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ABSTRACTS BOOK Join and Take Our Role to Fight TB & COVID-19 The 2nd Indonesian Tuberculosis International Meeting Virtual Conference | 28-29th August 2020
ABSTRACTS BOOK INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING
(INA-TIME) 2020 Virtual Conference TEMA:
“Join and Take Our Role to Fight TB & COVID-19”
Padang, 28-29 Agustus 2020
Diterbitkan oleh: LPPM Universitas Andalas
ABSTRACTS BOOK INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING (INA-TIME) 2020 VIRTUAL CONFERENCE TEMA: “Join and Take Our Role to Fight TB & COVID-19”
Editor : Dr. dr. Finny Fitry Yani, Sp.A (K) dr. Alexander Kam, Sp.PD dr. Vanny Asrytuti
Published by : LPPM Universitas Andalas Tahun 2020
ISBN 978-623-6703-42-7 Hak cipta dilindungi Undang-undang Dilarang memperbanyak, mencetak, dan menerbitkan sebagian atau seluruh buku ini dengan cara dan dalam bentuk apapun tanpa seizing penulis dan penerbit
ABSTRACTS BOOK INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING (INA-TIME) 2020 VIRTUAL CONFERENCE TEMA: “Join and Take Our Role to Fight TB & COVID-19” Steering Committee : Prof. H. dr. Darfioes Basir, SpA(K) Prof. H. dr. Taufik, SpP(K) Prof. H. dr. Zulkarnain Arsyad, SpPD-KP Dr. dr. Masrul, M.Sc, SpGK dr. Yusrizal Chan, SpP(K) dr. Zailirin YZ, SpP(K) dr. H. A. Aziz Djamal, M.Sc, DTM&H, SpMK(K) Editor : Dr. dr. Finny Fitry Yani, Sp.A (K) dr. Alexander Kam, Sp.PD dr. Vanny Asrytuti Reviewer : Prof. dr. Ari Natalia Probandari, MPH, PhD Prof. dr. Rovina Ruslami, SpPD, PhD dr. Rina Triasih, M.Med(Paed), PhD, SpA(K) Dr. dr. I Wayan Gede Artawan Eka Putra, M.Epid Dr. dr. Finny Fitry Yani, Sp.A (K) dr. Roza Kurniati, Sp.PD FINASIM dr. Regina Loprang dr. Sabrina Ermayanti, Sp.P(K) dr. Yessy Susanty Sabri, Sp.P(K) dr. Fauzar, Sp.PD-KP, FINASIM dr. Asrawati nurdin, Sp.A dr. Alexander Kam, Sp.PD dr. Ade Nofendra, Sp.A dr. Vesri Yoga, Sp.PD dr. Laura Zeffira, Sp.A
Published by : LPPM Universitas Andalas Tahun 2020
KATA PENGANTAR KETUA PELAKSANA INA-TIME 2020
Assalamualaikum Wr. Wb. Sejawat yang terhormat, dengan memanjatkan puji syukur kehadirat Allah SWT kita sangat berbahagia dengan terbitnya Abstracts Book INA-TIME 2020 (Indonesian Tuberculosis International Meeting). INA-TIME 2020 yang dilaksanakan pada 28-29 Agustus 2020 ini, merupakan kegiatan Internasional tahunan yang dilaksanakan oleh Sub Direktorat Tuberkulosis Kemenkes RI dan Jejaring Riset Tuberkulosis Indonesia (JetSet TB), yang untuk tahun ini bekerjasama dengan FK Unand dan didukung oleh organisasi profesi IDAI, PDPI, PAPDI, dan KOPI TB cabang Sumatera Barat. Pertemuan ilmiah ini membahas topik-topik terkini yang disampaikan oleh pakar tuberkulosis nasional dan internasional. INA-TIME adalah salah satu usaha untuk meningkatkan mutu penelitian, pelayanan, ilmu kedokteran, dan inovasi, serta untuk bertukar pengalaman antara nara sumber dan peserta dari seluruh kalangan yang terkait dengan masalah tuberkulosis, dalam rangka eliminasi TB tahun 2030 di Indonesia. Pelaksanaan INA-TIME 2020 kali ini berbeda dari pelaksanaan tahun sebelumnya, yaitu dilakukan secara Virtual Conference, sehubungan dengan situasi pandemi COVID-19 yang melanda Indonesia. Tema yang diangkat adalah “Join and Take Our Role to Fight TB & COVID -19”. Buku kumpulan abstrak ini terdiri dari berbagai penelitian, laporan kasus dan makalah. Abstrak tersebut berasal dari berbagai peneliti di ruang lingkup IDAI, PAPDI, PPDI, Yayasan dan LSM, Wasor TB, pengelola program TB di berbagai rumah sakit dan puskesmas, serta tenaga kesehatan lainnya yang fokus pada pengelolaan TB dan COVID-19. Terimakasih kami ucapkan kepada para peneliti dan nara sumber yang sudah berpartisipasi. Semoga penerbitan Abstracts Book ini dapat menjadi salah satu acuan ataupun pembelajaran untuk peneliti, mahasiswa dan tenaga kesehatan lainnya dalam memerangi TB terutama era pandemi COVID-19 ini. Akhir kata kami mohon maaf atas segala kekurangan dalam penyusunan buku ini. Wassalamualaikum Wr Wb Padang, Agustus 2020 Ketua Pelaksana Dr.dr.Finny Fitry Yani, Sp. A(K) THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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CONTENTS
COVER ..................................................................................................................................................... KATA PENGANTAR .............................................................................................................................
PAGE i v
CLINICAL ABSTRACT Single Nucleotide Polymorphisms (SNPs) of macrophage mannose receptor gene as protective factor of active pulmonary tuberculosis in Bandung .........................................
1
Mycobacterium tuberculosis infection and disease in healthcare workers in a tertiary referral hospital in Bandung, Indonesia ........................................................................
2
The Discovering of marine-derived microbe from mangrove plants and marine sponge as a source of anti-TB drugs ...............................................................................................
3
NLR as predictive diagnostic tool of COVID-19 in TB patients: A further consideration ........................................................................................................................................
4
The Effect of incentive spirometry and pursed lips breathing on inspiratory capacity, dypsnea, exercise capacity, and quality of life of sequelae pulmonary tuberculosis patients ...................................................................................................................................................
5
Polymorphisms of NAT2 Genotype in Previously Treated MDR TB Patients in West Sumatera ...............................................................................................................................................
6
Duration positive detected RT-PCR RNA virus of SARS-Cov-2 and routine laboratory finding in prolonged case adult COVID-19 patients .................................................................
7
Boosting BCG with recombinant influenza a viruses improves protective immunity against murine Mycobacterium tuberculosis infection .........................................................
8
Acetylator genotype polymorphisms in MDR TB patients .....................................................
9
The Profile of COVID-19 patients in Semen Padang Hospital, Indonesia ..........................
10
Survival analysis and risk factor associated with hearing disorder on drug resistant tuberculosis treatment ......................................................................................................................
11
Primary Drug Resistant Tuberculosis: Pattern and Risk Factors ........................................
12
Tuberculous pleural effusion with low pleural fluid adenosine deaminase levels in a adolescent : A case report .................................................................................................................
13
Multidrug-Resistant Tuberculosis (MDR-TB) spondylitis : A case report ..........................
14
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Former Pulmonary Tuberculosis develops into pulmonary Aspergilloma .......................
15
Interpreting Lantibiotics activity against Mycobacterium tuberculosis in human .......
16
Determinants of patient compliance on the treatment of Drug-Resistant Tuberculosis in TBC-RO treatment hospital in Aceh, Indonesia ...........................................
17
The Comparison of GENEXPERT MTB/RIF Assay with conventional Acid Fast Bacillus (AFB) smear for diagnosis of pulmonary Tuberculosis at Encik Mariyam General Hospital of Lingga, Riau Islands Province ....................................................................
18
Coexistence of Pulmonary Tuberculosis and Squamous Cell Lung Carsinoma: Case Report ...........................................................................................................................................
19
The Positivity rate of GENEXPERT in negative sputum acid fast Bacilli to diagnose Pulmonary Tuberculosis ...................................................................................................................
20
Problems with TB patients during the COVID-19 pandemic .................................................
21
The Relationship Between Former Tuberculosis Patients With Risk Factor of Lung Cancer .......................................................................................................................................................
22
Types of Lung Cancer in patients with Former Tuberculosis in Arifin Achmad General Hospital Riau Province in 2015-2019 ............................................................................................
23
Prevalence of positive interferon gamma release assays and one-year conversion rates and associated risk factors in medical and nursing students in Bandung, Indonesia ................................................................................................................................................
24
Pyopneumothorax as complication of Pulmonary Tuberculosis in Patients with Diabetes Mellitus : Case Report ........................................................................................................
25
BMI and its correlation to PBMC count in Pulmonary Tuberculosis Patient of Aceh Besar and Banda Aceh, Indonesia ...................................................................................................
26
Factors affecting Basic Immunization Status among Children aged 1-5 years in Rukun Warga 10, Kapuk, West Jakarta .........................................................................................
27
Diagnosis and Management of Primary Laryngeal Tuberculosis .......................................
28
Spectrum of cerebrospinal fluid analysis in Tuberculous Meningitis patients at Dr. M. Djamil Hospital Padang ....................................................................................................................
29
Impact of TB laboratory diagnosis in COVID-19 pandemic ...................................................
30
Gallbladder tuberculosis mimicking cholecystitis: A rare case report in an endemic area ..........................................................................................................................................................
31
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Nasopharyngeal Tuberculosis mimicking Nasopharyngeal Cancer .................................
32
Case Report: Spondylitis Tuberculosis in Siti Rahmah Hospital During Covid-19 pandemic ................................................................................................................................................
33
Serial case of Tuberculosis in hemodialisa patient Kasih Bunda Hospital 2020 .........
34
Characteristics of Tuberculous Lymphadenitis diagnosed by FNAB at RSI Siti Rahmah Padang in 2019 ...................................................................................................................
35
Potential problem of DOTS program during COVID-19 pandemic .....................................
36
The validity of lymphocyte to Netrophil Ratio in pleural fluid with the gold standar Tuberculous Pleurisy of The Indonesian Society of Respirology (PDPI) 2006 Consensus ..............................................................................................................................................
37
Drug Induced Hepatotoxicity on Pulmonary Tuberculosis with COVID-19 Coinfection: A case study .......................................................................................................................
38
Two Serial case of COVID-19 patients Co-Infected with HIV: comparison of pre-Anti Retroviral (ART) and on ART patient ...........................................................................................
39
False negative, reactivation or reinfection of positive SARS-COV-2 in patients recovered from COVID-19: A report of two cases ....................................................................
40
Coinfection of COVID-19 and Pulmonary Tuberculosis: A case report .............................
41
Antiviral therapy to lower the risk of Drug-Induced Liver Failure in patient with Pulmonary Tuberculosis and Chronic Hepatitis B Virus Co-Infection: An evidencebased case report ................................................................................................................................
42
Comparison of positivity rate MRT between specimens sputum and feces in TB children at Harapan Kita Woman and Children Hospital , Jakarta ....................................
43
Autoimmune hemolytic Anemia (AIHA) as a Novel Complication Of COVID-19 infection in Sanglah General Hospital ..........................................................................................
44
Coronavirus Disease 2019 in Chronic Kidney Disease .............................................................
45
Tuberculous Pleural effusion in child with Acute Lymphoblastic Leukemia ...............
46
The Association between age and length of Hospital Stay for Covid-19 Patients at Semen Padang Hospital in 2020 ......................................................................................................
47
Miliary Tuberculosis in Immunocompromised Patient Induced by Imatinib and Steroid : A case report .......................................................................................................................
48
Disseminated tuberculosis in breastfeeding mother :case report .......................................
49
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Maintaining Continuity of care for children with chronic disease during the COVID19 pandemi and infection prevention : A systematic review ...............................................
50
COVID-19 and delirium in elderly, a case report ......................................................................
51
Hematology profile of Tuberculosis Lymphadenitis patients at Siti Rahmah Hospital, Padang, Indonesia .............................................................................................................
52
Case report :A case of tuberculosis Verrucosa cutis of 39 years duration .......................
53
Acetylator Profiles in MDR TB patients with Short-Term Regimens ...................................
54
Case report : A case of Tuberculosis Verrucosa Cutis in 59 years old woman ...............
55
Adherence to Tuberculosis Preventive Treatment (PP-INH) of Household Under-five Contacts in Bandung ..........................................................................................................................
56
PUBLIC HEALTH ABSTRACTS Contribution of smoking to pulmonary tuberculosis incidence in Bandung, Indonesia ................................................................................................................................................
59
Comprehensive Prevention of Pulmonary Tuberculosis using Directly Observed Treatment Short-course (DOTS) Strategy ..................................................................................
60
Relations of Knowledge and Attitude of Pulmonary Tuberculosis (TB) Patients with Precautions of Tuberculosis in Andalas Health Center 2015 ...............................................
61
The Use of Rapid Molecular Diagnostics/Test to Find TB Cases in Indonesia: A Review of Information System Management ............................................................................................
62
Profile OF Pediatric Tuberculosis Patients: A Retrospective Descriptive Study Of BUNDA MEDICAL CENTRE HOSPITAL In 2019 ........................................................................
63
Factor Influenced Treatment Outcome in Drug Resistance Tuberculosis with Short Therapy Regimen and Individualized Treatment in Dr. Moewardi Hospital ..................
64
Increasing Tuberculosis CDR in Kampus Public Health Center Working Area by Forming Tuberculosis Cadres Together with Aisyiyah TB-Care ..........................................
65
Knowledge Of Final-Year Medical Students Regarding Tuberculosis Diagnosis ............
66
An Overview Social Stigma and Quality of Life Tuberculosis patients at East Java .....
67
Childhood Tuberculosis Before and During COVID-19 Pandemic at Padang City .........
68
Prediction Model of Tuberculosis among Children:Prospective Cohort Study in DKI Jakarta ....................................................................................................................................................
69
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Factors affecting non compliance to treatment among tuberculosis patients: qualitative and quantitative study ..............................................................................................
70
TB Linkage Strengthening in Primary Health Care to Increase Tuberculosis Cases Notification in Palembang ..............................................................................................................
71
Epidemiological Characteristic Of COVID-19 Cluster In Magetan District ...................
72
Monthly interim cohort analysis for drug-sensitive TB in Mimika, Papua: one year implementation ..................................................................................................................................
