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All Journal Folia Medica Indonesiana Jurnal Respirasi (JR) Biomolecular and Health Science Journal Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Indian Journal of Forensic Medicine & Toxicology

Kusmiati, Tutik

Departemen Pulmonologi Dan Ilmu Kedokteran Respirasi, Fakultas Kedokteran Universitas Airlangga

Author-ID : 4146932

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Other

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CORRELATION BETWEEN INTERFERON GAMMA RELEASE ASSAY OF ELISPOT METHOD AND CD4+ T LYMPHOCYTE CELL COUNT IN HIV POSITIVE PATIENTS Ambar, Nabil Salim; Aryati, Aryati; Kusmiati, Tutik; Triyono, Erwin Astha
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 25, No 3 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i3.1416

Introduction. HIV is a virus that can cause AIDS, which affects the immune system and weakens the body function in fighting disease. The primary cells that HIV attacks are CD4+ T lymphocytes. Opportunistic Infections (OIs) are the biggest risk factors of death in HIV patients and occur in CD4+ T cells <200 cells/μL lymphocytes. TB is a disease with a high mortality rate in the world where Indonesia is a TB endemic country with the highest morbidity rates of TB in the world. The most common OI in people with HIV is TB. The number of limitations on Tuberculin Skin Test (TST) is large, thus in vitro T cells test with (Interferon Gamma Release Assay) IGRA is used in diagnosing latent TB. The aim of this study was to determine the correlation between IGRA ELISPOT method and CD4+ T lymphocyte cell count in HIV positive patients.Method. This was an observational analytical study with cross sectional design. The number of samples was 56 HIV positive patients who were treated at the UPIPI Clinic of the Dr Soetomo Surabaya Hospital. The examination of CD4+ T lymphocyte count was perfomed with FACSCalibur and IGRA was examined with T-SPOT.TB. The results were analyzed using Spearman correlation test.Results. CD4 + lymphocyte cell counts based on WHO groupings were as follows: > 500 cells / μL (33.92%), 200-349 cells / μL (25%), 350-499 cells / μL (25%) and <200 cells / μL (16 , 07%). IGRA examination results showed 35.18% positive and 64.81% negative. The grouping of CD4+ T lymphocyte cell counts based on IGRA test results was 27.77% with positive IGRA and 48.14% with negative IGRA. Spearman correlation test between CD4+ T cell lymphocytes with IGRA in HIV positive patients showed r = 0,036 (p = 0,794).Conclusion. There was no correlation between interferon gamma release assay of ELISPOT method and CD4+ T lymphocyte cell count in HIV positive patients.

Impact of Bedaquiline on Multidrug-Resistant Tuberculosis Treatment to Mother and Baby: An Incidental Case Tutik Kusmiati1 , Faradila Nur Aini2
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 1 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i1.13669

Background: Bedaquiline is a new drug which is recommended by World Health Organization (WHO) forindividual regiment drug resistant-tuberculosis (DR-TB). The presence of regiment DR-TB in the bloodis long enough with T1/2 5-6 months, that is why bedaquiline is given on six months. Bedaquiline is notrecommended for pregnant women because there is no data related to safety. The author will report anincidental pregnant female on bedaquiline treatment.Case presentation: A 24-year-old woman with multidrug resistant tuberculosis (MDR TB) on individualregiment bedaquiline had incidental pregnancy at the 6th month treatment. In the beginning, the patientused bedaquiline because of the intolerance of second-line injectable drug. Bedaquiline regiment was usedfor 24th week. Pregnancy occured at the 6th month treatment. The patient continued the pregnancy and theMDR TB treatment was continued without bedaquiline. Nausea and vomiting were getting worse. Pretermlabour occured in 33/34 weeks by cesarean section. The baby had severe asphyxia, used continuous positiveairway pressure (CPAP), treated in NICU, had low weight but there was no disability. After several days oftreatment, the condition of baby was improving and was able to outpatient.Conclusion: The preterm labour, low birth weight, and neonatal emergency occured in a pregnant womanwith MDR TB on individual regiment bedaquiline. Mother and baby can survive. More case and researchdata are needed on the safety of bedaquiline during pregnancy.

