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All Journal Indonesian Journal of Rheumatology Jurnal Penyakit Dalam Indonesia
Cleopas M Rumende, Cleopas M
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Medicine & Pharmacology

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Osteoarticular Tuberculosis: A Secondary Manifestations to Tuberculous Pleural Effusion Singh, Gurmeet; Rumende, Cleopas M; Setyohadi, Bambang
Indonesian Journal of Rheumatology Vol 5, No 1 (2014)
Publisher : Indonesian Rheumatology Association

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Abstract

Tuberculosis appears to be increasing throughout the world after years of continuous decline, despite the introduction of effective chemotherapy. This resurgence is related to the increasing number of patients immunocompromised by chemotherapeutic agents used to treat other diseases or Acquired Immunodeficiency Syndrome (AIDS); the appearance of multiple drug-resistant strains of tuberculosis, and aging population. Musculoskeletal tuberculosis arises from haematogenous seeding of the bacilli soon after the initial pulmonary infection.1 Osteoarticular TB can occur in the knee - one study found of 1074 cases, 8.3 percent - or 90 cases - affected the knee.2 The clinical  symptoms are insidious onset, pain, swelling of the joint and limited range of movements. Investigations for suspected cases include: Mantoux test, radiological imaging, fine needle aspiration biopsy, surgical biopsy, bacteriological examination, histopathological examination, and polymerase chain reaction (PCR) of a suitable specimen. The mainstay of treatment is multidrug antitubercular chemotherapy. The main reason for poor outcome is delayed diagnosis.1 We report a case of osteoarticular manifestation of tuberculosis infection affecting the left knee presenting in a man with a history of tuberculosis pleural effusion. This case highlights, firstly, osteoarticular disease is always secondary to a primary lesion in the lung and, secondly, the diagnosis of tubercular arthritis can be challenging, particularly in the presence of confounding factors such as preexisting arthritis. Ethical approval was not required for this case study.
Peran Pemeriksaan Penanda Tumor Cairan Pleura dalam Diagnosis Efusi Pleura Maligna Akibat Kanker Paru Primer Rumende, Cleopas M; Sutandyo, Noorwati; Hanafi, Arif R; Rumende, Samuel K; Susanto, Erwin C; Sitorus, Truely P
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Introduction. Pleural effusion is a frequently acquired lung disorder and based on the type of cause it is divided into malignant and non-malignant pleural effusion. Cytological examination of pleural fluid to differentiate between malignant and non-malignant pleural effusion shows varying sensitivity. Research regarding the benefits of CEA and Cyfra 21-1 pleural fluid examination to detect malignant pleural effusion due to primary lung cancer in Indonesia is still very limited. The aims of this study is to determine the sensitivity and specificity of CEA and Cyfra 21-1 pleural fluid in diagnosing malignant pleural effusion due to primary lung camcer. Methods. A cross-sectional diagnostic study was conducted on patients with exudative pleural effusion at Dr. Cipto Mangunkusumo National Hospital (RSCM) and Darmais Cancer Hospital between September 2015 and May 2016. Patients underwent examinations for carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (Cyfra 21-1) in their pleural fluid. The ROC curves were generated to determine the optimal cut-off values for CEA and Cyfra 21-1 concentrations in pleural effusion, considering the area under the curve (AUC) obtained. Chi-square tests were performed to assess sensitivity and specificity, as well as to calculate positive predictive value, negative predictive value, and accuracy for each cut-off value for both CEA and Cyfra 21-1. Results. A total of 122 patients with exudative pleural effusion, positive cytology results were obtained in 80 patients. By using the CEA cut-off value of 4.23 ng/ml, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87.50%, 80.95%, 89.74%, 77.27% and 85.25% with an AUC value of 0.878 (0.814 - 0.942). By using the Cyfra 21-1 cut-off value of 26.9 ng/ml, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 78.75%, 71.43%, 84.00%, 63.82% and 76.23% with an AUC value of 0.817 (0.739 - 0.896). Conclusion. Examination of CEA and Cyfra 21-1 level in pleural fluid can be used to support the diagnose of malignant pleural effusion due to primary lung cancer.
Co-Authors Achmad Fauzi Agus Joko Susanto, Agus Joko Alimuddin, Suriani Anwar, Irma Wahyuni Ardi Findyartini, Ardi Ari F Syam ARIF R HANAFI, ARIF R Arvin Pramudita, Arvin Bambang Setyohadi Catarina Budyono, Catarina Dyah Purnamasari Eppy Eppy Gurmeet Singh Ika Prasetya Wijaya Iris Rengganis Kuntjoro Harimurti Leonard Nainggolan Lugyanti Sukrisman Nikko Darnindro Noorwati Sutandyo Rabbinu R Pribadi, Rabbinu R Rumende, Samuel K Sally A Nasution, Sally A Siti Setiati Sitorus, Truely P Suhendro Suhendro Susanto, Erwin C