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All Journal Jurnal Ilmu Kedokteran (Journal of Medical Science) Majalah Kedokteran Indonesian Journal for Health Sciences (IJHS)
Robiatul Adawiyah
Departemen Parasitologi Fakultas Kedokteran Universitas Indonesia
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Medicine & Pharmacology Nursing Public Health

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Diagnosis Cepat Kandidemia Neonatus dengan Pemeriksaan Spesimen Darah Pulasan Giemsa Ridhawati Ridhawati; Riva Ambardina Pradita; Mulyati Mulyati; Robiatul Adawiyah
Jurnal Ilmu Kedokteran Vol 13, No 2 (2019): Jurnal Ilmu Kedokteran
Publisher : Fakultas Kedokteran Universitas Riau

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26891/JIK.v13i2.2019.16-20

Abstract

Candidemia is one of the major problems in neonates with low birth weight (LBW). Neonatal candidemia has a high rate of morbidity and mortality. Early initiation of antifungal therapy could be decreasing the mortality, but this management often hampered due to late diagnosis. The gold standard for diagnosing candidemia is blood culture, but it takes a long time about 5 days. A rapid alternative method is needed to decrease candidemia morbidity and mortality. The method chosen in this study is Giemsa stain of blood smear which result could be read within one hour. The study was conducted in the Department of Parasitology, Faculty of Medicine Universitas Indonesia with a total blood samples of 170 from 2009-2012. Blood samples are devided in two, first is made thick blood smear than stain with giemsa, than read by microscope by 400×and 1000× magnification. The second is cultured on Sabauraud agar media and incubated in room temperature for ten days. Thirty four patients (20%) were positive for Candida, 28 (82.4%) positive samples with both giemsa staining and culture, while 6 (17,6%) positive culture samples but negative giemsa staining. The values of the sensitivity and specificity of the Giemsa stained blood smear examination were 82%, and 100%. This result shows that Giemsa staining has a good diagnostic value for detecting neonatal candidemia.
Diagnosis Kriptokokosis Meningeal pada Penderita AIDS dengan Deteksi Antigen Glucuronoxylomanan pada Cairan Otak Robiatul Adawiyah; Retno Wahyuningsih; Ridhawati Sjam; Darma Imran
Majalah Kedokteran UKI Vol. 34 No. 1 (2018): JANUARI - MARET
Publisher : Fakultas Kedokteran Universitas Kristen Indonesia

