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"Latar Belakang : Asma merupakan penyakit inflamasi kronik saluran napas dengan fungsi bersihan mukosilier yang menurun, maka itu bentuk matur dari spora Aspergillus fumigatus bisa tumbuh dan membuat sensitisasi Aspergillus yang merupakan kondisi awal aspergillosis paru pada asma dan dapat berkembang menjadi Allergic Bronchopulmonary Aspergillosis (ABPA). Penegakkan diagnosis aspergillosis paru didapatkan jika reaksi hipersensitisasi terhadap antigen A.fumigatus positif.Metode : Penelitian ini menggunakan metode potong lintang pada 86 pasien asma yang berobat ke RSUP Persahabatan dengan nilai Asthma Control Test (ACT) ≤ 24. Subjek penelitian dibagi 2 kelompok berdasarkan sensitisasi Aspergillus. Penilaian aspergillosis paru menggunakan pemeriksaan Imunoglobulin E (IgE) spesifik A.fumigatus. Kriteria diagnosis ABPA yang digunakan pada penelitian ini menggunakan kriteria International Society of Human and Animal Mycology (ISHAM) yaitu dua kriteria obligatory (IgE spesifik A.fumigatus dan IgE total) serta 3 kriteria tambahan (IgG spesifik A.fumigatus, eosinofil total, gambaran foto toraks). Pemeriksaan fungsi paru dilakukan pada penelitian ini termasuk spirometri, kapasitas difusi paru karbon monoksida (DLCO) dan nitrit oksida udara ekspirasi (FeNO).Hasil : Proporsi pasien asma tidak terkontrol yang memiliki aspergillosis paru didapatkan 3,5% (3/86) sedangkan proporsi ABPA didapatkan 1,1% (1/86). Terdapat faktor-faktor yang memengaruhi aspergillosis paru pada asma tidak terkontrol, diantaranya adalah nilai IMT (p=0,77), riwayat merokok (p=0,86) dan riwayat TB paru (p=0,03).. Karakteristik imunologi didapatkan nilai median IgE total pada subjek dengan aspergillosis paru 465(22-1690) IU/ml dan nilai median hitung total eosinofil 380 (0-770) sel/µl. Dari penilaian spirometri pada subjek aspergillosis paru didapatkan nilai median KVP 1630(950-2150) ml, nilai rerata KVP%prediksi 70±33,71%, nilai VEP1 1150(470-1240) ml, nilai median VEP1% prediksi 54(24-76)%, nilai rerata VEP1/KVP 59,33±14,57)% serta nilai rerata DLCO 84,67±24,66%. Nilai median FeNO pada asma tidak terkontrol dengan aspergillosis paru pada penelitian ini didapatkan 32 (12-45) ppb.Kesimpulan : Penegakkan diagnosis aspergillosis paru pada pasien asma tidak terkontrol harus dilakukan sejak awal, terutama pada pasien dengan riwayat TB  paru. Hal tersebut dapat mencegah aspergillosis paru pada asma tidak terkontrol berkembang menjadi penyakit ABPA serta kerusakan paru yang permanen.

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Background: Asthma is a chronic airway inflammation with decrease of mucocilliary clearance. The mature form of Aspergillus fumigatus spores could grow in this condition and caused an Aspergillus sensitization as an early progression to allergic bronchopulmonary aspergillosis (ABPA). Pulmonary aspergillosis could be diagnosed from a hypersensitivity reaction to the A. fumigatus antigen.

Methods : This cross-sectional study included 86 asthma patients with Asthma Control Test ACT score ≤ 24 and treated at Persahabatan Hospital Jakarta, Indonesia. Pulmonary aspergillosis was examined using specific immunoglobulin E (IgE) assay of A. fumigatus. The ABPA diagnostic in this study used the International Society of Human and Animal Mycology (ISHAM) criteria, which included two obligatory criteria (A. fumigatus-specific IgE and total IgE) and three additional criteria (A. fumigatus-specific IgG, blood eosinophil count, and thoracic x-ray). Lung function were examined using spirometry, diffusing capacity for carbon monoxide (DLCO), and fraction of exhaled nitric oxide (FeNO).

