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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: Pasien bekas TB yang telah diobati akan mengalami perubahan struktur anatomi paru permanen sehingga dapat meningkatkan risiko kejadian gejala sisa. Gejala sisa yang terjadi dapat meninggalkan lesi di paru dan ekstra paru. Pada lesi paru biasanya diawali dengan perubahan struktur bronkial dan parenkim paru seperti distorsi bronkovaskuler, bronkietaksis, emfisematus dan fibrosis. Fungsi paru pada pasien 6 bulan setelah menyelesaikan pengobatan TB kategori I ditemukan nilai tes fungsi paru cenderung lebih rendah walapun sudah menyelesaikan obat anti tuberculosis (OAT) selama 6 bulan. Metode: penelitian menggunakan metode potong lintang pada 65 pasien yang mendapatkan OAT lini I di Poli Paru RSUP persahabatan. Subjek penelitian akan menjalani pemeriksaan spirometri, DLCO, darah rutin dan HRCT toraks. Hasil: Pada penelitian ini didapatkan median usia subjek 45 tahun dengan usia paling muda 18 tahun dan usia paling tua 60 tahun. Jenis kelamin pada penelitian ini didapatkan laki-laki sebanyak 33 subjek (51%). Sebanyak 66% subjek terdapat kelainan spirometri. Hasil spirometri dengan kelainan terbanyak yaitu gangguan restriksi dan obstruksi (campuran) pada 29 (44%) subjek, gangguan restriksi sebanyak 13 (21%) subjek, satu (1%) subjek gangguan obstruksi dan 22 (33%) subjek tidak ditemukan kelainan. Derajat lesi pada HRCT toraks menggunakan modifikasi Goddard score didapatkan derajat lesi ringan sebanyak 33 (51%), sedang 20 (31%), berat 8 (12%) subjek. Karakteristik lesi terbanyak pada parenkim paru secara berurutan fibrosis, kalsifikasi, bullae, retikuler opasitas, ground glass opacity (GGO), nodul, konsolidasi dan jamur. Lesi saluran napas yang terbanyak secara berurutan yaitu bronkietaksis, ateletaksis, dilatasi trakea. Gangguan kapasitas difusi terbanyak yaitu derajat ringan 25 (38%), moderate 22 (33%) dan berat 3 (5%). Pada penelitian ini ditemukan perbedaan bermakna antara derajat kelainan kapasitas difusi paru terhadap derajat lesi pada HRCT toraks dan terdapat risiko 8,68 kali (IK 95% 2,3-32,72).. Kesimpulan: Terdapat hubungan bermakna antara derajat gangguan difusi paru terhadap derajat lesi pada HRCT toraks. Penurunan fungsi paru setelah menyelesaikan pengobatan TB dapat terjadi sehingga diperlukan pemeriksaan fungsi paru dan HRCT toraks secara berkala. ......Background: Former TB infection patients will experienced changes in anatomical structure of the lung. Hence, it wil increased risk of sequelae. Sequelae can occur in extra pulmonary. Lung lesions changes in the structure of the bronchial and lung parenchyma such as bronchovascular distortion, bronchietacsis, emphysema and fibrosis. Lung functions in patients 6 months after completing TB treatment found that lung function test tend to be lower even after completing treatment for 6 months. Methods: This studi used a cross-sectional method on 65 patients whom received anti tuberculosis drugs at Lung Polyclinic, Persahabatan Hospital. Research subjects will undergo spirometry, DLCO, blood test and HRCT thorax. Results: In this study median age of subjects was 45 years. The youngest was 18 years and oldest was 60 years. Male population was 33 (51%) subjects. Total 66% subjects have lung function impairment. Resulst of spirometry showed mixed disorder in 29 (44%) subjects, restriction disorder in 12 (19%) subjects, one subjects with obstructive disorders and 22 (33%) subjects are normal. Based on Goddard modificaion score showed mild degree in 33 (51%) subects, moderate 20 (31%) dan severe 8 (12%) subjects. The most characteristic lesions in the lung parenchymal were fibrosis, calcification, bullae, reticular opacity, GGO, nodules, consolidation and fungi. The most common airway lesions were bronchietacsis, atelectasis and trachel dilatation. The most common lung diffusion impairment is mild 25 (38%), moderate 22 (33%) and severe 3 (5%). In this study found that there was a significant difference among lung diffusion impairment and degree of lesion based on HRCT thorax with OR 8.68 (CI 95% 2.3- 32.72). Conclusion: There was significant relationship between lung diffusion impairment and degree of lesions based on HRCT thorax. Decrease lung function after completing TB treatment can occur so that routine lung function test and HRCT thorax imaging are recommended.

