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All Journal Jurnal Penyakit Dalam Indonesia
Teguh Harjono Karjadi, Teguh Harjono
Divisi Imunologi Alergi, Department Ilmu Penyakit Dalam, Fakultas Kedokteran, Universitas Lampung
Medicine & Pharmacology

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Cutaneous Adverse Drug Reaction Among HIV-Infected Patients Starting Antituberculosis Treatment Widhani, Alvina; Karjadi, Teguh Harjono; Yunihastuti, Evy; Salwani, Desi; Pramudita, Angga; Nababan, Saut Horas; Praptini, Mirna Nurasri; Mondrowinduro, Prionggo
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 4
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Introduction. Treatment of tuberculosis (TB) in HIV patients is complicated due to numerous comorbidities and possible adverse effects. One of which is cutaneous adverse drug reaction (CADR). This adverse event is often difficult to manage because of multiple medications the patients get. The objective of this study was to know the prevalence and risk factors of CADR among HIV-infected patients starting anti-TB treatment. Methods. This retrospective study reviewed data from medical records of new patients at Working Group on AIDS outpatient clinic at Cipto Mangunkusumo Hospital, Indonesia in January 2008-December 2010 that had started anti-TB treatment. Risk factors of CADR among HIV patients treated with antituberculosis drugs evaluated were sex, age, route of HIV transmission, TB manifestation, and baseline CD4+ cell count. Numeric data were analyzed using independent T-test if normally distributed, otherwise Mann Whitney U test were used. Chi-square or Fisher’s exact test were used for categorical data. p-value was considered significant if below 0.05. Results. Of 454 HIV-infected patients that started anti-TB treatment, median age was 30 years. Most patients were male and intravenous drug users/IDU. Median baseline CD4+ cell count was 61 cells/ μL. There were 10.6% subjects that developed CADR. Most common manifestations were maculopapular rashes (66.7%), followed by erythema multiforme (14.6%), and Stevens Johnson Syndrome (8.3%). Anti-TB drugs were stopped and then re-challenge was conducted in 54.2% patients. Anti-TB drugs were continued and only the suspected drug was stopped in 29.2% patients. The offending drugs were cotrimoxazole (41.7%), rifampicine (41.7%), ethambutol (16.7%), pyrazinamide (14.6%), pyrimethamine (12.5%), isoniazide (10.4%), streptomycin (8.3%), efavirenz (8.3%), fixed dose combination of antituberculosis drugs (8.3%), and nevirapine (4.2%). The proportion of CADR was higher in woman than man (12% vs. 10.3%, p=0.66), non-IDU than IDU (13% vs. 9.2%, p=0.20), without extrapulmonary TB than extrapulmonary TB (11.1% vs. 9.4%, p=0.29), but the associations weren’t statistically significant. Median age was higher (31 vs. 30 years, p=0.32) and CD4 cell count (59.5 vs. 62 sel/μL, p=0.96) was lower in CADR group than non CADR group. Conclusion. The prevalence of CADR among HIV-infected patients starting anti-TB treatment was 10.6%. Sex, age, route of HIV transmission, TB manifestation, and baseline CD4+ did not have statistically significant association with CADR.
Profilaksis Pasca Paparan Virus HIV pada Petugas Kesehatan Karjadi, Teguh Harjono
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 1
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Health workers (HCWs) are prone to get infected by HIV infection when carrying out their duties. The injuries can be caused by needle sticks, sharp objects (scalpels, lancets, or other) that have been exposed to body fluids or splashes of body fluids onto the body’s mucosa (eyes, nose, mouth) and non-intact skin have the potential to transmit the HIV infection. Post-exposure transmission due to contamination of body fluids to health workers can be prevented by providing post-exposure prophylaxis therapy. Post-exposure prophylaxis (PEP) is given as soon as possible and no later than 72 hours after exposure. Prophylaxis is given to HCWs who are significantly exposed using three antiretroviral drugs. In Indonesia, for adolescents and adults ≥ 10 years old, the main choice is Tenofovir (TDF) + Lamivudine (3TC) + Dolutegravir (DTG). Simultaneously with the administration of ARV drugs, counseling is also carried out regarding side effects of ARV, medication adherence, drug interactions, the possibility of seroconversion, and if necessary, management of anxiety that may arise. ARVs will be given for 28 days. After being given post-exposure prophylactic therapy, monitoring for side effects of ARV drugs must be carried out which are given in the 2nd and 4th week. Re-examination of HIV testing to see the effectiveness of treatment was carried out at 12 weeks and 6 months after exposure. Keywords: HIV infection, PEP of HIV
Performance of Xpert MTB/RIF by Using Gastric Lavage Samplein The Diagnosis of Pulmonary Tuberculosis in HIV Patients withSuspected Pulmonary Tuberculosis Mboeik, Manuel Lamberto Willem; Pitoyo, Ceva Wicaksono; Karjadi, Teguh Harjono; Karuniawati, Anis; Dewiasty, Esthika
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 1
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Introduction. Xpert MTB/RIF test on gastric lavage sample may improve pulmonary tuberculosis (TB) case finding, but its performance as a diagnostic test for pulmonary TB in HIV-infected adults patients has not been studied widely, including in Indonesia. This study aims to determine the performance of the Xpert MTB/RIF test in diagnosing pulmonary tuberculosis 30 | Jurnal Penyakit Dalam Indonesia | Vol. 5, No. 1 | Maret 2018 Manuel Lamberto Willem Mboeik, Ceva Wicaksono Pitoyo, Teguh Harjono Karjadi, Anis Karuniawati, Esthika Dewiasty among HIV-infected adult patients with suspected pulmonary tuberculosis by using gastric lavage sample. Method. A cross-sectional study was conducted on adult HIV-infected patients with suspected pulmonary tuberculosis in Cipto Mangunkusumo hospital Jakarta between February 2016 and June 2017. Gastric lavage sample and sputum sample collection were performed for Xpert MTB/RIF test and acif fast bacilli (AFB) smear examination. Results. Among total of 117 subjects, 81 (69,2%) subjects were unable to expectorate sputum. M tuberculosis was detected on Xpert MTB/RIF using gastric lavage samples in 34 (29,1%) subjects, AFB in 4 of 36 sputum samples and 2 of 117 gastric lavage samples. The drug sensitivity test on all 34 Xpert MTB/RIF positive subjects showed no rifampicin resistance. Fifty-one (43.6%) subjects were diagnosed as clinical pulmonary tuberculosis, 26 subjects among them were positive on Xpert MTB/ RIF assay, 4 subjects were smear sputum positive and 1 subject was gastric lavage smear positive. Using clinical diagnosis of pulmonary TB as gold standard, a single Xpert MTB/RIF assay using gastric lavage sample showed sensitivity of 50.98% (95% CI: 36.6-65.25), specificity 87.88% (95% CI: 77,1-94,62), positive predictive value 76,47% (95%CI: 61,67-86,78) and negative predictive value 69,88% (95% CI: 63,36-75.68). Conclusion. Xpert MTB/RIF performed on gastric lavage samples showed sensitivity of 50.98% and specificity 87.88% in clinical diagnosis of pulmonary tuberculosis in HIV-positive patients with pulmonary tuberculosis.
