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Abstrak :
Latar belakang: Aspergilosis paru kronik (APK) merupakan komplikasi yang sering ditemukan pada pasien dengan riwayat tuberkulosis (TB) paru. Pemeriksaan serologi Aspergillus yang cepat dan sensitif dibutuhkan untuk mendiagnosis APK. Penelitian ini membandingkan pemeriksaan serologi ELISA otomatis dan tes imunokromatografi pada dalam mendeteksi antibodi spesifik Aspergillus pada pasien dengan riwayat TB paru. Metode: Studi potong-lintang ini merupakan bagian dari penelitian payung tentang diagnosis APK pada pasien TB. Serum pasien diperiksa menggunakan ELISA otomatis dan tes imunokromatografi. Performa diagnosis diperoleh melalui perbandingan hasil pemeriksaan dengan diagnosis APK. Agreement antar tes dianalisis dengan Hasil: Didapatkan 68 pasien pasca TB dengan median usia 34,5 (17-72) tahun. Sebanyak 24 pasien diadiagnosis APK (35,3%). Proporsi positif ELISA otomatis dan tes imunokromatografi sebesar 48,5% dan 2,9%. ELISA otomatis memiliki sensitivitas 91,7%, spesifisitas 75%, nilai duga positif 66,7%, dan nilai duga negatif  94,3%. Tes imunokromatografi memiliki sensitivitas 8,3%, spesifisitas  dan nilai duga positif 100%, serta nilai duga negatif 66,7%. Agreement antara kedua tes sangat rendah (kappa score: 0,062). Kesimpulan: Pada pasien dengan riwayat TB paru, ELISA otomatis IgG spesifik Aspergillus dapat digunakan sebagai pemeriksaan penunjang APK di area dengan sumber daya mendukung. Sedangkan tes imunokromatografi dapat digunakan sebagai uji penapisan awal APK di daerah dengan keterbatasan sumber daya. ......Introduction: Chronic pulmonary aspergillosis (CPA) is common in post TB patients. Faster and more sensitive Aspergillus serological examination is necessary for CPA diagnosis. This study compared automated ELISA and immunochromatography test for Aspergillus specific antibody detection in post pulmonary TB patients. Method: This cross-sectional study is part of previous research on CPA diagnosis in tuberculosis. Patient’s sera were tested with automated ELISA and immunochromatography test. The results were compared to CPA diagnosis to obtain diagnostic performances. The agreement between tests was analyzed with Cohen’s kappa. Result: There were 68 previous TB patients with median age 34,5 (17-72) years old. CPA was diagnosed in 24 patients (35,3%). The positive result of automated ELISA and immunochromatography test were 48,5% and 2,9%. Automated ELISA showed sensitivity of 97%, specificity of 75%, PPV of 66,7%, and NPV of 94,3%. The immunochromatography test showed sensitivity of 8,3%, specificity and PPV of 100%, and NPV of 66,7%. There was very low agreement between tests (kappa score: 0,062). Conclusion: Automated ELISA Aspergillus specific IgG could be utilized for supporting CPA diagnosis in post TB patients, mainly in settings where resources are available. Immunochromatography test is applicable as an early screening tool for CPA detection in resource-constrained areas.