Results: Uncontrolled asthma patients who had pulmonary aspergillosis was 3.5% (3/86) while the proportion of ABPA was 1.1% (1/86).  A history of prior pulmonary tuberculosis (TB) was correlated with aspergillosis in uncontrolled asthma patients (p=0.03). The median value of total IgE and blood eosinophil count in pulmonary aspergillosis subjects was 465 (22-1690) IU/mL and 380 (0-770) cells/µL, respectively. Spirometry results of pulmonary aspergillosis subjects were median FVC 1630 (950-2150) ml, mean predicted FVC% predicted value 70±33.71%, mean FEV1 1150 (470-1240) ml, median predicted FEV1% 54 (24-24)%, mean FEV1/FVC 59.33±14.57%, and mean DLCO 84.67±24.66%. The median FeNO in uncontrolled asthma with pulmonary aspergillosis in this study was 32 (12-45) ppb.

Conclusion: Diagnosis of pulmonary aspergillosis in patients with uncontrolled asthma should be carried out early, especially in patients with a history of pulmonary TB. This would prevent pulmonary aspergillosis in uncontrolled asthma from developing into ABPA disease and permanent lung damage."

"Latar Belakang: Aspergilosis paru kronik (APK) dapat menjadi komplikasi infeksi tuberkulosis (TB) paru yang telah diobati. Gejala klinis APK dengan TB paru sangat mirip, sehingga sulit dibedakan. Diagnosis APK ditetapkan sesuai konsensus berdasarkan gejala klinis, hasil pemeriksaan radiologi dan laboratorium mikologi. Pemeriksaan antibodi dengan imunoglobulin G (IgG) spesifik Aspergillus menggunakan metode Enzyme-linked immunosorbent assay (ELISA) dapat membantu diagnosis APK. Penelitian ini bertujuan untuk mengetahui karakteristik klinis, profil IgG spesifik Aspergillus, serta prevalensi APK pada pasien bekas TB di beberapa rumah sakit di Jakarta.Metode: Penelitian prospektif dengan desain potong lintang ini dilakukan pada April 2019 - Februari 2020. Pemilihan subjek dilakukan dengan metode consecutive sampling. Subjek merupakan pasien bekas TB yang berasal dari poli rawat jalan dan rawat inap Rumah Sakit Umum Pusat Rujukan Respirasi Persahabatan Jakarta dan Rumah Sakit Graha Permata Ibu. Pemeriksaan IgG spesifik Aspergillus dan biakan sputum jamur dilakukan di Laboratorium Departemen Parasitologi FKUI.Hasil: Dari 97 pasien yang sesuai dengan kriteria penerimaan, 66 pasien (68%) berjenis kelamin laki-laki dan rerata usia 51,8±13,6 tahun. Gejala klinis lebih dari 3 bulan yang dilaporkan berupa mudah lelah (38,4%), sesak napas (34,02%), batuk (30,93%), hemoptisis (27,84%), penurunan berat badan (23,71%), dan nyeri dada (19,6%). Gambaran radiologi terkait APK berupa ektasis (57,8%), kavitas (27,8%), penebalan pleura (26,8%), fibrosis parakavitas (18,6%), dan bola jamur (6,2%). Hasil pemeriksaan IgG spesifik Aspergillus positif dilaporkan pada 51 pasien (52,6%), sedangkan biakan sputum jamur Aspergillus didapatkan pada 43 pasien (44,3%). Berdasarkan analisis hasil-hasil pemeriksaan tersebut, diagnosis APK ditegakkan pada 28 pasien (28,9%).Kesimpulan: Profil IgG spesifik Aspergillus pada 97 pasien bekas TB dalam penelitian ini menunjukkan hasil positif pada 51 pasien (52,6%). Gejala klinis lebih dari 3 bulan yang dilaporkan berupa batuk lama, hemoptisis, penurunan berat badan, mudah lelah, dan sesak napas. Gambaran radiologi terkait APK berupa ektasis, kavitas, penebalan pleura, fibrosis parakavitas, dan bola jamur. Prevalensi APK berdasarkan hasil-hasil pemeriksaan tersebut adalah 28,9%.