73
Gender differences in healthcare seeking behavior, diagnosis, and treatment pathway among TB patients: Secondary data analysis .........................................................
74
Knowledge, Attitude and Practice (KAP) Survey among Pharmacy Professionals for Tuberculosis care in Indonesia .....................................................................................................
75
Knowledge and practices in preventing transmission among tuberculosis patients: A cross – sectional study from Namu Ukur community health centre (Puskesmas), Langkat Regency, North Sumatera ............................................................................................
76
Tuberculosis infection control practices and knowledge in primary health centers in Bandung, Indonesia ..........................................................................................................................
77
Improvement in TB case finding at the correctional facilities in Indonesia in 2014 – 2019 through National Health Insurance (BPJS) Advocacy for inmates ...........................
78
The analysis of TB recovery outcomes based on the level accreditation on primary health care in Aceh ............................................................................................................................
79
Improving HIV testing among tuberculosis cases: Lessons from the Timika, Papua
80
Two Years Implementation of WiFi TB, an android based mandatory notification for private providers: Does it work? ....................................................................................................
81
Overview of tuberculosis missing cases in first level health facilities (FKTP) in Padang Panjang City ..........................................................................................................................
82
The role of tigo tungku sajarangan to implementation of the TB program in Agam Regency .................................................................................................................................................
83
TB photovoices-what health care workers want us to know ................................................
84
Mapping of private practitioners and their potential roles in public-private mix for tuberculosis control ..........................................................................................................................
85
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Active surveillance for tuberculosis in hospitals: To increase TB case notification .......
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Sitrust expansion: A continuous effort to increase access to quality TB diagnosis ........
87
Feasibility of using photovoice to uncover barriers to TB treatment from patient perspective ............................................................................................................................................
88
"Like Ping-Pong" TB patient referral system in Bandung: A qualitative study from a patient's perspective ..........................................................................................................................
89
"Like Ping-Pong" TB patient referral system in Bandung: A qualitative study from a patient's perspective ..........................................................................................................................
90
Nutritional status, sanitation, and hygiene associated with tuberculosis among children in rural areas of Bogor Regency, Indonesia: A community based crosssectional study ......................................................................................................................................
91
TB program in the COVID-19 era: Challenges for Asian and African Countries ..............
92
Description of Covid-19 epidemiology in Magetan district, East Java Province 2020 ....
93
Knowledge and perceived stigma towards tuberculosis among tuberculosis suspect by gender in community in Indonesia ..........................................................................................
94
BASIC SCIENCE Analysis of Supplementation of Channa striata and Sea Cucumber Extract Combination (Channa PlusR) on Effectiveness of Therapy in Pulmonary Tuberculosis Patients ..................................................................................................................................................
97
The Effect of Supplementation of Channa striata and Sea Cucumber Extract Combination (Channa PlusR) on Alteration of Hemoglobin and Neutrophils Levels, Thoracic Radiological Image, and Pulmonary Function in Pulmonary Tuberculosis Patients ...................................................................................................................................................
98
The Effect of Curcuma on The Improvement of Clinical Symptoms And Nutritional Status in Tuberculosis Patients in the Intensive Phase Category 1 Treatment ...............
99
TB INOVATION ABSTRACTS Efforts to Increase the Screening of Tuberculosis Suspect Cases through Art Performances "Randai TB" and "Jaka Keris" Activities. (Screening Cases at Group with the Risk Factors for Tuberculosis Transmission) ............................................................
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Networking, collection and delivery of sputum as well as supervision of tuberculosis patient treatment through KATIS (TB Cadres in Each Village) integrated with Sigesite .........................................................................................................................................................
101
TBC Care Village. Mojosongo Village, Surakarta City ................................................................
102
The program of having partnerships empowerment against TB from my district (in Bahasa called PELITA HATIKU) .........................................................................................................
103
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CLINICAL ABSTRACT
I-OP1A
Single Nucleotide Polymorphisms (SNPs) of macrophage mannose receptor gene as protective factor of active pulmonary tuberculosis in Bandung Yani Triyani1, Julia Hartati1, Budiman1, Nanan Sekarwana2, Endang Sutedja2, Dida Akhmad Gurnida2, Maya Tejasari1, Bachti Alisjahbana2 ,Ida Parwati2 1
Faculty of Medicine Universitas Islam Bandung, 2Faculty of Medicine Universitas Padjadjaran Bandung, Indonesia
Background. Macrophage Mannose Receptor (MMR) is a gene encoding Mannose receptor (MR), which recognize the mannose-capped lipoarabinomannan, (ManLAM) the most virulent antigen of Mycobacterium tuberculosis. MMR gene polymorphism is one of the risk factors for active pulmonary TB. Objective. This study was aimed to determine the correlation between polymorphism and active or latent pulmonary TB.
MMR gene
Methods. The study MMR gene polymorphism was analyzed by using case-control design consisting 74 subjects of the control group (latent TB) and case group (active pulmonary TB). The subject's venous blood was taken as 3mL for MMR gene DNA sequencing examination. The study was conducted from February 2014 to January 2015 at the Teaching Hospital, Faculty of Medicine, Universitas Padjadjaran Bandung, under a collaboration research team of TB-HIV Study Centre. The statistical analysis used Chi-squa re and odds ratio. Results. The study's result has shown, there were five single nucleotide polymorphisms (SNPs) of MMR gene in both groups (G1186A, G1195A, T1212C, C1221G, and C1303T) and one SNP in the control group (C1323T) only. The MMR gene polymorphism factor that correlated to the incidence of active pulmonary TB was T1212C (OR=0.253; CI 95%=0.111−0.575; p=0.001). Conclusions. It can be concluded that there were 5 SNPs MMR gene (G1186A, G1195A, T1212C, C1221G, and C1303T) on both groups, MMR gene polymorphism on T1212C site correlated with the incidence of active pulmonary tuberculosis and were protective. Keywords. Active pulmonary TB, latent TB, mannose-capped lipoarabinomannan (Man-LAM), Macrophage Mannose Receptor (MMR) gene, Polymorphism
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I-OP2A
Mycobacterium tuberculosis infection and disease in healthcare workers in a tertiary referral hospital in Bandung, Indonesia Lika Apriani1,2,3, Susan McAllister3, Katrina Sharples3,4, Isni Nurul Aini1, Hanifah Nurhasanah1, Rovina Ruslami1,5, Bachti Alisjahbana1,6, Dick Menzies7, Philip C Hill3 1
TB Working Group, Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 2Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 3Centre for International Health, Department of Preventive and Social Medicine, University of Otago, New Zealand, 4Department of Mathematics and Statistics, University of Otago, New Zealand, 5Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 6Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 7Montreal Chest Institute, McGill University Montreal, Canada
Background: Healthcare workers (HCWs) in high tuberculosis (TB) incidence countries are at risk for Mycobacterium tuberculosis infection and TB disease. Objective: We undertook a study to estimate the prevalence of tuberculin skin test (TST) positivity, history of TB disease, and to identify associated risk factors in HCWs in Bandung, Indonesia. Methods: A cross-sectional study was conducted between April-August 2018 at Hasan Sadikin Hospital. A stratified sample of the HCWs according to job category were recruited, screened by TST, and were assessed for symptoms of TB disease. A questionnaire was used to obtain history of TB disease, and identify associated risk factors. Summary statistics and logistic regression were used for analysis. Results: Of 455 HCWs recruited, 42 HCWs reported a history of TB disease; of these, 25 had been diagnosed with active TB after starting work in the Hasan Sadikin Hospital. Of those with no history of TB disease, 395 were tested by TST and 18 refused. The prevalence of positive TST plus history of TB disease after starting work in this hospital was 76.9% {95% confidence interval (CI) 72.6-80.8%} with the odds increase by 7% per year (95% CI 311%). There was a rapid rise in prevalence up to 10 years of work and then a plateau at around 80% TST positivity. Conclusions: A high proportion of HCWs reported a history of TB disease or were positive for M. tuberculosis infection, increasing with duration of work. A package of TB infection control measures will need to be implemented across the hospital to help protect HCWs from M. tuberculosis infection. Keywords: TST, healthcare workers, TB infection, TB disease 2
THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
I-OP3A
The Discovering of marine-derived microbe from mangrove plants and marine sponge as a source of anti-TB drugs Neny Sandrawati1,2, Ibtisamatul Aminah1,2, Shuci Permata Hati2, Fujia Yunita2,Indah Dwi Hesti2, Sinta Aprillita2, Hurul Aini2, Desrina Rahmi2, Febri2, Anggun Kemala Putri2, Dian Handayani2 1
Department of Biomedical, Faculty of Medicine, Andalas University, Padang, Indonesia. Sumatran Biota Laboratory/Faculty of Pharmacy, University of Andalas, Kampus Limau Manis, Padang, West Sumatera, Indonesia
2
Background. The discovery of anti-tuberculosis (TB) drugs goes very slowly and not proportional to the incidence of the disease. Symbiotic microorganisms from the marine environment have the potential to produce secondary metabolites that have anti-TB activity. Objective. This study focused on screening the ethyl acetate extracts from microbe-derived marine sponge and mangroves collected from the waters of West Sumatera, Indonesia against the Mycobacterium tuberculosis H37Rv. Methods.The endophytic microbe was isolated from four species of mangrove plants (Rhizophora apiculata, Sonneratia alba, Acanthus ilicifolius, Aegiceras corniculatum) and marine sponge Dactylospongia sp. The isolation of the microbe was carried out based on the difference in the morphological examination and yielded 63 isolates of microbe. Each of pure microbe isolates were cultivated on rice and Actinomycetes Broth medium, and further macerated with ethyl acetate. All of ethyl acetate extracts were firstly screened for antibacterial activity towards Staphylococcus aureus and Escherichia coli. The selected microbes were next subjected to the anti-TB assay with the Lö wenstein-Jensen method at a concentration of 5%, 3% and 1%. The identification of anti-TB microbes was conducted macroscopically, microscopically and molecularly with Sanger sequencing. Results. The results showed that 7 ethyl acetate extract of fungi and 3 extracts of bacteria were sensitive to Mycobacterium tuberculosis H37Rv. These fungi and bacteria were identified as Penicillium citrinum MD, Pestalotiopsis sp. MA, Gliomastix sp. RAA2, Purpureocillium lilacinum RAA6, Bacillus bataviensis SAA12, Streptomyces hydrogenans ACA7, and Streptomyces sp. ACA5. Conclusions. This study concluded that ethyl acetate extract microbes derived from marine habitats are potential to further explore as a source of the new antituberculosis agent. Keyword: Anti-Tuberculosis activity, Mycobacterium tuberculosis H37Rv, marine sponge, mangrove plant, Löwenstein-Jensen THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-OP4A
NLR as predictive diagnostic tool of COVID-19 in TB patients: A further consideration Andre Thadeo Abraham1, Riska Larasati2 Universitas Sebelas Maret Surakarta1,2
