Perbandingan Karakteristik Klinis dan Radiologis Pasien Tuberkulosis Paru Terkonfirmasi Bakteriologis dengan Status Immunokompromais dan Immunokompeten yang Kontrol di Poliklinik Paru Infeksi Rumah Sakit Umum Pusat DR. Sardjito

Eida Agisa Dewi, dr. Sumardi, SpPD-KP.; dr. Nur Rahmi Ananda, SpPD-KP

2026 | Tesis-Spesialis | S2 Ilmu Penyakit Dalam

Latar belakang: Tuberkulosis (TB) paru merupakan penyakit infeksi dengan perjalanan alamiah yang dipengaruhi oleh status imun penderitanya. Sistem imun utama terhadap penyakit ini melibatkan imunitas bawaan dan adaptif yang secara keseluruhan sangat dipengaruhi oleh berbagai kondisi immunokompromais (IKP). Pasien TB paru dengan kondisi IKP sering menunjukkan karakteristik klinis dan radiologis yang atipikal sehingga berisiko mengalami penundaan diagnosis. Tujuan:  Mengetahui  perbedaan  karakteristik  klinis  dan  radiologis  pasien tuberkulosis paru terkonfirmasi bakteriologis dengan status immunokompromais dan immunokompeten.

Metode Penelitian: Penelitian ini melibatkan penderita TB paru terkonfirmasi bakteriologis (terkonfirmasi berdasarkan hasil pemeriksaan pewarnaan sputum dan Gene Xpert) yang rutin kontrol di Poliklinik Infeksi Rumah Sakit Umum Pusat Dr. Sardjito selama periode Januari 2022 hingga Desember 2024. Kondisi IKP yang terlibat adalah DMT2, infeksi HIV, penyakit ginjal kronik (PGK), keganasan, hingga kondisi autoimun. Sementara itu, karakteristik klinis dasar yang dicatat adalah demam, batuk, hemoptisis, nyeri dada, sesak napas, keringat malam, dan penurunan berat badan. Karakteristik radiologis yang dievaluasi berupa ada/tidaknya konsolidasi, lesi milier, keterlibatan lobus atas paru, lobus medius, keterlibatan lobus bawah paru, limfadenopati pada hilus dan mediastinum, efusi pleura, kavitas, dan kalsifikasi.

Hasil Penelitian: Hasil penelitian ini menunjukkan terdapat penderita TB paru terkonfirmasi bakteriologis sebanyak 69 orang (27 orang = IKP dan 42 orang = non- IKP). Karakteristik klinis yang secara signifikan cenderung terjadi pada kelompok non-IKP, antara lain: batuk, penurunan berat badan, hingga demam (p < 0>

Kesimpulan: Penelitian ini membuktikan bahwa terdapat perbedaan karakteristik klinis dan radiologis berdasarkan berbagai kondisi IKP.

Background: Pulmonary tuberculosis (TB) is an infectious disease whose natural course is influenced by the host’s immune status. The immune response against this disease involves both innate and adaptive immunity, which are collectively affected by various immunocompromised conditions. Patients with pulmonary TB who are immunocompromised often exhibit atypical clinical and radiological characteristics, which may increase the risk of delayed diagnosis.

Objective: To compare the clinical and radiological characteristics of patients with bacteriologically confirmed pulmonary tuberculosis according to immunocompromised and immunocompetent status.

Methods: This study included patients with bacteriologically confirmed pulmonary TB (confirmed by sputum smear microscopy and GeneXpert examination) who routinely attended the Pulmonary Infection Clinic at Dr. Sardjito General Hospital during the period from January 2022 to December 2024. Immunocompromised conditions included type 2 diabetes mellitus, HIV infection, chronic kidney disease, malignancy, and autoimmune disorders. The baseline clinical characteristics recorded were fever, cough, hemoptysis, chest pain, dyspnea, night sweats, and weight loss. Radiological characteristics evaluated included the presence or absence of consolidation, miliary lesions, upper lobe involvement, middle lobe involvement, lower lobe involvement, hilar and mediastinal lymphadenopathy, pleural effusion, cavitation, and calcification.

Results: The study identified 69 patients with bacteriologically confirmed pulmonary TB (27 immunocompromised and 42 immunocompetent). Clinical characteristics that were significantly more common in the immunocompetent group included cough, weight loss, and fever (p < 0>

Conclusion: This study demonstrates that differences in clinical and radiological characteristics exist according to immunocompromised conditions.

Kata Kunci : Immunokompromais, immunokompeten, tuberculosis paru, klinis, radiologis