFB test yielded 50% sensitivity, 97.7% specificity, 75% PPV, and 93.5% NPV. Pleural TB prediction model was Logit (y) = -4,87 2+ 2,025 x exudate with MN > 50% + 3,308 x ADA + 2,438 x cytocentrifuged AFB. Conclusion: Diagnostic determinants and pleural TB score components are exudate with MN > 50%, ADA, and cytocentrifuged AFB. Scoring system is expected to aid pleural TB diagnosis. Based on ROC analysis, exudate with MN > 50% in pleural fluid analysis is good for screening, while ADA and cytocentrifuged AFB tests are good for diagnosis.