Kadar Interferon Gamma pada Kontak Serumah dengan Penderita Tuberkulosis

Menurut World Health Organization sekitar sepertiga penduduk dunia telah terinfeksi kuman tuberkulosis dan deteksi dini pada kontak serumah dengan penderita memungkinkan upaya pengobatan dan pencegahan dilakukan dengan efektif. Penelitian ini bertujuan untuk membandingkan hasil pemeriksaan tes Mantoux dengan pemeriksaan serologis kadar interferon gamma (IFN - γ) pada kelompok kontak serumah dengan penderita tuberkulosis yang mempunyai hasil pemeriksaan basil tahan asam (BTA) positif. Penelitian ini menggunakan desain kohort pada kelompok terpajan dan tidak terpajan pada penderita tuberkulosis (umur > 15 tahun). Pemilihan subjek dilakukan secara acak sederhana dan jumlah yang digunakan adalah 34 orang pada masing-masing kelompok. Penelitian ini menggunakan tes Mantoux selain observasi kadar IFN-γ. Analisis data menggunakan chi square dan tes Man Whitney. Penelitian tahun pertama menunjukkan hasil tes Mantoux positif pada kelompok terpajan sebesar 79,4% dan 5,9% pada kelompok tidak terpajan. Rata-rata kadar IFN - γ pada kelompok yang terpajan penderita tuberkulosis adalah 5,32 pg/ml sedangkan pada kelompok yang tidak terpajan sebesar 1,1 pg/ml. Ada hubungan yang bermakna antara status paparan dengan hasil tes Mantoux (nilai p = 0,0001 dan x2= 34,631). Ada perbedaan rata-rata kadar IFNγ secara bermakna antara kelompok terpajan dengan kelompok yang tidak terpajan (nilai p = 0,0001). Masih diperlukan penelitian lebih lanjut untuk mengikuti perkembangan IFN-γ berdasarkan status paparan untuk mengetahui pola dan cut off point pada kontak serumah dengan penderita tuberkulosis.Kata kunci: Kadar interferon gamma, kontak serumah, penderita tuberkulosisWorld Health Organization estimated that one third people worldwide were infected with mycobacterium tuberculosis. An early diagnosis and prompt treatment of possible pulmonary tuberculosis infection should be made for close contacts (housemate contacts) of patient with tuberculosis. The purpose of this research is to analyze the differences levels of IFN-γ and Tuberculine Skin Test (TST) on the housemate contacts and non-house- mate contacts with patients of tuberculosis. Cohort study performed on the housemate contacts and non-housemate contacts with patients of tuberculosis (age > 15 years old). We collected data with simple random sampling on 68 persons (34 exposed and 34 unexposed). Bivariate associations were described using chi square and Man Whitney test. During the first year of study, 76,4% of exposed persons with TST positive and 5,9% of unexposed persons. Average levels of IFN - γ in exposed persons 5,32 pg/ml, whereas in other groups 1,1 pg/ml. There is relationship between exposure sta- tus and unexposed status of TST (p value = 0,0001 and x2 = 34,631). There are differences in mean levels of IFN - γ between group exposed and unexposed (p value = 0,0001). Further research will be needed to keep abreast of IFN - γ level on the basis of exposure status to know the cut off point on the housemate contacts with patients of tuberculosis

Faktor HLA-DRB pada Penderita Tuberkulosis Paru dengan Pengobatan Strategi DOTS

HLA-DRB factor in pulmonal tuberculosis with DOTS strategic treatmentBackground: Tuberculosis remains one of the world's greatest public health problems, especially in developing countries. In Indonesia the results of DOTS strategic treatment and conversion have not been fruitful results. Many factors play important roles in the success of DOTS strategic treatment, but a little attention was given to the immuno genetics aspects. This study was aimed at theassociation between HLA-DRB factors and clinical output on DOTS strategic treatment (after first 2 months of treatment):conversion of sputum smear positive.Method: A nested case control study was carried out. The exposure variables were alleles of HLA-DRB (result of PCR examination), while the independent variables were sputum smear positive and negative (result of laboratories examination with Ziehl Neelsen staining, Niacin test). Body mass index (BMI) and sex were confounding variables. Odds ratio (OR) was calculated using bivariate and logistic regression for multivariate analysis.Result: A total sample of 73 new patients with active tuberculosis (sputum smear positive) in developing treatment with DOTS strategic treatment, consist of 34 cases and 39 controls. The odds ratio (OR) of HLA-DRB1*1502 and HLA-DRB5*01 were 3.2 (95%CI: 1.103-9.287). The OR of HLA-DRB1*1201 was 0.305 (95% CI: 0.117-0.798), OR of HLA-DRB3*01 was 0.214 (95% CI: 0.077- 0.592). The PAR (population attributable rate) of HLA-DRB1*1502 and HLA-DRB%*01 were 42.64%. While confounding variables were analyzed, only allele HLA-DRB1*1502 was significant, OR 4.9 (95% CI: 1.234-15.617), the probability was 70.57%.Conclusion: HLA-DRB1*1502 is an allele is a risk factor for the conversion of sputum smear positive after 2 months of treatment