NILAI DIAGNOSTIK PEMERIKSAAN MIKROSKOPIS BASH, TAHAN ASAM METODA KONSENTRASI DIBANDINGKAN DENGAN ICULTUR PADA SPUTUM TERSANGKA TUBERKULOSIS PARU

Abstract

Backgrounds: Microscopic examination to identify acid-fast bacilli (AFB) from sputum of suspected pulmonary tuberculosis can establish the diagnosis of pulmonary tuberculosis. Examination of culture is more accurate but it takes longer time, more expensive and not all laboratory has performed it. To obtain an MB-positive results using microscope, about 5,000 - 10,000 bacilli/ml of sputum are required, whereas using examination of culture only about 50 - 100 bacilli/inl are required. The most widely used staining technique in microscopic examination is Ziehl Nielsen technique that can detect acid-fast bacilli using ordinary microscope. The microscopic examination of acid-fast bacilli may use direct method and concentration method. The sensitivity of direct method is still very low (20-30%), which can be increased using concentration method because this method can find more bacilli. The results of preliminary study suggest that there are significant difference in microscopic examination of acid-fast bacilli between direct method and concentration method (p = 0,001). At Indonesia, we don't know the diagnostic value of concentration method in identifying acid-fast bacilli from sputum of suspected pulmonary tuberculosis. Objective : To find out the diagnostic value of microscopic examination of acid-fast bacilli using concentration method compared with culture. Material and Method: The study samples were 62 specimens from patients with suspected pulmonary tuberculosis that underwent examination in BP4 Laboratory Semarang and fulfilled the inclusion criteria. Microscopic examination of acid-fast bacilli using direct and concentration method was performed with Petroff method using Ziehl Nielsen staining method and culture examination using MGIT. Then we performed diagnostic test for concentration method to compare it with culture. Data were analyzed manually using 2x2 table to determine sensitivity, specificity, positive predictive value and negative predictive value. Results of Study: The microscopic examination of acid-fast bacilli (AFB) using concentration method can increase AFB-positive result by 12 samples (19,35%) as compared with direct method. The diagnostic value of AFB microscopic examination using concentration method to identify acid-fast bacilli in sputum as compared with culture examination have showed sensitivity of 63,41%, specificity 85,71%, positive predictive value 89,66% and negative predictive value 54,55%. Conclusion: Concentration method can be used as an alternative in the microscopic examination of acid-fast bacilli, so it can assist to establish the diagnosis of pulmonary tuberculosis. Latar Belakang Pemeriksaan mikroskopis untuk menemukan kuman Basil Tahan Asam (BTA) dari sputum tersangka Tuberkulosis Pam dapat menegakkan diagnosis TB paru. Pemeriksaan kultur lebih akurat tetapi membutuhlcan waktu yang lama, biaya yang tinggi dan belum dikerjakan di semua laboratorium. Untuk mendapatkan BTA positif melalui mikroskop diperlukan jumlah kuman sekitar 5.000 — 10.000 kuman / ml sputum, sedang dengan pemeriksaan kultur hanya sekitar 50 — 100 kuman/ml. Tehnik pewarnaan yang banyak digunakan dalam pemeriksaan mikroskopis adalah Ziehl Nielsen yang dapat mendeteksi BTA dengan menggunakan mikroskop biasa. Pemeriksaan mikroskopis BTA dapat menggunakan metoda langsung dan konsentrasi. Sensitivitas metoda langsung masih sangat rendah (20-30%),yang dapat ditingkatkan dengan metoda konsentrasi karena kuman akan lebih mudah ditemukan. Dan penelitian pendahuluan didapatkan basil bahwa terdapat perbedaan yang bermakna antara pemeriksaan mikroskopis BTA metoda langsung dan konsentrasi (p=0,001). Sampai saat ini di Indonesia belum 1 diketahui nilai diagnostik metoda konsentrasi dalam menemukan BTA dan sputum tersangka TB paru. Tujuan Penelitian : mengetahui nilai diagnostik pemeriksaan mikroskopis BTA metoda konsentrasi dibandingkan dengan kultur. Bahan dan Metoda : Sampel penelitian berupa 62 spesimen dari penderita tersangka tuberkulosis paru yang melakukan pemeriksaan di laboratorium BP4 Semarang dan memenuhi !criteria inklusi. Dilalcukan pemeriksaan mikroskopis BTA metoda langsung dan konsentrasi dengan metoda Petroff menggunakan pewarnaan Ziehl Nielsen serta pemeriksaan kultur dengan menggunakan MGIT. Kemudian dilakukan uji diagnostik pemeriksaan mikroskopis metoda konsentrasi dibandingkan dengan kultur. Data dianalisis secara manual dengan Label 2x2 untuk menentukan sensitivitas, spesifisitas, nilai ramal positif dan nilai ramal negatil _ Hasil Penelitian : Pemeriksaan mikroskopis 'BTA metoda konsentrasi meningkatkan hasil BTA positif sebanyak 12 sampel (19,35%) dibanding metoda langsung. Nilai diagnostik pemeriksaan mikroskopis BTA metoda konsentrasi untuk menemukan kuman BTA dalam sputum dibandingkan pemeriksaan kultur menunjukkan sensitivitas sebesar 63,41%, spesifisitas sebesar 85,71%, nilai ramal positif sebesar 89,66% dan nilai ramal negatif sebesar 54,55%. Kesimpulan : Metoda konsentrasi dapat digunakan sebagai metoda lain dalam pemeriksaan mikroskopis BTA, sehingga dapat membantu menegakkan diagnosis TB paru.