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Introduction: Chronic pulmonary aspergillosis (CPA) might become a complication of pulmonary tuberculosis (TB) that has been treated. The clinical symptoms of CPA can resemble with PTB, making it difficult to distinguish. The diagnosis of CPA is determined by the consensus based on clinical symptoms, radiological features, and mycological results. Antibody detection with Aspergillus- specific immunoglobulin G (IgG) using the Enzyme-linked immunosorbent assay (ELISA) method can contribute to CPA diagnosis. This study aims to determine the clinical characteristics, Aspergillus-specific IgG detection, and the prevalence of CPA in prior TB patients at several hospitals in Jakarta.

Method: This prospective cross-sectional study was conducted in April 2019 - February 2020. Patients recruitment was carried out by consecutive sampling method. Subjects were prior TB patients at Persahabatan National Respiratory Referral Hospital and Graha Permata Ibu Hospital. Detection of Aspergillus- specific IgG and fungal cultures from sputum were carried out in the Laboratory of the Parasitology Department, FMUI.

Results: Of 97 patients recruited according to inclusion criteria, 66 patients (68%) were male and the mean age was 51.8 ± 13.6 years. The clinical symptoms of more than 3 months were fatigue (38.4%), shortness of breath (34.02%), cough (30.93%), hemoptysis (27.84%), weight loss (23, 71%), and chest pain (19,6%). Radiological features associated with CPA were ectasis (57.8%), cavity (27.8%), pleural thickening (26.8%), para-cavitary fibrosis (18.6%), and fungal ball (6.2%). The Aspergillus-specific IgG positive were reported in 51 patients (52.6%), whereas Aspergillus sputum cultures were found in 43 patients (44.3%). Based on the analysis of those examinations, the diagnosis of CPA was determined in 28 patients (28.9%).

Conclusion: The detection of Aspergillus-specific IgG in 97 prior TB patients showed the positive results in 51 patients (52.6%). The clinical symptoms more than three months were fatigue, shortness of breath, cough, hemoptysis, and weight loss. The radiological features related to CPA were ectasis, cavitary lesions, pleural thickening, paracavitary fibrosis, and fungal ball. The prevalence of CPA based on those examinations was 28.9%."

"Latar belakang: Aspergilosis paru kronik (APK) merupakan penyakit paru destruktif yang bersifat progresif terutama disebabkan infeksi Aspergillus fumigatus. Penyakit ini dapat menjadi komplikasi infeksi tuberkulosis (TB) dan menyebabkan morbiditas serta mortalitas signifikan. Diagnosis APK masih menjadi tantangan karena gejala klinis tidak khas, serta belum ada alat diagnosis yang cepat dan akurat. Deteksi IgG Aspergillus berbasis lateral flow assay (LFA) menggunakan metode imunokromatografi (ICT) merupakan uji cepat dan sederhana untuk membantu diagnosis APK. Penelitian ini bertujuan untuk mengetahui hubungan uji ICT Aspergillus dengan karakteristik klinis dan radiologis APK pada pasien terkait TB paru.Metode: Penelitian berdesain potong lintang ini dilaksanakan pada April 2019-Juli 2023 dan merupakan bagian dari penelitian sebelumnya tentang diagnosis APK di Indonesia. Serum pasien APK diperiksa di Laboratorium Mikologi Departemen Parasitologi FKUI untuk deteksi ICT Aspergillus, kemudian dilanjutkan dengan analisis hasil penelitian.Hasil: Sebanyak 29 dari 54 (54%) serum pasien yang diteliti menunjukkan hasil uji ICT Aspergillus positif. Proporsi jenis kelamin perempuan (63%) lebih banyak dibandingkan laki-laki, sedangkan usia terbanyak 30-60 tahun (74%). Gejala klinis terbanyak adalah fatigue (57%), batuk ≥ 3 bulan (42%), hemoptisis (41%) diikuti sesak napas (24%), dan nyeri dada (20%). Adapun penyakit penyerta terbanyak adalah diabetes melitus (20%), penyakit kardiovaskular (11%), dan PPOK (9%). Gambaran radiologi paling dominan adalah kavitas (94%), diikuti infiltrat (72%), dan penebalan pleura (55%). Analisis statistik menunjukkan kaitan bermakna antara hasil ICT Aspergillus positif dengan gambaran radiologi berupa infiltrat, fibrosis parakavitas, fibrosis, efusi pleura, konsolidasi dan bronkiektasis (p <0,005). Hasil ICT Aspergillus tidak menunjukkan kemaknaan statistik dengan karakteristik klinis.Simpulan: Deteksi IgG spesifik Aspergillus metode ICT pada 54 pasien APK pada penelitian ini menunjukkan hasil positif 54%. Pada penelitian ini hasil ICT Aspergillus menunjukkan kaitan bermakna secara statistik dengan gambaran radiologi, tetapi tidak menunjukkan kaitan bermakna dengan karakteristik klinis pasien.

