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Abstrak :
Penyakit paru-paru akibat bakteri Nontuberculous Mycobacteria (NTM) semakin banyak terdeteksi pada kelompok rentan. Ketahanan NTM terhadap klorin mencapai 1000 kali lipat dibandingkan E. Coli, memungkinkan NTM bertahan di sistem distribusi air. Penelitian ini bertujuan menganalisis konsentrasi dan spesies NTM pada air bersih di rumah tangga dan Rumah Sakit X, serta mengestimasi dosis paparan NTM pada kelompok rentan menggunakan metode quantitative microbial risk assessment (QMRA). Metode penelitian meliputi enumerasi bakteri dengan media Middlebrook M7H10, elektroforesis, PCR, dan sanger sequencing. Rata-rata konsentrasi total NTM di rumah tangga Kecamatan Beji dan Sukmajaya, dengan sumber PDAM dan air tanah, adalah 14,7 CFU/L dan 11,3 CFU/L. Di Rumah Sakit X, konsentrasi rata-rata adalah 5,3 CFU/L. Ditemukan 2 spesies NTM pada 10 isolat (20%), yaitu Gordonia sp., Mycobacterium wolinskyi, dan Mycolicibacterium mucogenicum di rumah tangga, serta Streptomyces sp. di Rumah Sakit X. Estimasi dosis risiko paparan NTM menggunakan QMRA menunjukkan dosis paparan di rumah tangga sebesar 0,00434 CFU dan di Rumah Sakit X sebesar 0,00197 CFU. Meskipun konsentrasi NTM tergolong rendah, diperlukan langkah-langkah pengurangan paparan NTM seperti penggunaan filter dan UV, mengganti jenis perbandingan, serta mengurangi stagnasi air bersih untuk mengurangi risiko kesehatan. ......The incidence of lung Lung diseases caused by Nontuberculous Mycobacteria (NTM) are increasingly detected in vulnerable groups. NTM's resistance to chlorine is up to 1000 times greater than that of E. Coli, allowing NTM to persist in water distribution systems. This study aims to analyze the concentration and species of NTM in household and Hospital X clean water, and to estimate the NTM exposure dose to vulnerable groups using the quantitative microbial risk assessment (QMRA) method. The research methods included bacterial enumeration using Middlebrook M7H10 media, electrophoresis, PCR, and Sanger sequencing. The average total concentration of NTM in households in Beji and Sukmajaya Districts, with PDAM and groundwater sources, was 14.7 CFU/L and 11.3 CFU/L, respectively. At X Hospital, the average concentration was 5.3 CFU/L. Two NTM species were found in 10 isolates (20%), namely Gordonia sp., Mycobacterium wolinskyi, and Mycolicibacterium mucogenicum in households, as well as Streptomyces sp. in X Hospital. The NTM exposure risk dose estimation using QMRA indicated an exposure dose in households of 0.00434 CFU and 0.00197 CFU in Hospital X. Although the NTM concentration was relatively low, measures to reduce NTM exposure, such as using filters and UV, changing disinfectant types, and reducing clean water stagnation, are necessary to mitigate health risks.