Background. The neutrophil-to-lymphocyte ratio (NLR) is one of the indicators of an early warning system for COVID-19. A high NLR represents either increase of neutrophils and/or decrease lymphocytes. NLR is generally examined as helpful indicators for the visualization of patients with COVID-19. NLR values have a positive correlation with the expanding seriousness of lung injury of COVID-19. Objective. To evaluate the use of NLR as the predictive diagnostic tool of COVID-19 in TB patients. Methods. We used PubMed electronic database to search the literature about laboratory findings especially NLR in TB and COVID-19 patients and the role of lymphocyte in both groups. Results. The immunological process in TB is mediated by lymphocytes, therefore TB patients have higher lymphocyte counts. In contrast, lymphocytopenia happened in COVID19 patients. It is hypothesized that lymphocytopenia occurs as infiltration of the virus throughout the target organs, ACE2 receptor in the lymphocyte might be the target of the SARS-CoV-2 infection, and lymphocyte reduction caused by the pro-inflammatory cytokines increasing in COVID-19. The laboratory components make up the value of NLR both in COVID-19 and TB. Conclusions. There is a further study for NLR to be used as the predictive diagnosis of COVID-19 in TB patients as TB patients tend to have increased lymphocyte. Keywords: NLR, tuberculosis, COVID-19, diagnosis
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THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
I-OP5A
The Effect of incentive spirometry and pursed lips breathing on inspiratory capacity, dypsnea, exercise capacity, and quality of life of sequelae pulmonary tuberculosis patients Yusup Subagio Sutanto1, Elizabeth Widya Sondakh 1, Jatu Aphridasari 2, Ana Rima Setijadi2, Hendra Kurniawan2 Departement of Pulmonologyand Respiratory Medicine Medical Faculty of Sebelas Maret University / Dr. Moewardi General Hospital Surakarta
Background. Pulmonary rehabilitation plays an important role in nonpharmacology therapy to improve respiratory symptoms in pulmonary tuberculosis. This study aimed to analyze the effect of incentive spirometry and the effect of incentive spirometry and pursed lips breathing on inspiratory capacity (IC), shortness of breath symptoms, exercise capacity, and quality of life (QOL) on sequelae pulmonary tuberculosis patients. Methods. Clinical trial with pre and post test group design was performed on 32 sequelae pulmonary tuberculosis with advanced lesion patients at the Dr. Moewardi general hospital Surakarta between January and April 2018 by purposive sampling. Inspiratory capacity (spirometry), symptoms of breathlessness BORG scale), exercise capacity (6MWT), and QOL (SGRQ) were measured at baseline and after 4 weeks in the incentive spirometry and pursed lips breathing group. Results. There was an increase in IC of 34.43 ± 27.153% in the IS group and 26.104 ± 15.75% in PLB (p = 0.752), decreased BORG scale -0.94 ± 0.574 in IS and -0.88 ± 0.342 in PLB (p=0.838), 6MWT increase of 63,13 ± 10,782 metre in IS and 50,63 ± 18,062 metre in PLB (p = 0,086), and improvement of SGRQ value equal to -9,14 ± 10,18 in IS and -4, 29 ± 4.57 in PLB (p=0.752), with IS having a better chance than pursed lips breathing in increasing the percentage of IC (OR=1,018) and improvement of QOL (OR = 1,148) of patients with advanced pulmonary TB lesions. Conclusion. Incentive spirometry increase the IC, decreased breathing shortness symptoms, improved the capacity exercise, and improved the QOL of patients with sequelae pulmonary tuberculosis. Incentive spirometry is better than PLB in improving IC, decreasing symptoms of shortness of breath, increasing exercise capacity, and improving QOL of patients with pulmonary TB although not significant. Keywords: sequelae pulmonary tuberculosis, pulmonary rehabilitation, incentive spirometry, pursed lips breathing, inspiratory capacity, BORG scale, 6MWT, SGRQ THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-OP6A
Polymorphisms of NAT2 Genotype in Previously Treated MDR TB Patients in West Sumatera Masrul Basyar1 , Yessy Susanty Sabri1 , Afriani1 , Mega Senja1 Bagian Pulmonologi dan Kedokteran Respirasi Fakultas Kedokteran Universitas Andalas1
Background. Pharmacokinetic variability is a factor in the occurrence of resistance. INH pharmacokinetic variability is influenced by genetic factors in the presence of polymorphisms of arylamine N-acetyltransferase type 2 (NAT2) which affect plasma drug levels and half-life. Drug levels under therapeutic doses can cause resistance. Objective. This study describesNAT2 genotype polymorphism patients who have previously treatedanti-tuberculosis drugswhich have MDR TB.Methods: This is a cross sectional study of MDR TB patients who had previously received OAT at Dr. M Djamil, Achmad Mochtar Bukittinggi Hospital and West Sumatra Lung Hospital September 2019 to January 2020. NAT2 genotypes were obtained from PCR and sequencing results. Results. This study found 10 types of alleles which carry fast acetylator(NAT2*12A, NAT2*12B, NAT2*4) and slow (NAT2*6F, NAT2*5Q, NAT2*5D, NAT2*5C, NAT2*6C). Twosamples with acetylator status could not be determined (unknown) with SNP reference rs1304162037 mutation point 776C>A, and rs148566670 mutation point 823T>A. Frequency of fast acetylators (NAT2 * 4 / NAT2 * 4, NAT2 * 12B / NAT2 * 12B, NAT2 * 12A / NAT2 * 12A)in19 patients in this studywas more (63.17%) th``an non-fast acetylators (slow:NAT2*6F/NAT2*6F, NAT2*5Q/NAT2*5Q, NAT2*5D/NAT2*5D; and intermediates: NAT2*6C/NAT2*12B, NAT2*12B/NAT2*5C), but the difference is not significant statistically(p= 0.831) Conclusions. The frequency of fast acetylators was found more frequently than non-fast acetylators in MDR TB patients who had previously received OAT, but there was no statistically significant association. Keywords: MDR TB, relapse, NAT2, polymorphism, acetylator
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THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
I-OP7A
Duration positive detected RT-PCR RNA virus of SARS-Cov-2 and routine laboratory finding in prolonged case adult COVID-19 patients Fredia Heppy Fakultas Kedokteran Universitas Baiturrahmah
Background. Corona Virus Disease-19 (COVID-19) is an infectious disease caused by a newly discovered coronavirus named Severe Acute Respiratory Syndhrome Corona Virus 2 (SARS-Cov-2). Maximal duration positive real time PCR (RT-PCR) RNA virus of SARS-Cov-2 has been detected for 6 weeks. Prolonged case positive RT-PCR RNA virus lead to chronic inflamation subsequent prolong isolation and complication of immobilisation. Describing of duration positive detected RT-PCR RNA virus and routine laboratory finding in prolonged case patients are important to be evaluated to prevent potential complication. Objective. This study aims to describe duration positive detected of RT-PCR RNA Virus SARS-Cov-2 and routine laboratory finding in prolonged case COVID-19 patients. Methods. We observed duration positive detected RT-PCR RNA Virus of SARS-Cov-2 and routine laboratory finding with method retrospective study. Data of confirmed COVID-19 case, duration positive case and laboratory finding were taken from medical record in Semen Padang Hospital from March to August 2020. Prolonged case adult COVID-19 patient defined as patients more than and equal 13 years old whom duration detected of RT-PCR RNA virus more than 6 weeks. Results. From March to August 2020 there were 30 prolonged cases adult patients with positive detected RT-PCR RNA virus of SARS-Cov-2 in Semen Padang hospital. Mean duration positive detected RT-PCR RNA virus of SARS-Cov-2 is 48 ± 11 days with maximal duration is 82 days. Routine laboratory finding were in normal limit whereas mean haemoglobin, haematocryte, platelet, neutrophil, lymphosite count and neutrophil/lymphosite ratio, platelet/lymphosite ratio respectively 13,8 ± 1,33 g/dL, 41,2 ± 2,43 %, 259.800 ± 63362/mm3, 5080 ± 1671/mm3, 2256 ± 674/mm3, 2,72 ± 1,33 and 125 ± 52. Conclusions. In prolonged case adult COVID-19 patients was found duration positive detected RT-PCR RNA virus of SARS-Cov-2 around 7- 8 weeks with maximal duration case almost 12 weeks. Routine laboratory finding was found in normal limit. Key word: COVID-19, prolonged case, RT-PCR detection, routine laboratory finding
THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-OP8A
Boosting BCG with recombinant influenza a viruses improves protective immunity against murine Mycobacterium tuberculosis infection Muflihah H1,4 , Fló rido M1 , Lin LCW1 , Xia Y2 , Triccas JA3 , Stambas J2 , Britton WJ1,3 Tuberculosis Research Program, Centenary Institute, University of Sydney, Camperdown, NSW 2050, Australia 1 School of Medicine, Deakin University, Geelong, Victoria 3216, Australia 2 Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia3 4Faculty of Medicine, Universitas Islam Bandung, Bandung, 40116, Indonesia4.
Background. The current Mycobacterium bovis BCG vaccine provides inconsistent protection against pulmonary infection with Mycobacterium tuberculosis (M. tuberculosis). Immunity induced by subcutaneous BCG wanes and does not promote early recruitment of T cell to the lungs after M. tuberculosis infection. Pulmonary immunization may increase and prolong immunity at the site of M. tuberculosis infection. We have shown that recombinant influenza A viruses (rIAVs) expressing an M. tuberculosis CD4+ T cell epitope (PR8-p25, X31p25) as primary tuberculosis vaccine is immunogenic and protective. Objective. We aimed to investigate the potential use of rIAVs to improve BCG using simultaneous immunization (SIM) and prime-boost strategy. Methods. Mice were immunized with subcutaneous BCG and intranasal rIAVs at 12 weeksinterval as BCG boosting or with BCG and PR8-p25 at the same time as SIM, and were infected with aerosol M. tuberculosis. The immunogenicity was assessed by IFN-γ ELISpot and flow cytometry of intracellular cytokine staining. Results. SIM resulted in equal protection to BCG alone against early, acute and chronic M. tuberculosis infection. Boosting BCG with rIAVs resulted in increased frequency of IFNgsecreting specific T cells and polyfunctional CD4+ T cells compared to the BCG alone (pA. Frequency of fast acetylators (NAT2 * 4 / NAT2 * 4, NAT2 * 12B / NAT2 * 12B, NAT2 * 12A / NAT2 * 12A)in32 patients in this studywas more (62.3%) than slow acetylators 9,37% (NAT2*6C/ NAT2*6C, NAT2*6F/NAT2*6F, NAT2*7C/ NAT2*7C,NAT2*5A/ NAT2*5A, NAT2*5Q/NAT2*5Q, NAT2*5D/NAT2*5D); and intermediates 6,25% (NAT2*6C/NAT2*12B, NAT2*12B/NAT2*5C) Conclusion: The most acetylator genotype in MDR TB patients in West Sumatera wasfast acetylators. We found two new SNP reference in this study. Key words: Acetylator, SNP, mutation, MDR TB
THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-OP10A
The Profile of COVID-19 patients in Semen Padang Hospital, Indonesia Fauzar1,2, Roza Kurniati1,2, Farhan Abdullah2, Alexander Kam1 Department of Internal Medicine, Faculty of Medicine, Andalas University M.Djamil General Hospital, Padang, West Sumatera, Indonesia1 Semen Padang Hospital, Padang, West Sumatera, Indonesia2
Background. Coronavirus Disease 2019 (COVID-19) cases have started to be reported in Indonesia since March 2020. The rapid increase in the number of cases, including in Padang, has led the government to designate several hospitals as referrals for COVID-19 patients. One such hospital is Semen Padang Hospital (SPH). The profile of COVID-19 patients is needed to describe the pattern of this disease in Padang. Objective. The aim of this study is to reveal the profile of COVID-19 patients in SPH, Indonesia. Methods. This was a retrospective study conducted in SPH. This study was conducted and collected data of COVID-19 patients from March 2020 to June 2020. Results. There are 60 patients with mean age 46.8 years old, 43% male and 57% female. The clinical manifestations are cough (73%), fever (38%), sore throat (25%), and fatigue (32%). There are 82% patients admitted that they have contacted with other COVID-19 patients or have activities in COVID-19 cluster area, and only 7% have travelled to other cities. The mean length of stay is 32,15 days. The mean laboratory data: Hemoglobin 13.6 gr/dl, white blood cells (WBC) 8,158.33/mm3, platelet 280,983.33/mm3, and neutrophil to lymphocyte ratio (NLR) 2.94. Chest radiograph results are bronchopneumonia (23%), cardiomegaly (7%), and normal (70%). Conclusions. The profile of COVID-19 patients in SPH are more female patient, cough is the most clinical manifestation that appeared, the mean laboratory data (hemoglobin, WBC, and platelet) are normal, and normal chest radiography is the most chest radiograph results in these patients. Keywords: COVID-19, Profile, Padang
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THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
I-SOP1A
Survival analysis and risk factor associated with hearing disorder on drug resistant tuberculosis treatment Astuti Setyawati1, Hasto Nugroho2, I Gusti Ngurah Widiyawati3, Jatu Aviani4, Ario Wirawan Lung Hospital, Salatiga Central Java –Indonesia1
Background. Drug resistant tuberculosis is a disease caused by bacteria that are resistant to tuberculosis drug. Treatment of drug resistant tuberculosis use the first line and second line tuberculosis drug in along time, one of which is kanamycin. Kanamycin injection can cause side effect on hearing disorder. Objective. This study aims to determine the survival analysis and risk factors associated with the hearing disorder on drug resistant tuberculosis treatment. Methods. This study is a retrospective cohort study by taking data on medical records of drug resistant tuberculosis patients from March 2017 to December 2019 at Ario Wirawan Lung Hospital in Salatiga, Central Java. Statistical analysis using Kaplan Meier method and chi square test. Results. From 93 patients of drug resistant tuberculosis, hearing disorder was found in the form of tinnitus in 35 patients (37.6%). The incidence of tinnitus was found in short treatment regiment (STR) is 52%, and individual regiment is 32.9%. Survival analysis for the incidence of tinnitus in STR is 5 months, while in individual regiment is 15 months. The risk factors associated with the incidence of tinnitus were gender {p=0.009, OR=3.317(1.3268.298)}, while age, Diabetes Mellitus, and the regiment of drug resistant tuberculosis were not significantly related. Conclusions. Closed supervision and monitoring of side effect in hearing disorder is important, especially in women who received drug resistant tuberculosis treatment. Keywords. drug resistant tuberculosis, hearing disorder, individual regiment, short treatment regiment, tinnitus.
THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-SOP2A
Primary Drug Resistant Tuberculosis: Pattern and Risk Factors Mayuarsih Kartika, Jatu Aphridasari Pulmonology dan Respiratory Medicine Moewardi Hospital / Sebelas Maret University, Surakarta, West Java Province
Background: The number of drug resistant tuberculosis patient is keep rising. Prior antituberculosis becomes the significant risk factor. However, tuberculosis is an airborne disease, it can occur in population with no history of anti-tuberculosis. Objective: The aim of this study is to describe the pattern of primary drug resistant tuberculosis and analize its risk factors. Methods: Restrospective study was designed to describe and analize the pattern and risk factor within the primary drug resistant tuberculosis patients in Moewardi hospital from 2016 to 2019. Results: Sixty seven patient was diagnosed with primary drug resistant tuberculosis. Resistance patterns varies from monodrug resistant (25.6%), polidrug resistant (15.38%), multi-drug resistant (46.1%) and extensively drug resistant (2.56%). Patients with diabetes mellitus had more possibility become polidrug resistant tuberculosis. Conclusion: The most common pattern of primary drug resistant tuberculosis is multi drug resistant. The only risk factor that statistically significant is diabetes mellitus. Keywords: primary, resistant, tuberculosis, pattern, risk
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THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
I-SOP3A
Tuberculous pleural effusion with low pleural fluid adenosine deaminase levels in a adolescent : A case report Praisilia R. V. Najoan, Audrey M. I. Wahani Departement of Pediatrics, Faculty of Medicine, Prof. Dr. R. D. Kandou General Hospital, Manado, Indonesia Background. Tuberculous pleural effusion are more common than malignant pleural effusion in areas of high incidence of tuberculosis. Adenosine deaminase (ADA) is useful in diagnosis of TPE. Objective. To know the important of ADA value in tuberculous pleural effussion in children. Case. A 13-year-old boy admitted to hospital with shortness of breath, reccurent cough, fever and chest pain. After admission, chest radiograph revealed bilateral pleural effusion. Tuberculine skin test induration was 20 mm. Pleural fluid analysis result was clear yellowish color, no sediment, Rivalta positive, cell count 600 cell/uL, PMN 10%, MN 90%, glucose 49 mg/dL, protein ratio fluid : serum = 0,6, LDH 185 IU/L, LDH ratio fluid : serum 0,75, AFB (+), Adenosine Deaminase (ADA) 28 IU/L, on gram staining there was no bacteria found. Sputum AFB smear test were negative. Xpert MTB/Rif Assay from sputum result show a detected M. Tuberculosis, Rifampicin drug resistance not detected. Anti HIV result was non reactive. Patient was given anti-tuberculosis medication for 12 months and prednisone for 4 weeks. Conclusions. Pleural fluid ADA interpretation has to be undertaken with caution, especially in areas with high tuberberculosis incidence. Keywords. Adenosine deaminase, tuberculosis, pleural effusion
THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-SOP4A
Multidrug-Resistant Tuberculosis (MDR-TB) spondylitis : A case report Yuliza1 , Soedarsono1,2 , Mahbub Imam2 Departement of Pulmonology and Respiratory Medicine Medical Faculty Universitas Airlangga/Dr. Soetomo Hospital1 Universitas Airlangga Hospital, Surabaya, East Java -Indonesia2
Background. MDR-TB defined as resistance to at least isoniazid and rifampicin, and became a new challenge to global TB burden. The skeletal system can be involved in 1–3% of all TB cases. MDR-TB spondylitis can be due to acquired resistance from the past inadequate treatment, or to primary resistance. The diagnosis of MDR-TB spondylitis requires a high index of suspicion based on epidemiologic, clinical, and radiologic features. Cultures and susceptibility testing remain the gold standard, but this take several weeks to obtain. Objective. To reveal a spondylitis case cause by MDR-TB. Case. We present a 35 years old male patient admitted to the hospital with chronic back pain, hypoesthesia, and night sweating. The patient had previously treated with 18 months antiTB drugs for spondylitis TB. Physical examination showed pain, hyposthesia and spasticity. MSCT examinations showed abcess and destruction of vertebral bodies. The patient underwent biopsy afterward with histopathology result is chronic granulomatous inflamation and Xpert®MTB/RIF result is MTB detected low and Rifampicin resistance detected. The patient treated with individual regimen of MDR-TB drugs consist of bedaquiline, levofloxacine, linezolid, clofazimine, cycloserine. The diagnosis of MDR-TB spondylitis requires a high index of suspicion. A spondylitis MDR-TB patient may present with chronic back pain and neurologic deficit. Thus, the diagnosis usually made on histopathology examination and Xpert®MTB/RIF. Conclusions. MDR-TB spondylitis is a rare case of extrapulmonary tuberculosis. The diagnosis established from histopathology examination and Xpert®MTB/RIF results. So, it strongly recommended that all suspicion of TB spondylitis are also check Xpert®MTB/RIF to rule out the resistances. Keywords: tuberculosis, spondylitis, MDR-TB spondylitis, histopathology examination
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THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
I-SOP5A
Former Pulmonary Tuberculosis develops into pulmonary Aspergilloma Vandu Primadana1, Sri Indah Indriani1, Azizman Saad1, Hariadi Hatta2, Ilhami Romus3, Dewi Anggraini4 Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Riau1 Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Riau2 Department of Anatomical Pathology, Faculty of Medicine, University of Riau3 Department of Microbiology, Faculty of Medicine, University of Riau Arifin Achmad General Hospital Riau Province, Indonesia4
Background, Pulmonary tuberculosis (TB) is a pulmonary disease with a high number of cases in Indonesia, and still big problem in Indonesia, pulmonary TB can cause cavity formed, presence of cavity had a high risk of fungal colonization. As we known aspergillus spores called conidia are often found in environment air, the diameter of conidia is small therefore, it can reach alveoli. The patients who have been diagnosed with TB and underwent anti-tuberculosis drug therapy should be considered is a pulmonary aspergilloma to avoid misdiagnosis. Case, in this patient hemoptysis is complained of patients, patients with history of antituberculosis drug in 2010 and then performed Computed tomography (CT) scan thorax showed aspergilloma appearance. Furthermore, the most accurate test is histopathology test thereafter, core needle biopsy CT guided was performed and the result is aspergillus then patient was histopathologically proven. Discussion, accurate examination is needed to diagnose pulmonary aspergilloma. If we do not thought of pulmonary aspergilloma in patient especially former pulmonary tuberculosis then will not did the right test and the management becomes inappropriate. Conclusion, the need to thought about pulmonary aspergilloma in patients who have been diagnosed with TB and have underwent therapy for TB therefore, In this patient we found histopathological proven is aspergillus spp and that treatment with itraconazole then patient has clinical improvement. Keywords : Pulmonary tuberculosis, cavity, aspergillus, pulmonary aspergilloma, former pulmonary tuberculosis
THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-SOP6A
Interpreting Lantibiotics activity against Mycobacterium tuberculosis in human Najmiatul Fitria 1,2 , Ade Sukma3 Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Andalas, Padang1 Unit of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, the Netherlands2 Department of Livestock Product Technology, Faculty of Animal Science, Universitas Andalas, Padang3
Background. More than 50 different lantibiotics have been identified with different structures and modes of action. A need to understand the interpretation of lantibiotics activity against mycobacterium tuberculosis is pressing since many antibacterial agents lead to resistance nowadays. Objective. This study aimed to provide an overview of the evidence on the clinical microbiology activity of the lantibiotics group. Methods. We conducted a framework for reporting lantibiotics activity using the MICRO (Microbiology Investigation Criteria for Reporting Objectively) checklist. Two electronics databases (Pubmed and EMBASE) were used to conduct this study. Results. The initial search discovered 20 references (Pubmed 8 and EMBASE 12). We included human study, English written, and full articles in this study. Of all these original articles, only four articles included in the review. The rest of the eight articles do not provide original research. These included articles reported the testing phase on the pre-analytical and analytical phases. In this review, we found bacteriocins AS-48, subtilin, and nisin as part of lantibiotics group seems to be a promising agent to combat antimicrobial resistance (AMR) in humans. None of the included articles come to the post-analytical phase. Even in the analytical phase, they did not do external quality assurance. Conclusions. Lantibiotics, with its several features, may advance their candidacy as therapeutic agents. There is more effort to do. Finishing the analytical phase, especially on quality assurance and avoiding bias. Next to the post-analytical phase on single agents and multidrug resistance against Mycobacterium tuberculosis. Keywords: Lantibiotics, Mycobacterium tuberculosis.
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I-SOP7A
Determinants of patient compliance on the treatment of Drug-Resistant Tuberculosis in TBC-RO treatment hospital in Aceh, Indonesia Khairuman1 , Ida2 , Asfriyati2 Student Administration and Health Policy FKM, Universitas Sumatera Utara1 Lecture of Public Health Faculty, Universitas Sumatera Utara2
Background. Medication compliance with drug-resistant tuberculosis is a major factor in healing patients. The eTB-Manager data for cases of patients dropping out of drug-resistant tuberculosis is quite high at an average of 6% per year in three Drug Resistance Tuberculosis treatment hospitals in Aceh. From 2015 to 2018 as many as 29 people (18%) of 165 patients dropped out of treatment. Objective. This study aims to analyze the factors that influence patient compliance during treatment at the Drug Resistant Tuberculosis Treatment service in Aceh in 2019. Methods. This type of research is a cross sectional survey method. The study population was all patients in the treatment of Drug Resistance Tuberculosis in Dr. Zainoel Abidin Regional Hospital, Cut Mutia Regional Hospital and Tgk.Chiek Di Tiro Regional Hospital with 70 samples. The research data was collected through a structured interview questionnaire. Data analysis uses multiple logistic regression tests. Results. The results showed 49 respondents (70.0%) complied with medication and 21 non-adherent respondents (30%). There are two variables that significantly influence patient compliance in Drug Resistance Tuberculosis treatment in Aceh, namely patient motivation (B=4,631; OR=102,617; - value=0,0001) and patient knowledge (B=3,092; OR=22,023; -value=0.005). If the level of knowledge and motivation of patients is increased it will affect the compliance of Drug Resistance Tuberculosis treatment in Aceh. It is recommended to healthcare workers for Drug Resistance Tuberculosis treatment services to continuously improve communication, information and education (IEC) to patients and their families. Furthermore, it is recommended that the Health Service and Hospital Drug Resistance Tuberculosis services to form a Patient Group, increase socialization about Drug Resistance Tuberculosis, reduce the stigma of Drug Resistance Tuberculosis in the community and increase psychosocial support to increase patient knowledge and motivation in Drug Resistance Tuberculosis treatment Conclusion: The patient compliance of the treatment drug-resistant was influenced by patient motivation and knowledge of Drug Resistance Tuberculosis. Keywords: compliance,, motivation, knowledge. Drug Resistance Tuberculosis, drop out of treatment. THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-SOP8A
The Comparison of GENEXPERT MTB/RIF Assay with conventional Acid Fast Bacillus (AFB) smear for diagnosis of pulmonary Tuberculosis at Encik Mariyam General Hospital of Lingga, Riau Islands Province Rizki Romadani1, Suryadi1, Azizman Saad2, Zarfiardy Aksa Fauzi2 Encik Mariyam General Hospital, Riau Islands1 Consultant of Pulmonologist Arifin Achmad General Hospital, Riau2
Background. Tuberculosis (TB) is still a global problem. The majority of TB cases are found in low to middle income countries such as Indonesia, it ranked as the second profound country after India. WHO recommend GeneXpert MTB/Rif assay for diagnostic new TB cases. The aim of this study was to compare the performance of the sputum GeneXpert MTB/RIF assay with the conventional sputum AFB smear for diagnosis of pulmonary TB. Objective. The aim of this study was to compare the performance of the sputum GeneXpert MTB/RIF assay with the conventional sputum AFB smear for diagnosis of pulmonary TB. Methods. An observasional analytic study with the cross-sectional design. The sample of this study was all suspected pulmonary TB patient and the sampling technique used purposive sampling from January to December 2019 at Encik Mariyam General Hospital. Results. The sensitivity and specificity of GeneXpert had 100% and 77.6% of conventional AFB smear of 133 study samples. Among patients with a positive diagnosis of Mycobacterium tuberculosis (MTB) infection, 30 were AFB smear positive and 53 by sputum GE method. Most of the patient was male (79%) and the average age was 43.7 years old. Conclusions. GeneXpert is considered as an effective diagnostic tool for rapid diagnosis of MTB in smear negative and positive specimens. Keywords: GeneXpert, conventional AFB smear, sensitivity, specificity
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THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
I-SOP9A
Coexistence of Pulmonary Tuberculosis and Squamous Cell Lung Carsinoma: Case Report Evi Restuti1, Zarfiardy1, Adrianison1, Andreas Makmur2, Wiwit Ade Fidiawati3 Department of Pulmonology and Respiratory Medicine1, Department of Radiology2, Department of Anatomical Pathology3, Faculty of Medicine University of Riau, Arifin Achmad General Hospital Pekanbaru Riau Province, Indonesia
Background. Pulmonary tuberculosis and lung cancer are common diseases that cause substantial morbidity and mortality worldwide. Although the two rarely occur together, a relationship has been establish between them. Pulmonary tuberculosis and lung cancer could have similar radiography and clinical symptoms. The coexistence of pulmonary tuberculosis and lung cancer was estimated 2%. Objective. The aim of this study was to analyze the relationship between pulmonary tuberculosis and lung cancer. Case. A 51 years old male with a heavy smoking status index brinkman hospitalized in Arifin Achmad General Hospital with complain breathlessness, chronic cough, chest pain, fever, night sweat and loss of body weight. Patients were previously knows as pulmonary tuberculosis in the intensive treatment of category-1 anti tuberculosis drug in a month. It was confirmed by positive sputum acid fast bacilli and genexpert. Physical examination revealed mass at right colli size 2x2x1 cm, soft consistency and no pain. Chest x-ray and CT scan showed mass in right perihiller and pleural effusion dextra. Bronchoscopy was found infiltrative stenosis in the right upper lobe. Brushing and washing bronchoscopy, pleural puncture and Fine Needle Aspiration Biopsy at right colli lymphadenopathy have been perfomed and citology result is squamous cell carcinoma. Patients treated with chemoteraphy and were continued anti tuberculosis drug. Conclusions. The relationship between pulmonary tuberculosis and lung cancer has been known for years. Pulmonary tuberculosis and lung cancer are able to mimics each other sometimes with clinical and radiological features. If there is pulmonary infiltrates and pleural effusion or peripheral lymphadenopathy, we must search tuberculosis too out of metastatic lesion and other infectious diseases. We should not make delay in the diagnosis of active TB in cancer cases. Therefore every newly patient that diagnosed as pulmonary tuberculosis and had poor respons treatment should be carefully evaluated for coexistence malignancy. Keywords : Pulmonary tuberculosis, squamous cell carcinoma THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-SOP10A
The Positivity rate of GENEXPERT in negative sputum acid fast Bacilli to diagnose Pulmonary Tuberculosis Roni Ardian1, Andry Wahyudi Agus1, Zarfiardy Aksa Fauzi1, Azizman Saad1 Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Riau Arifin Achmad General Hospital Riau Province, Indonesia1
Background. Tuberculosis (TB) is still one of the world's public health problems that need special attention. Acid Fast Bacilli (AFB) with Ziehl Neelsen stain method can be done quickly, easily, accurately and does not require expensive costs. GeneXpert is a molecular test based on polymerase chain reaction (PCR). Objective. This study aimed to rate the positivity of GeneXpert in negative sputum AFB to diagnose pulmonary tuberculosis. Methods. This study is a cross-sectional descriptive-analytic of suspected TB patients who went to pulmonary polyclinic at Arifin Achmad Regional General Hospital in Riau Province from January 2018 to September 2018. All patients had clinical and chest x-ray suspect with TB, three times sputum microscopic examination AFB method with Ziehl Neelsen stain and sputum examination with GeneXpert method. Results. The number of patients suspected TB in this study were 249 men (71.4%) and 100 women (28.6%). In AFB method with Ziehl Neelsen stain found there were 310 patients with negative sputum (88.8%), +1 were 21 patients, +2 were found 18 patients and no patient with +3 were found. Of the 349 patients who were examined by AFB, 310 patients with negative sputum results were examined for GeneXpert with the results of 75 patients MTB detected. The positivity rate of Genexpert method in a negative sputum AFB sample is 24,2%. Conclusions. The examination with the GeneXpert method has a higher level of positivity than the Acid Fast Bacilli examination. Keywords: Ziehl Neelsen stain, Acid Fast Bacillus, GeneXpert, Pulmonary tuberculosis, negative sputum.