Abstrak :
Latar belakang: Indonesia memiliki beban tuberkulosis yang tinggi. Kerusakan paru yang ditimbulkan mendasari terjadinya aspergillosis paru kronik (APK). Salah satu kriteria diagnosis APK ialah bukti keterlibatan Aspergillus. Mempertimbangkan keterbatasan kultur, deteksi antibodi ELISA menjadi modalitas alternatif. Penelitian ini bertujuan membandingkan performa diagnostik pemeriksaan IgG spesifik Aspergillus ELISA manual dan otomatis pada pasien riwayat TB paru. Metode: Penelitian potong lintang ini membandingkan pemeriksaan IgG spesifik Aspergillus ELISA manual Bordier dan ELISA otomatis Immulite menggunakan serum pasien dengan riwayat TB. Performa diagnostik dibandingkan dalam bentuk proporsi hasil positif, sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif. Hasil: Terdapat total 68 subjek, dengan median usia 34,5 tahun, proporsi lansia 11,76% dan proporsi laki-laki 42,65%. Proporsi hasil positif pemeriksaan IgG spesifik Aspergillus ELISA manual dan ELISA otomatis masing-masing 13,24% dan 48,53%. Pemeriksaan IgG spesifik Aspergillus ELISA manual memiliki sensitivitas 20,83%, spesifisitas 90,91%, nilai duga positif 55,56%, dan nilai duga negatif 67,80%. Pemeriksaan IgG spesifik Aspergillus ELISA otomatis menunjukkan sensitivitas 91,67%, spesifisitas 75%, nilai duga positif 66,67%, dan nilai duga negatif 94,29%. Kesimpulan: Performa diagnostik dan teknis pemeriksaan IgG spesifik Aspergillus ELISA otomatis lebih baik dibandingkan ELISA manual, tetapi pemilihan modalitas diagnosis perlu mempertimbangkan faktor keterjangkauan, aksesibilitas, dan akurasi sesuai kebutuhan dan ketersediaan sumber daya. ......Introduction: Indonesia has high tuberculosis (TB) burden. The resulting lung damage underlies chronic pulmonary aspergillosis (CPA) development. CPA is diagnosed in patients with evidence of Aspergillus involvement as one of its criteria. Taking into account the limitations of culture, ELISA antibody detection becomes alternative modality. This study aims to compare diagnostic performance between manual and automated ELISA for Aspergillus-specific IgG in patients with treated TB. Method: This cross-sectional study compares Aspergillus-specific IgG test using Bordier manual ELISA and Immulite automated ELISA on sera from patients with treated TB. Diagnostic performance was compared in positive test proportion, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). Result: There are 68 subjects, with median age of 34,5 years, elderly subjects proportion of 11,76%, male proportion of 42,65%. Positive results proportion from Aspergillus-specific IgG manual and automated ELISA are 13,24% and 48,53%, respectively. Manual ELISA shows 20,83% sensitivity, 90,91% specificity, 55,56% PPV, 67,80% NPV. Automated ELISA shows 91,67% sensitivity, 75% specificity, 66,67% PPV, 94,29% NPV. Conclusion: Technical and diagnostic performance of automated ELISA Aspergillus-specific IgG test is better than manual ELISA, but choosing diagnostic modality needs consideration on factors such as affordability, accessibility, and accuracy according to the needs and available resources.

Abstrak :
Latar belakang: Aspergillosis paru kronik (APK) menjadi salah satu penyakit yang sering ditemukan pada pasien dengan kerusakan jaringan paru, misalnya tuberkulosis (TB). Deteksi antibodi Aspergillus merupakan modalitas utama pendukung diagnosis APK. Penelitian ini, bertujuan untuk mengetahui cut-off optimal ELISA manual Bordier dalam deteksi antibodi Aspergillus di Indonesia. Metode: Penelitian ini menggunakan desain studi potong lintang. Pemeriksaan sampel menggunakan metode ELISA manual Bordier sebagai uji diagnostik APK. Data yang diperoleh dianalisis untuk menentukan cut-off optimal pemeriksaan. Hasil: Sebagian besar subjek penelitian merupakan kelompok usia <60 tahun (89,1%) dengan rentang usia 17-72 tahun dan median 34 tahun. Cut-off optimal memberikan sensitivitas 43,48% dan spesifitas 