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All Journal Sari Pediatri Paediatrica Indonesiana Jurnal Respirologi Indonesia Archives of Pediatric Gastroenterology, Hepatology, and Nutrition
Nastiti Kaswandani
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Cipto Mangunkusumo, Jakarta
Health Professions Medicine & Pharmacology

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Infeksi Tuberkulosis Laten pada Anak: Diagnosis dan Tatalaksana Nastiti Kaswandani; Madeleine Ramdhani Jasin; Gufron Nugroho
Sari Pediatri Vol 24, No 2 (2022)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp24.2.2022.134-40

Abstract

Infeksi laten tuberkulosis (ILTB) adalah keadaan respons imun persisten terhadap antigen Mycobacterium tuberculosis tanpa bukti manifestasi klinis tuberkulosis aktif. Anak-anak lebih mudah terinfeksi dan menjadi penderita tuberkulosis (TB) aktif dibandingkan orang dewasa setelah kontak erat dengan pasien TB aktif. Masa inkubasi TB bervariasi selama 2-12 minggu, biasanya 4-8 minggu. Investigasi kontak dan penegakan diagnosis ILTB harus dilakukan pada anak yang memiliki risiko tinggi terinfeksi, yaitu memiliki kontak erat dengan penderita TB aktif, dengan HIV, serta dengan kondisi imunokompromais lainnya. Pengobatan pencegahan ILTB bertujuan mencegah anak yang terinfeksi M.tuberculosis berkembang menjadi tuberkulosis aktif. Pedoman WHO yang kemudian diadopsi oleh Petunjuk Teknis Penanganan Infeksi Laten Tuberkulosis Kementerian Kesehatan Republik Indonesia tahun 2020 memberikan rekomendasi pemberian terapi pencegahan tuberkulosis yang terdiri dari beberapa pilihan obat dan durasi pemberian, antara lain isoniazid selama 6 bulan, isoniazid – rifampisin selama 3 bulan, isoniazid -  rifapentin sekali sepekan dalam 3 bulan, atau rifampisin selama 4 bulan. Diagnosis dini dan pemberian terapi pencegahan yang cepat penting untuk menurunkan kejadian TB aktif sehingga visi pemberantasan TB dunia pada tahun 2050 bisa tercapai.
Jadwal Imunisasi Anak Usia 0 – 18 Tahun Rekomendasi Ikatan Dokter Anak Indonesia Tahun 2023 Mei Neni Sitaremi; Soedjatmiko Soedjatmiko; Hartono Gunardi; Nastiti Kaswandani; Setyo Handryastuti; Raihan Raihan; Cissy B Kartasasmita; Ismoedijanto Ismoedjianto; Kusnandi Rusmil; Zakiudin Munasir; Dwi Prasetyo; Gatot Irawan Sarosa; Hanifah Oswari; Dominicus Husada; Ari Prayitno; Martira Maddepunggeng; Sri Rejeki H Hadinegoro.
Sari Pediatri Vol 25, No 1 (2023)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp25.1.2023.64-74

Abstract

Satuan Tugas Imunisasi Ikatan Dokter Anak Indonesia (IDAI) secara berkala mengevaluasi jadwal imunisasi untuk menyesuaikan dengan vaksin baru, program imunisasi Kemenkes, WHO position paper dan sumber-sumber lain. Di dalam jadwal imunisasi rekomendasi IDAI tahun 2023 ini ada beberapa tambahan antara lain vaksin dengue baru, dan keterangan tambahan beberapa vaksin lain. Untuk memudahkan dalam melaksanakannya dilampirkan juga tabel jadwal imunisasi tahun 2023. Untuk memahami dasar pertimbangan jadwal imunisasi dan perubahannya perlu mempelajari uraian di dalam artikel ini dan keterangan di bawah tabel tersebut untuk diterapkan ke dalam layanan imunisasi.
Co-Infection of Tuberculosis and COVID-19 in Children: A Case Report Madeleine Ramdhani Jasin; Talitha Rahma Ayuningtyas; Achmad Rafli; Irawan Mangunatmadja; Wahyuni Indawati; Nastiti Kaswandani
Jurnal Respirologi Indonesia Vol 44, No 1 (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.v44i1.323