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THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
I-SOP11A
Problems with TB patients during the COVID-19 pandemic Umi Fatmawati Instalasi Farmasi RSUD Dr. Soetomo Surabaya
Background. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). TB is a lung disease with a mortality rate of 13 people per hour who die. Cases of undiscovered potential for transmission are very high, such as COVID-19. Methods. This study aims to determine the problem of TB patients in the COVID-19 pandemic. This type of research is a library of data analysis, data reduction, data display and verification / conclusion. Results. The results showed that TB patients could not go to health services fearing COVID19, health facilities were afraid of examining TB patients, impaired TB control, decreased community participation in suppressing the danger of TB transmission, decreasing TB services in various health facilities, centralized government in COVID-19, the difficulty of changing TB transmission habits and non-compliance taking medication. Conclusions. Problems can be overcome by providing understanding to patients that TB services can still be carried out with health protocols, the government remains serious in controlling and finding new cases, community participation to reduce of transmission, services continue by complying with health protocols. TB services can also be done online through the Go-Drug system so that patients do not need to leave the house. Changing the habit to discipline the health protocol. The role of supervisors in swallowing drugs is optimized to increase compliance. Keywords: Covid-19, TB, Problems, Solutions
THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-SOP12A
The Relationship Between Former Tuberculosis Patients With Risk Factor of Lung Cancer Evitrie Martarita, Rita Erdayani, Sri Melati Munir, Zarfiardy Aksa Fauzi Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Riau, Arifin Achmad General Hospital Riau Province, Indonesia
Background. The relationship between Pulmonary Tuberculosis (TB) and Lung Cancer (LC) is still controversial. Objective. This study described the characteristics of patients and relationship TB with an increased risk of developing LC. Methods. We retrospectively reviewed from medical record 203 lung cancer patients. There were 24 LC patients with history of pulmonary tuberculosis and Anti Tuberculosis Treatment (ATT) at Arifin Achmad General Hospital Riau Province from 2015 to 2018. This study uses a quantitative approach to data analysis methods Regression. Results. The result showed that 24 patients (11,82%) LC with pulmonary TB history with men (22 patients, 91,6%), aged 41-60 years (19 patients, 79,16%), type of adenocarsinoma (12 patients, 50%), III B stage (9 patients, 37,5%), type 1 category of ATT (13 patients, 54,16%). The test F (0.035) > F table (0.004) with p value 0.853, showed that there is relationship between former TB patients with risk factor of lung cancer. The length of time the occurrence of LC from former TB less than 5 years were 20 patients (83,33%). Conclusions. Patients cured TB as former TB is represent a group at risk for developing LC. There is significantly relationship between pulmonary TB with risk factor of LC. Keywords. Relationship, pulmonary tuberculosis, lung cancer, anti tuberculosis treatment, Arifin Achmad Hospital.
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I-SOP13A
Types of Lung Cancer in patients with Former Tuberculosis in Arifin Achmad General Hospital Riau Province in 2015-2019 Fajar Agung Prayogo1, Azizman Saad1, Zarfiardy Aksa Fauzi1,Sri Melati Munir1 Department of Pulmonology and Respiratory Medicine, Faculty of Medicine University of Riau, Arifin Achmad General Hospital, Riau1
Background. Chronic inflammation and fibrosis due to Tuberculosis (TB) can induce genetic mutation and alterations. Imbalance between tissue damage agents that can result in Deoxyribonucleid Acid (DNA) damage and tissue repair mechanism is thought to generate a microenviroment that predisposed to malignant transformation. Methods. A study aims to determined the type of lung cancer in patient with formerTB at Arifin Achmad General Hospital Riau Province in 2015-2019. The research aim all the medical record patient with Lung cancer and history of pulmonary tuberculosis. ResultS. This study shows the results that most types of lung cancer in patients with former tuberculosis are Non-small cell lung carcinoma (NSCLC), namely adenocarcinoma in 30 patients (66.7%), and squamous cell carcinoma 13 pastient (28,9%) and rest are Small cell lung carcinoma 2 patients (4,4,%). ConclusionS. TB is the most important inflammation-inducing factors in the lung that has a more profound role in the emergence of cancer. It is assumed that former TB is one of the risk factors for cancer. Keywords: Former TB, Lung cancer, Type of lung cancer
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I-SOP14A
Prevalence of positive interferon gamma release assays and one-year conversion rates and associated risk factors in medical and nursing students in Bandung, Indonesia Lika Apriani1,2,3, Susan McAllister3, Katrina Sharples3,4, Isni Nurul Aini1, Hanifah Nurhasanah1, Dwi Febni Ratnaningsih1, Agnes Rengga Indrati1,5, Rovina Ruslami1,6, Bachti Alisjahbana1,7, Reinout van Crevel8, Dick Menzies9, Philip C Hill3 1
TB Working Group, Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 2Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 3Centre for International Health, Department of Preventive and Social Medicine, University of Otago, New Zealand, 4Department of Mathematics and Statistics, University of Otago, New Zealand, 5Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 6Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 7Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 8Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. 9Montreal Chest Institute, McGill University Montreal, Canada
Background. Healthcare students in high tuberculosis (TB) incidence countries are at risk for Mycobacterium tuberculosis infection and TB disease. Objective. We undertook a study to estimate the prevalence of interferon-gamma release assays (IGRA) and the one-year test conversion rates, and identify associated risk factors in healthcare students. Methods. A cohort study was conducted in Bandung, Indonesia. All students who started their clinical programme in in August 2016 and January 2017 were recruited. QuantiFERON-TB Gold Plus (QFT-Plus) was used for the IGRA. IGRA negative students at baseline had a repeat test after one year. A questionnaire and a logbook were used to identify the associated risk factors. IGRA conversion was defined as a negative baseline test and a positive follow up test. Results. Of the 379 students, 70 (18.5%) were IGRA positive at entry into clinical programme and no factors were significantly associated with IGRA positivity. However, students who had BCG vaccination had a lower risk of IGRA positivity of borderline significance (OR 0.54, 95% CI 0.271.08, P=0.082). 293 (94.8%) IGRA negative students were tested at one year; 26 (8.9%) underwent IGRA conversion. Being a medical student (ARR 5.15, 95% CI 1.82-14.59, P=0.002) and participation in sputum collection or bronchoscopy procedures were associated with IGRA conversion (ARR 2.74, 95% CI 1.29-5.79, P=0.008). One student developed pleural TB during one-year follow up. Conclusions. The annual risk of IGRA conversion was high and associated with occupational exposures. TB infection control is important while this sub-population may be suitable for evaluation and implementation of vaccines against M. tuberculosis infection. Keywords: IGRA, healthcare students, TB infection, conversion 24
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I-SOP15A
Pyopneumothorax as complication of Pulmonary Tuberculosis in Patients with Diabetes Mellitus : Case Report Salma Septiani1, Zarfiardy Aksa1, Azizman Saad1, Hariadi Hatta2 Department of Pulmonology and Respiratory Medicine1 Department of Thoracic Surgery Faculty of Medicine University of Riau2
Background. Pyopneumothorax is a rare but serious complication of evolutive pulmonary tuberculosis (TB), it is one complication of pulmonary TB and cause significant morbidity and mortality. Prevalence of TB among diabetics is 2 to 5 times higher and make the management even more difficult. Objective. To explain complication of Pulmonary Tuberculosis an Diabetes Mellitus patients such as pyopneumothorax illustrated by case. Case. A 46 years old female hospitalized in Arifin Achmad General Hospital with complain breathlessness, chronic cough, right sided chest pain, fever, night sweat and loss of body weight. In physical examination revealed hypersonor at right side and decrease of breath sounds. Chest radiograph showed hyperlucent avascular with pleural line at right side that matched as right pneumothorax. A right thoracostomy tube was immediately placed, evaluation of pleural fluid is empyema. Acid fast bacilli (AFB) from pleural fluid and sputum was positive, Genexpert detected medium and rifampicin not resitance, patient treated with antituberculosis drug (ATD). During 2 months of thoracostomy there was no expand of lung and pleural thickening and aggravated with controlled DM type II as underlying disease, bronchoscopy was normally. This patient consult to thoracic surgery and performed thoracotomy decortication and the lungs begin expand and improves of clinical condition. Conclussions. Tuberculous Pyopneumothorax is due to the rupture of parenchymal nidus or cavity into the pleural space. Thoracotomy decortication was perfomed because of pleural thickening and the lung was not expand. The presence of DM prolongs healing and affects the success of therapy in pyopneumothorax patients as complications arising in TB patients who need some experts such as thoracic surgery for better management. Keywords. Pulmonary tuberculosis, pyopneumothorax, diabetes mellitus, pleural thickening, thoracotomy decortication.
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I-SOP16A
BMI and its correlation to PBMC count in Pulmonary Tuberculosis Patient of Aceh Besar and Banda Aceh, Indonesia. Nona Rahmaida Puteri1, R.M. Agung Pranata2 & Maulidar1 Balai Litbangkes Aceh1 FK Universitas Syiah Kuala2
Background. Evidence regarding the association between body mass index (BMI) and the Peripheral Blood Mononuclear Cells (PBMC) Count in TB patients is limited and inconsistent. In addition, diabetes mellitus type 2 in TB patient may alter the number in unrevealed manner. Objective. We investigated the effect of BMI on TB-DM and TB non-DM PBMC counts in TB patients. Methods. All adult with TB in Aceh Besar and Banda Aceh, during 2018 were included in this cross-sectional study. An corelation test was used to evaluate the association of BMI in two groups with the Mean comparation was used to evaluate associations of BMI and PBMC counts in both groups. Results. Of the 70 eligible patients, 28.6% (20) were TB-DM patient, and 71.4% (50) were TB Non-DM patients. Mean age was 44.58 years, and 60% of patients were male. The total PBMC mean in TB-DM group is 4.23 x 106 cells/ml and in TB non-DM is 4.22 x 106 cells/ml (p 0.697). In depht BMI to PBMC count analysis we found negative correlation (p 0.314). Conclusions. This finding shows there is no significant differences of PBMC counts in all the groups, considering possiblities of gaining adequate numbers of PBMC in underweight TBDM without the need to take excessive amount of blood for the preparation in specific analysis that need PBMCs. Keywords. Body mass index (BMI), Peripheral blood mononuclear cells (PBMC) , Tuberculosis (TB), diabetes mellitus (DM)
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I-SOP17A
Factors affecting Basic Immunization Status among Children aged 1-5 years in Rukun Warga 10, Kapuk, West Jakarta Harrison P.B. Panjaitan1 , Desi M. Utami1 , Dhiya F. Khalisa1 , Kristo B.P. Siahaan1 , Aria Kekalih2 Former Medical Student of Uni\versitas Indonesia1 Department of Community Medicine, Faculty of Medicine, Universitas Indonesia2
Background. Basic immunization is an important prevention in public health. It consists of hepatitis B, BCG, Polio, DPT, Hib, and Measles vaccine. Indonesian government targeted that at least 80% of infants aged 0-11 years old in every village/urban village get basic immunization, a program known as universal child immunization. Objective. This study aimed to investigate factors affecting basic immunization status in Rukun Warga 10, Kapuk, West Jakarta. Methods. A cross sectional study was conducted by using validated questionnaire. Subjects were mothers with child aged 1 – 5 years old. The sampling method used was convenient sampling. Results. A total of 110 subjects were included in this study. There were 74.5% of subjects whose children had complete basic immunization status. From multivariate analysis, there were four associated factors, i.e. birth order [1 st child vs. 3rd+ child (ref.), p=0.010, OR=7.345 (95%CI 1.600- 33.722); 2nd child vs. 3 rd+ child (ref.), p=0.027, OR=3.972 (95%CI 1.173-13.456)], source of information [healthcare professional vs. non-healthcare professional (ref.), p=0.017, OR= 8.905 (95% CI 1.470–53.939)], mother's knowledge [moderate vs. good (ref.), p=0.014, OR= 8.892 (95%CI 1.562 – 50.611); bad vs. good (ref.), p=0.110], and mother's perception of distance from home to immunization provider [near vs. distant (ref.), p=0.015, OR= 6,692 (95% CI 1.437 – 31.172); moderate vs. distant (ref.), p=0.486]. Conclusions. Factors affecting basic immunization status in this community were birth order, source of information, mother's knowledge, and mother's perception of distance from home to immunization provider. Keywords: Basic Immunization, Knowledge, Pediatric, Public Health.
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I-SOP18A
Diagnosis and Management of Primary Laryngeal Tuberculosis Ade Asyari*, Novialdi*, Opi Akbar* *
Departement of Oto Rhino Laryngology Head and Neck Surgery, Faculty of Medicine Andalas University/ M. Djamil General Hospital, Padang
Background: Laryngeal tuberculosis is a specific inflammation of the larynx caused by Mycobacterium tuberculosis. Laryngeal tuberculosis is usually a secondary infection of pulmonary tuberculosis, while primary laryngeal tuberculosis is very rare. Laryngeal tuberculosis is frequently misdiagnosed because the symptoms and signs are changing. The most common symptoms of primary laryngeal tuberculosis is hoarseness. Objective: The aim of this case presentation is to report case of laryngeal tuberculosis without pulmonary involvement. Methods: Evidence based literature study of primary laryngeal tuberculosis through Google Scholar, Pubmed Medline and hand searching. Results: This case reported was 25 year old woman that complained of hoarseness for 6 months. The results of histopathological examination of the larynx showed a tuberculous caseosa appearance, radiological and sputum AFB examination showed no lung involvement. Conclusion: Primary laryngeal tuberculosis is rare. Histopathological examination is the gold standard for diagnosis of primary laryngeal tuberculosis. Management of primary laryngeal tuberculosis with antituberculosis drugs showed good result. Keywords: Primary laryngeal tuberculosis, Hoarseness, Histopathological examination, Antituberculosis drugs
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I-SOP19A Spectrum of cerebrospinal fluid analysis in Tuberculous Meningitis patients at Dr. M. Djamil Hospital Padang Elsi Rahmadhani Hardi1, Anggi Anugerah Basir1, Yuliarni Syafrita2 Neurology Resident at Faculty of Medicine Andalas University / Dr. M. Djamil Hospital, Padang, Indonesia1 Neurology Staff at Faculty of Medicine Andalas University / Dr. M. Djamil Hospital, Padang, Indonesia2
Background. Tuberculous (TB) infection in central nervous system, particularly TB meningitis still causes high morbidity and mortality rate. Tuberculous meningitis mortality rate reaches 50% from all of mortalities because of central nervous system infection. Immediate diagnosis is required in order to determine appropriate management for each cases. An appropriate management is expected will decrease its mortality rate. The most important parameter in tuberculous meningitis diagnosis is cerebrospinal fluid analysis. Objective. The aim of this study was to describe about cerebrospinal fluid characteristics in meningitis patients as a criteria for tuberculous meningitis diagnosis. Methods.This was a prospective study involved patients with tuberculous meningitis who were treated at Neurology ward of Dr. M. Djamil Hospital Padang. Subjects were taken from May 2018 to April 2019 by using total sampling method. The inclusion criteria was patient diagnosed tuberculous meningitis by using Marais criteria. Results. Seventy nine people were recruited in this study, then 15 people were excluded. Therefore, 64 people were reported. Based on cerebrospinal fluid (CSF) color analysis, xanthochrome CSF was found in 55% samples and clear CSF in 45% samples. From cells counting type in CSF, we found predominant monocyte in 55% samples (86%). Lower glucose concentration from normal (Marais criteria) was found in 33% samples dan the ratio of CSF to serum glucose was 0,05). Conclusions. The conclusion of this study is that there is no relationship between age and length of hospital stay and the distribution of the prevalence of Covid-19 is dominant in patients with the adult group aged 19-59 years. Keywords. Covid-19, Age, Length of Hospital Stay
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I-SOP38A
Miliary Tuberculosis in Immunocompromised Patient Induced by Imatinib and Steroid : A case report Randa Fermada1, Fauzar1, Roza Kurniati1, Irza Wahid1 Internal Medicine Department Medical Faculty of Andalas University / RSUP M. Djamil Padang1
Background. Miliary tuberculosis is tuberculosis that occurs due to hematogenous spread of Mycobacterium Tuberculosis from the primary complex. The use of steroid and cytotoxic drugs increases the incidence of miliary tuberculosis. Typical manifestations of tuberculosis, miliary or snow storm appearance on chest X ray, evidence of tuberculosis germs from microbiological examination can help the diagnosis of milary tuberculosis. Case. A 33 years old male patient admitted to the hospital with breathlessness, chroniccough, fever, anorexia, weigh loss and night sweating withDepartement of Internal damn shadow sign. Currently, this patient consume imatinib for chronic myelogenous leukemia therapy and steroid for autoimmune hemolytic anemia. There are no specific signs found in the physical examination. Chest X ray showed snow storm appearance. The patient underwent Xpert®MTB/RIF, result is detected low MTB. Patient treated with regimen 2(HRZE)/4(HR) tuberculosis drugs. Imatinip and steroid was stopped. Discussion. 2-4 weeks of using steroid with a daily dose prednisone equivalent more than 15 mg increases of the risk of latent tuberculosis infection becoming active. Imatinib affects response of T cells to Mycobacterium Tuberculosis, thereby triggering tuberculosis reactivation. In this case, diagnosis has been made from typical manifestations of tuberculosis, snow storm appearance on the chest X ray, and low detected MTB on Xpert®MTB/RIF Summary. Miliary tuberculosis predisposition increase in patient which are used steroid and cytotoxic drugs. It has been recommended to detect wheater there are laten tuberculosis infection or not before using steroid and cytotoxic drugs. The diagnosis established from chest X ray and Xpert®MTB/RIF result. Keywords. Miliary tuberculosis, TB, imatinib, steroid.
