Perbedaan Kadar Serum Procalcitonin pada Anak dengan Tuberkulosis Pulmonal dengan Pneumonia

Abstract

Latar Belakang Tuberkulosis pulmonal masih merupakan masalah yang dihadapi di dunia, terutama di negara berkembang. Indonesia menempati urutan kelima terbanyak. Di Sumatera Utara terdapat 111 kasus per 100.000 penduduk pada tahun 2014. Angka tersebut kemungkinan besar belum tepat, terutama pada populasi anak, karena penegakan diagnosis yang masih sulit. Procalcitonin diduga dapat membantu dalam penegakan diagnosis TB pulmonal dan menyingkirkan diagnosis infeksi saluran nafas lainnya, terutama pneumonia. Tujuan Untuk mengetahui perbedaan kadar serum procalcitonin pada anak yang menderita TB pulmonal dan pneumonia. Metode Penelitian ini merupakan suatu penelitian dengan metode studi cross sectional dilakukan di Rumah Sakit Umum Pusat Haji Adam Malik, Kecamatan Kemenangan Tani, Medan Tuntungan, Kotamadya Medan. Sampel yang terkumpul sebanyak 50 anak yang telah memenuhi kriteria inklusi dengan 25 anak yang didiagnosis tuberkulosis pulmonal dan 25 anak yang didiagnosis pneumonia. Dilakukan pemeriksaan procalcitonin terhadap semua anak sebelum diberikan terapi. Data dianalisa dengan menggunakan uji Kolmogorov-Smirnov dan uji Mann Whitney. Hasil Pada 50 subjek, 25 subjek dengan diagnosis tuberkulosis pulmonal dan 25 anak dengan diagnosis pneumonia. Dijumpai median kadar procalcitonin serum pada anak dengan TB pulmonal sebesar 0,45 ng/mL dengan rentang 0,02-31,00 ng/mL. Nilai tersebut lebih rendah dibandingkan dengan kadar procalcitonin serum pada anak dengan pneumonia 1,03 ng/mL dengan rentang 0,07-24,60 ng/mL. Namun didapatkan bahwa kadar procalcitonin serum pada sampel dengan tuberkulosis pulmonal dan pneumonia tidak menunjukkan perbedaan yang bermakna secara statistik (P=0.76; IK 95%=0.64-0.87). Kesimpulan Tidak terdapat perbedaan kadar procalcitonin serum yang signifikan secara statistik (nilai P= 0,79; IK 95%= 0,64-0,87) antara penderita tuberkulosis pulmonal dan pneumonia pada anak.

Introduction Pulmonary tuberculosis (Tb) and pneumonia are diseases that cause lung consolidation and sometimes hard to distinguish. The value of procalcitonin may vary, depending on going inflammatory process. Bacterial infections will trigger the release of inflammatory mediators (IL-1β and TNF-α) that induced production of procalcitonin. Pulmonary Tb produced IFN-γ which can actually suppress the production of procalcitonin. Procalcitonin was expected as a biomarker to differentiate pulmonary Tb from pneumonia. Objective To determine the difference in serum procalcitonin level between children with pulmonary TB and pneumonia. Methods This cross-sectional study was conducted from June until September 2017 in Haji Adam Malik general hospital, Medan, North Sumatera, Indonesia. Inclusion criteria for this study were children under 18 years of age, diagnosed with Tb/pneumonia and did not received any treatment yet. Exclusion criteria consist of other severe infection, immunodeficiency condition and parents or guardians who do not agree to include their children in this study. Results We concluded 25 children diagnosed with pulmonary Tb and 25 children diagnosed with pneumonia. All patients were measured for body weight, body height, nutritional status, and procalcitonin level before treatment. Data were analyzed using SPSS 15 with Kolmogorov-Smirnov and Mann-Whitney tests. In this study, the median serum procalcitonin level in children with pulmonary TB was 0.45 ng/mL this level was lower than in children with pneumonia 1.03 ng/mL. The test result showed that there were no statistically significant difference in serum procalcitonin level between children with pulmonary TB and pneumonia (p value= 0.76; 95% CI= 0.64- 0.87). Discussion Procalcitonin is produced by respon of inflammation, especially bacterial infections. Normally serum procalcitonin levels are below 0.1mg/ml. The value of procalcitonin may vary, depending on going inflammatory process. Bacterial infections will trigger the release of inflammatory mediators (IL-β and TNF-α) that induced production of procalcitonin. Tuberculosis disease produced IFN-γ which can actually suppress the production of procalcitonin. In this study we found level of procalcionin with pneumonia is higher than in Tb 1,03 ng/mL and 0,45 ng/mL. In pneumonia, procalcitonin can help to determine bacteremia, severity of infection, to detect sepsis and also to determine prognosis. Conclusion There was no significant difference in serum procalcitonin levels between patients with pulmonary tuberculosis and pneumonia in children.