Abstract

Background: Coinfection of TB and COVID-19 might occur, yet few evidence has been reported. Current COVID-19 pandemic also results in disruption at TB management in the community.Case: A 5-month-old boy came with recurrent seizure, with history of persistent cough and fever for 1 month prior, also positive possible TB contact. He was diagnosed with disseminated TB, involving miliary appearance in chest Xray also meningitis, coinfected with COVID-19.Discussion: During COVID-19 pandemic, TB service in the community is disrupted, resulting in delay in TB diagnosis, as observed in this patient, leading to severe manifestation. Coinfection of TB and COVID-19 can occur and may lead to more severe symptoms in either both diseases. Management of TB COVID-19 coinfected children is similar to those without COVID-19. Our patient received treatment consisting of 2 RHZE then 10 RH. Monitoring of symptoms and possible sequelae is necessary.Conclusion: Coinfection TB and COVID-19 may occur in children, and both can lead to more severe manifestation of each condition, particularly if diagnosis is delayed. Strengthening TB care in the community is essential so that there will be no delay in diagnosis, also no disruption in treatment and monitoring.
Clinical manifestations and prognosis of tuberculous spondylitis in an adolescent with disseminated tuberculosis: a case report Handryastuti, Setyo; Kaswandani, Nastiti; Hendriarto, Andra; Tobing, Singkat Dohar Apul Lumban; -, Pebriansyah; Rafli, Achmad
Paediatrica Indonesiana Vol. 64 No. 2 (2024): March 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.2.2024.176-83

Abstract

Indonesia is one of the countries with the highest number of tuberculosis (TB) cases globally. Around 10-20% of adolescents with TB infection progress to pulmonary TB, and less than 0.5% develop miliary or central nervous system TB. TB spondylitis occurs in only 5.6% of extrapulmonary TB patients. The clinical manifestations of disseminated and TB spondylitis are heterogeneous and insidious, with several potential risk- and prognostic factors. We report the case of a 16-year-old male admitted with abdominal distension, paraplegia, and urinary retention. He was diagnosed with disseminated TB with TB spondylitis. This case was unique because the patient had no classic symptoms of pulmonary TB. This report focuses on the diagnosis, comprehensive management, and prognosis of TB spondylitis, as well as the risk factors for disseminated TB. The management consisted of antituberculous agents and surgery. The prognosis is influenced by the patient’s age, severity of kyphosis deformity, number of vertebrae involved, lesion site, and patient’s health status, including nutritional status.
Correlation Between Tuberculosis Type and Comorbidities with Nutritional Recovery Rates Post-Tuberculosis Treatment in Pediatric Patients Amelia, Safira; Kaswandani, Nastiti
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 3 No. 3 (2024): APGHN Vol. 3 No. 3 August 2024
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.3.3.2024.1-11

Abstract

Background: Tuberculosis remains a significant cause of mortality in children. Nutritional status is one of the major risk factors for tuberculosis severity. This study investigated the factors influencing nutritional status in tuberculosis patients. Methods: This is a retrospective, cross-sectional study conducted in the tertiary national-referral hospital in Jakarta, Indonesia. Data were obtained from electronic health records from 2012-2018. This study included patients aged 0-18 years-old who were diagnosed and treated with anti-tuberculosis drugs. Patients who did not complete the therapy for minimum 2 months were excluded. Results: A total of 207 patients were included in this study. The type of tuberculosis was associated with the nutritional status of children after 2 months of treatment (p value = 0.014; 95% CI = 0.422 - 0.914). Children with extrapulmonary TB showed better improvement in nutritional status compared to those with pulmonary TB. Comorbidities were also associated with nutritional status (p-value = 0.020; CI95% = 1.063 - 2.382). Patient without comorbidities experience better nutritional status improvement than those with comorbidities. Conclusion: The nutritional status of tuberculosis patients improved after the 2-months of treatment. The type of tuberculosis and the presence of comorbidities influence the outcomes of nutritional status during anti-tuberculosis treatment.
Jadwal Imunisasi Anak Usia 0-18 Tahun Rekomendasi Ikatan Dokter Anak Indonesia Tahun 2024 Kaswandani, Nastiti; Gunardi, Hartono; Prayitno, Ari; Kartasasmita, Cissy B.; Prasetyo, Dwi; Husada, Dominicus; Sarosa, Gatot Irawan; Oswari, Hanifah; Ismoedijanto, Ismoedijanto; Rusmil, Kusnandi; Maddepunggeng, Martira; Sitaresmi, Mei Neni; Raihan, Raihan; Handryastuti, Setyo; Soedjatmiko, Soedjatmiko; Hadinegoro, Sri Rezeki S.; Munasir, Zakiudin
Sari Pediatri Vol 26, No 5 (2025)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp26.5.2025.328-36