A Woman with Tuberculosis Multidrug Resistance and QTc Prolongation Repetitive Interval: A Case Report Tutik Kusmiati; Ni Made Mertaniasih; Johanes Nugroho Eko Putranto; Budi Suprapti; Soedarsono; Abdul Rahman Bahmid
Indian Journal of Forensic Medicine & Toxicology Vol. 15 No. 4 (2021): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v15i4.17119

Background : Prolonged QTc interval is one of the side effects of the short-regimen MDR-TB. QTcprolongation is a risk factor for Torsades de pointes and is influenced by many factors. Case : 47-year-oldwoman who was diagnosed with MDR-TB through GeneXpert examination and received short-regimenMDR-TB. This patient experienced repeated QTc prolongation, with peak QTc interval 600 msec occurringat 4th month with mild hypokalemia without clinical symptoms. The patient completed 9 months of shortregimentherapy with improve chest x ray followed by negative sputum culture. Conclusion : Short-regimenMDR-TB contains several drugs that cause QTc prolongation. Clinical evaluation is required in patientswith QTc prolongation before changing the regiment.

Factors Associated with Acid Fast Bacilli and Sputum Culture Conversion in Patients with Multidrug-Resistant Tuberculosis in Surabaya Naomi Rahmasena; Isnin Anang Marhana; Muhammad Yamin Sunaryo Suwandi; Tutik Kusmiati; Tuksin Jearanaiwitayakul
Biomolecular and Health Science Journal Vol. 4 No. 2 (2021): Biomolecular and Health Science Journal
Publisher : Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bhsj.v4i2.29763

Introduction: Indonesia is a high incidence country of multidrug-resistant tuberculosis. There are approximately 11,000 MDR TB cases, 2.8% of them are new cases and 16% of them are relapse cases. Although guidelines for MDR-TB are frequently designed, medication freely provided, and centers for treatment duly expanded, studies on time to sputum culture conversion have been very limited in Indonesia. Therefore the aim of the study is to identify risk factors that effect on sputum and culture conversion.Methods: Data on short-term regimen for MDR TB in Dr. Soetomo General Hospital from January 1st – December 31st, 2018 were collected with a total sampling approach, and fulfill the inclusion and exclusion. Data were analyzed by computer software IBM SPSS Statistic 24 for windows. Results: Male is more likely to have delayed sputum conversion and culture conversion but no statistical difference is observed (p>0.05). Smoking history is more likely to have delayed sputum and culture conversion but only in sputum smear test shows a significant difference (p≤ 0.05). Alcohol consumption has delay effect on sputum and culture conversion but there is statistically difference in only culture conversion (p<0.05). The high baseline smear test also affects delay the sputum and culture conversion but only in sputum smear reveals a significant effect (p<0.05).Conclusion: In this present study, we identified sex, smoking history, high bacillary loads as significant factors on sputum conversion. In addition, we revealed that alcohol-consumption history is a significant factor affecting on culture conversion.

Diagnostic Value of Encode TB IgG and IgM Rapid Test to Support Pulmonary Tuberculosis Diagnosis Notrisia Rachmayanti; Aryati Aryati; Tutik Kusmiati
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 26, No 2 (2020)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v26i2.1524

Diagnosis of tuberculosis can be established through the detection of antigens by Acid Fast Bacilli (AFB), microscopy,culture, and Polymerase Chain Reaction (PCR). The World Health Organization (WHO) 2012 issued a recommendation not touse antibody detection in the diagnosis of tuberculosis. However, there is high demand from clinicians to detectanti-tuberculosis antibody in patients who are challenging to do a bacteriological examination. The purpose of this researchwas to determine the diagnostic value of anti-M.tuberculosis IgG and IgM Encode TB to support lung tuberculosis diagnosis.This study was a cross-sectional by using consecutively sampling, which was performed in the Dr. Soetomo Hospital,Surabaya, Indonesia, from November 2017 until May 2018. A total of 52 patients were included and evaluated for clinical orbacteriological examination using AFB microscopy or PCR (Gene Xpert) as the gold standard and tested theanti-M.tuberculosis IgG and IgM with immunochromatography. Encode Tuberculosis (TB) IgG was positive in 12 patientsfrom the tuberculosis group and one false-positive in the non-tuberculosis group. The diagnostic sensitivity, specificity,positive predictive value, negative predictive value, and accuracy of Encode TB IgG dan IgM were 35%, 94%, 92%, 43% and55.7%, respectively. The specificity was high that the positive result was considered as TB; the sensitivity was low that thenegative results were not excluded from TB. Encode TB IgG/IgM rapid test was not recommended to use as a singlediagnostic test and must be combined with other diagnostic tests to increase the sensitivity.