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Abstract

AbstrakKriptokokosis meningeal karena ragi berkapsul Cryptococcus sering didapatkan pada penderita AIDS dan menyebabkan kecacatan dan kematian. Diagnosis dini yang diharapkan dapat diatasi dengan diagnosis pemeriksaan tinta India yang rendah dan kultur yang perlu 5-7 hari. Sebagai alternatif, WHO merekomendasikan deteksi antigen dengan cara uji aglutinasi lateks untuk deteksi antigen glucuronoxylomanan (GXM) dan lateral flow asay yang mendeteksi kompleks antigen Cryptococcus sp. Mengingat antigen GXM juga dapat ditemukan pada orang sehat, perlu ditetapkan nilai batas (cut off) yang untuk mendiagnosis kriptokokosis klinis. Pada penelitian ini, nilai cut off GXM dicari dengan memeriksa cairan otak yang tidak diencerkan, diencerkan 100×, 300×, dan 500× dengan menggunakan metoda aglutinasi lateks (PASTOREX TM CRYPTO PLUS 61747 (kat. 7EM2093, Bio-Rad Perancis). Tiap dilusi dihitung sensitivitas, spesifisitas, NPP, NPN, dan nilai kappa untuk menilai kesetaraan antara metode uji dengan baku emas (tinta india dan kultur) serta uji McNemar untuk mengetahui perbedaan antara metode uji dan baku emas. Receiver operating characteristics (ROC) curve dinilai untuk mengetahui kombinasi terbaik sensitivitas dan spesifisitas. Deteksi antigen GXM pada cairan otak menunjukkan sensitivitas dan spesifisitas yang bervariasi pada dilusi yang berbeda. Sensitivitas terbaik didapatkan pada LCS yang tidak diencerkan, namun spesifisitas terbaik ditemukan pada dilusi 500× (100%) disusul oleh dilusi 300× (98,1%). Secara keseluruhan berdasarkan sensitivitas, spesifisitas, NPP, NPN, nilai kappa dan nilai ROC, dilusi 300× merupakan dilusi terbaik. Uji McNemar memperlihatkan tidak ada perbedaan antara metode uji dan baku emas. Dilusi cairan otak 300× merupakan nilai cut off deteksi GXM untuk menegakkan diagnosis kriptokokosis meningeal. Kata kunci: Cryptococcus neoformans, meningitis, diagnosis AbstractMeningeal cryptococcosis is caused by encapsulated yeast Cryptococcus. This infection has a high morbidity and mortality rate. Early diagnosis is one of the keys to reduce morbidity and mortality. India ink examination is hampered by its low sensitivity, while culture is time consuming. WHO recommends antigen detection methods as an alternative, i.e. latex aglutination for Glucuronoxylomannan (GXM) and lateral flow assay (LFA) for antigen complex for Cryptococcus. Since GXM antigen is also found in healthy people, cut off value for clinical cryptococcosis needs to be established. In this studi, the GXM antigen detection was conducted by latex agglutination test (PASTOREXTM CRYPTO PLUS 61747 kat. 7EM2093, Bio-Rad, France). To establish the cut off value, a neat concentration, as well as 100, 300 and 500 times dilution of spinal fluids were tested. Sensitivity, specificity, PPV, NPV and kappa value for each dilution were calculated against the gold standard (india ink examination and culture). McNemar test was performed to evaluate the difference between the test and the gold standard. Receiver operating characteristics(ROC) curve was used to determine the best combination of sensitivity and specificity. GXM antigen detection on spinal fluid showed variation of sensitivity and specificity in different dilutions. The neat solution gave the best sensitivity, while the best specificity was shown by 500× dilution (100%) and then followed by 300× dilution (98,1%). Overall, 300× dilution gave the best combination of sensitivity, specificity, PPV, NPV, (p=0,07). In conclusion, 300× dilution of spinal fluid is the best cut off value for GXM detection for diagnosing meningeal cryptococcosis. Key words: Cryptococcus neoformans, meningitis, diagnosis
Micafungin: In-Vitro Activity to Candida and Aspergillus and In-vivo Activity to Candida parapsilosis Retno Wahyuningsih; Idham Amir; Robiatul Adawiyah
Majalah Kedokteran UKI Vol. 34 No. 4 (2018): OKTOBER-DESEMBER
Publisher : Fakultas Kedokteran Universitas Kristen Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33541/mkvol34iss2pp60