Abstrak :
Latar Belakang: Tuberkulosis dan HIV merupakan beban utama penyakit menular di negara-negara dengan keterbatasan sumber daya. Di sisi lain, hipertensi pulmoner yang merupakan komplikasi akibat TB-HIV sering terabaikan meskipun angka kematiannya tinggi karena gejala tidak khas. Hipertensi pulmoner pada pasien TB dan bekas TB dengan HIV berhubungan dengan kerusakan parenkim paru dan inflamasi sistemik kronik yang mengakibatkan remodeling vaskular pulmoner. Tujuan penelitian ini adalah untuk mengetahui proporsi probabilitas hipertensi pulmoner pada pasien TB dan bekas TB dengan HIV secara ekokardiografik. Metode: Metode yang digunakan dalam penelitian ini adalah cross sectional pada pasien TB dan bekas TB dengan HIV yang berobat di RSUP Persahabatan. Pemeriksaan ekokardiografi dilakukan di poliklinik Jantung RSUP Persahabatan. Pengambilan sampel dilakukan secara consecutive sampling dari Mei hingga Agustus 2023. Hasil: Terdapat 54 subjek yang memenuhi kriteria inklusi dalam penelitian ini, 9 subjek dieksklusi sehingga tersisa 45 subjek. Jenis kelamin subjek mayoritas laki-laki sebanyak 86,7%, usia terbanyak adalah 18-45 tahun sebanyak 77,8%, status TB terbanyak adalah TB klinis sebanyak 42,2% dan lama menderita HIV terbanyak adalah kurang dari atau sama dengan 1 tahun sebanyak 51,1%. Proporsi probabilitas hipertensi pulmoner secara ekokardiografik didapatkan probabilitas rendah sebesar 91,1% dan probabilitas sedang- tinggi sebesar 8,9%. Tidak terdapat hubungan yang bermakna antara demografik dan karakteristik klinis subjek dengan probabilitas hipertensi pulmoner. Kesimpulan: Proporsi probabilitas hipertensi pulmoner secara ekokardiografik pada pasien TB dan bekas TB dengan HIV sebesar 91,1% untuk probabilitas rendah dan 8,9% untuk probabilitas sedang-tinggi. ......Background: Tuberculosis and HIV represent the main burden of infectious diseases in resource-limited countries. On the other hand, pulmonary hypertension, which is a complication of TB-HIV, is often overlooked even though the death rate is high because the symptoms are not typical. Pulmonary hypertension in TB and former TB patients with HIV is associated with lung parenchymal damage and chronic systemic inflammation which results in pulmonary vascular remodeling. The aim of this study was to determine the proportion of echocardiographic probability of pulmonary hypertension in TB and former TB patients with HIV. Method: The method used in this study was cross sectional on TB and former TB patients with HIV who were treated at Persahabatan Central General Hospital. Echocardiography examination was carried out at the Cardiology polyclinic of Persahabatan Central General Hospital. Sampling was carried out by consecutive sampling from May to August 2023. Results: There were 54 subjects who met the inclusion criteria in this study, 9 subjects were excluded, leaving 45 subjects. The majority of subjects‘ gender was male at 86.7%, the majority age was 18-45 years at 77.8%, the highest TB status was clinically TB at 42.2% and the majority had suffered from HIV for less than or equal to 1 year at 51.1%. The proportion of echocardiographic probability of pulmonary hypertension showed a low probability of 91.1% and a medium-high probability of 8.9%. There was no significant relationship between the demographic and clinical characteristics of the subjects and the probability of pulmonary hypertension. Conclucion: The proportion of echocardiographic probability of pulmonary hypertension in TB and former TB patients with HIV was 91.1% for low probability and 8.9% for medium-high probability.