Abstract

Satuan Tugas Imunisasi Ikatan Dokter Anak Indonesia secara periodik melakukan kaji ulang jadwal imunisasi dengan menyelaraskan dengan buku pedoman imunisasi di Indonesia edisi ke 7 tahun 2024, dan sumber-sumber lainnya. Jadwal imunisasi selalu dievaluasi ulang karena beredarnya vaksin baru yang telah disetujui oleh BPOM dan vaksin yang tidak tersedia lagi di Indonesia. Terdapat beberapa perubahan dalam jadwal imunisasi rekomendasi IDAI tahun 2024 yaitu ketersediaan jenis vaksin, seperti pada pneumococcal conjugate vaccine (PCV), vaksin rotavirus, vaksin varisela, vaksin dengue, dan vaksin human papillomavirus (HPV). Agar dalam pelaksanaan lebih mudah, disertakan juga tabel jadwal imunisasi tahun 2024 di akhir.
Co-Infection of Tuberculosis and COVID-19 in Children: A Case Report Jasin, Madeleine Ramdhani; Ayuningtyas, Talitha Rahma; Rafli, Achmad; Mangunatmadja, Irawan; Indawati, Wahyuni; Kaswandani, Nastiti
Jurnal Respirologi Indonesia Vol 44 No 1 (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.v44i1.323

Abstract

Background:Coinfection TB and COVID-19 might occur, yet few evidence has been reported. Current COVID-19 pandemic also results in disruption at TB management in the community. Case: A 5-month-old boy came with recurrent seizure, with history of persistent cough and fever for 1 month prior, also positive possible TB contact. The diagnosis was disseminated TB (miliary and meningitis), coinfected with COVID-19.Discussion: During COVID-19 pandemic, TB service in the community is disrupted resulting in delay in TB diagnosis, as observed in this patient, leading to severe manifestation. Coinfection of TB and COVID-19 can occur and may lead to more severe symptoms in either both diseases. Management of TB COVID-19 coinfected children is similar to those without COVID-19. Our patient received treatment consisting of 2 RHZE then 10 RH. Monitoring of symptoms and possible sequelae is necessary.Conclusion: Coinfection TB and COVID-19 may occur in children, and both can lead to more severe manifestation of each condition, particularly if diagnosis is delayed. Strengthening TB care in the community is essential so that there will be no delay in diagnosis, also no disruption in treatment and monitoring.Keywords COVID-19, tuberculosis, coinfection, children
Therapeutic reassessment of first-line antiepileptic drugs in pediatric patients unresponsive to second-line agents: a randomized trial in Jakarta Perdani, Roro Rukmi Windi; Arozal, Wawaimuli; Mangunatmadja, Irawan; Kaswandani, Nastiti; Handryastuti, Setyo; Medise, Bernie Endyarni; Wardani, Amanda Saphira; Thandavarayan, Rajarajan Amirthalingam; Oswari, Hanifah; Lee, Hee Jae
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

