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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: 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. ......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.

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

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ABSTRACT
Pulmonary aspergillosis is an opportunistic infection caused by Aspergillus spp mold. The incidence of this infection has dramatically increased which is related to the increasing utilization of immunosuppressive drugs such as corticosteroids and cytotoxic therapy. Diagnosis of pulmonary aspergillosis has been challenging since not only the signs and symptoms of the disease are nonspecific, but also tissue biopsy as gold standard is considered invasive. Sputum culture and antibody detection has been routine examinations done to the patient with suspected pulmonary aspergillosis sent to the Mycology Laboratory of Department of Parasitology FMUI, but the diagnostic value of antibody detection is not available. The aim of this study is to compare antibody detection with immunodiffusion method using crude antigen of Aspergillus with sputum culture as reference test. This cross sectional study used 689 samples obtained from medical records of patients with suspected pulmonary aspergillosis who undergo both sputum culture examination and antibody detection in Mycology Laboratory of Department of Parasitology FMUI in 2008 2015. Descriptive analysis showed the prevalence of pulmonary aspergillosis based on positive culture result is 0,4 . The sensitivity and specificity of antibody detection are 33,33 and 95,62 respectively, resulted from diagnostic test using 2x2 table. Statistical analysis using McNemar rsquo s test shows significant difference between mentioned examinations and low level of agreement Kappa 0,026.