Testicular Tuberculosis in an HIV Positive Patient Co-infection with Pulmonary Tuberculosis Mimicking Malignancy: A Case Report Wahyu Agung Purnomo; Tutik Kusmiati; Soedarsono Soedarsono
Jurnal Respirasi Vol. 6 No. 2 (2020): May 2020
Publisher : Faculty of Medicine Universitas Airlangga

Background: Extrapulmonary involvement can be seen in more than 50% of patients with concurrent HIV and tuberculosis (TB). Approximately 7% of those are presented as a rare case, namely testicular TB, with scrotal mass as common clinical manifestation. Testicular TB should be a different diagnosis, especially in areas with a high prevalence rate for TB.Case: A 24-year-old male with HIV positive co-infection with pulmonary TB presented with a progressively increasing painless right testicular swelling of 1-month duration. History of chronic cough was complained, accompanied by loss of appetite and decrease of body weight. There was no history of testicular traumatic accident before. Genital examination was right testicular mass measuring 7cm x 4cm and depletion of right side scrotal skin with pus and necrotic tissue. He had right orchidectomy by an urologist in a private hospital; then an anatomical pathology was examined. The result of the microscopic evaluation showed granuloma inflammation process typical for orchitis tuberculosis. The patient was reactive for HIV and had Mycobacterium tuberculosis (MTB) detected, Rifampicin resistant not recognized as the result of Gene Xpert MTB/RIF assay.Conclusion: Although a rare case, testicular TB should be a different diagnosis when there is a patient with HIV positive concurrent pulmonary TB with scrotal mass as clinical manifestation, especially in areas with a high prevalence rate for TB.

Cerebellar Tuberculoma in a Patient with Lung Tuberculosis New Case: A Case Report Gemilang Khusnurrokhman; Tutik Kusmiati
Jurnal Respirasi Vol. 6 No. 3 (2020): September 2020
Publisher : Faculty of Medicine Universitas Airlangga

Background: Tuberculosis (TB) is an infectious disease which can occur in the lungs and extra lung. One kind of extra lung TB is Cerebellum tuberculoma, which is one of rare manifestations form of TB, difficult to diagnosed, because sign and symptom is not specific.Case: A 17-year-old female presented a TB symptoms. She also had contact with her neighbor that was diagnosed with TB. In physical examination there was reduced motor function on her right extremities. Chest radiology revealed opacities in 2/3 superior in the left lung before treatment. Computed Tomography (CT) head scan with contrast showed ring contrast enhancement in left subcortical hemisphere cerebellum with size as 1.8 x 1.8 x 1.7 cm. Multiple lymphadenopathy in right-left upper-aid jugular and lymph node subcentimeter in right of submandibular, right-left lower jugular with varieties of size, the biggest is 1.6 x 1.5 cm. After 6 months treatment the tuberculoma of cerebellum was gone. Conclusion:Cerebellum tuberculoma is a rare presentation of active TB. Radiological imaging plays an important role in the diagnosis and monitoring of the disease. The appereance of tuberculoma on our patient CT showed nodular-enhancing lesion. Intracranial tuberculoma should be treated conservatively, since the majority of these lesions resolve completely with Anti-Tuberculosis Drugs (ATD). Our patient started ATD and the lesions completely disappeared within 6 months. We wanted to present our case due to well-responded to ATD and being an example of atypical presentation of tuberculosis both clinically and radiologically.

Allergic Reaction due to Anti-Tuberculosis Drugs, How to Manage? Nur Prasetyo Nugroho; Tutik Kusmiati
Jurnal Respirasi Vol. 7 No. 2 (2021): May 2021
Publisher : Faculty of Medicine Universitas Airlangga

Tuberculosis (TB) still becomes a significant health problem in Indonesia. The first-line anti-tuberculosis drug (ATD) is still the most effective TB drug, but it can have some side effects. One of them is allergic skin reactions that can affect a patient's compliance. Allergic reactions due to ATD are found in 4-6% of TB cases and are the third most frequent side effect after gastrointestinal and liver function disorder. All first-line ATD can cause allergic reactions. Allergic reactions due to ATD can be mild, such as itching and reddish rashes, to severe and life-threatening rashes, such as anaphylactic shock, Steven Johnson Syndrome (SJS), and Toxic Epidermal Necrotic (TEN). The most important things in the management are identifying and stopping drugs. It includes drug challenge and desensitization of causing drug. Desensitization must be distinguished from drug challenge or provocation tests, which are diagnostic tools. The proper management of ATD allergic reactions can improve compliance and patient's outcomes.

