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C-Reactive Protein and Procalcitonin as Markers for Post-Bronchoscopic Complications: A Literature Review Indriani, Sri Indah; Yovi, Indra; Syaf, Syarlidina; Simatupang, Elvando Tunggul Mauliate
Jurnal Respirologi Indonesia Vol 44, No 2 (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.v44i2.638

In the respiratory system, bronchoscopy is a basic procedure utilized for both diagnostic and therapeutic purposes. Despite being a generally safe procedure, bronchoscopy can result in complications that range in severity from moderate to severe. Pulmonary infection is among the potential complications that can happen after a bronchoscopy procedure. An incidence of 0.2% to 5.2% has been described typically for complications such as empyema, lung abscess, and pneumonia that may develop after bronchoscopy procedures. Although these complications are uncommon, their prognosis can be quite bad. The risk of pulmonary infection, specifically pneumonia, has been related in several studies to sepsis and mortality in patients enduring bronchoscopy procedures. The initiation of the infection exposure process into the lung can be assisted through a variety of factors, including the underlying diagnosis and the type of intervention performed during the bronchoscopy procedure. A critical complication that needs additional consideration is the potential transmission of infection through bronchoscopy procedures. It is beneficial to consider prophylactic antibiotics before a procedure due to the possibility that infectious agents will be transferred from one patient to another. Antibiotic prophylaxis may involve the utilization of C-reactive protein (CRP) and Procalcitonin (PCT) testing as determining parameters. Serial PCT and CRP 24–96 hours post-bronchoscopy procedure might help to determine one of the post-bronchoscopy complications.

Lung Abscess Located in Lesion of Lung Tumor and Multiple Cavities due to Pulmonary Tuberculosis: A Case Report Indriani, Sri Indah; Simatupang, Elvando Tunggul Mauliate; Wibowo, Adityo; Makmur, Andreas; Fidiawati, Wiwit Ade
Jurnal Respirasi Vol. 10 No. 1 (2024): January 2024
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v10-I.1.2024.55-60

Introduction: People with tuberculosis (TB) have an increased risk of pulmonary cancer. They are also disproportionately affected by risk factors like immune suppression, smoking, and alcohol misuse. A lung tumor is reported to have occurred after an episode of TB, but we reported a patient with a lung tumor with co-infection TB and lung abscess at the same time. Case: A 73-year-old man was hospitalized at Arifin Achmad General Hospital, Pekanbaru, with a 3-day history of bloody cough 2-3 times a day, 1-2 tablespoons estimated by the patient for blood from the cough. The patient had a cough with white phlegm in the last 4 months before the bloody cough. The patient also had a fever, night sweats, a limp body, decreased appetite for 6 months, and decreased body weight by 15 kg in the last year. Heterogenic consolidation on the superior lobe of the lung with prominence compression and irregular boundaries in the apex was found. We found an air bronchogram and multiple cavities with air-fluid levels inside the lesion. We also found a satellite nodule in the inferior lung and a mass connected with the chest wall. GeneXpert showed low detection for Mycobacterium tuberculosis. The patient was diagnosed with a left lung abscess, pulmonary TB, left lung tumor T4N2M1a, unspecified type of tumor stage IVA PS2, and osteoporosis. Conclusion: Lung tumors could also be diagnosed with co-infection TB. Proper diagnosis to make sure cancer and TB are co-infected is necessary. Therefore, it will not be just a single disease that is treated.

Diagnosis Approach of Endobronchial Tuberculosis: Literature Review Ginting, Mario Oktafiendi; Indriani, Sri Indah; Simatupang, Elvando Tunggul Mauliate
Indonesian Journal of Tropical and Infectious Disease Vol. 13 No. 1 (2025)
Publisher : Institute of Topical Disease Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v13i1.60257

