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Pulmonary Mycoses in Indonesia: Current Situations and Future Challenges Anna Rozaliyani; Anwar Jusuf; Priyanti ZS; Erlina Burhan; Diah Handayani; Henie Widowati; Satria Pratama; Findra Setianingrum
Jurnal Respirologi Indonesia Vol 39, No 3 (2019)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Cases of pulmonary mycosis or pulmonary fungal diseases continues to increase in frequency along with the expanding population with impaired immune systems, including patients with pre-existing pulmonary diseases. Changing profile of underlying diseases might cause altering diseases profile as well. In previous decades, Pneumocystis pneumonia was the most common pulmonary mycosis in HIV-infected patients. As the increasing number of TB cases, pulmonary malignancy, chronic obstructive pulmonary disease (COPD) and certain chronic diseases, other pulmonary mycoses also increase such as chronic pulmonary aspergillosis, cryptococcosis, histoplasmosis, and other filamentous fungal infection. Furthermore, the airborne fungal particles of Aspergillus and other fungi could seriously worsen asthma or allergic respiratory diseases. In low- and middle-income countries, including Indonesia, lack of diagnostic facilities may lead to inadequate treatment. It will contribute to poor clinical outcomes with high mortality rates. The awareness among clinicians and other health workers of this epidemiology changes is the important step in early diagnosis and better managemenet of pulmonary mycosis in the future. (J Respir Indo. 2019; 39(3): 210-4)

Diversity of Fungal Colonization in Respiratory Tract of NaÃ¯ve Lung Cancer and The Emergence of Voriconazole Resistant Aspergillus Jamal Zaini; Abul A'la Al Maududi; Zahrah Annisa; Denny Grecius Siregar; Findra Setianingrum; Mulyati Tugiran; Ridhawati Sjam; Robiatul Adawiyah; Anna Rozaliyani; Sita Andarini; Elisna Syahruddin
HAYATI Journal of Biosciences Vol. 30 No. 6 (2023): November 2023
Publisher : Bogor Agricultural University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.4308/hjb.30.6.1139-1148

Fungal spores in the air can be inhaled and enter the human respiratory tract. The entry of fungi into the respiratory tract can cause colonization or infection depending on the host immune response. Fungal colonization is the first step into debilitating fungal disease in humans, especially in immunocompromised groups. The increased rate of drug-resistant fungi has been reported in human disease and the environment. This study aims to examine the diversity of fungal colonization in humans and the rate of fungal resistance to voriconazole. This cross-sectional study was done in patients with naÃ¯ve lung cancer who had not been previously treated with any cancer therapy nor given antifungal agent. Induced sputum from 70 subjects was collected and inoculated in the Sabouraud Dextrose Agar medium. Macroscopic and microscopic examinations were performed to identify fungal species. Voriconazole susceptibility tests were done using the disc diffusion method. This study found Candida albicans, Aspergillus niger, Aspergillus fumigatus, and Penicillium sp. among the most common lower respiratory tract colonies. This study also found the colonization of up to 5 species in a single subject. A high rate of voriconazole-resistant Aspergillus sp. was found (42.4%) among 59 isolates tested. Given that these subjects had never taken antifungal agents previously, the high rate of voriconazole resistance might be attributed to the environment, such as community and agriculture. Mitigation of antifungal use in the agricultural sector, fungal diversity in the environment, and clinical study of fungal colonization/ infection in other high-risk groups are needed.

Clinical Performance of the Aspergillus Western Blot IgG Kit for Serodiagnosis of Chronic Pulmonary Aspergillosis in Post-Tuberculosis Patients Anna Rozaliyani; Sresta Azahra; Findra Setianingrum; Heri Wibowo
Jurnal Respirologi Indonesia Vol 43, No 4 (2023)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v43i4.562

Background: Chronic pulmonary aspergillosis (CPA) by Aspergillus spp., which causes slowly progressive destruction to lung parenchyma, is a major complication of pulmonary tuberculosis (TB). Clinical and radiological features of CPA are not typical and might resemble TB. Therefore, detecting Aspergillus-specific IgG is critical for diagnosing CPA.Methods: This cross-sectional study was conducted to evaluate the performance of Aspergillus Western Blot (Asp-WB) IgG kit (LDBio Diagnostics, Lyon, France) for CPA diagnosis in 63 post-TB patients. The analysis was performed by comparing Asp-WB with Aspergillus ELISA IgG (Asp-ELISA) and fungal culture as standard method.Results: Of the 63 patients studied, twenty six (41%) met the probable CPA criteria. The Asp-WB results were positive in 13 probable CPA patients and 3 non-CPA patients, with the significant difference of 50% vs. 8% (p< 0.001). The sensitivity and specificity of Asp-WB were 50% and 93%. False negative results of Asp-WB were detected from non-fumigatus CPA that grew Aspergillus niger. CPA patients with mild symptoms (less than 3 months) indicated early progression of CPA might showed positive Asp-WB test result in low sensitivity of Asp-WB test.Conclusion: The Asp-WB has potential to use as confirmatory test to assist diagnosis of CPA in post-TB patients.

