AKURASI LOOP-MEDIATED ISOTHERMAL AMPLIFICATION (LAMP) DIBANDINGKAN KULTUR BAKTERI TAHAN ASAM (BTA) PADA PASIEN DEWASA SUSPEK LIMFADENITIS TUBERKULOSIS: SEBUAH TINJAUAN SISTEMATIK DAN META-ANALISIS

Hafidh Abimanyu Hidayat, dr. Rizka Humardewayanti Asdie, Sp.PD-KPTI; dr. Heni Retnowulan, M.Kes., Sp.PD-KP; dr. Noor Asyiqah Sofia, Sp.PD-KPsi

2025 | Skripsi | PENDIDIKAN DOKTER

Di Indonesia laju insidensi tuberkulosis sebesar 385 kasus tiap 100.000 penduduk mencapai kedua di dunia (WHO, 2022). Sebanyak 36% penyintas tuberkulosis memiliki manifestasi limfadenitis tuberkulosis (Gautam et al., 2018). Sifat paucibacillary dari aspirat limfe dan biopsi limfonodi menyulitkan diagnosis dengan GeneXpert MTB/RIF (Antel & Verburg, 2019) sebagai rekomendasi alat diagnostik limfadenitis tuberkulosis dari World Health Organization. Loop-mediated isothermal amplification (LAMP) berpotensi untuk memiliki profil akurasi (sensitivitas, spesifisitas, positive likelihood ratio, negative likelihood ratio) yang lebih baik daripada GeneXpert MTB/RIF karena bisa mendeteksi konsentrasi asam nukleat 0,2 mcg/ 25 mcL.

Pencarian sistematis dengan kata kunci tuberkulosis, loop-mediated isothermal amplification, dan limfadenitis tuberkulosis menemukan 317 sampel dari 7 artikel yang sesuai kriteria inklusi dan kriteria eksklusi. Bias penelitian pada semua artikel terpilih rendah. LAMP memiliki sensitivitas 83,6% (CI 95t,7-89,8%), spesifisitas 91,3% (CI 95Q,0-99,1%), LR (+) 9,615 (CI 95% 1,197-77,251), dan LR (-) 0,180 (CI 95% 0,117-0,277) dibandingkan kultur BTA pada pasien dewasa suspek limfadenitis TB. LAMP dapat menggantikan GeneXpert MTB/RIF sebagai baku emas diagnosis limfadenitis tuberkulosis.

Tuberculosis incidence rate in Indonesia reaches 385 cases each 100.000 residents (WHO, 2022). Approximately 35% tuberculosis patients have tuberculous lymphadenitis (Gautam et al., 2018). Lymph aspirate and lymph node biopsy have paucibacillary property, thus restrict the performance of culture and GeneXpert MTB/RIF (Antel & Verburg, 2019) as current modality for diagnosing tuberculous lymphadenitis supported by World Health Organisation. Loop-mediated isothermal amplification (LAMP) has the potential to be superior to GeneXpert MTB/RIF for diagnosing tuberculous lymphadenitis as it possesses capability to detect tuberculosis nucleic acid at concentration of 0,2 mcg/ 25 mcL of sample.

Systematic searching with keyword tuberculosis, loop-mediated isothermal amplification, tuberculosis lymphadenitis has found 317 total samples from 7 articles in accordance with inclusion and exclusion criteria. QUADAS-2 assesses low-risk bias for all articles. LAMP has sensitivity 83,6% (CI 95t,7-89,8%), specificity 91,3% (CI 95Q,0-99,1%), LR (+) 9,615 (CI 95% 1,197-77,251), and LR (-) 0,180 (CI 95% 0,117-0,277) to acid fast culture in diagnosing suspected tuberculous lymphadenitis. LAMP has the potential to substitute GeneXpert MTB/RIF as the gold standard for diagnosing tuberculous lymphadenitis.

Kata Kunci : TB, LAMP, kultur BTA, limfadenitis TB, diagnosis