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Background: Chronic pulmonary aspergillosis (CPA) is a progressive, destructive lung disease mainly caused by Aspergillus fumigatus infection. The disease can be a complication of tuberculosis (TB) infection and cause significant morbidity and mortality. Diagnosis of CPA is still challenging because the clinical symptoms are not typical, and there are no fast and accurate diagnostic tools. Detection of IgG-specific Aspergillus using the immunochromatography (ICT) method is a quick and simple test to assist CPA diagnosis. The study aimed to determine the correlation between the ICT Aspergillus test and the clinical and radiological characteristics of CPA in TB-related patients.

Method: This cross-sectional study was carried out in April 2019-July 2023 and was part of a previous study on CPA diagnosis in Indonesia. All sera of CPA patients were examined at the Clinical Parasitology Laboratory, Faculty of Medicine Universitas Indonesia for ICT Aspergillus detection, followed by analysis of the study results.

Result: Twenty-nine of the 54 patient sera showed positive results of ICT Aspergillus. There were more female (76%) than male patients, with the majority aged 30–60 years (74%). The most common clinical symptoms were fatigue (57%), cough ≥3 months (42%), hemoptysis (41%), shortness of breath (24%), and chest pain (20%). The most common comorbidities were diabetes mellitus (20%), cardiovascular diseases (11%), and COPD (9%). The dominant of radiological features were cavities (94%), followed by infiltrates (72%), and pleural thickening (55%). The statistical analysis showed a significant correlation between positive ICT Aspergillus results and radiological features, including infiltrates, paracavity fibrosis, fibrosis, pleural effusion, consolidation, and bronchiectasis. However, the ICT Aspergillus did not show statistical significance with clinical characteristics.

Conclusion: The ICT Aspergillus detection in this study showed positive results of 54%. There was a significant correlation between ICT Aspergillus positive result with radiology features, but no significant correlation with clinical characteristics."

"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.

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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."

