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All Journal Indonesian Journal of Tropical and Infectious Disease Jurnal Respirasi (JR) Medicosphere
Kusmiati, Tutik
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Earth & Planetary Sciences Health Professions Immunology & microbiology Mechanical Engineering Medicine & Pharmacology Public Health Social Sciences

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Disseminated Tuberculosis in An Immunocompetent Patient Presenting with Ptosis and Diplopia: A Case Report Zahra, Nadhifa Az; Pradnyandari, Anak Agung Sagung Putri; Kusmiati, Tutik; Widjaja, Stella Agatha
Jurnal Respirasi Vol. 11 No. 3 (2025): September 2025
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v11-I.3.2025.269-275

Abstract

Introduction: Tuberculosis (TB) remains a global health burden to this day, with pulmonary TB (PTB) being one of its most common types. A lapse in the host immune response may lead to the dissemination of TB infection, causing extrapulmonary TB (EPTB) that is more difficult to manage, as it frequently shows atypical complaints. However, its manifestations among immunocompetent patients are rarely well-investigated. Case: A 28-year-old human immunodeficiency virus (HIV)-negative woman presented with a history of chronic progressive bilateral headache, followed by diplopia and ptosis of her left eyelid. She also had classical TB symptoms 3 months prior. She had a history of household tuberculous contact for years, but she was never tested for TB nor given an anti-TB treatment (ATT). Chest X-ray revealed cavities and pleural thickening in the apex of the left lung. Contrast-enhanced magnetic resonance imaging (MRI) of the brain showed multiple intracranial tuberculomas and meningeal enhancement in most brain areas. GeneXpert tests from both sputum and cerebrospinal fluid (CSF) suggested TB infections. She was later diagnosed with simultaneous tuberculous meningoencephalitis (TBME) and PTB. After a 17-day course of oral ATT, streptomycin injection, and intravenous corticosteroid, she was discharged with improved clinical conditions and scheduled for outpatient follow-up until she completed 12 months of ATT. Conclusion: In immunocompetent patients, disseminated TB is an uncommon occurrence and is frequently characterized by atypical symptoms. Findings from this case emphasize that comprehensive assessment and timely therapeutic intervention are critical for minimizing morbidity and mortality of TB infection.
Resistance Pattern of Anti-TB Drugs in Drug-Resistant TB of Pulmonary Tuberculosis Patients in Dr. Soetomo Academic Hospital, Surabaya, Indonesia Marsha Maritsa, Olivia; Mertaniasih, Ni Made; Permatasari, Ariani; Kusmiati, Tutik
Indonesian Journal of Tropical and Infectious Disease Vol. 13 No. 2 (2025)
Publisher : Institute of Topical Disease Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v13i2.66525

Abstract

Pulmonary tuberculosis is an infectious disease that can be transmitted through the air due to infection with Mycobacterium tuberculosis bacteria. According to the WHO, TB is the second-highest cause of death in infectious diseases in the world. This study aims to determine patterns of anti-TB drug resistance in drugresistant TB patients in Dr. Soetomo Academic Hospital from January 2022 to December 2023. This was a descriptive retrospective using patient medical record data in Dr. Soetomo Academic Hospital for the period January 2022 - December 2023. This study included 261 drug resistant pulmonary TB patients, the majority of whom were new TB patients (61.3%). Anti-TB drug resistancewas most prevalent in RR-TB (43.7%), with the highest number of new cases (28.4%). Drug susceptibility test showed High-dose Isoniazid (INHHD) had a high resistance rate (56%). Isoniazid (H) had a high resistance rate (66%). Pyrazinamide (Z) showed high sensitivity (66%). Levofloxacin (Lfx) showed high sensitivity (89%). High-dose Moxifloxacin (MfxHD) high sensitivity level (94%). Moxifloxacin (Mfx) high sensitivity level (92%). Bedaquiline (Bdq) high sensitivity level (98%). Linezolid (Lzd) high sensitivity level (99%). Clofazimine (Cfz) high sensitivity level (97%). Amikacin (Amk) high sensitivity level (100%). Drug-resistant pulmonary TB patients recently show a high drug sensitivity pattern to the second-line anti-TB drugs. MTB has become resistant to Isoniazid. However, it is still sensitive to Pyrazinamide by 66% and Levofloxacin by 89%. Moxifloxacin, Bedaquilin, Linezolid, Clofazimine, and Amikacin have high sensitivity >90%.
Factors That Reduce The Incidence of Lung Tuberculosis Other Than Isoniazid Preventive Therapy (IPT) in Latent Igra Positive HIV-TB Patients Karina Yuniati, Shinta; Kusmiati, Tutik; Triyono, Erwin Astha; Aryati
Journal of Diverse Medical Research: Medicosphere Vol. 1 No. 4 (2024): J Divers Med Res 2024
Publisher : Faculty of Medical - UPN Veteran Jawa Timur

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33005/jdiversemedres.v1i4.20

Abstract

Background. One crucial public health measure to stop persons living with HIV (PLWHA) from developing active TB is isoniazid preventative therapy (IPT). Only few hospitals in Indonesia continue to offer IPT. Aim. The purpose of this study was to assess how IPT affected the incidence of TB in patients with latent HIV infection. Method. This study uses a prospective cohort design and is quasi-experimental in design. Samples for the study were obtained by convenience sampling and the study was carried out in the inpatient and outpatient departments of UPIPI Dr. Soetomo Hospital. Latent IGRA positive HIV-TB patients who satisfied the inclusion requirements made up the samples. Result. Of the 59 patients who finished the screening exam, 23 fulfilled the inclusion requirements for this study. Using the ELISPOT method, the IGRA T-SPOT.TB test yields 36 (64.29%) negative findings and 23 (35.18%) positive results. After six months of IPT administration, analysis of the data revealed that the incidence of active pulmonary TB in latent HIV-TB patients was 0% in the IPT group and 0% in the non-IPT group. Antiretroviral medication used for more than four years and a CD4+ T lymphocyte count of more than 200 cells/μL were factors that contributed to the lack of pulmonary tuberculosis in both groups. Conclusion. ARV used for more than four years and CD4+ lymphocyte count more than 200 cells/L contributing significantly in pulmonary tuberculosis incidence.
Co-Authors Aryati Erwin Astha Triyono Karina Yuniati, Shinta Marsha Maritsa, Olivia Ni Made Mertaniasih Permatasari, Ariani Pradnyandari, Anak Agung Sagung Putri Widjaja, Stella Agatha Zahra, Nadhifa Az