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All Journal Tropical Medicine Journal Mandala of Health : A Scientific Journal
Ning Rintiswati
Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
Dentistry Health Professions Medicine & Pharmacology Public Health

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Factors Associated with Delayed Diagnosis among Tuberculosis Patient in Kebumen District Edwin Sovvan Aritonang; Ning Rintiswati; Riris Andono Ahmad
Tropical Medicine Journal Vol 3, No 2 (2013): Tropical Medicine Journal
Publisher : Pusat Kedokteran Tropis

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1405.366 KB) | DOI: 10.22146/tmj.5865

Abstract

ABSTRACTIntroduction: Tuberculosis is a major global health problem. It is estimated that almost 9 million new cases detected in 2011 and 1.4 million died because of TB. Early diagnosis and effective treatment are the key elements of the TB control program. Delayed diagnosis associated with a longer duration of infectiousness, increase the severity of the disease, more severe complication and even death.Objectives: To determine the factors associated with delayed diagnosis among tuberculosis patients in Kebumen District.Methods : A cross sectional study among newly diagnosed TB patients in April to June 2013 in Kebumen was conducted. The data was collected using a questionnaire interviewing officers of government health care facilities which have implemented DOTS programs already. Data was analyzed by a logistic regression test with confidence interval (CI) of 95%.Results: Eighty five pulmonary TB patients were studied consisting of 65 TB smear positive and 20 smear negative/roentgen positive patients. The median duration of delayed patients was 3.9 weeks; delayed health service was 2.6 weeks and delayed diagnosis was 7.6 weeks. Multivariate analysis showed that factors associated with delayed diagnosis were the type of health services which first visited (p value = 0.002 and OR = 6.87), level of knowledge about TB (p value = 0.002 and OR = 6.41), educational level (p value = 0.024 and OR = 5.68) and the number of visits to health service (p value = 0.021 and OR = 3.87).Conclusion : The median duration of delayed diagnosis was 7.6 weeks. Delayed diagnosis among TB patients in Kebumen Distict was associated with type of health services which is non-DOTS, low level of knowledge about TB,  low levels of education and the number of visits to health services ≥3 times.Keywords: delayed diagnosis, TB patients, Kebumen District
Factors Associated with Tuberculosis Treatment Success Among Human Immunodeficiency Virus - Tuberkulosis (HIV-TB) in H. Adam Malik General Hospital, Medan Anna Yusria; Ning Rintiswati; Sumardi Sumardi
Tropical Medicine Journal Vol 4, No 1 (2017): Tropical Medicine Journal
Publisher : Pusat Kedokteran Tropis

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (300.548 KB) | DOI: 10.22146/tmj.37174