"Latar Belakang: Asma merupakan penyakit heterogen yang memiliki karakteristik gangguan inflamasi kronik yang ditandai oleh pelepasan mediator inflamasi oleh sel-sel inflamasi pada saluran napas. Pada pasien asma alergi dan nonalergi terjadi peningkatan eosinofil di darah tepi. Selain eosinofil darah, bromotyrosine juga menjadi penanda hayati stres oksidatif yang dibentuk dari residu protein tirosin oleh asam hipobromit yang dihasilkan oleh eosinofil Saat ini di Indonesia belum terdapat penelitian kadar bromotyrosine urin pada pasien asma.Metode Penelitian: Penelitian ini merupakan penelitian pontong lintang pada pasien asma stabil yaitu pasien asma terkontrol dan tidak terkontrol berdasarkan asthma control test (ACT) yang datang ke poli asma PPOK di RSUP Persahabatan, Jakarta, Indonesia dari Januari hingga Mei 2021. Pengambilan sampel dilakukan secara consecutive sampling dan data subjek yang memenuhui kriteria inklusi diambil dari pemeriksaan eosinofil darah dan bromotyrosine urin dengan ELISA.Hasil Penelitian: Dua puluh tiga pasien asma terkontrol dan 25 pasien asma tidak terkontrol yang memenuhi kriteria inklusi. Nilai median kadar bromotyrosine urin pasien asma terkontrol 0,914 µg/mL dan asma tidak terkontrol 0,949 µg/mL dengan nilai p = 0,062. Nilai median kadar eosinofil absolut pada pasien asma terkontrol 270 sel/mm3 dan asma tidak terkontrol 380 sel/mm3 (p> = 0,635), sedangkan nilai median kadar eosinofil pada pasien asma terkontrol 3,6% dan asma tidak terkontrol 4,5% (p = 0,657). Korelasi bromotyrosine urin dengan eosinofil absolut dan eosinofil pada pasien asma yaitu r=-0.051 (p = 0,732) dan r=-0.044 (p = 0,767). Namun, korelasi tersebut tidak bermakna secara statistik.Kesimpulan: Tidak ada perbedaan yang bermakna antara kadar bromotyrosine urin pasien asma terkontrol dan tidak terkontrol secara statistik. Terdapat korelasi antara bromotyrsoine urin terhadap eosinofil absolut dan eosinofil, namun korelasi tersebut tidak menyimpulkan suatu hubungan sebab-akibat.

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Background: Asthma is a heterogeneous disease characterized by chronic inflammatory disorders characterized by the release of inflammatory mediators by inflammatory cells in the airways. In allergic and nonallergic asthma patients, there is an increase of eosinophils in the peripheral blood. In addition to blood eosinophils, bromotyrosine is also a biomarker for oxidative stress formed from protein tyrosine residues by hypobromic acid derived from eosinophils. There has been no study of urinary bromotyrosine levels in asthmatic patients in Indonesia.

Methods: This study was a cross-sectional study on stable asthma patients, grouped into controlled and uncontrolled based on the asthma control test (ACT), who were treated at the COPD asthma polyclinic at Persahabatan Hospital, Jakarta, Indonesia between January and May 2021. Sampling was carried out by consecutive sampling and subjects who met the inclusion criteria were examined for their blood eosinophils and urine bromotyrosine by ELISA.

Results: This study included 23 patients with controlled asthma and 25 patients with uncontrolled asthma. There was a difference between median value of urinary bromotyrosine levels in controlled asthma patients (0.914 g/mL) and uncontrolled asthma (0.949 g/mL) although it was not significant (p = 0.062). The median value of absolute blood eosinophil levels in controlled asthmatic patients was 270 cells/mm3 and uncontrolled asthma was 380 cells/mm3 (p = 0.635), while the median value of blood eosinophil levels in controlled asthmatic patients was 3.6% and uncontrolled asthma was 4.5% (p= 0.657). The correlation of urinary bromotyrosine with absolute blood eosinophils and blood eosinophils count in asthmatic patients was r=-0.051 (p = 0.732) and r=-0.044 (p = 0.767), respectively. However, its correlation was not significant.

Conclusion: There was no significant difference between urinary bromotyrosine levels in controlled and uncontrolled asthma patients. There was a correlation between urinary bromotyrsoine on absolute blood eosinophils and blood eosinophil counts, although its correlation did not conclude a cause-and-effect relationship."

"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.

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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."