100%. Sedangkan, sensitivitas pada cut-off 0.780, 0.850 dan 0.930 menunjukkan sensitivitas yang lebih baik dibandingkan dengan cut-off 1,595 dan cut-off pabrik (>1,0). Diabetes (15,6%) dan asma (10,9%) diketahui menjadi temuan yang lebih banyak pada pasien APK dibandingkan penyakit komorbid lainnya. Kesimpulan: ELISA manual Bordier cut-off 1,595 dengan spesifitas 100%, dapat menjadi alat skrining awal diagnosis APK. Hasil positif pada pemeriksaan disertai gejala klinis dan radiologis mengarah APK dapat digunakan untuk menegakkan diagnosis, sedangkan hasil negatif membutuhkan investigasi lanjut dengan pemeriksaan ELISA otomatis. ......Introduction: Chronic pulmonary aspergillosis (APK) is one of the diseases that are often found in patients with lung tissue damage, for example tuberculosis (TB). Aspergillus antibody detection is the main modality supporting the diagnosis of APK. This study aims to determine the optimal cut-off of Bordier's manual ELISA in the detection of Aspergillus antibodies in Indonesia. Method: This study used a cross-sectional study design. Sampel examination using Bordier's manual ELISA method as a diagnostic APK test. The data obtained are analyzed to determine the optimal cut-off of the examination. Result: Most of the study subjects were <60 years old age group (89.1%) with an age range of 17-72 years and a median of 34 years. The optimal cut-off provides 43.48% sensitivity and 100% specificity. Meanwhile, the sensitivity at cut-offs of 0.780, 0.850 and 0.930 showed better sensitivity compared to cut-offs of 1.595 and factory cut-offs (>1.0). Diabetes (15.6%) and asthma (10.9%) are known to be more common in APK patients than other comorbid diseases. Conclusion: ELISA manual Bordier cut-off 1,595 with 100% specificity, can be an early screening tool for APK diagnosis. Positive results on examination accompanied by clinical and radiological symptoms leading to APK can be used to establish a diagnosis, while negative results require further investigation with automated ELISA examination.

Abstrak :
Latar belakang: Infeksi tuberkulosis (TB) adalah masalah kesehatan yang sudah lama menjadi beban dunia, terutama di Indonesia. Metode diagnosis dengan GeneXpert MTB/RIF merupakan metode diagnosis dengan banyak kelebihan, termasuk lebih efektif dan efisien dibandingkan metode kultur Lowenstein-Jensen sebagai gold standard. WHO menyarankan penggunaan TCM GeneXpert dan foto toraks sebagai upaya triase pasien suspek TB. Penelitian menunjukan bahwa penggabungan kedua metode ini memiliki positive predictive value yang besar. Meskipun demikian, penelitian tentang TCM TB dan kaitannya dengan hasil pemeriksaan foto toraks masih sangat terbatas. Metode: Penelitian ini merupakan penelitian deskriptif analitik berdesain potong lintang dengan jumlah sampel minimal 68 subjek. Data pada penelitian ini merupakan data sekunder dari penelitian dengan judul “A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL)” yang telah dilaksanakan sebelumnya dan kemudian diseleksi berdasarkan kriteria inklusi dan eksklusi. Hasil: Dari 69 subjek yang diikutsertakan dalam penelitian, sebanyak 42 (60,78%) subjek memiliki hasil TCM negatif. Temuan foto toraks yang terbanyak ditemukan adalah infiltrat (86,96%), diikuti kavitas (56,25%), fibrosis parakaviter (37,68%), penebalan pleura (34,78%), nodul (14,49%), dan bronkiektasis (10,14%). Antara temuan foto toraks dan hasil TCM, ditemukan hubungan yang bermakna antara hasil TCM dengan kavitas, fibrosis parakaviter, penebalan pleura, dan nodul. Kesimpulan: Terdapat hubungan yang bermakna antara hasil TCM dengan beberapa temuan foto toraks pada pasien TB, yakni kavitas, fibrosis parakaviter, penebalan pleura, dan nodul. ......Background: Tuberculosis (TB) infection is a health problem that has long been a burden on the world, especially in Indonesia. The GeneXpert MTB/RIF diagnostic method is a diagnostic method with many advantages, including being more effective