Manajemen Pemberian Antibiotik dengan Hasil Uji Kepekaan Resisten: [Management of Antibiotics Use with Resistant Sensitivity Test Results] Deny Perdana Putra; Tutik Kusmiati
Jurnal Respirasi Vol. 1 No. 1 (2015): Januari 2015
Publisher : Faculty of Medicine Universitas Airlangga

The use of antibiotics in developed countries 13-37% and 30-80% in developing countries. Inappropriate use of antibiotics around 40-62%. There is a relationship between the use of antibiotics in bacterial resistance. Reported a man, 45 years old with a diagnosis of pneumonia + sepsis + DM Type 2 + hypoalbuminemia + anemia + suspek nephrotic syndrome. Empirical therapy is given Meropenem and Levofloxacin 1 750 3 1 grams milligrams. Evaluation after empirical therapy showed no improvement clinically and radiologically. The result of the patient ‘s sputum cultures of Pseudomonas aeruginosa which are resistant to antibiotics tested, therefore the definitive therapy can not be given based on antibiotic susceptibility. The cause of this multifactorial resistance in patients with Pseudomonas resistance to antibiotics through four mechanisms. Therefore, definitive therapy based on local patterns of bacteria and sensitivity test on pneumonia issued by the Department of Microbiology Clinic. Based on the data, antibiotic Piperacillin-tazobactam 4 4, 5 grams are then administered. The results of the evaluation of clinical, radiological and laboratory showed significant improvements in patients.

TB MDR Primer dengan Limfadenitis TB pada Wanita SLE: [Primary Multidrug-Resistant Tuberculosis Mixed with Lymphadenitis Tuberculosis in a Woman with SLE] Ika Yunita Sari; Tutik Kusmiati
Jurnal Respirasi Vol. 1 No. 3 (2015): September 2015
Publisher : Faculty of Medicine Universitas Airlangga

Background: Primary resistance is the resistance that occurs in patients who have never received treatment OAT or had ever received treatment OAT is less than 1 month. The incidence of primary MDR in Central Java in 2006 2.07%. Extrapulmonary TB about 15-20% of all cases of TB, and TB lymphadenitis is the highest form (35% of all extrapulmonary TB). Patients with decreased immune systems (SLE) can increase the incidence of TB. Research in Spain get 6x higher TB incidence in patients with SLE. Case: We present the case of 19 year old woman SLE who received treatment for 11 months whose came with shortness of breath and chronic cough since 2 month prior to admission. In physical examination we found right and left submandibula lymphonodi enlargement as solid, slightly mobile nodule with diameter 3 cm. Chest X ray showed lung inflammation which suspicion of specific process and minimal left pleural effusion, and concluded as pulmonary TB. FNAB confirmed lymphadenitis TB with granulomatous inflammation. One of AFB result is positive and Gene Xpert is MTB positive with rifampicin resistant that make this patient categorized as primary MDR TB with lymphadenitis TB. This patient received Pirazinamid 1500 mg, Ethambutol 800 mg, Kanamicin 750 mg, Levofloxacin 750 mg, Ethionamide 500 mg, Cicloserin 500 mg, and B6 100 mg. Conclusion: MDR TB in general occur in patients with a history of OAT previous TB (MDR TB secondary). Primary MDR TB with lymphadenitis tb is a rare case, but can occur on the condition that decreases the immune system, one of SLE. This involves multiple immune disorders caused by the use of long-term immunosuppressive therapy.

Co-Authors Abdul Rahman Bahmid Aryati Aryati Aryati Aryati Aryati Aryati Bakhtiar, Arief Budi Suprapti Deny Perdana Putra Erwin Astha Triyono Gemilang Khusnurrokhman Hapsari Paramita Narendrani Ida Bagus Ngurah Rai Ika Yunita Sari Indrawanto, Dwi Wahyu Isnin Anang Marhana Kadek Widianiti Made Agustya Darmaputra Wesnawa Mega Rizkya Arfiana Mohammad Yamin Sunaryo Suwandi Nabil Salim Ambar Naomi Rahmasena Ni Made Mertaniasih Notrisia Rachmayanti Novita Maulidiyah Nur Prasetyo Nugroho Permatasari, Ariani Prayitno, Jongky Hendro Putranto, J.Nugroho Eko Resti Yudhawati S. Soedarsono Semedi, Bambang Pudjo Setiawati, Rosy Soedarsono Soedarsono Syafa'ah, Irmi Tuksin Jearanaiwitayakul Umi Fatmawati Wahyu Agung Purnomo Winariani Koesoemoprodjo

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