"Latar belakang : Asma memengaruhi sekitar 300 juta orang di seluruh dunia dan menjadi masalah kesehatan global yang serius yang mempengaruhi semua kelompok umur. Asma alergi adalah fenotipe asma yang paling mudah dikenali dan sering dimulai sejak masa anak-anak. Sebagian besar asma alergi berhubungan dengan sensitisasi saluran napas akibat pajanan aeroalergen umum, terutama yang berasal dari tungau debu rumah. Proses inflamasi eosinofilik saluran napas menghasilkan produk akhir berupa nitrit oksida. Kadar nitrit oksida udara ekspirasi (FeNO) merupakan salah satu penanda hayati yang mengukur inflamasi saluran napas dan kadar FeNO yang tinggi pada pasien asma berhubungan dengan inflamasi saluran napas eosinofilik.Penilitian ini bertujuan mengetahui hubungan kadar IgE spesifik Der p dan Der f  dengan kadar FeNO pada pasien asma tidak terkontrol di RSUP Persahabatan.Metode : Penelitian ini merupakan studi potong lintang dengan jumlah sampel 86 subjek pasien asma tidak terkontrol berdasarkan asthma control test di RSUP Persahabatan. Metode pengumpulan subjek dilakukan dengan teknik consecutive sampling. Pemeriksaan IgE spesifik tungau debu rumah menggunakan protia Q96M. Pemeriksaan FeNO menggunakan Bedfont NObreath.Hasil : Dari 86 subjek asma tidak terkontrol didapatkan hasil rerata usia pasien asma tidak terkontrol di RSUP Persahabatan adalah  52,45 + 12,94 tahun, sebagian besar berjenis kelamin perempuan (84,9%).Proporsi pasien asma yang alergi terhadap tungau debu rumah  mencapai 64%. Prorporsi alergi Der p dan Der f 58%, alergi Der p 4,7% dan alergi Der f 1,2%. Median kadar IgE spesifik tungau debu rumah pada pasien asma tidak terkontrol di RSUP Persahabatan adalah 3,94 (0-100) IU/ml untuk Der p dan 4,47 (0-100) IU/ml untuk Der f. Median FeNO pasien asma tidak terkontrol adalah 26 (3-92) ppb. Dilakukan uji korelasi Spearman untuk kadar IgE spesifik dan kadar FeNO pasien asma tidak terkontrol. Terdapat hubungan bermakna antara kadar IgE spesifik Der p (nilai p = 0,009, r = 0,279, uji Spearman) dan Der f (nilai p = 0,001, r = 0,339, uji Spearman) dengan FeNO.Kesimpulan : Terdapat hubungan yang bermakna antara kadar IgE spesifik tungau debu rumah Der p dan Der f dengan FeNO pada pasien asma tidak terkontrol. Namun tingkat korelasi yang didapatkan lemah.

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Background : Asthma affects approximately 300 million people worldwide and is a serious global health problem affecting all age groups. Allergic asthma is the most easily recognized asthma phenotype and often begins in childhood. Most allergic asthma is associated with airway sensitization due to exposure to common aeroallergens, particularly those from house dust mites. The eosinophilic inflammatory process of the airways produces the final product in the form of nitric oxide. Fractional exhaled nitric oxide (FeNO) levels are one of the biomarkers that measure airway inflammation and high FeNO levels in asthma patients are associated with eosinophilic airway inflammation. This study aims to determine the relationship between Dermatophagoides pteronysinnus (Der p) and Dermatophagoides  farinae (Der f) specific IgE levels with FeNO levels in uncontrolled asthma patients at Persahabatan Hospital.

Method : This cross sectional study in 86 uncontrolled asthma patients based on asthma control test less than 24 points. The method of collecting subjects was done by consecutive sampling technique. House dust mite specific IgE assay using protia Q96M. FeNO examination using Bedfont NObreath.   

Result : From 86 subjects with uncontrolled asthma, the mean age of uncontrolled asthma patients at Persahabatan Hospital was 52.45 + 12.94 years, most of them were female (84.9%). The proportion of asthma patients who were allergic to house dust mites reached 64. %. The proportion of allergy to Der p and Der f 58%, allergy to Der p 4.7% and allergy to Der f 1.2%. The median level of specific IgE for house dust mites in patients with uncontrolled asthma at the Persahbatan Hospital was 3.94 (0-100) IU/ml for Der p and 4.47 (0-100) IU/ml for Der f. The median FeNO of uncontrolled asthmatic patients was 26 (3-92) ppb. Spearman correlation test was performed for specific IgE levels and FeNO levels in patients with uncontrolled asthma. There was a significant relationship between specific IgE levels Der p (p value = 0.009, r = 0.279) and Der f (p value = 0.001, r = 0.339) and FeNO.

