UJI DIAGNOSTIK MYCOBACTERIA GROWTH INDICATOR TUBE ( MGIT ) PADA PENDERITA TUBERKULOSIS PARU TERSANGKA DI RUMAH SAKIT UMUM PUSAT Dr KARIADI DAN BP4 SEMARANG DIAGNOSTIC TEST MYCOBACTERIA GROWTH INDICATOR TUBE ( MGIT ) IN SUSPECT PULMONARY TUBERCULOSIS PATIENT AT KARIADI HOSPITAL AND BP4 SEMARANG

Abstract

Background The identification of acid fast bacteria ( AFB ) in the sputum is still significant in establishing the diagnosis of pulmonary tuberculosis until now, although at could be identified only in half of the pulmonary tuberculosis patients. Primary isolation of the specimens usually requires 6 to 8 weeks on classical media. Bactec culture technique allow cultivation in 7 days, but it appears too expensive and unavailable in all clinical laboratory. MUTT culture media which allow cultivation in 7 days , with lower cost as well should be evaluated to establish the diagnosis of pulmonary tuberculosis. Objectives To investigate the diagnostic performance of MGIT in suspect pulmonary tuberculosis patients. Methods A cross sectional study of diagnostic test. Setting : In Kariadi hospital and BP4 ( Lung diseases care and Health centre ) Semarang . Study period was since August through February 2000. Patients : suspected pulmonary tuberculosis patients who fulfilled the inclusion criteria. The gold standard in this study use Kudoh culture. Results During this period , 62 patients were enrolled, 1 patient dropped. Of the 61 patients, 15 ( 24.59 % ) patients had positive result for acid fast bacteria and 46 ( 75.41 % ) patients were negative. The result of Kudoh cultivation media revealed 27 ( 44.26 % ) were positive and 34 ( 55.73 ) were negative. MGIT cultivation media revealed 42 ( 65.85 % ) patients were positive and 19 ( 31.14 % ) were negative. All ( 15 ) patients with positive AFB from the satin were folloed by cultivation in Kudoh and MGIT media. Both Kudoh and MGIT culture gave 11 ( 73 .33 % ) patients with positive results respectively. Culitvation of the negative AFB stained sputum revealed. Kudoh culture gave 16 ( 34.78 % ) patients with positive and 30 ( 65.21 % ) patients with negative results. MGIT culture showed 31 ( 67.39 % ) patients with positive and 15 ( 32.60 % ) with negative results. Conclusion The diagnostic performance of MGIT in suspect pulmonary tuberculosis patients were : sensitivity 81.48%, specificity 41.17 %, Positive predictive value 52.38 % and negative predictive value 73.68 % respectively. Latar belakang Hingga saat ini ditemukannya Basil Tahan Asam ( BTA ) di dalam sputum masih penting untuk menegakkan diagnosis TB paw. Tetapi pemeriksaan ini hanya bisa mendiagnosis separoh kasus TB pant. Biakan cara konvensional memerlukan waktu 6 - 8 minggu. Bialcan Bactec, mendeteksi kuman dalam waktu 7 hari, dirasakan terlalu mahal dan tidak semua fasilitas laboratorium mempunyai alat pemeriksaan ini. Pemeriksaan kultur MGIT yang bisa mendeteksi kuman dalam waktu 7 hari dengan harga lebih rnurah kiranya dapat dicoba dalam mendiagnosis TB paru tersebut. Tujuan : Penelitian ini bertujuan untuk mengetahui besarnya nilai diagnostik MGIT pada penderita TB paru. Metodologi : cross sectional study untuk uji diagnostik . Waktu dan tempat : Selama bulan Agustus 1999 sarnpai dengan Februari 2000 di RS Dr Kariadi dan BP 4 Semarang. Sampel : adalah penderita TB paru tersangka yang memenuhi kriteria inklusi dan eksklusi . Sebagai baku emas penelitian ini adalah biakan Kudoh. Hasil : Didapatkan sejumlah 62 sampel , 1 dinyatakan drop out. Dari 61 sampel tersebut jumlah BTA positif sebanyak 15 ( 24,59 % ) dan negatif sebanyak 46 ( 75,41 % ). Biakan Kudoh positif sebanyak 27 ( 44,26 %) dan negatif sebanyak 34 ( 55,73 % ) serta biakan MGIT positif sebanyak 42 sampel ( 68,85 ) dan negatif sebanyak 19 ( 31,14 %) . Penderita dengan BTA positif (,15 sampel ) dilakukan kultur Kudoh dan MGIT , hasilnya : Kudoh positif sebanyak 11 ( 73 , 3 % ) dan MGIT positif juga 11 ( 73,3 % ). Sedangkan Kudoh dan MUTT negatif masing -masing sebanyak 4 ( 26,6 % ). Penderita dengan BTA negatif dilakukan kultur Kudoh dan MGIT, hasilnya : Kudoh positif sebanyak 16 ( 34,78 % ) dan negatif sebanyak 30 ( 65,21 % ). MGIT positif sebanyak 31 ( 67,39 % ) dan MUTT negatif sebanyak 15 ( 32,60 % ). Kesimpulan : Nilai diagnostik MGIT pada TB tersangka adalah : Sensitivitas 81,48 % , Spesitivitas 41,17 % . Nilai ramal positif 52 , 38 % , nilai ramal negatif 73,68 % .