Survei Kebutuhan Edukasi Pasien Lupus Eritematosus Sistemik Josephine, Jennifer; Widhani, Alvina; Cahyanur, Rahmat; Karjadi, Teguh Harjono
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 4
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Introduction. Patients with systemic lupus erythematosus (SLE) who suffer from chronic illness, need tailored education to better manage their condition. As nowadays education through internet and social media contributes significantly. This study aimed to assess internet usage related to lupus, educational needs, and education sources preferences among patients. Methods. This study was a cross-sectional study conducted on adult SLE patients at Allergy and Clinical Immunology Clinic, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, between July-August 2023. Respondents completed a set of questionnaires regarding their internet usage related to lupus, education platform preferences, and educational needs assessment tool (ENAT). Results. Sixty-five female subjects participated, with a median (range) age of 32 (19-56) years. Respondents who used the internet and social media for lupus-related matters were 92.3%. The ENAT domains prioritized by patients were knowledge about the disease (score 89%) and emotional management (score 85%). The primary sources of education desired by patients were direct education from doctors/nurses (87.7%), Instagram (55.4%), and YouTube (55.4%). Conclusions. SLE patients expressed a strong need for knowledge about the disease and emotional management, with doctors/nurses as the preferred sources of education. The widespread use of the internet for lupus-related information indicates a great opportunity for providing education through online platforms, particularly through Instagram, and YouTube.
Efektivitas Vaksin COVID-19 mRNA Booster Kedua pada Tenaga Kesehatan di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo dan Faktor yang Memengaruhinya Lubis, Siti Taqwa Fitria; Koesnoe, Sukamto; Yunihastuti, Evy; Shatri, Hamzah; Karjadi, Teguh Harjono; Harimurti, Kuntjoro; Pitoyo, Ceva Wicaksono; Yunir, Em
Jurnal Penyakit Dalam Indonesia
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Introduction. The emergence of the Omicron variant during the pandemic had an impact on the effectiveness of the COVID-19 vaccine. The spread of Omicron increased rapidly even in populations that had been vaccinated with booster doses, causing a high incidence of infection. This study aimed to determine the effectiveness and factors related to the effectiveness of the second mRNA booster vaccine as well as antibody levels after the second mRNA booster vaccine in healthcare workers at Cipto Mangunkusumo National General Hospital. Methods. This study used a cohort design. Total sampling of 271 healthcare workers were obtained from previous research and continued with consecutive sampling. Selected subjects were interviewed, and blood samples were taken to measure IgG sRBD antibody levels. The effectiveness of the vaccine was calculated, and bivariate and multivariate analysis was carried out to assess the factors that influenced the effectiveness of the second mRNA booster vaccine. Results. A total of 9 subjects (5.6%) were infected with COVID-19 in the second booster vaccine group and 11 subjects (9.7%) in the first vaccine group. The effectiveness of the vaccine against COVID-19 infection was 42% (CI 95% -37 – 75%), p = 0,215. Age, gender, hypertension, type 2 DM, obesity, smoking, and COVID-19 infection before booster have no relationship to the effectiveness of the second booster mRNA vaccine. In 48 subjects who had their antibody levels checked during the first and second boosters, there was an increase from 4,743 AU/ml (IQR 6,053.3) to 8,532 AU/ml (IQR 8,040.3). Conclusions. The effectiveness of the second mRNA booster vaccine against COVID-19 infection in healthcare workers was 42%. There were no factors related to the effectiveness of the second mRNA booster vaccine. The sRBD antibody levels after the second booster vaccine were higher than the first booster vaccine.
Co-Authors Alvina Widhani, Alvina Angga Pramudita Anis Karuniawati Ceva W. Pitoyo Desi Salwani, Desi E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Em Yunir, Em Esthika Dewiasty, Esthika Evy Yunihastuti Josephine, Jennifer Kuntjoro Harimurti Mboeik, Manuel Lamberto Willem Mondrowinduro, Prionggo Nababan, Saut Horas Praptini, Mirna Nurasri Rahmat Cahyanur Siti Taqwa Fitria Lubis, Siti Taqwa Fitria Sukamto Koesnoe