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I-SOP39A
Disseminated tuberculosis in breastfeeding mother : case report Dewi Oktavia Djasmi1, Roza Kurniati1, Fauzar1 Departement of Internal Medicine, Faculty of Medicine, Andalas University-M Djamil General Hospital, Padang, Sumatera Barat, Indonesia
Background. Disseminated tuberculosis is defined as the presence of two or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis. Disseminated TB is a life-threatening condition, especially if the diagnosis and treatment are delayed. Case. We report on a case of disseminated TB in an immunocompetent breastfeeding woman, 21-years-old admitted in M. Djamil hospital. Her symptoms and clinical signs were breathlessness, chronic cough, fever, night sweat and loss of body weight. From physical examination, decreased breath sounds in the left lung as high as RIC V. Smear PCR were positive for Mycobacterium tuberculosis. Chest x-ray showed milliary pattern and pleural effusion sinistra. Pleural fluid analysis suggests an exudate. The patient was initially started on first-line therapy of isoniazid, rifampin, pyrazinamide, and ethambutol, with pyridoxine. Discussion. Breastfeeding is not contraindicated if the mother is being treated for active tuberculosis or latent TB with first-line agents. Pyridoxine should be given to both the infant and mother while an isoniazid-containing regimen be used. For mothers who are taking tuberculosis drugs, newborn children should be given prophylactic tuberculosis, namely Isoniazid at a dose of 5-10 mg / kg per day for 6 months. Summar. Diagnosing and treating active or latent TB in pregnancy and during postpartum period is very important as it affects both mother and baby. It can cause significant morbidity and mortality if not correctly diagnosed and treated adequately. Keywords. breastfeeding mother, disseminated tuberculosis, pleural efusion, pulmonary tuberculosis, miliary pattern
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I-SOP40A
Maintaining Continuity of care for children with chronic disease during the COVID-19 pandemi and infection prevention : A systematic review Yelly Herien1, Fitri Mailani2 1
2
Pediatric Nursing Department, Faculty of Nursing, Universitas Andalas, Padang, Indonesia Medical Surgical Nursing Department, Faculty of Nursing, Universitas Andalas, Padang, Indonesia * Correspondence: [email protected], (+62 852 6347 9874)
Background.The primary burden of disease in children and young people has shifted from infectious diseases towards chronic conditions. Children with chronic disease need frequent exposure to the hospital setting. COVID-19 pandemic has made many changes in health care. Some conditions such as chronic kidney disease are at significant risk for experiencing infectious diseases such as COVID-19 because of their compromised immune system. Objective. This study aims to review and describe adaptations in managing chronic diseases to maintain continuity of care during pandemic and precautions to reduce the risk of COVID19 in this vulnerable group. Methods. Four databases, Pubmed, Proquest, Science Direct and Springer Link were reviewed for relevant article. Sixteen studies of children with renal disease, blood disorders, diabetes, TB, asthma and other diseases were identified. Results. Overall, many treatments, hospital visit and Medical Information System must be modified. Proper design of the HD unit should be kept relatively isolated by spacing the dialysis chairs/ beds at least 1 m apart. Health Care Provider (HCP) who treats children with DM, cancer, blood disorder promotes tele-consultation or video-consultation, if hospital visit is mandatory it is recommended to advance book online or by phone. Challenges must also be faced, increasing rate of DKA in pediatric diabetes, stigma of TB and other respiratory diseases with cough, fever are COVID-19 patients, etc. Conclusions. This systematic review found that staff, patient and environment management in control strategies of infection are increasingly tightened in chronic disease. The findings suggest comprehensive management and readiness of health services to manage this condition. Keyword . Child, COVID-19, Chronic Disease, Infection ulosis, drop out of treatment.
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I-SOP41A
COVID-19 and delirium in elderly, a case report Roza Mulyana Departement of Internal Medicine, Faculty of Medicine, Andalas University-M Djamil General Hospital, Padang, Sumatera Barat, Indonesia
Background. Coronavirus disease 2019 (Covid-19) was first reported in Wuhan, China. One of atypical presentations of Covid-19 is delirium, which is a common neuropsychiatric syndrome in elderly patients, characterized by a sudden onset and fluctuating course. Delirium leading to prolonged hospital stay, increased risk of cognitive decline, and mortality. Inflammation is one of multiple noxious delirium insults and Covid-19 is recognized as a disease with inflammation. Case . A 69 years old woman was admitted to the Andalas University Hospital, presented with shortness of breath and confused. She had no fever or cough, sometimes resisted feeding and rejected therapeutic intervention. The chest X-ray revealed pneumonia (multifocal bilateral lung opacities) and corona virus polymerase chain reaction (SARS-CoV2 PCR) assay was positive. Comprehensive geriatric assessment was delivered. Psychiatrist assessed patient as delirium and treated her with antipsychotic drug, in addition to Covid-19 treatment given. The patient was discharged after hospitalized for 27 days, till SARS-CoV-2 PCR negative twice. Discussion. This case highlights the importance of paying attention to specific problem in elderly especially delirium. Covid-19 patients are hospitalized in isolation room and may not be accompanied by family. This condition affects the treatment during hospitalization. It needs approach with integrated geriatric service to get better outcome. Summary. The importance of this case lies in multidisciplinary approach in older patient with positive for Covid-19 and favorable response to the medical treatment given. Keywords. Covid-19, delirium, elderly, case report
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I-SOP42A
Hematology profile of Tuberculosis Lymphadenitis patients at Siti Rahmah Hospital, Padang, Indonesia Debie Anggraini 1, Meta Oktora2 Department of Clinical Pathology, Faculty of Medicine, Baiturrahmah University, Padang, Indonesia. 1 Department of Anatomy Pathology, Faculty of Medicine, Baiturrahmah University, Padang, Indonesia. 2
Background. Tuberculosis (TB) is a progressive granulomatous infectious disease caused by Gram-positive acid-resistant bacilli classified in genus Mycobacterium. Tuberculosis in humans is caused by Mycobacterium tuberculosis (MTB) and mainly attacks the lungs, can also infect intestines, meninges, bones, lymph nodes, skin that cause extra-pulmonary TB. Tuberculosis lymphadenitis was is an inflammatory process in lymph nodes as result of MTB activity. Inflamatory process which caused by MTB activity often associated with the most common complication, namely anemia. Anemia in TB is caused by inflammatory process associated with bone marrow suppression due to proinflammatory cytokines, thus inhibiting the proliferation and differentiation of erythroid progenitor cells. This chronic TB infection also affects iron hemostasis, thus further affecting hematological profile of TB patients. Objective. to determine hematology profile of TB lymphadenitis patients in Siti Rahmah Hospital, Padang, Indonesia. Methods. This was a descriptive study, with population being patients diagnosed with TB lymphadenitis based on fine needle biopsy results of Colli. The samples of this study were consisted of 24 patients and examined hematology profile. Results. TB lymphadenitis patients in women was higher than in men, the mean age was 26.7519.53 years old dominated by adulthood (54%). The mean of hemoglobin levels in was 11.81.522 g/dL, the mean of leucocyte count was 104003018.926/ mm3, the mean of thrombocyte count was 33475074440.668/mm3, and the mean of erythrocyte sedimentation rate was 35.25 31.489 mm/h. Conclusions. Hematology profile in TB lymphadenitis patient was the mild anemia, leukocytosis and increase level of ESR. Keywords. Hematology profile, Tuberculosis lymphadenitis, Padang , Indonesia
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I-SOP43A
Case report : A case of tuberculosis Verrucosa cutis of 39 years duration Indah Indria Sari1, Tutty Ariani2 Department of Dermatology-Venereology, School of Medicine, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia1 Department of Dermatology-Venereology, Infectious Dermatology Division, Dr. M. Djamil Hospital, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia2
Background. Tuberculosis verrucosa cutis (TVC) is rare true secondary cutaneous tuberculosis and commonly delays in diagnosis. The lesions of TVC progress slowly and if untreated, the lesions persist for many years. Case. Reported a case of TVC in a 49-year-old woman with brownish reddish patches with rough in the edge of patches, not accompanied by pain, itch and numbness on the right leg that has expanded since ± 39 years ago. There was a history of trauma before the lesions appear. There was no history of bacilli Calmette – Guerin (BCG) immunization and tuberculosis infection in patient and families. A physical examination revealed two welldemarcated annular lesions on her right leg. The lesions had raised hyperkeratotic brownish-red border and exhibited central slightly atrophic skin on the right knee and upper back thigh to the calf. There was increasing of erythrocyte sedimentation rate (ESR). Chest radiograph was in normal limit. Acid – fast bacilli examination from sputum and lesions, and GeneXpert examination were negative. The result of histopathological examination with hematoxylin eosin staining and immunohistochemistry with ESAT 6 staining are suitable for TVC. Patient was treated with anti tuberculosis drug in form of fixed dose combinations (FDC) for twelve months, showed clinical improvement and there was no side effect during the treatment period. Discussion. Tuberculosis verrucosa cutis (TVC) is asymptomatical disease and patient commonly never seek for treatment leading to chronic course. If treated, TVC has good response following the antitubercular drug. Keywords. delays in diagnosis, disease duration, tuberculosis verrucosa cutis
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I-SOP44A
Acetylator Profiles in MDR TB patients with Short-Term Regimens Deddy Herman1 , Russilawati1 , Fenty Anggrainy1 , Elsis Mareta Edriyenti1 Bagian Pulmonologi Dan Kedokteran Respirasi Fakultas Kedokteran Universitas Andalas1
Background. The clinical efficacy of high-dose INH in MDR TB patients with short term regiment depends on the dose, acetylator phenotype and the degree of INH resistance. The pharmacokinetic variability of INH can be assessed by the plasma INH concentration. Objective. This study measuredplasma INH concentrations 2 hours after administration and comparedwith acetylator phenotype data.Methods: This study was conducted in November 2019-January 2020, includingMDR TB patients with short-term regimentat least 1 monthat Dr. M. Djamil Padang, Achmad Mochtar Bukittinggi Hospital and West Sumatra Lung Hospital. The plasmaINHconcentration was from the serum taken after 2 hours of INH administration, thenestimated plasma concentration was assessed by liquid chromatography and compared with the patient's acetylator phenotype data. Results. This study reported plasma isoniazid concentrations 2 hours after administration in 26 patients. The plasma INH concentrationin this study was 0.00-18.2 mg/L with an average of 4.69 mg/L. 15 patients had a known acetylator phenotype, most of them (86,67%) was fast acetylator. Plasma isoniazid concentrationin fast acetylators is 1.25 mg/L with a range of 0-8.5 mg/L, while in slow acetylators the median is 5.24 mg/L with a range of 0.25-14.16 mg / L. Conclusions. The most common acetylators in MDR TB patients with shortterm regimen are fast acetylators. Variation of acetylator phenotype in MDR TB patients affectedplasma INH concentration, median of fast acetylators lower than slow acetylators. Key words. INH concentration, phenotype, acetylator
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I-SOP45A
Case report : A case of Tuberculosis Verrucosa Cutis in 59 years old woman Indah Kencana1, Tutty Ariani2 Department of Dermatology-Venereology, School of Medicine, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia1 Department of Dermatology-Venereology, Cosmetic Dermatology Division, Dr. M. Djamil Hospital, Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia2
Background. Tuberculosis verrucosa cutis (TVC) is rare true secondary cutaneous tuberculosis and commonly delays in diagnosis. Lesions progress slowly and if untreated persist for many years. Case: Reported a case of TVC in a 58-year-old woman with a chief complaint of purplish red patches with rough in the edge of patches, not accompanied by pain, itch and numbness on the right arm that has increased in size since ± 3 months ago. There was a history of gotten cut of knife before the lesions appear about ± 4 months ago. There was a history of tuberculosis infection in patient's husband. History of bacilli Calmette – Guerin (BCG) immunization is unknown. A physical examination showed purplish red plaque with welldemarcated lesion and verrucous lesion on her right arm. There was increasing of erythrocyte sedimentation rate (ESR). Chest radiograph was showed bronchopneumonia. Acid – fast bacilli examination from sputum and GeneXpert examination were negative. The result of histopathological examination with hematoxylin eosin staining was showed pseudoephiteliomatous hyperplasia, datia langhans cell, histiocyte, and epitheloid which suitable for TVC. Patient was treated with anti tuberculosis drug in form of fixed dose combinations (FDC) for twelve months and showed improvement. Conclusion. The chronicity of TVC is Clinically, histopathological characteristics and response to therapy confirmed the diagnosis of TVC.