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Introduction: Co-infection of TB/HIV is currently a serious health threat to the world population. Efforts to control tuberculosis and HIV programs still facing obstacles, especially if the two diseases allied, it will be more difficult and challenging for both prevention program. Both TB and HIV have higher burden disease and need to be cope urgently. Adequate treatment of TB in co-infected patients can reduce the high morbidity and mortality of patients, prevent treatment failure and improve the success rate.Objectives: Determine the proportion of successful treatment of TB among HIV-TB patients in H. Adam Malik General Hospital between 2011-2013 and identified the factors that influenced the success of their TB treatment.Methods: A case control study design using medical records of HIV-TB patients in VCT polyclinic of H. Adam Malik General Hospital from 2011-2013.Results: The average success rate of TB treatment among HIV-TB patients in H. Adam Malik General Hospital was 68.56%. Male, age ≤40 years, pulmonary TB, CD4 count <200, anemia, HIV stage 3 and adherence to TB treatment dominated this research, (60,82%, 76,29%, 71,13%, 74,23%, 60,82%, 55,15% and 53,09% respectively). Gender (aOR 3.87 95% CI: 1.21 - 18.31), CD4 101-200 (aOR 5.06 95% CI: 1.06 - 24.04), CD4> 200 (aOR 15, 80 95% CI: 3.18 - 78.64), status of anemia (aOR 2.00 95% CI: 1.22 -  3.26) and adherence to TB treatment (aOR 6.16 95% CI: 2.07 - 18.31) were statistically significant in multivariate analysis. Other factors such as age, classification of TB disease and HIV stage were not significant (p values> 0.05). Conclusion: Female, CD4 cell counts 101-200, CD4 count> 200, status of anemia and adherence to  TB treatment determined the successful of TB treatment among HIV-TB patients. Implementation of TB/HIV collaborative program and DOTS strategy in TB treatment increases the success rate of TB treatment among HIV-TB patients at H. Adam Malik General Hospital.Keyword: success, tuberculosis treatment, HIV-TB   INTISARIPendahuluan: Ko-infeksi TB/HIV saat ini menjadi ancaman kesehatan serius bagi penduduk dunia. Upaya penanggulangan program TB maupun HIV selama ini masih menghadapi kendala apalagi jika kedua penyakit tersebut bersekutu akan lebih menyulitkan dan menjadi tantangan bagi penanggulangan kedua program. Baik TB maupun HIV, keduanya mempunyai burden disease yang cukup tinggi untuk segera ditangani. Pengobatan TB yang adekuat pada pasien koinfeksi dapat menekan tingginya angka morbiditas dan mortalitas pasien, mencegah kegagalan terapi serta meningkatkan angka keberhasilan.Tujuan: Mengetahui proporsi keberhasilan pengobatan TB pada penderita HIV di RSUP H. Adam Malik Medan tahun 2011-2013 serta mengidentifikasi faktor-faktor yang mempengaruhi keberhasilan pengobatan TB-nya.Metode: Desain penelitian yang digunakan adalah case control, menggunakan data sekunder Poliklinik VCT Pusyansus RSUP H. Adam Malik Medan 2011-2013.Hasil: Rata-rata keberhasilan pengobatan TB pada penderita HIV di RSUP H. Adam Malik Medan tahun 2011-2013 sebesar 68,56%. Jenis kelamin laki-laki, umur ≤40 tahun, lesi TB di paru, jumlah CD4 <200, status anemia, stadium 3 HIV dan keteraturan pengobatan OAT mendominasi penelitian ini, masing-masing sebesar 60,82%, 76,29%, 71,13%, 74,23%, 60,82%, 55,15% dan 53,09%. Variabel jenis kelamin (aOR 3,87 95%CI: 1,21 - 18,31), jumlah CD4 101-200 (aOR 5,06 95%CI: 1,06 - 24,04), CD4 >200 (aOR 15,80 95%CI: 3,18 - 78,64), tidak anemia (aOR 2,00 95%CI: 1,22 - 3,26) dan keteraturan pengobatan TB (aOR 6,16 95%CI: 2,07 - 18,31) berhubungan signifikan dalam analisis multivariat. Faktor lain yaitu umur, klasifikasi penyakit TB dan stadium HIV tidak bermakna (nilai p>0,05).Simpulan: Jenis kelamin perempuan, jumlah CD4 101-200, jumlah CD4 >200, tidak anemia dan teratur menjalani pengobatan OAT menentukan keberhasilan pengobatan TB pada penderita HIV-TB. Implementasi program kolaborasi TB/HIV dan penerapan strategi pengobatan TB dengan DOTS meningkatkan angka keberhasilan pengobatan TB di RSUP H. Adam Malik Medan.Kata kunci: keberhasilan, pengobatan tuberkulosis, HIV-TB
STUDI PENDAHULUAN NONTUBERCULOUS MYCOBACTERIA (NTM): PEMBENTUKAN BIOFILM, MOTILITAS GESER, DAN POLA KEPEKAAN ANTIBIOTIK Titik Nuryastuti; Ning Rintiswati; Praseno Praseno
Mandala Of Health Vol 11 No 1 (2018): Mandala Of Health
Publisher : Fakultas Kedokteran Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (369.205 KB) | DOI: 10.20884/1.mandala.2018.11.1.570

