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Abstrak :
Indonesia sedang dilanda kehidupan modern, terutama kota-kota besar, seperti Jakarta, Surabaya dan sebagainya yang menuntut tersedianya prasarana memadai, salah satu di antaranya gedung bertingkat, megah dan modern yang umumnya dilengkapi dengan sistem Air Condition (AC), untuk memberikan rasa nyaman. Tahun 1976 L.pneu dikenal pertaana kali pada saat kejadian luar biasa (Oubreak) di American Legion Convention, Philadelphia. Tahun 1979 WHO berasumsi adanya hubungan antara kualitas udara ruangan (INDOOR AIR QUALITY) dengan transmisi suatu infeksi dan tahun 1986 WHO melaporkan adanya sekumpulan gejala yang dikenal dengan Sick Building Syndrome (SBS). Sampai saat ini belum diketahui secara tepat definisi SBS, sehingga sering digambarkan sebagai sekelompok keluhan; yang sering dijumpai adalah ngantuk, hidung tersumbat, pusing, tenggorokan kering, panas dingin dan sebagainya. Untuk menentukan salah satu faktor peayebab SBS sangat sulit karena SBS dipengaruhi oleh beberapa faktor, salah satu di antaranya adalah faktor mikroorganisme. Kuman L.pneu mudah hidup dan berkembang biak pada suasana lingkungan lembab dan hangat, yang sesuai dengan penggunaan peralatan atau perangkat AC (misalaya cooling rower, evaporated condenser dsb). Sedangkan SBS memberikan suatu petunjuk tentang tidak sehatnya keadaan lingkungan kerja, yang dapat memberikan dampak langsung maupun tidak langsung terhadap peningkatan produktivitas. Pada penelitian pendahuluan (Agustus 1993) ditemukan adanya SBS, sehingga penelitian ini bertujuan untuk melakukan identifikasi hubungan antara terjadinya SBS dengan adanya kuman L.pneu di P.T.Indosat Jakarta. Tahun 1993 Departemen Tenaga Kerja Pusat PeIayanan Ergonomi, Kesehatan dan Keselamatan Kerja, tidak cukup menemukan faktor-faktor yang dapat mempengaruhi SBS, kecuali faktor microorganisme dan penerangan. Penelitian terbagi menjadi dua bagian yaitu lingkungan dan tenaga kerja. Penelitian lingkungan dilakukan terhadap 33 sampel (sediaan usap perangkat AC) yang dinmamkan pada BCYE, ternyata belum dapat di deteksi adanya kuman L.pneu melalui test Legionella Agglutination Latex Kit . Penelitian tenaga kerja (sampel 110 orang), pada wawancara ditemukan adanya SBS dengan keluhan yang dominan baik saat sekarang maupun satu bulan terakhir adalah sering merasa cepat leiah, ngantuk, pegal linu, mulut kering, pusing-pening, leher kaku, tenggorokan kering sedangkan pada pemeriksaan antigen di urin dengan ratio ≥3 :15 orang(13,6 %), ratio ≥7,5: 2 orang (1,9%), ratio 0: 8 orang (7,3%), ratio ≤3 : 95 orang (86,4%). Sehingga diduga adanya keluhan utama cepat lelah dan sering ngantuk disertai keluhan tambahan pegal linu, mulut kering, tenggorokan kering (p ≥0,1) atau keluhan utama cepat lelah dan sering ngantuk disertai keluhan tambahan panas-dingin (p≥0,05). Dalam penelitian ini ternyata SBS dijumpai, walaupun hubungan dengan kuman L.pneu belum dapat ditentukan dengan pasti, kemungkinan adanya kuman L.pneu belum dapat disingkirkan, karena waktu pengambilan kuman dan keterbatasan tes yang dipakai hanya pada kuman L.pneu serogrup 1 sampai serogrup 6 atau L.micdadei. ......Relationship of Legionella Pneumophila and Sick Building Syndrome in PT Indosat Building Jakarta 1994Indonesia is being struck by modern living, especially in big cities like Jakarta, Surabaya etc which claimed the presence of adequate infra-structure, one of them, is high-rise building, glorious and modern and equipped with an Air Condition (AC) system to provide comfortable feelings. In 1976, L.pneu was recognized for the first time at an outbreak in the American Legion Convention, Philadelphia. In 1979 WHO assumed the presence of a relationship between indoor air quality and an infection transmission. In 1986, WHO reported the presence of a group of symptoms which was known as " Sick Building Syndrome" (SBS). Up to now the correct SBS definition is not yet known, so that often it is pictured as a group of complaints: most often met include sleepiness, nose obstruction, dizziness, dry throat, fever etc. To determine one of the SBS causal factor is very difficult because it is influenced by several factors, one of which is the microorganism factor. L.pneu live and bread easily in humid and warm environment, which is created by using equipment or AC set (like cooling tower, evaporated condenser etc). Whereas SBS provide an indication on the unhealthiness of the working environment condition, which in turn showed its direct or indirect impact towards productivity promotion. In the preliminary study (August 1993) the presence of SBS was found, so that this study aimed at carrying out the identification of relationship between the occurrence of SBS and the presence of L.pneu in P.T. Indosat Jakarta. In 1993, The Ergonomic, Health and Work Safety Center of the Manpower Department has not found enough factors that could influenced SBS except microorganism and lighting factors. The study was divided into two parts, namely environment and manpower. The environmental study was conducted towards 33 samples (swab preparation of AC set) that was planted on BCYE, turned out to be incapable of detecting the presence of L.pneu by way of testing Legionella Agglutination Latex Kit. The study of manpower (a sample of 110 people) disclosed the presence of SBS with dominant complaints both during the interview as well as the last one-month, namely tiredness feelings, sleepiness, stiff and painful feelings, dry mouth, dizziness, stiff neck, drythroat. Antigen examination of urine with a ratio ≥3 : 15 people (13,6%), ratio of ≥7,5: 2 people (1,9%), ratio 0: 8 people (7,3%), ratio ≤ 3: 95 people (86,4%). Thus, the presence of main complaint like suspected rapid tiredness and frequent sleepiness accompanied by muscle ache, dry mouth and throat (p ≥0.1) or main complaint of rapid tiredness and frequent sleepiness accompanied by additional fever (p ≥0.05). This study found SBS, although the association with L.pneu cannot as yet be determinedunequivocally: the possibility of L.pneu presence cannot as yet be set aside, because of the isolation timing and test limitation in that only sero-group 1 to 6 of L.pneu or L.micdadei.