Abstract

Abstract Candida and Aspergillus, are two important fungi that can cause systemic or invasive mycoses in human. Micafungin is an antifungal agent belongs to echinocandin group with antifungal activity against Candida and Aspergillus. In this study in vitro activity of micafungin against Candida and Aspergillus, and in vivo activity to Candida parapsilosis were presented. A study on the in-vitro activity of micafungin for Candida and Aspergillus was conducted at our laboratory in August-September 2010. We used E-test on Mueller Hinton agar supplemented by 2% glucose and methylen blue as indicator. The strains tested were isolated from blood, bronchial lavage, urine, stool and skin. Candida albicans (ATCC 90028), and Candida parapsilosis (ATCC 22019) were use for quality control of the experiments. The minimum inhibitory concentration (MIC) was read at 24-48 hours after incubation for Candida and 48 hours for Aspergillus. According to MIC the response to micafungin was determined as susceptible (S), susceptible dose dependent (SDD)/ intermediate and resistant (R). Quality control was done in the same method. To support the laboratory work we present an in vivo activity of micafungin as a case report of C. parapsilosis candidemia. All Candida and Aspergillus isolates were within the range of susceptible. From Candida group, C. parapsilosis even though susceptible but shows the highest MIC (0.75 – 1.5). Aspergillus niger showed highest MIC (0.32), and the most frequent causative agent of aspergillosis Aspergillus fumigatus shows low MIC value. The result of quality control is within expected range. Micafungin shows a good antifungal activity to all Candida and Aspergillus Jakarta isolates. In vivo activity of micafungin against C. paraspilosis is inline with the in-vitro result. Key words: Candida, Aspergillus, neonate, candidemia Abstrak Candida dan Aspergillus, adalah dua jamur penting penyebab mikosis invasif atau sistemik pada manusia. Mikafungin diketahui sebagai antijamur golongan echinocandin yang mampu mengeliminasi Candida dan Aspergillus. Dalam penelitian ini kami ingin meneliti kemampuan in vitro mikafungin terhadap Candida dan Aspergillus, serta menyampaikan laporan kasus aktivitas in vivo mikafungin terhadap Candida parapsilosis. Studi untuk mengetahui aktivitas invitro dari mikafungin terhadap Candida dan Aspergillus, dilakukan di laboratorium mikologi departemen Parasitologi FKUI pada bulan Agustus-September 2010. Kami menggunakan E-test pada media agar Mueller Hinton dengan indikator glukosa 2% dan metilen biru. Strain yang kami periksa diisolasi dari darah, cairan bronkial, urin, tinja dan kulit. Sebagai kontrol kualitas uji kepekaan, kami gunakan Candida albicans (ATCC 90028), dan Candida parapsilosis (ATCC 22019). Konsentrasi hambat minimal (KHM) dibaca setelah inkubasi 24-48 jam untuk Candida dan 48 jam untuk Aspergillus. Respons terhadap mikafungin dibaca sebagai susceptible (S), susceptible dose dependent (SDD) / intermediate and resistant (R). Kontrol kualitas uji kepekaan juga dibaca dengan metode yang sama. Guna memperkuat hasil laboratorium, kami laporkan aktivitas in vivo mikafungin terhadap C. parapsilosis pada kasus kandidemia. Seluruh isolat Candida dan Aspergillus sensitif terhadap mikafungin. Dari golongan Candida, C. parapsilosis walaupun masih sensitif namun menunjukkan KHM tertinggi (0,75 - 1,5). Aspergillus niger menunjukkan KHM tertinggi (0,32), dan strain Aspergillus fumigatus sebagai penyebab tersering aspergillosis menunjukkan nilai KHM rendah. Aktivitas Mikafungin bagus sebagai antijamur terhadap semua strain Candida dan Aspergillus di Jakarta. Aktivitas in vivo mikafungin terhadap C. paraspilosis sesuai dengan in-vitro.Kata kunci: Candida, Aspergillus, neonatus, kandidemia
Kriptokokosis Meningeal: Epidemiologi Berbasis Molekular, Manifestasi Klinis dan Luarannya Robiatul Adawiyah; Anna Rozaliyani; Retno Wahyuningsih
Majalah Kedokteran UKI Vol. 35 No. 2 (2019): APRIL - JUNI
Publisher : Fakultas Kedokteran Universitas Kristen Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33541/mkvol34iss2pp60