and efficient than the Lowenstein-Jensen culture method as the gold standard. WHO recommends the use of GeneXpert molecular test and chest X-ray as an effort to triage patients with suspected TB. Research shows that the combination of these two methods has a large positive predictive value. However, research on GeneXpert molecular rapid test and its relation to chest X-ray results is still very limited. Methods: This research is a cross-sectional analytical descriptive study with a minimum sample size of 68 subjects. The data in this study are secondary data from a study entitled " A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL)" and then selected based on inclusion and exclusion criteria. Results: Of the 69 subjects included in the study, 42 (60.78%) subjects had negative molecular rapid test results. The most common chest X-ray findings were infiltrates (86.96%), followed by cavities (56.25%), paracavitary fibrosis (37.68%), pleural thickening (34.78%), nodules (14.49%), and bronchiectasis (10.14%). Between chest X-ray findings and molecular rapid test results, a significant relationship was found between molecular rapid test results with cavities, paracavitary fibrosis, pleural thickening, and nodules. Conclusion: There is a significant relationship between molecular rapid test results and several chest X-ray findings in TB patients, namely cavities, paracavitary fibrosis, pleural thickening, and nodules.

Abstrak :
Identifikasi Pneumocystis jirovecii pada pasien dengan koinfeksi tuberkulosis (TB) paru masih menjadi tantangan karena gambaran klinis maupun radiologis keduanya yang mirip dan P. jirovecii tidak dapat dikultur. Identifikasi P. jirovecii di Indonesia masih berdasarkan pemeriksaan mikroskopik yang seringkali kurang sensitif. Oleh karena itu, dikembangkan teknik real time PCR yang lebih sensitif dan spesifik dengan gen target mitochondrial large subunit (mtLSU) dan mitochondrial small subunit (mtSSU) rRNA. Penelitian ini bertujuan untuk mengoptimasi deteksi gen mitochondrial large dan small subunit rRNA dalam mengidentifikasi P. jirovecii pada pasien terkait TB paru. Penelitian ini menggunakan 26 sampel sputum pasien terkait TB paru. Optimasi teknik real time PCR berupa optimasi konsentrasi primer, probe, suhu penempelan, volume cetakan DNA dan uji reaksi silang dilakukan untuk mendapatkan kondisi yang optimal dalam amplifikasi gen mtLSU dan mtSSU rRNA. Hasil penelitian menunjukkan hasil optimasi deteksi kedua gen tersebut dapat mengidentifikasi P. jirovecii 1 dari 26 sampel (3,84%). Uji real time PCR yang telah di optimasi dalam penelitian ini dapat mendeteksi P. jirovecii pada sampel klinis pasien terkait TB paru. ......Identification of Pneumocystis jirovecii in patients with co-infected pulmonary tuberculosis (TB) is still a challenge because the clinical and radiological features of both are similar and P. jirovecii cannot be cultured. Identification of P. jirovecii in Indonesia is still based on microscopic examination which is often less sensitive. Therefore, a more sensitive and specific real time PCR technique was developed with mitochondrial large subunit (mtLSU) and mitochondrial small subunit (mtSSU) rRNA target genes. This study aimed to optimize the detection of mitochondrial large and small subunit rRNA genes to identify P. jirovecii in pulmonary TB-related patients. A total of 26 sputum samples of pulmonary TB-related patients were collected. Real time PCR technique optimization including the optimization of primer and probe concentrations, annealing temperature, DNA template volume and cross-reaction testing, was carried out to obtain optimal conditions for mtLSU and mtSSU rRNA gene amplification.  The results showed that the optimization of detection for both genes could identify P. jirovecii in 1 out of 26 samples (3.84%). The optimized real time PCR test in this study can detect P. jirovecii in clinical samples of pulmonary TB-related patients.