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I-SOP46A
Adherence to Tuberculosis Preventive Treatment (PP-INH) of Household Under-five Contacts in Bandung Isni Nurul Aini,1 Panji F Hadisoemarto,1,2 Hanifah Nurhasanah,1 Bachti Alisjahbana,1,3 Rovina Ruslami1,4 TB Working Group, Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia1, Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia2, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia3, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia4
Background. The Indonesian tuberculosis (TB) control guideline recommends INH preventive TB treatment (PP-INH) for 6 months for under-five contacts of adult pulmonary TB (PTB) patients and for people with HIV. From 2017 to 2019, we conducted an interventional study to increase the uptake of PP-INH in Bandung. Here we report the adherence to PP-INH of household under-five contacts in Bandung. Methods. Fifteen Puskesmas in Bandung were randomized to two intervention arms in a cross-over trial. The first arm completed intervention in April 2018, and the second in March 2019. All under-five children in contact with adult pulmonary TB cases were screened for TB and were put in PP-INH if the examination result was normal. The number of TB patients, under-five contacts, and those who started PP-INH were obtained from forms TB01, TB03, and a study registry and were recorded until the study ended in November 2019. TB01P forms from these patients were reviewed to measure PP-INH completion rate. Results. We identified 96 contacts of under-five from 88 adults bacteriologically confirmed PTB cases. Of these under-five contacts, 93 (96.8%) initiated PP-INH, among which 60 (64.5%) completed the 6-month treatment. Thirty-one (33.3%) children dropped out and two children developed TB. Conclusions. In spite of the high proportion of children initiating the treatment, adherence to PP-INH in Bandung was low. Research that evaluates the non-adherence and intervention to increase the adherence to PP-INH in child contacts is required in this and similar settings. Keywords. Adherence, PP-INH for under-five contacts
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PUBLIC HEALTH
I-SOP1B
Contribution of smoking to pulmonary tuberculosis incidence in Bandung, Indonesia Panji Fortuna Hadisoemarto MD1,2*, Raspati Cundarani Koesoemadinata MD1,3,4*#, Manik Intan Gumilang BSc5, Prof Ida Parwati6, Bachti Alisjahbana PhD1,7 1
Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 2Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 3Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands, 4Indonesian Society for Microbiology, Bandung Branch, Indonesia, 5Undergraduate Programme, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 6Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia, 7Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
Background. Primary data reporting the contribution of smoking to tuberculosis (TB) incidence in Indonesia are scarce. Objective. This study aims to estimate the effect of smoking on TB incidence and the risk of tuberculosis attributable to smoking among presumptive TB patients in Indonesia, a country with the third highest incidence of TB globally which one third of its population are active smokers. Methods. Between 2012-2014, presumptive TB patients aged ≥15 years old presenting with cough for at least 2 weeks to Hasan Sadikin General Hospital Bandung underwent interview, chest x-ray examination, and were asked to provide 2 sputa for microscopic examination and Mycobacterium tuberculosis culture. The prevalence of smoking and bacteriologically confirmed TB among these patients and their corresponding confidence interval (CI) was determined. Multivariable logistic regression was used to assess the association between smoking status with bacteriologically confirmed TB controlling for age and gender. Population attributable proportion was estimated. Results. Of 198 presumptive TB patients (58.1% males, median age 40 years old), 101 (51.0%; 95% CI 43.8-58.2) were ever-smoker and 71 (35.9%; 95% CI 29.2-43.0) had bacteriologically confirmed TB. Ever-smoking was associated with bacteriologically confirmed TB (crude OR: 2.00; 95% CI 1.10-3.62) which remained significant after adjustment by age and gender (adjusted OR: 3.14; 95% CI 1.44-6.83). The incidence of bacteriologically confirmed TB that was attributable to smoking (population attributable proportion) was 22.3% (95% CI 16.6-28.7). Conclusion. Smoking is an important risk factor for bacteriologically confirmed TB. Smoking cessation program should be promoted as an intervention to reduce TB incidence and prevent TB transmission. Keywords. Smoking, TB, population attributable proportion. THE 2nd INDONESIAN TUBERCULOSIS INTERNATIONAL MEETING | 28-29th AUGUST 2020
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I-SOP2B
Comprehensive prevention of pulmonary tuberculosis using directly observed treatment short-course (DOTS) strategy Artha Budi Susila Duarsa1, I Putu Dedy Arjita2 1,2
Faculty of Medicine, Islam Al-Azhar University
Abstract Tuberculosis is one of the most frequently occurred infectious diseases in public health. This disease could be a serious problem and affected to death. So, a continuous TB control program needs to be implemented. The government has provided free services for TB sufferers in Indonesia. This services can be access in government health services and a few of private health services. The development of TB prevention strategies in Indonesia is carried out with the DOTS (Directly Observed Treatment Short-course) strategy. DOTS is a pulmonary treatment strategy that gave priority to control of taking medication, prevents dropping out of treatment and finds new cases in the community. The main focus of DOTS is the discovery and healing of patients. Indonesia has implemented the DOTS strategy since 1995. Unfortunatelly, the implementation of the DOTS strategy has not been completed successfully. This problem caused by occurring new patients with smear TB (+) (Case Detection Rate/CDR) in the community. Suspected access / suspected TB is an important factor in the low CDR. Target of TB control programs is achieving a CDR of at least 70% and healing 85% of all patients. Comprehensive TB prevention not only diagnosis and treatment (curative) but also integrate effort both government and community. TB prevention has become a joint government and community responsibility like promotive, preventive, curative and rehabilitative by comprehensive and sustainable. So, Using the DOTS strategy can be optimized in the prevention of pulmonary TB in Indonesia. Keywords. Comprehensive prevention, pulmonary tuberculosis, government, community, DOTS.
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I-SOP3B
Relations of knowledge and attitude of pulmonary tuberculosis (TB) patients with precautions of tuberculosis in Andalas Health Center 2015 Doni Andika Putra1, Yenny Muchtar2, Elmatris Sy3 1
Faculty of Medicine Andalas University, Padang, Indonesia, 2Pulmonology Department of Andalas University, Padang, Indonesia, 3Chemistry Department of Andalas University, Padang, Indonesia
Background. Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis. TB incident in Padang has increased from 927 cases to 1105 in 2015 with the highest incidence happens in Andalas Health Center. The behavior of individuals includes knowledge, attitudes, and actions is one of the factors for disease transmission. Objective. This study aims to determine the relations of knowledge and attitude to precautions of pulmonary TB transmission in Andalas Health Center. Methods. This study uses an observational analytic design and using TB-01 form and a questionnaire. The study was conducted in November 2015 - April 2016 with the population is the TB patients in Andalas Health Center. Total sample of 60 people with sampling random technique. Data analysis was performed using chi-square test. Results. The result shows that most of respondents have the high knowledge (95%), the attitude positive (51,7%), and precautions is equal between good and bad (50.0%). The statistical test shows no significant relationship between knowledge with precautions (p=1,000) and between attidute with precaution (p=0,605) transmission of tuberculosis. Conclusion. It is concluded that there was no correlation between knowledge and attitude with tuberculosis transmission precautions. Keywords. Knowledge, attitude, precautions, pulmonary tuberculosis.
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I-SOP4B
The use of rapid molecular diagnostics/test to find TB cases in Indonesia: A review of information system management Maria Holly Herawati, Dina Bisara, Oster Suryani, Aris Yulianto
Background. Indonesia is one of the most contribution towards world's TB case based on WHO data in 2018. Some studies have findings that GeneXpert MTB/RIF could detect nearly 90.3% cases compared to sputum smear microscopy. WHO said that information systems should be developed through management system, especially controlling TB prevalence in Indonesia. Objective. The aim of this study is to give an overview of information systems management by utilizing TCM to find TB case in Indonesia. Methods. This study was a cross-sectional, involved 42 hospitals and 2 primary healthcare facilities had undergonerapid molecular diagnostics at least 6 months in 42 districts/municipalities, 26 provinces. Area sampling was done by 2 steps stratification. First step based on underdevelop region and non underdevelop region. Second steps based on fiscal capacity from any district. Sampling are take by using Non Probability Sampling. Data pooling were collected by quantification and qualitative method. Results. Comparison of TB discovery targets with microscopy and TCM shows the numbers 16.81, and 29.72. Distribution of health facilities using TB information systems for recording and reporting TB activities is 95.5%, while health facilities have regulations that regulate TB recording and reporting staff by 20.6%. The distribution of health facilities that have collaborations is included in the information system both between health facilities and health services in 81.8%, and health facilities that have special personnel handling TBC recording and reporting systems by 72.7%. Conclusion. There is a relationship between health facilities that have regulations on information system personnel and TBC case finding with TCM, at = 5%, there is a significant difference between the average TB case finding and TCM in health services that have regulations on information system personnel and those who do not have the rules. Keywords. GeneXpert MTB/RIF, case findings TBC , systems Information.
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I-SOP5B
Profile of pediatric tuberculosis patients: A rectrospective descriptive study of Bunda Medical Centre Hospital in 2019 Anisha Fazlisia*, Kurnia Maidarmi Handayani**, Elsi Wineri**
Background. Indonesia had around 70.000 cases of pediatric tuberculosis in 2018 only 62.029 cases had been reported. There were 1.560 cases of pediatric tuberculosis in West Sumatera and 321 cases were in Padang. Bunda Medical Centre Hospital is one of private hospital in capital city of West Sumatra. The hospital has been involved in DOTS-based for tuberculosis management. They have been diagnosed, treated, and reported 97 cases of pediatric tuberculosis in 2018. The success rate was at 90.2%. Objective. The objective of this study was to describe profile of pediatric tuberculosis patients in Bunda Medical Centre Hospital since January till December 2019. Methods. This retrospective descriptive study investigated pediatric tuberculosis patient's TB 03 forms in Bunda Medical Centre Hospital since January to December 2019. Results. We obtained 65 subjects. Most of them were males (66%). Most age group was 0-4 years old (67.7%). Patients were clinically diagnosed using scoring system (all of patients having score more than 6). Most of them were diagnosed as pulmonary tuberculosis (97%). Conclusion. Based on this study we concluded most of pediatric tuberculosis cases at Bunda Medical Centre Hospital were males and most of age group was 0-4 years old in 2019. Almost all of patients were diagnosed as pulmonary tuberculosis. There is no one diagnosed by bacteriological confirmation. Keywords. Clinically diagnosed, pediatric, tuberculosis.
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I-SOP6B
Factor influenced treatment outcome in drug resistance tuberculosis with short therapy regimen and individualized treatment in Dr. Moewardi Hospital Jatu Aphridasari1,2, Ramaniya Kirana1,2 1
Pulmonology and Respiratory Medicine Department , Medical Faculty of Sebelas Maret University, 2Dr. Moewardi General Hospital Surakarta
Background. Tuberculosis (TB) remains a serious global public health problem in Indonesia. The 2011 World Health Organization (WHO) guidelines on the management of drug resistance tuberculosis (DR-TB) recommends an 8 months intensive phase and a total duration of ≥20 months of therapy but this regimen had a poor outcomes. This led, WHO updated its treatment guidelines for DR-TB in May 2016 and included a recommendation on the use of the shorter MDR-TB regimen under specific conditions. Method. A retrospective study was designed to determine the factors that influence the treatment outcome of DR-TB in the short therapy regimen (STR) and individualized treatment at Dr. Moewardi Hospital from September 2017 to December 2019. Results. Sixty four patients (44.4%) had undergone therapy with STR and 80 patients (56.6%) with individualized treatment. Treatment outcomes of DR-TB patients were as follows: 34 were cured (53.1%) in STR group and 18 were cured (22.5%) in individualized treatment group. In both group, conversion time was influence the treatment outcome and statistically significant. Adverse events are statistically significant influence the treatment outcome in individualized treatment. Conclusions. The success rate of DR-TB treatment was 53.1% in STR group and 22.5% in individualized treatment group. Treatment outcomes of DR-TB patients is influenced by conversion time in STR group. While in the individualized treatment group, it is influenced by conversion time and adverse events. Keywords. Treatment outcomes, drug resistance TB, short therapy regimen, individualized treatment.
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I-SOP7B
Increasing tuberculosis CDR in kampus public health center working area by forming tuberculosis cadres together with Aisyiyah TB-Care Esti Yolanda1, Yuliarni1 1
Campus Public Health Center of Palembang, Lorok Pakjo, Palembang
Background. Estimated number of tuberculosis suspects in Campus Public Health Center (PHC) working area in 2019 was 785 peoples and tuberculosis case detection rate (CDR) from January-October 2019 was only 35,5%. Health care provider of Campus PHC had carried out home visits together with Integrated Health Post (IHP) cadres, but still had not reached the target, one of many reasons was financial support. Aisyiyah TB-Care is an organization that had been chosen as Principal Recipient of Global Fund in Indonesia and willing to fund tuberculosis case netting in Campus PHC. Objective. To increase tuberculosis CDR in Campus PHC working area. Methods. This is one group pretest-posttest pre-expreimental study. We auditioned 16 candidates and 10 passed as tuberculosis cadres. Before netting tuberculosis case, these cadres were trained. People who lived around tuberculosis patient were documented. After one month, we compared the number of tuberculosis CDR before and after intervention. Results. This study showed that before intervention, the mean tuberculosis CDR per-month (January-November 2019) was only 34,27+21,29 cases and never reached monthly tuberculosis CDR target (65 cases per-month). After one month intervention, this study showed tuberculosis CDR escalation (73 cases in one month). Conclusion. Tuberculosis cadres intervension funded by Aisyiyah TB-Care increased tuberculosis CDR in Campus PHC working area. Keyword. Tuberculosis, case detection rate, cadres, Aisyiyah TB-Care.