The body mass index profiles in chronic pulmonary aspergillosis: trend and variability in post tuberculosis patients Findra Setianingrum; Anna Rozaliyani
Qanun Medika - Jurnal Kedokteran FK UMSurabaya Vol 8 No 01 (2024): Qanun Medika Vol 08 No 01 January 2024
Publisher : Universitas Muhammadiyah Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30651/jqm.v8i01.20763

Tuberculosis (TB) is the main risk factor for chronic pulmonary aspergillosis, especially in patients with residual cavitary lesions after completion of TB therapy. The body mass index (BMI) is one of the established markers in predicting the mortality of CPA. However, the data regarding BMI profiles of CPA patients in Indonesia is still limited. We evaluated the BMI profiles of CPA patients among post-TB patients. Patients diagnosed as CPA based on clinical, radiology and the Aspergillus IgG test. 50 patients were included with a mean age of 35 years; 13 patients met the criteria of CPA. The overall median of BMI in these patients was 21. The median BMI in the CPA group was 19,3. The lowest (19,8) median BMI value was observed in the positive Aspergillus IgG group (11,5 – 30 mg/L) with a minimum BMI of 14,7 and a maximum BMI of 29,2. The differences in median BMI across CPA and non CPA groups and Aspergillus IgG level were not statistically significant. However, there is a trend that lower BMI were distributed among patients with positive Aspergillus IgG. More than one third of CPA patients in this study were classified as underweight. Future study is necessary to better depict the BMI profiles in larger scale of populations of CPA in Indonesia in order to achieve better diagnosis and management of CPA.

The Potential of Herbal Combinations as Adjunctive Therapy for Standard Care of COVID-19 Patients: A Lesson Learned from Indonesia Rozaliyani, Anna; Pratama, Satria; Setianingrum, Findra; Yunita, Fenny; Rumende, C. Martin
Pharmaceutical Sciences and Research Vol. 10, No. 3
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

The pandemic of novel coronavirus disease (COVID-19) has become a global disaster that occurred between the end of 2019 and 2023. It caused immeasurable damage to almost all aspects of human life. The disease has opened a lot of new perspectives on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) origins and pathogenesis, the nature of the virus, the potential for new treatments, and new policies to overcome this pandemic. This review aims to know the potential of plants that are beneficial to combat the diseases, including immunomodulators in the management of COVID-19. Studies reporting COVID-19 with the keywords SARS-CoV-2, COVID-19, pathogenesis, clinical manifestations, medicinal plants, and their benefits were included. We also discussed the molecular pathways of the bioactive compound that may interact with the pathogenesis of COVID-19. Clinical management for COVID-19 is still being refined from time to time because many aspects are not yet fully understood and need further studies. Therefore, effective, non-invasive, and affordable treatment must be sought immediately to meet this very urgent need. The commotion situation of the COVID-19 pandemic has encouraged various efforts to develop new drugs, including alternative therapies from potential medicinal plants. The pharmacotherapeutic activity of Indonesia-based medicinal plants for COVID-19 has evolved, including Phyllanthus niruri, Andrographis paniculata, Anacardium occidentale, Zingiber officinale, and Glycyrrhiza glabra. The potential benefits of that combination of herbal medicinal plants also need to be explored for better contribution in managing COVID-19, particularly in Indonesia.

Genetic Variation and Antifungal Susceptibility Profile of Candida auris Adrir, Mutia Syarifah; Setianingrum, Findra; Adawiyah, Robiatul; Hasyim, Ammar Abdurrahman; Rozaliyani, Anna
Jurnal Ilmu Kedokteran Vol 19, No 1 (2025): Jurnal Ilmu Kedokteran
Publisher : Fakultas Kedokteran Universitas Riau

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26891/JIK.v19i1.2025.1-13

Candida auris is an invasive yeast that has spread worldwide since it was first identified in Japan in 2009. C.auris has spread through four genetic clades that emerged between 2008 and 2013 and caused nosocomial outbreaks. The mortality rates of C.auris infections vary significantly between regions, ranging from 30 to 60%. C.auris infections can cause fungemia, invasive candidiasis, and spread to various organs. C.auris has a defense mechanism against the innate immune response and virulence factors that are not fully understood. High thermal and salinity tolerance, excretion of protease enzymes, and the ability to form biofilms are the main virulence factors that influence the pathogenicity of C.auris. Due to limited facilities, the diagnosis of C.auris infections is still hampered in some countries. Accurate strain identification methods are essential to prevent the rapid spread of this pathogen. Molecular techniques, including PCR and sequencing of the D1/D2 region of 28s rDNA or internal transcribed spacer using specific primers, are recommended for faster and more accurate identification. Genetic analysis revealed single-nucleotide polymorphisms (SNPs) that differed between clades, especially in the nuclear and mitochondrial genomes. C.auris exhibits high resistance to fluconazole, amphotericin B, and echinocandins, with some strains being resistant to all three. Resistance mechanisms include ERG11 gene mutations, Erg11p overexpression, and efflux pump activity. The rise of multidrug-resistant strains and high genetic variation complicates infection management, requiring heightened attention to prevent further spread.