Abstrak :
Bakteri patogen,seperti NTM, dapat ditemukan di limgkungan seperti tanah dan perairan alami. Sumber air baku untuk air bersih dari perairan akan diolah di instalasi pengolahan air minum. Meskipun klorin digunakan untuk disinfeksi dalam pengolahan air minum, NTM yang resistem terhadap klorin tetap dapat tumbuh di sistem distribusi perpipaan. Air dari sistem distribusi ini akan mengalir menuju rumah tangga dan fasilitas umum, seperti rumah sakit, kemudian air digunakan melalui shower yang berpotensi melepaskan NTM dalam biofilm sebagai partikel aerosol. Partikel aerosol ini dapat terhirup oleh manusia dan berpotensi menyebabkan penyakit bagi individu yang memiliki sistem kekebalan tubuh yang lemah. Penelitian ini dilakukan di rumah tangga dan Rumah Sakit X di Kecamatan Beji dan Sukmajaya, Kota Depok. Shower di Rumah Sakit X menunjukkan pertumbuhan NTM dalam biofilm yang lebih tinggi dibandingkan rumah tangga. Rata-rata NTM dalam biofilm di rumah tangga adalah 7,00 × 102 CFU/swab pada sumber air tanah, (7,25 ± 5,30) × 102 CFU/swab pada sumber air PDAM, dan (0,85 ± 1,10) × 103 CFU/swab di Rumah Sakit X dengan sumber air PDAM. Sementara itu, perbedaan permukaan shower juga memengaruhi keberadaan NTM pada biofilm yang tumbuh di shower dengan gagang berbahan krom (25%) dan plastik (12,5%). Hasil penelitian pada isolat bakteri dari rumah tangga dan Rumah Sakit X berdasarkan PCR, elektroforesis, dan sanger sequencing, ditemukan dua spesies NTM, yaitu Mycobacterium intracellulare dan Mycobacterium senegalense. ......Pathogenic bacteria, such as NTM, can be found in environments such as soil and natural waters. Raw water sources for clean water from waters will be treated in drinking water treatment plants. Although chlorine is used for disinfection in drinking water treatment, chlorine-resistant NTM can still grow in the piped distribution system. Water from these distribution systems will flow to households and public facilities, such as hospitals, where it is used in showers, potentially releasing NTM in biofilms as aerosol particles. These aerosol particles can be inhaled by humans and potentially cause illness for individuals with weakened immune systems. This study was conducted in households and Hospital X in Beji and Sukmajaya sub-districts, Depok City. Showers in Hospital X showed higher growth of NTM in biofilm than households. The average NTM in biofilm in households was 7.00 × 102 CFU/swab at groundwater source, (7.25 ± 5.30) × 102 CFU/swab at PDAM water source, and (0.85 ± 1.10) × 103 CFU/swab at Hospital X with PDAM water source. Meanwhile, differences in shower surfaces also affected the presence of NTM in biofilms grown in showers with chrome (25%) and plastic (12,5%) handles. The results of research on bacterial isolates from households and Hospital X based on PCR, electrophoresis, and sanger sequencing, found two NTM species, namely Mycobacterium intracellulare and Mycobacterium senegalense.

Abstrak :
Tuberkulosis (TB) sampai dengan saat ini masih merupakan salah satu masalah kesehatan utama di Indonesia. Sepuluh persen dari TB ekstraparu adalah TB tulang, dan sekitar 50% penderita TB tulang menyerang tulang belakang (Spinal Tuberkulosis). Respon tubuh terhadap Mycobacterium tuberculosis (M.tb) sehingga menimbulkan penyebaran ekstraparu, khususnya respon makrofag sebagai pertahanan lini pertama, masih belum sepenuhnya dimengerti. Makrofag menghasilkan molekul reactive oxygen species (ROS) sebagai hasil dari oxygen burst untuk mengeliminasi antigen. Nitrat Oksida (NO) dan mieloperoksidase (MPO) berperan pada oxygen burst Selain itu, Pada fagositosis terdapat organel lisosom yang di dalamnya terdapat enzim hidrolase (fosfatase asam dan beta glukuronidase) berguna pada pencernaan intraseluler. Penelitian ini menguji hipotesis bahwa ada gangguan fungsi makrofag pada pasien TB tulang belakang. Monosit diisolasi dari peripheral blood mononuclear cells (PBMC) dari lima pasien TB tulang belakang dan lima orang sehat sebagai kontrol. Monosit