Conclusion : There is a significant relationship between the levels of specific IgE for house dust mites Der p and Der f with FeNO in patients with uncontrolled asthma. However, the correlation level obtained is weak."

"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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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. test shows significant difference between mentioned examinations and low level of agreement Kappa 0,026."

"Latar belakang: Aspergilosis Paru Invasif merupakan penyakit yang berbahaya dan berisiko tinggi kematian. Penelitian mengenai skoring sebelumnya berdasarkan parameter risiko klinis dan biomarker baru untuk memprediksi API. Pada penelitian ini peneliti menggunakan parameter sederhana untuk mendiagnosa API. Tujuan: Studi ini bertujuan untuk mengembangkan model diagnosis API berdasarkan karakteristik klinis, laboratorium, foto toraks dan komorbid. Metode: Penelitian ini dilaksanakan dengan desain potong lintang, secara retrospeksif, menggunakan data rekam medis di RS Dr. Cipto Mangunkusumo (RSCM) sejak Januari 2018 hingga Desember 2022. Model determinan diagnosis Aspergilosis Paru Invasif dikembangkan dari analisis multivariat dengan regresi logistik kemudian diuji performa dan validitas internalnya. Hasil: Total sampel sebanyak 227 pasien dengan eksklusi sebanyak 20 pasien dan yang dilakukan analisis sebanyak 207 pasien. Dua ratus tujuh subjek terdiri dari 110 pasien API dan 97 pasien non-API. Pada penelitian ini demam memiliki skor 2, konsolidasi memiliki skor 2, fibrosis memiliki skor 1, jumlah neutrofil absolut memiliki skor 1, penggunaan steroid memiliki skor 2, Neutrophil Lymphocyte Ratio (NLR) memiliki skor 1. AUC =0.771, p< 0.05 yang menunjukkan hasil performa skor sedang untuk membedakan faktor determinan API. Kesimpulan: Penelitian ini menghasilkan diagnosis API,demam skor 2, konsolidasi skor 2, fibrosis skor 1, jumlah neutrofil absolut skor 1, penggunaan steroid skor 2, NLR skor 1. Skor 0-4 memiliki probabilitas 43,67% atau risiko rendah dan skor 5-8 memliki probabilitas 83,67% atau risiko tinggi faktor-faktor determinan API.

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Background: The diagnosis of IPA is complex because it relies on clinical, radiological, and microbiological criteria. Microbiology is at the core of most diagnostic tests/criteria; however, the results take a lot of time. Researchers use a combination of clinical, radiological, laboratory, and comorbid characteristics to diagnose IPA. Objective : This study aims developed IPA diagnosis model based on clinical characteristics, chest X Ray and patients comorbid. Method: This research was carried out with cross sectional design, retrospectively, using medical record data at Dr. Cipto Mangunkusumo (RSCM) from January 2018 to December 2022. The determinant model for the diagnosis of Invasive Pulmonary Aspergillosis was developed from multivariate analysis with logistic regression and then tested for performance and internal validity. Results: The total sample was 227 patients with the exclusion of 20 patients and 207 patients were analyzed. Two hundred seven subjects consisted of 115 IPA patients and 92 non-IPA patients. In the multivariate analysis this study involved fever, consolidation, fibrosis, absolute neutrophil count, Neutrophil Lymphocyte Ratio (NLR), and steroid used. In this study, fever had a score of 2, consolidation had a score of 2, fibrosis had a score of 1, absolute neutrophil count had a score of 1, steroid had a score of 2. AUC = 0.771, p< 0.05. Conclusion: This study resulted in a diagnosis of API, fever score 2, consolidation score 2, fibrosis score 1, absolute neutrophil count score 1, steroid score 2. A score of 0-4 has a probability of 43.67% or low risk and a score of 5-8 has a probability of 83.67% or high risk API determinant factors."