Abstrak :
Dewasa ini, insiden tuberkulosis ekstrapulmoner semakin meningkat. Konfirmasi bakteriologi sering sulit karena kuman da1am jumlah sedikit di tempat infeksi dapat menimbulkan keru3akan jaringan dan kuman menginfeksi tempat yang sulit untuk pengambilan spesimen. Hingga saat ini, di Indonesia belum ada laporan angka keberhasilan isolasi mikobakterium dari penderita dengan kecurigaan tuberkulosis ekstrapulmoner. Pada penelitian ini dilakukan pemeriksaan mikroskopis basil tahan asam, biakan dan pemeriksaan PCR terhadap 83 spesimen penderita dengan kecurigaan tuberkulosis ekstrapulmoner. Biakan dilakukan secara duplo pada dua macamjenis media padat yaitu media Lowenstein-Jensen (LJ) dan media LJ mengandung asam piruvat 2% serta satu macam media cair yaitu Middlebrook 7H9. Ekstraksi DNA menggunakan metoda Boom dan reaksi PCR dilakukan untuk mendeteksi fragmen DNA sebesar 123 bp pada 186110. Hasil biakan lebih tinggi didapatkan pada pemakaian kedua macam media padat secara bersamaan daripada pemakaian satu jenis media padat. Sebanyak 20 (24,1 %) isolat mikobakterium berhasil diisolasi. Empat isolat (4,8%) adalah MOTT dan sisanya adalah M. tuberculosis. Hasil perneriksaan PCR mendapatkan sensitivitas 87,5% hila biakan digunakan sebagai baku emas. Analisis statistik kornbinasi pemeriksaan pcwarnaan basil tahan asarn dan PCR menggunakan biakan dan P A sebagai baku emas atau biakan M tuberculosis dan PCR menggunakan pemeriksaan mikroskopis dan PCR sebagai baku standard menunjukkan basil berbeda bermakna (p= 0,017 dan p= 0,009) sehingga kombinasi pemeriksaan ini dapat digunakan untuk meningkatkan diagnosis penderita dengan kecurigaan tuberkulosis ekstrapulmoner. ......The incidence of extrapulmonal tuberculosis (EPTB) is rising in the recent years. Bacteriological confirmation ofEPTB is often difficult because low amount of bacteria may cause severe infection and the location of infection renders the specimen collection to be difficult. Until now, data conseming mycobacterium isolation and detection rate of M tuberculosis causing EPTB in Indonesia is not available.ln this study we examined 83 specimens from patients with suspected EPTB by microscopic acid-fast staining, culture and PCR assay. Cultures were done in duplo on two kinds of solid media (LowensteinJensen (LJ) and LJ with pyruvic acid 2%) and on one liquid medium (Middlebrook 7H9). The PCR assay was based on the detection of a 123 bp DNA fragment of the insertion sequence 186110. DNA was isolated with silica method. The results showed that isolation rate by culture on two solid media together were higher than on one solid medium only. Twenty (24,1%) mycobacterium isolates were isolated from 83 EPTB specimens. Four (4,8%) isolates were identified as MOTT and 16 (19,3%) as M tuberculosis. The s.!nsitivity of 186110 PCR for detection of M tuberculosis was 87,5% with bacterial culture as the gold standard. Combination of microscopic acid-fast staining and PCR showed in significantly difference result when culture and histopathologic finding was used as the gold standard (p= 0,00 17). Combination of culture and PCR also showed in significantly defference result when microscopic acid-fast staining and histopathologic finding was used as the gold standard (p= 0,009). We conclude that combination of two assay i.e. acid-fast staining and PCR or bacterial culture and PCR, are more sensitive than using one method only, resulting in better diagnosis of patients with suspected EPTB.