The Prevalence and Factors Associated with Drug-induced Hepatitis in HIV-positive Tuberculosis Patients

Introduction: Tuberculosis (TB) have demonstrated a global increase since 1990 along with the increase of world's population and the transmission of human immunodeficiency virus (HIV). Anti- tuberculosis drugs are very effective, but it may cause drug-induced hepatitis (DIH). The aim of this study was to assess the prevalence and association of several risk factos with the occurence of drug-induced hepatitis in HIV-positive tuberculosis patients. Method: We conducted a retrospective case-control study based on medical records of HIV-positive TB patients who seek medical attention to HIV Referral Center at Cipto Mangunkusumo Hospital between July 2008 and December 2010. Overall, we enrolled 168 medical records with 42 cases and 126 controls. Chi-square and logistic regression test analysis were conducted for analyzing risk factors of drug-induced hepatitis in HIV-positive tuberculosis patients. Results: Drug-induced hepatitis were found in 42 (8.04%) patients.The prevalence of DIH was highest among 35 (25.2%) male patients, aged < 35 years old in 32 (26.0%) patients, with albumin level < 3.5 g% in 10 (11.2%) patients, body mass index (BMI) < 18.5 kg/m2 in 14 (18.4%) patients, CD4+ count < 100 cells/mm3 in 29 (24.4%) patients, and those who received rifampicin (R), isoniazid (H), and pirazinamid (Z) regiments for their anti-tuberculosis drugs 24 (31.2%) patients. No risk factors were found to have statistically significant association with DIH. Conclusion: The prevalence of DIH is quite high. Although no risk factor was found statistically significant, but evaluation and liver biochemical examination should be carried out regularly in patients with DIH risk factors

Pulmonary Papillomatosis: a Rare Case of Recurrent Respiratory Papillomatosis Presenting with Multiple Nodular and Cavitary Lesions

Pulmonary papillomatosis is an extremely rare variant of recurrent respiratory papillomatosis which is hard to treat, causes prolonged morbidity, and may transform into malignant disorder in several cases. Since the symptoms and radiologic findings are not specific, pulmonary papillomatosis is often being misdiagnosed. Although considered benign, pulmonary papillomatosis carries the most significant mortality. This is a case report of a 26 year old man who complained recurrent chronic cough, slight hemoptoe, occasional pleuritic pain, and several episodes of fever. He also had laryngeal papillomatosis and undergone serial endoscopic resection since his childhood. Multiple nodular and cavitary lesions, some with air fluid level, were found in both lung fields at chest radiography and scintigraphy. Diagnosis of pulmonary papillomatosis complicated with secondary infection was made after endoscopic and histologic study. Key words: pulmonary papillomatosis, recurrent respiratory papillomatosis, nodular lesion, cavitary lesio

Diagnosis and Management of Blastocystis Hominis Infection in Patient with HIV-AIDS

The incidence of AIDS/HIV infection has been increasing worldwide. Patients with AIDS/HIV infection is at high risk to get opportunistic infection which is often become life-threatening. Common infections associated with AIDS/HIV are tuberculosis (TB) infection and viral hepatitis. Commensal organism found in human body is actually not pathogenic. Blastocystis hominis is generally considered as commensal organism of intestinal tract and might cause opportunistic infection in patients with AIDS. We reported a case of young male patient with AIDS/HIV infection and evidence of opportunistic infection of Blastocystis hominis found in ascitic fluid along with concomitant lung TB and viral hepatitis. Patient was well-responded to treatment of B. Hominis

Tuberculous Peritonitis Presenting Acute Recurrent Pancreatitis

Tuberculosis (TB), one of the oldest diseases known to affect humans, is a major cause of death worldwide. TB is still a major problem in Indonesia. This disease, which is caused by bacteria of the Mycobacterium tuberculosis, usually affects the lungs, although other organs are involved in up to one- third of cases. Approximately 95% cases of TB and 98% death because of TB occur in developing country. Gastrointestinal tuberculosis is uncommon, making up 3.5% of extrapulmonary cases in the United States. This kind of TB may involve gastrointestinal tract, peritoneal, lymph nodes, or solid intraabdominal organs (viscera). A 17 years old male admitted to hospital with TB peritonitis presenting unusual clinical manifestation. At the first admission patients was diagnosed with acute pancreatitis based on elevation of amylase and lipase level up to 285 and 2,046 U/L and after finishing further examination, patients suffered from tuberculous peritonitis which based on literature manifested some gastrointestinal disorders. Diagnostic confirmation was accomplished by conducting serum-ascites albumin gradient (SAAG) of < 1.1 g/dL, peritoneal thickening and the presence of ascites with fine mobile septations on ultrasound, positive polymerase chain reaction (PCR) TB from ascitic fluid. Patients received conventional antitubercular therapy for 12 months of rifampicin, isoniazid, pyrazinamide, and ethambutol. The addition of corticosteroids for the first two or three months of treatment may reduce the incidence of late complications arising from adhesive disease, such as small bowel obstruction

Abdominal Tuberculosis: Diagnostic and Management Problems

Abdominal tuberculosis, as one of the manifestations of extrapulmonary tuberculosis, may involve gastrointestinal tract, peritoneum, mesenteric lymph nodes, liver, and also spleen. Most patients have constitutional symptoms of fever, pain, diarrhea, constipation, alternating constipation and diarrhea, weight loss, anorexia and malaise. It also has an insidious course without any specific laboratory, radiological or clinical findings and makes it difficult to diagnosis. Anti tuberculosis treatments with initiation phase for 2 months and continue with continuation phase for 7 months is effective. Steroids may be used to reduce acute inflammation and limit delayed fibrotic complications. We report a male patient with abdominal tuberculosis involving peritoneum, liver, colon, paraaorta lymph nodes, and spleen, which at first suggested as a Malignancy. Drug induced hepatitis due to anti tuberculosis drug during treatment was emerged and substituted with other regimen. After given anti tuberculosis treatment and steroid as adjunctive treatment, the clinical condition of patient was improved

