Tesis

Deteksi IgG Spesifik Aspergillus Metode Enzyme-Linked Immunosorbent Assay (ELISA), Biakan Sputum, dan Uji Kepekaan Jamur Terhadap Vorikonazol pada Pasien Terduga Aspergilosis Paru Kronik di RS Persahabatan = Detection of Aspergillus-Specific IgG Using the Enzyme-Linked Immunosorbent Assay (ELISA) Method, Sputum Culture, and Antifungal Susceptibility Testing to Voriconazole in Patients with Suspected Chronic Pulmonary Aspergilosis at Persahabatan Hospital.

Latar belakang: Aspergilosis paru kronik (APK) merupakan komplikasi penting pascatuberkulosis paru. Data mengenai peran deteksi IgG spesifik Aspergillus, hasil biakan sputum, dan profil uji kepekaan jamur terhadap vorikonazol masih terbatas di Indonesia. Tujuan: Mengetahui hasil deteksi IgG spesifik Aspergillus dengan metode ELISA, hasil biakan sputum, dan uji kepekaan jamur terhadap vorikonazol pada pasien pasca-TB paru dengan dugaan APK di RSUP Persahabatan. Metode: Penelitian observasional ini menggunakan data sekunder pada 35 pasien pascaTB paru yang memenuhi kriteria inklusi. Diagnosis APK ditetapkan berdasarkan kriteria klinis, radiologis, dan mikologis. Pemeriksaan mikologi meliputi biakan sputum dan deteksi IgG Aspergillus metode ELISA. Uji kepekaan jamur terhadap vorikonazol dilakukan dengan metode difusi cakram pada isolat Aspergillus spp. yang tumbuh. Hasil: Dari 35 pasien yang diteliti, 27 pasien (77,1%) memenuhi kriteria diagnosis APK. Usia rerata pasien adalah 53 tahun, dengan jumlah pasien laki-laki 55,6%. Sebanyak 51,9% subyek termasuk gizi kurang. Komorbid tersering adalah hipertensi (18,5%), sedangkan keluhan terbanyak adalah batuk berdahak kronik (85,2%). Biakan jamur positif Aspergillus spp. didapatkan pada 14 (40,0%) pasien pasca-TB paru. Adapun hasil IgG spesifik Aspergillus positif didapatkan pada 17 (48,6%) pasien. Dari 19 isolat Aspergillus yang diisolasi, spesies terbanyak adalah A. fumigatus (9/19). Hasil uji kepekaan jamur terhadap vorikonazol menunjukkan 9 isolat sensitif, 5 isolat intermediate, dan 5 isolat resisten. Simpulan: Pada 35 pasien pascaTB paru yang diteliti, proporsi hasil positif deteksi IgG spesifik Aspergillus sebesar 48,6%, biakan Aspergillus dari sputum 40,0%, sedangkan hasil uji kepekaan jamur terhadap vorikonazol menunjukkan 9 isolat sensitif, 5 isolat intermediate, dan 5 isolat resisten.
Kata Kunci: aspergilosis paru kronik, biakan jamur, IgG Aspergillus, pasca-TB paru, uji kepekaan, vorikonazol


Background: Chronic pulmonary aspergilosis (CPA) is an important complication in post-pulmonary tuberculosis (PTB) patients. Data on the role of Aspergillus-specific IgG detection, sputum culture results and antifungal susceptibility testing to voriconazole are still limited in Indonesia. Objective: To evaluate the role of Aspergillus-specific IgG detection using ELISA, sputum culture results and antifungal susceptibility testing to voriconazole in post-PTB patients with suspected CPA at Persahabatan General Hospital. Methods: This observational study used secondary data from 35 post-PTB patients who met the inclusion criteria. The diagnosis of CPA was established based on clinical, radiological, and mycological criteria. Mycological examination included sputum culture and Aspergillus IgG detection using ELISA were performed to support the diagnosis of CPA. Antifungal susceptibility testing to voriconazole was performed using the disc diffusion method on growing Aspergillus spp. isolates. Results: Of the 35 patients studied, 27 (77.1%) met the diagnostic criteria for CPA. The average age of patients was 53 years, with 55.6% of patients were male. Fifty-one percent of subjects were malnourished. The most common comorbidity was hypertension (18.5%), while the most common complaint was chronic cough (85.2%). Positive fungal cultures for Aspergillus spp. were found in 14 (40,0%) post-TB patients, while positive Aspergillus-specific IgG results were found in 17 (48.6%). Of the 19 Aspergillus isolates, the most common species was A. fumigatus (9/19). Antifungal susceptibility testing to voriconazole showed 9 sensitive isolates, 5 intermediate isolates, and 5 resistant isolates. Conclusion: In the 35 post-TB patients studied, the proportion of positive results for Aspergillus-specific IgG detection was 48.6%, and for Aspergillus sputum culture 40,0%, while antifungal susceptibility testing to voriconazole showed 9 sensitive isolates, 5 intermediate isolates, and 5 resistant isolates.
Keywords: chronic pulmonary aspergilosis, fungal culture, Aspergillus IgG, postpulmonary TB, susceptibility testing, voriconazole