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Diagnostic challenge of Pneumocystis jirovecii pneumonia infection mimicking interstitial lung disease in initially HIV negative patient Kristy, Anastasia; Yaniswari, Ni Made Dwita
Jurnal Prima Medika Sains Vol. 5 No. 2 (2023): December
Publisher : Program Studi Magister Kesehatan Masyarakat Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jpms.v5i2.4455

Background: Pneumocystis jirovecii pneumonia (PJP) infections are common in immunocompromised patients and are rarely found in immunocompetent patients. Lung radiology in PJP patients could mimic the appearance of interstitial lung disease (ILD) and could be used to diagnose HIV-negative patients. Clinicians should rule out false negatives in patients with patterns suggestive of opportunistic infections and risk factors for HIV infection. Case illustration: A 34-year-old man presented with a chief complaint of shortness of breath, had history of 15 years of smoking, and daily chlorine exposure. The radiology pattern and initial HIV-negative test results suggested an ILD diagnosis. Owing to persistent symptoms despite initial management and the presence of risk factors, repeat HIV testing was initiated and was positive. The patient was treated with cotrimoxazole and showed rapid clinical improvement. Discussion: The diagnosis of PJP in our patient was based on radiology and an HIV-positive status. In patients who are not immunocompromised, the diagnosis of PJP is unlikely, and other diagnoses, such as ILD, should be considered. However, in the HIV testing window period of infection, a poor advanced state of HIV could cause a false negative result. Therefore, clinical judgement is essential in suspecting such a result. The empirical treatment course of cotrimoxazole has been shown to provide better clinical outcomes in PJP. Conclusion: The possibility of PJP must be considered in patients with initially HIV-negative results, especially in patients with risk factors and clinical symptoms suggestive of immunocompromise. While some ILD showed similar PJP, the risk factors for ILD and PCP could be distinguishing factors. Retesting for HIV infection can confirm the diagnosis and rule out false-negative results.

Type-A Thymoma: A Case Report Hermawan, Yosua Kevin; Yaniswari, Ni Made Dwita
Jurnal Respirologi Indonesia Vol 44, No 3 (2024)
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.v44i3.677

Background: Thymoma is a neoplasm that arises from the thymus gland. Around one-third of the patients are asymptomatic. Five subtypes of thymoma differentiate from the cell’s morphology based on the World Health Organization (WHO). Type-A thymoma comprises oval or spindle epithelial cells.Case: We presented a 49-year-old woman with a persistent cough and shortness of breath when performing heavy tasks. Chest radiography showed opacity on the mediastinum. Chest computed tomography with contrast revealed a tumor in the anterior part of the mediastinum and pericardial effusion. The patient underwent an Ultrasonography (USG) guided transthoracic needle aspiration (TTNA) and the histopathology examination showed a type-A thymoma. The patient was referred to a cardiothoracic surgeon for further management.Discussion: Type-A thymoma has a good prognosis and is rarely associated with myasthenia gravis. It has a less malignant nature compared to type B2 thymoma. However, it still can cause respiratory problems through the mass effect of the tumor itself. Surgery is usually the treatment of choice. Radiotherapy and chemotherapy can also be considered if complete resection is hard to achieve.Conclusion: Type-A thymoma has a less malignant nature and has a good prognosis. In this case, the tumor caused compression into the right lung resulting in the partial collapse of the right middle lobe and pericardial invasion were taken into consideration due to pericardial effusion.

The Role of Macronutrients in Chronic Obstructive Pulmonary Disease: A Review Kristy, Anastasia; Hardian, Harris; Putra, Wayan Wahyu Semara; Yaniswari, Ni Made Dwita; Tania, Tryna
Jurnal Respirasi Vol. 10 No. 2 (2024): May 2024
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v10-I.2.2024.161-167

The incidence of chronic obstructive pulmonary disease (COPD) is rising and is still regarded as one of the challenging medical issues. Regardless of the main relationship between tobacco smoking and toxic particle exposure with COPD, factors like nutritional status also play an important role in COPD progression and outcome, as the factor is an adaptable aspect. Malnutrition, sarcopenia, and obesity are nutritional problems that are often encountered in COPD patients. Macronutrients, namely carbohydrates, fat, and protein, support the adjunctive treatment options for COPD. The ideal dietary pattern includes low carbohydrates, medium fats preferably polyunsaturated fatty acids (PUFA), and high proteins to improve COPD symptoms, preserve muscle mass, and delay disease progression. High carbohydrate intake might also increase the respiratory quotient (RQ) which results in higher carbon dioxide (CO2) production and oxygen (O2) demand compared to fat and protein intake. Daily calorie intake should be adjusted to personal nutritional status. Higher calories in malnourished, sarcopenic patients and targeted weight loss in obese patients show improvements in lung function, frequency of exacerbations, and hospitalization rate. In obese individuals with COPD, however, maintaining a slightly higher body mass index (BMI) of 25-30 kg/m2 was associated with lower mortality. This literature review summarized the significant role of macronutrients in COPD patients and the practical approach to macronutrient intervention in individuals with different nutritional statuses.

Type-A Thymoma: A Case Report Hermawan, Yosua Kevin; Yaniswari, Ni Made Dwita
Jurnal Respirologi Indonesia Vol 44 No 3 (2024)
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.v44i3.677

Background: Thymoma is a neoplasm that arises from the thymus gland. Around one-third of the patients are asymptomatic. Five subtypes of thymoma differentiate from the cell’s morphology based on the World Health Organization (WHO). Type-A thymoma comprises oval or spindle epithelial cells.Case: We presented a 49-year-old woman with a persistent cough and shortness of breath when performing heavy tasks. Chest radiography showed opacity on the mediastinum. Chest computed tomography with contrast revealed a tumor in the anterior part of the mediastinum and pericardial effusion. The patient underwent an Ultrasonography (USG) guided transthoracic needle aspiration (TTNA) and the histopathology examination showed a type-A thymoma. The patient was referred to a cardiothoracic surgeon for further management.Discussion: Type-A thymoma has a good prognosis and is rarely associated with myasthenia gravis. It has a less malignant nature compared to type B2 thymoma. However, it still can cause respiratory problems through the mass effect of the tumor itself. Surgery is usually the treatment of choice. Radiotherapy and chemotherapy can also be considered if complete resection is hard to achieve.Conclusion: Type-A thymoma has a less malignant nature and has a good prognosis. In this case, the tumor caused compression into the right lung resulting in the partial collapse of the right middle lobe and pericardial invasion were taken into consideration due to pericardial effusion.

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