Pulmonary tuberculosis (PTB) remains a global health problem and the leading cause of death from infectious diseases. Indonesia as an endemic country and the second highest contributor of PTB cases in the world provides support and attention to PTB case finding and treatment success. Endobronchial tuberculosis (EBTB) is problematic PTB because the lesions are often not detected by sputum examination and chest X-ray. Clinically, there is no significant difference in symptoms between TB and EBTB. In general, EBTB gives a more severe clinical appearance due to airway stenosis. Bronchoscopy and thoracic computed tomography scan (CT scan), along with microbiological investigations, are the most useful diagnostic tools for confirming and evaluating tracheobronchial stenosis. In addition, bronchoscopy can also be used as a longterm treatment in cases of EBTB due to airway stenosis. The goals of treatment are the eradication of Mycobacterium tuberculosis (Mtb) bacilli with antituberculosis drugs (ATD) and the prevention of airway stenosis. Intervention of bronchoscopic techniques and surgery are required for those patients who develop severe tracheobronchial stenosis that causes significant symptoms, including dyspnea, repeated post-obstructive pneumonia or bronchiectasis. The most common complications of EBTB are airway stenosis, atelectasis, hemoptysis and shortness of breath accompanied by wheezing despite the administration of ATD. Bronchoscopic intervention can support the acceleration of EBTB treatment, prevent repeated hospitalizations and improve the quality of life of patients. Acceleration of diagnosis and administration of ATDs in a complete and routine way is expected to reduce morbidity and even mortality rates in EBTB cases.

Current Knowledge of Mycobacterium Other Than Tuberculosis (MOTT) in this Current Era: Definition, Taxonomy, and Diagnose Indriani, Sri Indah; Pratiwi, Adelia; Simatupang, Elvando Tunggul Mauliate; Simanjuntak, Arya Marganda
Respiratory Science Vol. 4 No. 3 (2024): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v4i3.122

Globally, Pulmonary Tuberculosis (PTB) remains a health concern, with an annual increase in cases. Indonesia is the second-highest contributor to PTB cases globally, below India, which also saw an increase in cases, particularly after the COVID-19 pandemic. Nontuberculous Mycobacteria (NTM) infections contribute to the increase in PTB cases through misdiagnosis and overlapping conditions. The occurrence of changes in the composition of NTM species in the Mycobacterium genus is the premise for updating the diagnosis of NTM with several supporting examination modalities. Clinical, radiological, and microbiological criteria have been established by the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) for the diagnosis of NTM. The relationship between these three criteria is essential as a guideline for distinguishing infections caused by Mycobacterium tuberculosis (Mtb) from those caused by NTM.

Giant Intrapulmonary Mature Teratoma with Thoracostomy Intervention: A Rare Case Report Indriani, Sri Indah; Simatupang, Elvando Tunggul Mauliate; Bergant, Briliant; Makmur, Andreas; Rangkuti, Ina Farida
Malang Respiratory Journal Vol. 6 No. 1 (2024): March 2024 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2024.006.01.06

Background: Teratoma usually found in mediastinum and rarely found in the lung. Mature teratomas are the most common histological type of germ cell tumours, followed by seminoma. First case reported by Mohr in 1839 and until now only few cases of intrapulmonary teratomas have been reported. Case: A man, 64-years old man, nonsmoker complains of shortness of breath since 6 months and worsened in a week. Patient had history medication for tuberculosis in 2019. Chest Contrast CT-Scan showed hypodense mass and suggestive for benign left lung tumor. TTNA were performed and suggestive for teratoma. Joint conference with several department agree to proceed with thoracostomy. Thoracostomy with wide excision been done to remove the mass and examined for anatomic pathology then confirmed for mature teratoma. During thoracostomy, we cannot removed 100% of the tumor because it adhesive with aorta and parietal pleura. Patient treated in ICU and worsens. Unfortunately, patient passed away four days later. Conclusion: Teratoma is rarely found inside of the lung. Early diagnosis and resection of intrapulmonary teratoma is critical to prevent complications and provide definitive treatment.

The Correlation Between Type and Stage of Lung Cancer with The Chronic Obstructive Pulmonary Disease Group at Arifin Achmad Hospital, Pekanbaru Gurning, Andi Sarikawan; Munir, Sri Melati; Yunus, Faisal; Fauzi, Zarfiardy Aksa; Adrianison, Adrianison; Yovi, Indra; Indriani, Sri Indah
Jurnal Respirologi Indonesia Vol 45 No 2 (2025)
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.v45i2.512