yang terisolasi dikultur dengan stimulasi dari macrophage colony-stimulating factor (M-CSF) selama tujuh hari untuk pematangan. Kemampuan fagositosis makrofag dinilai aktivitasnya terhadapa sel darah merah domba (SDMD). Sedangkan nitrat oksida (NO), mieloperoksidase (MPO), betaglukuronidase, dan aktivitas fosfatase asam diselidiki dengan metode spektrofotometer. Analisis data dengan menggunakan aplikasi SPSS versi 20. Kami menemukan bahwa monosit yang diisolasi dari PBMC pasien TB tulang belakang secara signifikan lebih sedikit dibandingkan dengan kelompok kontrol (2992.103 vs 6474.103 (sel / mL)) dan juga lebih sedikit makrofag yang melekat pada sel darah merah domba (SDMD) (264.103 vs 598.103 (sel / mL)). Namun, produksi NO (2346 vs 325,17 (μmol / gram protein)), dan MPO (570,7 vs 17,4 (unit / mg), beta-glukuronide (0,149 vs 0,123 (unit / mg)), dan asam fosfatase aktivitas (1776,9 vs 287,9 (unit / mg)) dari makrofag kelompok TB tulang belakang lebih tinggi daripada kelompok yang sehat serta korelasi negatif kuat dan bermakna antara fagositosis makrofag dengan tiap variabel tersebut. Selain itu, Terdapat korelasi positif lemah dan tidak bermakna antara kejadian fagositosis dan uji WST. Meskipun pengenalan rendah pada benda asing, proses makrofag intraseluler, termasuk aktivitas oksidatif dan fungsi lisosom, tinggi secara signifikan. Hasil ini menunjukan penurunan fungsi makrofag pada pasien TB tulang belakang serta terdapat kemungkinan adanya dominasi imunitas non-spesifik bawaan pada infeksi TB tulang belakang Tuberculosis (TB) is still one of the main health problems in Indonesia. Ten percent of extrapulmonary TB is bone TB and about 50% of people with bone TB affected to the spine. The immune response against Mycobacterium tuberculosis (M.tb), which causes extrapulmonary spread, particularly the response of macrophages as a first-line defense, is still not fully understood. Macrophages produce reactive oxygen species (ROS) molecules as a result of oxygen bursts to eliminate antigens. Nitric Oxide (NO) and myeloperoxidase (MPO) play a role in oxygen burst. Also, phagocytosis process involved lysosomal organelles in which there are hydrolase enzymes (acid phosphatase and betaglucuronidase), which have important role in intracellular digestion. This study examined the hypothesis about impairment of macrophage function in spondylitis TB patients. Monocytes were isolated from peripheral blood mononuclear cells (PBMC) collected from five spinal TB patients and five healthy people as controls. Isolated monocytes were cultured by stimulation of macrophage colony-stimulating factor (M-CSF) for seven days for maturation. The phagocytic ability of macrophages is assessed as to their activity on sheep red blood cells. Whereas nitric oxide (NO), myeloperoxidase (MPO), betaglucuronidase, and acid phosphatase activity were investigated by spectrophotometer methods. Data was analyzed using SPSS version 20. We found that monocytes isolated from PBMC of spondylitis TB patients were significantly less than in the control group (2992,103 vs 6474,103 (cells / mL)) and also fewer macrophages attached to red blood cells sheep (264,103 vs 598,103 (cells / mL)). However, NO production (2346 vs 325.17 (μmol / gram protein)), MPO (570.7 vs. 17.4 (units/mg), beta-glucuronide (0.149 vs 0.123 (units/mg)), and acids phosphatase activity (1776.9 vs 287.9 (units/mg)) of macrophages in the spondylitis TB group were higher than in the healthy group. There was a strong and significant negative correlation between phagocytosis of macrophages with each of the previous variables. There was no significant difference between phagocytic ability and the WST test. Although the recognition against foreign bodies was low, intracellular macrophage processes, including oxidative activity and lysosomal function, were significantly higher than control. This result showed a decrease of macrophage function in spondylitis TB patients as well as a possible dominance of non- specific immunity.