"Latar belakang: Tuberkulosis (TB) dan kanker paru merupakan dua masalah kesehatan dunia dengan angka kematian yang tinggi. Risiko TB meningkat pada pasien dengan keganasan termasuk kanker paru dengan prevalensi 0,7% - 18,7%. Tuberkulosis paru dan kanker paru memiliki gejala yang mirip sehingga diagnosis keduanya sering kali terlambat menyebabkan prognosis yang lebih buruk. Bronkoskopi merupakan suatu tindakan efektif untuk mendiagnosis TB dan kanker paru. Penelitian ini bertujuan untuk mengetahui proporsi TB paru pada pasien terduga kanker paru melalui pemeriksaan tes cepat molekular (TCM) bilasan bronkus.Metode: Penelitian ini menggunakan metode potong lintang dengan subjek terduga kanker paru yang akan menjalani bronkoskopi di RSUP Persahabatan dan berusia minimal 18 tahun pada periode Maret sampai Juli 2024. Bilasan bronkus dilakukan pemeriksaan TCM menggunakan InaTB-Rif untuk mendiagnosis TB.Hasil: Sebanyak 104 subjek memenuhi kriteria inklusi dan ekslusi dengan karakteristik usia berada pada median 60 tahun (18-80 tahun), jenis kelamin laki-laki (61,5%), status gizi baik dengan indeks massa tubuh normal (60,6%), memiliki riwayat merokok (54,8%) dan bekas TB (21,2%). Subjek penelitian yang memiliki komorbid paling banyak adalah diabetes melitus (DM) tipe 2 yaitu 20,2%. Sebagian besar mengeluhkan batuk, gambaran radiologi mayoritas tampak massa dan kompresi serta massa infiltratif pada temuan bronkoskopi. Proporsi TB paru pada pasien yang menjalani bronkoskopi dengan terduga kanker paru yaitu 22,12% dengan dua pasien terdeteksi resisten rifampisin (8,67%). Analisis bivariat menunjukkan bahwa fibrosis dan ratio neutrofil limfosit memiliki hubungan yang bermakna secara statistik dengan hasil TCM.Kesimpulan: Diagnosis TB pada pasien terduga kanker paru perlu dipertimbangkan terutama pada negara dengan beban TB yang tinggi seperti Indonesia sehingga tata laksana dapat diberikan secara optimal.

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Background: Tuberculosis (TB) and lung cancer are two global health problems with high mortality rates. The risk of TB increases in patients with malignancies including lung cancer with a prevalence ranging from 0.7% to 18.7%. Pulmonary tuberculosis and lung cancer have similar symptoms, often leading to delayed diagnosis and resulting in a worse prognosis. Bronchoscopy is an effective procedure for diagnosing TB and lung cancer. This study aims to determine the proportion of pulmonary TB in suspected lung cancer patients through the examination of bronchial washing using a rapid molecular test (RMT).

Method: This was a cross-sectional study with suspected lung cancer patients who would undergo bronchoscopy at Persahabatan Hospital National Respiratory Center and at least 18 years old in the period from March to July 2024. Bronchial washing was examined by RMT using InaTB-Rif to diagnose TB.

Results: A total of 104 subjects met the inclusion and exclusion criteria, with a median age of 60 years (range 18 to 80 years), predominantly were male (61.5%), and demontrated good nutritional status with a normal body mass index (60.6%), had a history of smoking (54.8%), and former TB (21.2%). The most common comorbidity among the subjects was type 2 diabetes mellitus, accounting for 20.2%. Most participants reported cough and radiological findings predominantly revealed masses, compression, and infiltrative masses in bronchoscopy results. The proportion of pulmonary tuberculosis in patients who underwent bronchoscopy for suspected lung cancer was 22.12%, with two patients detected as resistant to rifampicin (8.67%). Bivariate analysis revealed that fibrosis and neutrophil-lymphocyte ratio had a statistically significant with RMT.

Conclusion: The diagnosis of tuberculosis in suspected lung cancer patients needs to be considered especially in high TB burden countries such as Indonesia so the management could be given optimally."