Performa Pemeriksaan Xpert MTB/RIF dengan Menggunakan Spesimen Bilasan Lambung dalam Mendiagnosis Tuberkulosis Paru pada Pasien HIV Tersangka Tuberkulosis Paru

Manuel Lamberto Willem Mboeik, Ceva Wicaksono Pitoyo, Teguh Harjono Karjadi, Anis Karuniawati, Esthika Dewiasty

Abstract

Pendahuluan. Uji Xpert MTB/RIF pada sampel bilasan lambung dapat meningkatkan temuan kasus Tuberkulosis (TB) paru, namun performanya pada orang dewasa dengan HIV belum banyak diteliti, termasuk di Indonesia. Penelitian ini bertujuan untuk menilai performa pemeriksaan Xpert MTB/RIF dengan menggunakan sampel bilasan lambung dalam mendiagnosis TB paru pada pasien HIV dewasa tersangka TB paru.

Metode. Penelitian ini menggunakan desain studi potong lintang terhadap pasien HIV dewasa tersangka TB paru di Poliklinik UPT HIV dan ruang rawat inap dewasa Rumah Sakit Cipto Mangunkusumo Jakarta antara Februari 2016 hingga Juni 2017. Dilakukan pemeriksaan sampel bilasan lambung dengan Xpert MTB/RIF dan pulasan basil tahan asam (BTA) dan pemeriksaan sampel sputum BTA.

Hasil. Dari total 117 subjek, 81 subjek (69,2%) tidak dapat mengeluarkan sputum namun dapat dilakukan sampel bilasan lambung. Didapatkan 34 (29,1%) sampel bilasan lambung positif pada uji Xpert MTB/RIF, 4 dari 36 pemeriksaan BTA sputum positif dan 2 dari 117 pemeriksaan BTA sampel bilasan lambung positif. Uji kepekaan obat pada ke 34 subjek yang positif Xpert MTB/RIF pada sampel bilasan lambung menunjukkan hasil tidak terdapat resistensi terhadap rifampisin. Dari 51 (43,6%) subjek yang didiagnosis klinis TB paru, didapat 26 subjek positif pada uji Xpert MTB/RIF sampel bilasan lambung. Hasil analisis menunjukkan bahwa uji Xpert MTB/RIF mempunyai sensitivitas 50,98% (IK 95%: 36,60- 65,25), spesifisitas 87,88% (IK 95%: 77,51-94,62), nilai duga positif 76,47% (IK 95%: 61,67-86,78) dan nilai duga negatif  69,88% (IK 95%: 63,36-75,68).

Simpulan. Xpert MTB/RIFdengan sampel bilasan lambung menunjukkan sensitivitas 50,98% dan spesifisitas 87,88% dalam diagnosis klinis TB paru pada pasien HIV tersangka TB paru.

 

Kata Kunci:  Bilasan lambung, Dewasa, HIV, TB paru, Xpert MTB/RIF

Performance of Xpert MTB/RIF by Using Gastric Lavage Sample in The Diagnosis of Pulmonary Tuberculosis in HIV Patients with Suspected Pulmonary Tuberculosis

Introduction. Xpert MTB/RIF test on gastric lavage sample may improve pulmonary tuberculosis (TB) case finding, but its performance as a diagnostic test for pulmonary TB in HIV-infected adults patients has not been studied widely, including in Indonesia. This study aims to determine the performance of the Xpert MTB/RIF test in diagnosing pulmonary tuberculosis among HIV-infected adult patients with suspected pulmonary tuberculosis by using gastric lavage sample.

Method. A cross-sectional study was conducted on adult HIV-infected patients with suspected pulmonary tuberculosis in Cipto Mangunkusumo hospital Jakarta between February 2016 and June 2017. Gastric lavage sample and sputum sample collection were performed for Xpert MTB/RIF test and acif fast bacilli (AFB) smear examination.

Results. Among total of 117 subjects, 81 (69,2%) subjects were unable to expectorate sputum. M tuberculosis was detected on Xpert MTB/RIF using gastric lavage samples in 34 (29,1%) subjects, AFB in 4 of 36 sputum samples and 2 of 117 gastric lavage samples. The drug sensitivity test on all 34 Xpert MTB/RIF positive subjects showed no rifampicin resistance. Fifty-one (43.6%) subjects were diagnosed as clinical pulmonary tuberculosis, 26 subjects among them were positive on Xpert MTB/ RIF assay, 4 subjects were smear sputum positive and 1 subject was gastric lavage smear positive. Using clinical diagnosis of pulmonary TB as gold standard, a single Xpert MTB/RIF assay using gastric lavage sample showed sensitivity of 50.98% (95% CI: 36.6-65.25), specificity 87.88% (95% CI: 77,1-94,62), positive predictive value 76,47% (95%CI: 61,67-86,78) and negative predictive value 69,88% (95% CI: 63,36-75.68).

Conclusion. Xpert MTB/RIF performed on gastric lavage samples showed sensitivity of 50.98% and specificity 87.88% in clinical diagnosis of pulmonary tuberculosis in HIV-positive patients with pulmonary tuberculosis.

Keywords

Adult, HIV, Gastric lavage, Pulmonary TB, Xpert MTB/RIF

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