Abstract

Abstrak Cryptococcus sp. sebagai penyebab kriptokokosis meningeal telah banyak diteliti di dunia, tetapi epidemiologi molekular, manifestasi klinis, penegakan diagnostik dan luaran klinisnya belum dibahas secara komprehensif. Tujuh nama baru Cryptococcus sp. telah diusulkan dan berdasarkan hal itu penyebarannya bervariasi di beberapa negara. Cryptococcus. gattii masih lebih terbatas area penyebarannya dibandingkan C. neoformans. Keragaman genotipe dapat diperoleh baik dalam satu negara maupun pada satu pasien kriptokokosis meningeal. Manifestasi klinis yang mucul berbeda-beda, namun utamanya adalah sakit kepala, demam dan penurunan kesadaran. Prosedur diagnosis dapat dipilih mulai dari pemeriksaan konvensional hingga uji berbasis molekular dan protein. Luaran klinis dipengaruhi oleh beberapa faktor, diantaranya beban jamur, penyakit dasar, status imun pasien, diagnosis dini, serta ketersediaan obat. Kata Kunci: Cryptococcus, kriptokokosis, spesies, aspek klinik. Abstract Cryptococcus sp. as the cause of meningeal cryptococcosis had been widely studied around the world. But its molecular epidemiology with clinical manifestations, diagnostic procedures and clinical outcomes have not been comprehensively discussed. Seven new names for Cryptococcus sp. have been proposed and the distribution varies in several countries. However, C. gattii is still more restricted in area than C. neoformans. Genotype diversity was obtained in both one country and in one patient meningeal cryptococcosis. The clinical manifestations that appear are different, however the main ones are headache, fever and decreased consciousness. Diagnosis procedures could be carried out from conventional to molecular and protein-based. Clinical outcomes are influenced by several factors, including fungal load, underlying disease, patient’s immune status and early doagnosis as well as the availability of drugs.Key words: Cryptococcus, molecular epidemiology, clinical aspects
KANDIDIASIS VULVOVAGINALIS PADA PASIEN SLE Risya mawahdah; Pangisti Dwi Ananingsih; Sri Wahdini; Robiatul Adawiyah; Alfa Putri Meutia
Indonesian Journal for Health Sciences Vol 6, No 2 (2022): September
Publisher : Universitas Muhammadiyah Ponorogo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24269/ijhs.v6i2.4934

Abstract

Pendahuluan: Kandidiasis vulvovaginalis merupakan peradangan di daerah vagina dan melibatkan vulva yang disebabkan oleh infeksi jamur Candida. Sekitar 75% wanita, setidaknya memiliki satu episode kandidiasis vulvovaginalis ketika usia reproduktif dan setengahnya memiliki dua atau lebih episode. Faktor risiko terjadinya kandidiasis vulvovaginalis, yaitu kehamilan, penggunaan kontrasepsi, terapi estrogen, diabetes mellitus, penggunaan imunosupresi, dan antibiotik sistemik.  Laporan Kasus: Dilaporkan kasus seorang perempuan, usia 33 tahun dengan keluhan keputihan sejak 2 bulan yang lalu. Pasien dilakukan swab vagina dan dilakukan pemeriksaan laboratorium cairan swab vagina secara lengkap untuk mencari penyebab keputihan. Pasien merupakan penderita Sistemik Lupus Eritomatosus (SLE) sejak 4 tahun yang lalu dan mengkonsumsi obat Hydroxychloroquine 400 mg/ hari selama 1 tahun, Methylprednisolone 4 mg/hari dan antihistamin untuk atasi keluhan gatal dimukosa badan pasien. Pasien pernah mengalami keputihan tiga tahun yang lalu. Dari hasil pemeriksaan langsung swab vagina didapatkan sel ragi dan pseudohifa, dilanjutkan dengan kultur yang memberikan  hasil pertumbuhan koloni ragi. Dari hasil uji resitensi terhadap obat jamur didapatkan hasil sensitif terhadap antifungal Itrakonazol, Ketokonazol, Flukonazol, dan Nystatin.
Co-Authors Agnes Kurniawan Alfa Putri Meutia Anna Rozaliyani Atik Arimurti Darma Imran Idham Amir Ika Puspa Sari Mulyati Mulyati Pangisti Dwi Ananingsih Retno Wahyuningsih Retno Wahyuningsih Retno Wahyuningsih Ridhawati Ridhawati Ridhawati Sjam Ridhawati Sjam Risya mawahdah Riva Ambardina Pradita Sri Wahdini