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I-SOP8B
Knowledge of final-year medical students regarding tuberculosis diagnosis Elly Usman1, Pratiwi Putri Masrul2 1
Department of Pharmacology, Faculty of Medicine, Universitas Andalas, Padang, Indonesia Independent Researcher, Bandung (WHO TDR-Implementation Research Alumni, Universitas Gadjah Mada), Indonesia
2
Background. According to the World Health Organization (WHO), Indonesia is a high burden country for TB, Multi-Drug Resistant TB (MDR-TB), and TB/HIV. In line with a national target for elimination of Tuberculosis in 2030, sufficient knowledge among general practitioners is a cornerstone to achieve high case- finding and efficient TB casemanagement. As a future general practitioner, a front liner in the health care, it is essential to asses a knowledge of medical students regarding tuberculosis diagnosis. Objective. The study aimed to determine knowledge regarding tuberculosis diagnosis among final-year medical students. Methods. This was a cross-sectional study survey that used a self-administered questionnaire on knowledge about tuberculosis diagnosis. It was performed among medical students who had completed clinical practice in the Department of Internal Medicine and Department of Pulmonology. Results. Among 125 respondents who filled out the questionnaire, only 102 were valid. The mean of correct answer was 79%. Questions about main symptom of TB, definition of TB new cases, and fundamental examination of TB for adult cases have the highest corrected answer, 98%, 99%, and 99%, respectively. While the knowledge about algorithm of rapid molecular test TB (The Xpert MTB/RIF assay) has the lowest corrected score of 5%. Among the 102 respondents, only 2 respondents answer all questions correctly. Conclusion. Though data show sufficient knowledge about the diagnosis of tuberculosis, this survey is considered the need for increased knowledge regarding national TB regulations and the implementation of novel TB diagnostic tools. Keywords. Knowledge, medical student, tuberculosis, tuberculosis diagnosis.
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I-SOP9B
An overview social stigma and quality of life tuberculosis patients at East Java Eppy Setiyowati1, Ni Njoman Juliasih2, Reny Mareta Sari3, Fery Agus Andriawan4, Siti Hardianti5 1
Faculty of Nursing and midwifery, University of Nahdlatul Ulama Surabaya 2.3 Institute of Tropical Diseases, UniversitasAirlangga, Indonesia 4.5 Student in Faculty of Nursing and midwifery, University of Nahdlatul Ulama Surabaya
Background. The experience of rejection from the community makes patients of the pulmonary tuberculosis depressed and worsens their quality of life. Objective. The research objective was to assess the development of social stigma and quality of life for patients tuberculosis. Methods. A community based cross-sectional survey was conducted from Januari – Maret 2020. Any person 15 years and above with cough who seek treatment at the East Java Health Center, and the sample size of the 2 groups consisting of patients tuberculosis was 55 respondents and 55 respondents were family. The sampling technique used simple random sampling, the data collection instrument used a questionnaire sheet. Statistical analysis used linear regression test with a significance level of α = 0.05. Results. The most of (60%) experienced bad social stigma and most of (58.2%) tuberculosis patients had a bad quality of life. The results of the linear regression test, the value of ρ = 0.007 and α = 0.05, which means that there is a relationship between social stigma and the Quality of Life of tuberculosis patients at the East Java Health Center. Conclusion. The worse the social stigma experienced by patients tuberculosis, the worse the quality of life. It is hoped that the family gives full support to TB sufferers in order to be able to improve the quality of life so that the patient's physical health improves. Keywords. Tuberculosis, social stigma, quality of life.
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I-SOP10B
Childhood tuberculosis before and during COVID-19 pandemic at Padang City Finny Fitry Yani1, Ratno Widoyo2, Feri Mulyani Hamid3, Eva Westari3, Titi Infanti 3 1
Department of Child Health dr. M.Djamil Hospital/Faculty of Medicine Universitas Andalas,2 Faculty of Public Health Universitas Andalas, 3 Padang City Health Office
Background. COVID-19 pandemic since March 2020 in Indonesia has caused many disruptions to the health system, especially to chronic diseases such as tuberculosis. Objective. To describe childhood TB achievement before and after the COVID-19 pandemic at Padang City. Methods. This retrospective descriptive study was carried out the data of all childhood TB patients in Padang City between January until July at the same period of 2019 and 2020. We compared the data about new case finding and INH prophylaxis in children age 0-14 years old. The data was collected from 23 health care centers, 17 hospitals and private clinics. Data were analyzed by SPSS 23 software. Results. There 52.7% of the 372 cases of childhood TB patients, and 1.3 % of 116 cases of INH prophylaxis were founded in the Hospital. Compared with the first seven months of 2019, in the same period of 2020, childhood TB patient and INH prophylaxis decreased as much as 46.9% and 36.6%. The decreasing cases caused by COVID-19 pandemic was showed since April 2020. During this session, the case of childhood TB and case of INH prophylaxis was significantly decreasing, there 75.2% and 77,3% in order. Conclusion. The policy of stay at home from the government and people worrying about COVID-19 transmission make many people not visit community health care, Hospital or other, including children with TB symptoms. On the other hand, active case finding cannot run well at this session. Keywords. AFB contact, childhood tuberculosis, mantoux, thorax radiology, tuberculosis ontact.
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I-SOP11B
Prediction model of tuberculosis among children: Prospective cohort study in DKI Jakarta Erni Rita1, Tria Astika Endah Permatasari2, Ika Kurniaty3, Giri Widakdo4 1,4
Faculty of Nursing Science, Universitas Muhammadiyah Jakarta Faculty of Medicine and Health, Universitas Muhammadiyah Jakarta 3 Faculty of Engineering, Universitas Muhammadiyah Jakarta
2
Background. Tuberculosis is one of the leading infectious diseases in children in the world, including in Indonesia. The average age of a child suffering from tuberculosis is less than 14 years. Objective. This study aims to obtain a prediction model of TB incidence in children. Methods. Research with a prospective cohort study design in April-July 2019. A sample of 81 children was traced from adult TB patients who were positive for TB obtained from TB form 01 in 3 (three) Puskesmas namely Cakung District Health Center, Sawah Besar District Health Center, and Menteng District Health Center. Multivariate analysis with multiple logistic regression was used to analyze the prediction model of TB incidence in children. Results. Of the 81 children there were 16.5% who tested positive for TB obtained using a pediatric TB score which was the result of an assessment of the Molecular Rapid Test (TCM), Tuberculin Test, X-ray X-rays, and clinical symptoms. Based on the results of multivariate logistic regression analysis, it is known that nutritional status is the main predictor that determines the occurrence of TB in children (RR = 18.03; CI 2.13-152.67) after being controlled by the age and sex of the child as a confounder. While contact history was not significant in predicting the occurrence of TB in children. Conclusion. Nutritional status can predict TB incidence among children. Periodic measurement of nutritional status in children is needed to monitor the growth and development of children supported by other examinations to prevent the early occurrence of TB. Keywords. Tuberculosis, children, nutritional status, TB contact history, screening.
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I-SOP12B
Factors affecting non compliance to treatment among tuberculosis patients: Qualitative and quantitative study Fazidah Aguslina Siregar1, Lita Sri Andayani1, Tri Makmur2 1
Faculty of Public Health, University of Sumatera Utara, Medan, 20155, North Sumatera, Indonesia 2 Faculty of Medicine, Islamic University of Sumatera Utara, Medan, North Sumatera, Indonesia
Background. Incidence of tuberculosis in Indonesia remains high and non compliance to treatment become a major obstacles to efficient tuberculosis control. This impacted in disease relaps and increasing new cases. Objective. This study identified risk factors associated with non compliance to treatment among tuberculosis patients. Methods. This study was designed using mixed methods, quantitative and qualitative study. The quantitaive study was unmatched case control study with study recruits was 105 at a case: control ratio of 1:2. The qualitative study using indepth interview and Focused Group Discussion. Data was analyzed by using simple and multiple logistic regression in quantitative study, while content analysis was applied for the qualitative study. Results. Of the multiple logistic regression revealed that low education level, history of treatment, poor of knowledge, and lack of social support were significantly associated with non compliance to tuberculosis treatment. This findings was supported by qualitative study found that knowledge, social support, duration of treatment, and personal factor were factors related to non compliance to tuberculosis treatment. Conclusion. Poor knowledge, lack of social support, long term treatment, and personal factors were associated with non compliance to treatment. Therefore, health education regarding tuberculosis treatment and side effect is necessary to improve knowledge and perception of the community about tuberculosis as well as provide social support during treatment period. Keywords. Non compliance, tuberculosis treatment, quantitative, qualitative study.
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I-SOP13B
TB linkage strengthening in primary health care to increase tuberculosis cases notification in Palembang Muhammad Idrus1, Eva Oktavia Karolina Simatupang2*, Tri Hartati 3 1
Dinas Kesehatan Kota Palembang 2,3 Yayasan KNCV Indonesia (YKI)
Background. According to Global TB report 2019, estimated TB cases in Indonesia is 845.000 with 67% cases were notified. GPs/Clinics contributed only 1% of notification. Objective. Global fund Catalytic Funding project aims to find missing cases, especially in private sector, held by PDPI and YKI. A strengthening of District-based Public Private Mix (DPPM) approach in private providers has being implemented to increase notification in Palembang City. Methods. Professional organization coalition (KOPI TB) and DPPM team were established in July 2019. From September to November 2019, four consecutive workshops in primary level had been conducted to strengthen TB service among GPs/Clinics. There are two aspects contributed significantly in TB linkage strengthening. First, the establishment of MoU between Puskesmas and GP/Clinic to increase the access to standardized TB diagnosis and treatment (including HIV testing) in private providers. Second, active participation from National Health Insurance Provider (BPJS) in engaging GPs/Clinics and in monitoring TB case notification reported by private providers through WiFi TB. Results. 21 GPs/Clinics are actively reporting TB cases through WiFi TB. Sputum samples from 61 TB presumptives identified by 12 GPs/Clinics were examined using Xpert MTB Rif. In adition, 112 TB cases has been reported through WiFi TB compared to 11 cases before the workshop. Conclusion. MoU development and BPJS involvement in TB linkage strengthening at primary health cares have been increasing TB notification in Palembang City. Keyword. PPM, tuberculosis control.
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I-SOP14B
Epidemiological characteristics of COVID-19 clusterin Magetan district Frans Abidondifu1, Fariani Syahrul2, Agoes Yudi Purnomo3 1
FETP student, Airlangga University Department of Epidemiology, Faculty of Public Health, Airlangga University 3 Magetan District Health Office
2
Background. Coronavirus Disease 2019 (COVID-19) is a new type of disease that had never been identified in humans. Magetan District Government first reported a confirmed COVID19 case on March 19, 2020, and until 6th April 2020, there were cluster of infections with 3 confirmed cases. Objective. This study aims to describe the epidemiological characteristics of the COVID-19 cluster in Magetan district. Method. This research is a descriptive study that was done by collecting COVID-19 information from the contact tracing data of the Magetan District Health Office from 19th March to 6th April 2020, including age, gender, onset data, symptoms, exposure history, risk factors, residence, and CFR. Results. Data up to April 6, 2020 had one group of COVID-19 cluster from the Bogor cluster were 3 confirmed cases, contact tracing result 18, were aged 50-59 years 44.44%, were Females 66.67%, were housewife 44.44%, are close contacts 66.67%, hadsore throat 44.44%, and had cough 33.33%, average of 16 days as the incubation period, cases in Ngariboyo subdistrict 66.67%, and COVID-19 CFR was 11%. Conclusion. COVID-19 Bogorclusteris the initial source of transmission in Magetan district throught close contact. The government must increase the testing capacity and centralized isolation for all suspects cases. The government conducted a screening at the entrance of the area for the perpetrators of the trip and intensified contact tracing in the public health center area. Involve all stakeholders in the community for information distribution and encourage the movement of citizens concerned about COVID-19 prevention. Keywords. COVID-19, cluster,epidemiology, Magetan.
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I-OP1B
Monthly interim cohort analysis for drug-sensitive TB in Mimika, Papua: One year implementation Trisasi Lestari Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
Background. Monthly interim cohort analysis (MICA) is a surveillance strategy embedded in the integrated management of drug-resistant tuberculosis and recommended by the National TB Control Program. We apply similar methods to a cohort of drug-sensitive TB cases in Mimika district, Papua. Objective. We aim to ensure continuity of care for transferred patient, to improve coverage of diabetes and HIV screening, and to ensure contact investigation has been conducted. Methods. Since January 2019, TB officer from all TB clinics were invited by the District Health Office to a one day MICA meeting at Mimika District Hospital. New smear positive TB or GenXpert positive TB cases identified in puskesmas or hospitals are listed and treatment status was confirmed by the provincial TB coordinators. New cases identified in hospital are often transferred to puskesmas and TB officer at puskesmas should confirm if patient has reach and starts TB treatment in puskesmas. Missing TB cases will be follow up by puskesmas. All new cases who has starts treatment will be asked for status of blood sugar and HIV screening test, as well as contact investigation. Results. All health facilities which provided TB treatment are actively participated in the MICA meeting. Out of 192 smear positive and 512 GenXpert Rifampicin Sensitive TB cases identified in 2019, 640 (90.9%) received TB treatment. Out of 398 bacteriologically confirmed cases who were diagnosed in hospital, 178 (44.7%) was successfully transferred to Puskesmas. Coverage of blood sugar screening has improved from 50.5% in 2018 to 76.9% in 2019. Coverage of HIV screening has been steady at 87.0%. Contact investigation has been conducted to 620 index cases, a 19% increase from the previous year. Average delay from diagnosis to blood sugar and HIV test was 2 weeks. Conclusion. MICA meeting is effective to prevent missing TB cases, improve coverage of blood sugar and HIV test, and ensure continuity of care for transferred TB patient. Support from the district health office is essential for sustainability of the program. Keywords. Tuberculosis, surveillance, MICA, cohort analysis.
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I-OP2B
Gender differences in healthcare seeking behavior, diagnosis, and treatment pathway among TB patients: Secondary data analysis Elza Elmira, Lisa Stevens, Erik Post1 1
USAID Tuberculosis in Private Sectors Family Health International 360 Asia and The Pacific Regional Office
2
Background. TB notification in Indonesia is 41% higher in males than females. Reasons for gender discrepancies in TB diagnosis and care are unclear. Objective. This study aims to better understand gender differences in patients' preferences and pathways to TB care. Methods. Using Indonesian Demographic Health Survey Data 2017 and programmatic data, we simulate patient pathways for four urban districts: Denpasar, Medan, Jakarta Utara, and Jakarta Selatan. Results. Findings suggest no significant difference in the TB patient pathway between men and women. Regardless of gender, when experiencing fever/cough, patients tend to visit private health facilities for initial care-seeking (67% male versus 69% female), although less than 10% of these facilities have diagnostic and treatment capabilities. Despite this, over 73% of men and 72% of women with TB were diagnosed in public sectors, indicating low private sector diagnosis or reporting. However, only 60% of men and 55% of women diagnosed in the public sector were treated there, suggesting a shift to the private sector post-diagnosis. Treatment completion rates were better in public versus private sector: 85% and 74% respectively. Overall, female patients have 3% higher treatment completion rates than males. Multivariate logistic regression indicates a statistically significant difference in treatment outcome between gender and sectors (p-value