Background: The relationship between lung cancer (LC) and chronic obstructive pulmonary disease (COPD) has been extensively studied but is still up for debate. COPD is a molecularly based illness and one of the independent risk factors for lung cancer, particularly squamous cell carcinoma. This study uses spirometry to assess the relationship between the type and stage of LC and COPD in a group of LC patients at Arifin Achmad Hospital. Methods: This cross-sectional study was conducted on lung cancer patients in Arifin Achmad Hospital, Pekanbaru, from June 2022 to December 2022. Based on spirometry examination, patients were grouped according to the degree of COPD. Then, the relationship between the COPD group and the type and degree of cancer was determined. Results: The study involved 52 patients predominantly male (71.2%), aged over 40 years (92.3%), Smokers and former smokers with Severe Brinkman index (69.2%), restrictive lung function (34.6%), COPD group D (40.4%), adenocarcinoma (61.5%), stage IV lung cancer (92,3%) and WHO Performance Status Scale 2 (61.5%). The FEV1/FVC rate in this study was 66.67%. There is a link between the stage of lung cancer and the group of COPD (P=0.001). Conclusion: There is a relation between the stage of LC in the COPD group, which is predominantly with stage IV lung cancer, and group D of COPD.

C-Reactive Protein and Procalcitonin as Markers for Post-Bronchoscopic Complications: A Literature Review Indriani, Sri Indah; Yovi, Indra; Syaf, Syarlidina; Simatupang, Elvando Tunggul Mauliate
Jurnal Respirologi Indonesia Vol 44 No 2 (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.v44i2.638

In the respiratory system, bronchoscopy is a basic procedure utilized for both diagnostic and therapeutic purposes. Despite being a generally safe procedure, bronchoscopy can result in complications that range in severity from moderate to severe. Pulmonary infection is among the potential complications that can happen after a bronchoscopy procedure. An incidence of 0.2% to 5.2% has been described typically for complications such as empyema, lung abscess, and pneumonia that may develop after bronchoscopy procedures. Although these complications are uncommon, their prognosis can be quite bad. The risk of pulmonary infection, specifically pneumonia, has been related in several studies to sepsis and mortality in patients enduring bronchoscopy procedures. The initiation of the infection exposure process into the lung can be assisted through a variety of factors, including the underlying diagnosis and the type of intervention performed during the bronchoscopy procedure. A critical complication that needs additional consideration is the potential transmission of infection through bronchoscopy procedures. It is beneficial to consider prophylactic antibiotics before a procedure due to the possibility that infectious agents will be transferred from one patient to another. Antibiotic prophylaxis may involve the utilization of C-reactive protein (CRP) and Procalcitonin (PCT) testing as determining parameters. Serial PCT and CRP 24–96 hours post-bronchoscopy procedure might help to determine one of the post-bronchoscopy complications.

Hypoxemia During Bronchoscopy and The Risk Factors Related Putri, Chyntia Triana; Indriani, Sri Indah; Yovi, Indra
Jurnal Respirologi Indonesia Vol 45 No 1 (2025)
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.v45i1.651

Background: Hypoxemia, a common complication of bronchoscopy, often occurs even with oxygen supplementation, particularly during procedures performed under sedation, with reported incidences ranging from 2.5% to 69%. Hypoxemia during bronchoscopy which is defined as desaturation under 90% or more than 5% decreasing of basal SpO2, becomes a concern due to possible fatal complications. This study aims to determine the incidence of hypoxemia during bronchoscopy and identify its predisposing risk factors. Methods: An analytic observational study with a cross-sectional design was held in our center from October 2022 until June 2023. As many as 100 consecutive patients who underwent bronchoscopy and met inclusion criteria were evaluated prospectively. The patient’s oxygen saturation was monitored by finger pulse oximetry during the procedure. Demographic characteristics, comorbidities, lung function, PaO2 value, ASA score, types of intervention, sedative agents, duration of sedation and procedure were recorded. The risk factors for hypoxemia during bronchoscopy were evaluated. Results: The incidence of hypoxemia during bronchoscopy in our center was 15%. Bivariate analysis showed pleural effusion as a comorbidity (9 patients; 60%), restrictive-obstructive lung function test (10 patients; 66.7%) and PaO2 value (76.87±8.219) were statistically significant (P<0.05) related to the existence of hypoxemia during bronchoscopy. Three other factors such as age, ASA score and duration of procedure with P<0.25 were included in multivariate analysis and found that the most influencing factor was the restrictive-obstructive lung function test (P=0.001; OR=13.845). Conclusion: Comorbidity (pleural effusion), lung function (restrictive-obstructive) and PaO2 value were some factors significantly related to hypoxemia during bronchoscopy with lung function being the most influencing factor.

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