Abstract

Nontuberculous mycobacteria (NTM) adalah mikrorganisme yang banyak dijumpai di lingkungan, namun, baru-baru ini dianggap patogen karena kejadian infeksinya meningkat secara signifikan. Penelitian ini bertujuan untuk mengetahui kemampuan pembentukan biofilm isolat NTM, korelasinya dengan sifat motilitas geser, dan untuk menganalisis pola kepekaan antibiotik. Strain NTM yang dipakai dalam penelitian ini adalah 10 isolat klinis NTM yang diperoleh dari laboratorium TB, Departemen Mikrobiologi, Fakultas Kedokteran UGM Yogyakarta. Kemampuan pembentukan biofilm dideteksi dengan menggunakan uji mikrotiter dan pewarnaan dengan kristal violet 1%. Uji motilitas geser dilakukan pada medium motilitas, terdiri dari 0,3% Middlebrook 7H9-agar tanpa suplemen. Pola kepekaan antibiotik diteliti dengan teknik dilusi sesuai metode CLSI. Dari penelitian ini menunjukkan bahwa 7 dari 10 isolat NTM merupakan penghasil biofilm kuat, sementara 1 isolat sebagai strain penghasil biofilm moderat, dan 2 isolat tidak menghasilkan biofilm. Sementara itu, strain pembentuk biofilm mampu melakukan motilitas geser pada agar semisolid, dan 2 isolat NTM yang tidak memiliki kemampuan pembentukan biofilm tidak dapat melakukan motilitas geser. Sifat pembentukan biofilm berkorelasi dengan kemampuan isolat NTM untuk melakukan motilitas geser pada media agar semisolid. Klaritromisin merupakan antibiotik yang paling efektif terhadap isolat NTM yang diuji (poten terhadap 50% isolat uji), diikuti oleh gentamisin (40%), sedangkan kanamisin, levofloxacin, dan ofloxacin menunjukkan tingkat potensi yang sama (30%). Ceftriaxone hanya mampu menghambat pertumbuhan isolat NTM sekitar 20%. Selanjutnya, kotrimoksazol dan amoksisilin memiliki aktivitas in vitro yang buruk terhadap isolat NTM karena tidak ada isolat NTM yang sensitif terhadap kedua antibiotik ini. Nontuberculous mycobacteria (NTM) are ubiquitous organisms commonly found in the environment. However, recently it is considered as emerging global interest since the incidence increase significantly. This study aimed to investigate the biofilm forming ability of NTM isolates, correlated with the sliding motility properties, and to analyze their antibiotic susceptibility pattern. NTM strain included in this study were 10 NTM clinical isolates obtained from TB laboratory, Microbiology Departement, Faculty of Medicine UGM Yogyakarta. Biofilm forming capability was detected by using biofilm development assay in microtiter plate and staining with 1% crystal violet. Sliding motility assay was performed on motility medium, consisting of Middlebrook 7H9- 0.3% agar without supplements. Antibiotic susceptibility pattern was investigated by macrobroth dilution technique according to CLSI methods. Our study revealed that 7 out of 10 NTM isolates produced biofilm strongly, while 1 isolate demontrated as moderate biofilm former strain, and the remaining 2 isolates did not produce biofilm on polysterene substrate. Meanwhile, biofilm-former strain are able to slide on semisolid agar, and 2 non-adherent NTM isolates did not have ability to perform sliding motility. A good correlation was found between mycobacterial sliding and biofilm assembly of NTM isolates. Clarithromycin has been shown as the most effective antibiotic against NTM isolates tested, which was active against 50% of all isolates, followed by gentamycin (40%), while kanamycin, levofloxacin, and ofloxacin showed the same level of potency (30%). Ceftriaxone was only able to inhibit the growth of NTM isolates about 20%. Furthermore, cotrimoxazole and amoxicillin had poor in vitro activity against NTM species.
Co-Authors Anna Yusria Edwin Sovvan Aritonang Praseno Praseno Riris Andono Ahmad Sumardi Sumardi Titik Nuryastuti