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

Abstract

Background Epilepsy has a significant incidence in children, with 20-25% resistance to standard antiepileptic drugs (AEDs). Drug-resistant epilepsy (DRE) refers as the failure of two or more AEDs, either as monotherapies or in combination, to achieve seizure freedom, which includes the absence of all seizure types, even auras. Treatment algorithms for children with epilepsy range from starting with the lowest effective dose to using add-on or substitution therapy of AEDs. It usually started from using first-line AEDs (valproic acid, phenytoin, phenobarbital, carbamazepine) with titrated dose based on the patient condition, if seizure persist, another first-line AEDs may be added or substituted. Second-line AEDs (topiramate, levetiracetam, oxcarbazepine) are introduced when seizure persist despite optimal doses of first-line drugs with good compliance. Epilepsy treatment response is a dynamic process, not a fixed state. In some cases, repeating the medication cycle remains an option, as patient may initially appear drug-resistant but later respond to treatment. Thus, first-line AEDs may also serve as substitution therapy in children unresponsive to second-line agents as studies show comparable effectiveness between the two regimens. Objective To evaluate the efficacy and safety of first-line AEDs as substitution therapy (intentional replacement of patient’s current medication) in children resistant to second-line AEDs. Methods This 12-week, open-label, multicenter, randomized controlled trial was conducted in 91 epileptic children. Children aged 1 – 18 years with DRE, were randomized into the intervention (patients who received substitution therapy:  one AEDs was changed to first-line of AEDs) and control (patients who got standard therapy: one AEDs was changed to second-line of AEDs) groups. The primary outcome was the difference in the proportion of responders between the two groups. Secondary outcomes were analyzing the different improvements in quality of life (QoL), EEG feature, and time to achieve seizure reduction in both groups. The QoL was assessed by Quality of Life in Childhood Epilepsy Questionnaire 55 (QOLCE-55) to assess cognitive, emotional, social, and physical functions. Results There were no significant differences in the proportion of responders between the substitution therapy group (62.5%) and the standard therapy group (68.4%). Both groups experienced substantial reductions in seizure frequency, ranging from 78% to 80%. For further analysis, the average difference of seizure frequency before and after intervention was statistically significant in each group, it was P=0.000 in substitution group and P=0.00 in standard group. The analysis of quality of life showed the mean of total score in both groups was low even though the score was higher in the substitution group. For spesific function of quality of life, the cognitive and social function, was improved significantly in the group p<0.05). However, there were no significant differences of EEG improvement, seizure duration, time to achieve seizure frequency reduction, or adverse effects between the two groups. Conclusions First-line AEDs have comparable efficacy as second-line AEDs with mild to moderate adverse effects in DRE children. Thus, the repeated use of first-line AEDs as substitution therapy might be an option for children who resistant to second line AEDS.
Co-Authors -, Pebriansyah Aman Bhakti Pulungan Amelia, Safira Angela Kimberly Tjahjadi Ari Prayitno Ari Prayitno, Ari Arwin AP Akib Ayuningtyas, Talitha Rahma Bambang Supriyatno Bambang Tridjadja Bernie Endyarni Medise Cissy B Kartasasmita Cissy B. Kartasasmita Cynthia Utami Damayanti Rusli Sjarif Darmawan B Setyanto Darmawan B Setyanto Darmawan B. Setyanto Dhyniek Nurul FLA Dominicus Husada Dwi Prasetyo Dwi Prasetyo Dwi Putro Widodo Finny Fitry Yani Gatot Irawan Sarosa Gatot Irawan Sarosa, Gatot Irawan Gufron Nugroho Hanifah Oswari Hanifah Oswari Hartono Gunardi Hartono Gunardi Hartono Gunardi Hendriarto, Andra Irawan Mangunatmadja Irawan Mangunatmadja Ismoedijanto Jasin, Madeleine Ramdhani Jose RL Batubara Karina Sugih Arto Kusnandi Rusmil Kusnandi Rusmil Lee, Hee Jae Maddepunggeng, Martira Mardjanis Said Martira Maddepunggeng Mei Neni Sitaremi Mei Neni Sitaresmi Murti Andriastuti, Murti Nastiti Noenoeng Rahajoe Nia Kurniati Nurul Iman Nilam Sari Rafli, Achmad Raihan Raihan Raihan Raihan, Raihan Roro Rukmi Windi Perdani, Roro Rukmi Rulina Suradi Setyo Handryastuti Soedjatmiko Soedjatmiko Soedjatmiko Sri Rejeki H Hadinegoro. Sri Rezeki Hadinegoro Sri Rezeki S. Hadinegoro, Sri Rezeki S. Sukman Tulus Putra Talitha Rahma Ayuningtyas Thandavarayan, Rajarajan Amirthalingam Tobing, Singkat Dohar Apul Lumban Wahyuni Indawati Wahyuni Indawati Wahyuni Indawati, Wahyuni Wardani, Amanda Saphira Wawaimuli Arozal Widodo Tirto Zakiudin Munasir Zakiudin Munasir