Perkembangan Terkini Penyakit Influenza dan Peran Favipiravir dalam Tata Laksana Penyakit Anna Rozaliyani; Asiyah Taqiyya Fakhrur Razi; Ammar Abdurrahman Hasyim; Findra Setianingrum; Rulliana Agustin; Erlang Samudro; Alvin Kosasih
MEDICINUS Vol. 38 No. 6 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/3trygg29

Influenza virus infection remains a major global health challenge, particularly for vulnerable groups with compromised immune systems. Influenza is primarily caused by infection of influenza A and B viruses, with a varying clinical spectrum, ranging from asymptomatic cases to life-threatening conditions. Influenza viruses tend to undergo rapid genetic mutations, limiting the long-term effectiveness of vaccine-induced immune responses. Diagnosing influenza remains challenging due to the nonspecific signs and symptoms of the disease. The gold standard for influenza diagnosis is reverse transcription polymerase chain reaction (RT-PCR) test. Antiviral drugs are an essential prophylactic and therapeutic strategy to reduce influenza-related morbidity and mortality, especially in high-risk populations. Favipiravir has the potential to be a promising therapy against influenza, SARS-CoV-2, and other RNA virus infections. Prevention and control of influenza virus infections, including vaccination, are management strategies that must be optimized.

The body mass index profiles in chronic pulmonary aspergillosis: trend and variability in post tuberculosis patients Setianingrum, Findra; Rozaliyani, Anna
Qanun Medika - Jurnal Kedokteran FK UMSurabaya Vol 8 No 01 (2024): Qanun Medika Vol 08 No 01 January 2024
Publisher : Universitas Muhammadiyah Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30651/jqm.v8i01.20763

Tuberculosis (TB) is the main risk factor for chronic pulmonary aspergillosis, especially in patients with residual cavitary lesions after completion of TB therapy. The body mass index (BMI) is one of the established markers in predicting the mortality of CPA. However, the data regarding BMI profiles of CPA patients in Indonesia is still limited. We evaluated the BMI profiles of CPA patients among post-TB patients. Patients diagnosed as CPA based on clinical, radiology and the Aspergillus IgG test. 50 patients were included with a mean age of 35 years; 13 patients met the criteria of CPA. The overall median of BMI in these patients was 21. The median BMI in the CPA group was 19,3. The lowest (19,8) median BMI value was observed in the positive Aspergillus IgG group (11,5 – 30 mg/L) with a minimum BMI of 14,7 and a maximum BMI of 29,2. The differences in median BMI across CPA and non CPA groups and Aspergillus IgG level were not statistically significant. However, there is a trend that lower BMI were distributed among patients with positive Aspergillus IgG. More than one third of CPA patients in this study were classified as underweight. Future study is necessary to better depict the BMI profiles in larger scale of populations of CPA in Indonesia in order to achieve better diagnosis and management of CPA.

KAVITAS PARU DENGAN PENYEBAB INFEKSI Findra Setianingrum; Finny Nandipinto; Anna Rozaliyani
Qanun Medika - Jurnal Kedokteran FK UMSurabaya Vol 10 No 01 (2026): Qanun Medika Vol 10 No 01 January 2026
Publisher : Universitas Muhammadiyah Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30651/jqm.v10i01.30047

Pulmonary cavities are an important radiological finding in various infectious and non‑infectious diseases. Infection‑related cavities are usually associated with tuberculosis (TB), non‑tuberculous mycobacterial (NTM) infection, chronic pulmonary aspergillosis, and echinococcosis, each with distinct mechanisms of formation and radiologic patterns. In TB and NTM, tissue necrosis and bronchiectasis lead to the formation of cavitary spaces that serve as reservoirs for organisms with a high burden and facilitate transmission. Residual cavities may then undergo secondary colonization by Aspergillus spp, resulting in a spectrum of chronic pulmonary aspergillosis with findings such as aspergilloma and thick‑walled cavities. Echinococcus forms cysts that, when ruptured, can appear as cavitary lesions with the “water lily” sign, adding yet another differential diagnosis for pulmonary cavities. Understanding radiologic patterns, pathogenesis, and microbiological correlations can be used as an important clue to distinguish etiologies and to select appropriate management for patients.

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