Kumpulan naskah pertemuan ilmiah nasional XV PB PAPDI tahun 2017

xxiv, 956 hal; 15 x 23 c

Prediktor Mortalitas Pasien dengan Ventilator-Associated Pneumonia di RS Cipto Mangunkusumo

AbstrakVentilator-associated pneumonia (VAP) merupakan infeksi yang sering terjadi di intensive care unit (ICU) dan memiliki angka mortalitas yang tinggi. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien. Mengetahui faktor-faktor prediktor mortalitas pasien VAP di RSCM. Penelitian ini merupakan studi kohor retrospektif pada pasien di ICU RSCM yang didiagnosis VAP selama tahun 2003–2012. Data klinis dan laboratorium beserta status luaran selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel kelompok usia, infeksi kuman risiko tinggi, komorbiditas, renjatan sepsis, kultur darah,prokalsitonin, ketepatan antibiotik empiris, acute lung injury, skor APACHE-II, dan hipoalbuminemia. Variabel diidentifikasi dengan analisis multivariat regresi logistik. Dari 201 pasien didapatkan mortalitas selama perawatan 57,2%. Kelompok usia, komorbiditas, renjatan sepsis, prokalsitonin, ketepatan antibiotik empiris, dan skor APACHE II merupakan variabel yang berpengaruh terhadap mortalitas pada analisis bivariat. Prediktor mortalitas pada analisis multivariat adalah antibiotik empiris yang tidak tepat (OR 4,70; IK 95% 2,25 sampai 9,82; p<0,001), prokalsitonin > 1,1 ng/mL (OR 4,09; IK 95% 1,45 sampai 11,54; p=0,01), usia ≥ 60 tahun (OR 3,71; IK 95% 1,35 sampai 10,20;p=0,011), dan renjatan sepsis (OR 3,53; IK 95% 1,68 sampai 7,38; p=0,001). Disimpulkan bahwa pemberian antibiotik empiris yang tidak tepat, prokalsitonin yang tinggi, usia 60 tahun atau lebih, dan renjatan sepsis merupakan prediktor independen mortalitas pada pasien VAP.Kata Kunci: prediktor mortalitas, ventilator-associated pneumoniaAbstractVentilator-associated pneumonia (VAP) is a frequently found infection with high mortality rates in intensive care unit (ICU). The prediction of outcome is important in decision-making process. To determine predictors of mortality in patients with VAP in Cipto Mangunkusumo Hospital (CMH), we performed a retrospective cohort study on patients admitted to the ICU who developed VAP between 2003–2012. Clinical and laboratory data along with outcome status were obtained for analysis. We compared age, presence of high-risk pathogens infection, presence of comorbidity, septic shock status, blood culture result, procalcitonin, appropriateness of initial antibiotics therapy, presence of acute lung injury, APACHE II score, and serum albumin between the two-outcomegroups. Logistic regression analysis was performed to identify independent predictors of mortality. A total of 201 patients were evaluated in this study. In-hospital mortality rate was 57.2%. Age, comorbidity, septic shock status, procalcitonin, appropriateness of initial antibiotics therapy, and APACHE II score were significantly different between outcome groups. The independent predictorsof mortality in multivariate logistic regression analysis were inappropriate initial antibiotics therapy (OR: 4.70; 95% CI 2.25 to 9.82; p < 0.001), procalcitonin > 1.1 ng/mL (OR: 4.09; 95% CI 1.45 to 11.54; p = 0.01), age ≥ 60 years old (OR: 3.71; 95% CI 1.35 to 10.20; p = 0.011), and presence of septic shock (OR: 3.53; 95% CI 1.68 to 7.38; p = 0.001). It was concluded that inappropriate initial antibiotic therapy, high serum procalcitonin, age 60 years or older, and septic shock were independent predictors of mortality in patients with VAP. Keywords: predictor of mortality, ventilator-associated pneumonia

The Importance of the Timing of Tocilizumab Administration in Moderate to Severely Ill COVID-19: Single Centered Experience Case series

One of the main causes of death in COVID-19 is the dysregulation of the host’s immune system which leads to cytokine storm, a potentially fatal systemic inflammatory syndrome. Interleukin 6 (IL-6) is a pro-inflammatory cytokine that is produced in response to infections and tissue injuries and is believed to play a pivotal role in the event of a cytokine storm, as signified by its increase in the process. Considering the role of IL-6 as a pro-inflammatory cytokine in the process of cytokine storm in COVID-19, perceiving IL-6 as a therapeutic target could prove to be promising. Tocilizumab is a monoclonal antibody that competitively inhibits the binding of IL-6 to its receptor (IL-6R). The use of IL-6R blocker is recommended for severe COVID-19 patients in the latest therapeutic guideline published by the World Health Organization (WHO), but the timing of the administration has not been specified. While previous studies about the use of tocilizumab in COVID-19 patients have shown various results, these studies do not emphasize on plasma IL-6 levels when deciding the time of tocilizumab administration. In this case series, we present three patients with moderate to severe COVID-19 infections that receive tocilizumab as an adjunct to the standard of care therapy. This case series introduces the novel idea that the timely use of tocilizumab as signified by plasma IL-6 levels in moderate to severe COVID-19 patients could potentially improve overall clinical condition and increase survival rate