Validitas Rapid Diagnostic Test Immunochromatography untuk deteksi malaria falsiparum

ULOMO, Jono, Dr.Med.dr. Suwarso, Sp.PK

2006 | Tesis | PPDS I Patologi Klinik

Malaria merupakan masalah kesehatan penting, angka kesakitan malaria sejak tiga tahun terakhir menunjukkan peningkatan, setiap tahunnya di Indonesia terdapat 15 juta penderita dan 30.000 orang diantaranya meninggal dunia. Jawa Bali sebagian besar bebas penularan tetapi kabupaten Purworejo masih menunjukkan adanya penularan malaria. Diagnosis mikroskopis dengan memeriksa sediaan darah diwarna Giemsa masih merupakan gold standard (baku emas). Pemeriksaan dengan mikroskop untuk melihat spesies dan stadium parasit, walaupun relatif murah, tetapi memerlukan keahlian dan pengalaman yang cukup tinggi serta relatif kurang praktis. Teknik immunochromatography (ICT) sebagai tes alternatif merupakan teknik yang lebih praktis karena cepat dan tidak membutuhkan ketrampilan khusus. Validitas ICT ini bervariasi menurut jenis antigen dan nama dagang. Dalam penelitian ini akan diketahui validitas ICT tersebut, terutama di daerah endemis. Penelitian dilakukan di daerah Purworejo, sesuai kriteria inklusi, pasien dipilih dan diambil darahnya dan dilakukan pemeriksaan malaria metode apusan darah mikroskopis dan dipstik. Hasil tersebut dianalisa dengan statistik deskriptif dan uji perbandingan metode dengan tabel 2x2. Dari 273 pasien 105 diantaranya menunjukkan hasil positif terhadap Plasmodium falciparum, baik menggunakan metode apus darah maupun dipstik, sedangkan 11 sampel menunjukkan hasil positif dengan metode apus darah dan negatif dengan metode dipstik, tujuh negatif apus darah positif dipstik, seratus lima puluh negatif kedua metode. Dari perhitungan data diperoleh nilai sensitivitas dan spesifisitas masing-masing sebesar 90,51% dan 95,54%, PPV: 93,75%, NPV: 93,16%, akurasi : 93,49%, likelihood rasio (+) : 20,3, likelihood rasio (-): 0,09. Sensitivitas pada angka parasit < 100/ul, ≥ 100/ul, ≥ 500/ul, ≥ 2500/ul dan ≥ 5000/ul masing-masing 86,7%, 92,9%, 95,4%, 100% dan 100%. Kesimpulan. Rapid diagnostic test ICT mempunyai sensitivitas 90,51%. Hal ini cukup baik untuk mendeteksi adanya malaria falsiparum sehingga dapat dipergunakan sebagai alat skrining dan diagnosis di daerah endemis.

Malaria is an important health problem. The malaria morbidity have been enhancing since last three years. Every year, in Indonesia 15 million cases detected and 30.000 out of them died. Java and Bali are free contagion area, but there is malaria transmission found in Purworejo district. Microscopic diagnosis by Giemsa-stained blood examination is still a gold standard. By using the microscopic examination method, we are able to determine species and parasites stages cheaper however it needs high skill requirement. Immunochromatography technique (ICT) is an alternative test method. It is a simple technique, faster and not require special skill. The validity of ICT is various according to antigen type and the trade mark. The aim of the research is determine the validity of ICT test, especially in endemic area. A diagnostic test is carried out in the study, an alternative test is compared by a microscopic conventional method as a gold standard. Research is done in Purworejo. Subjects involved in the study are patients who met the inclusion criteria. Their blood is drawn by lancet, and then the malaria examination done by microscopic method and dipstick method. The result analyzed by descriptive statistic test and 2x2 table comparison test method. One hundred and five out of 273 patiens are Plasmodium falciparum positive, detected by both blood-stained and dipstick test method. Among eleven samples which showed positive result using microscopic examination but negative using dipstick test; seven of 273 samples are negative using microscopic examination but positive by dipstick test. One hundred and fifty of 273 samples are negative using microscopic examination and dipstick test. The ICT test has sensitivity, specificity, positive predictive value, negative predictive value, and accuracy respectively 90,51%, 95,54%, 93,75%, 93,16% and 93,49%. Likelihood ratio (+) elucidate 20,3, Likelihood ratio (-) 0,09. The sensitivity diagnostic in density of parasite < 100/ul, ≥ 100/ul, ≥ 500/ul and ≥ 2500/ul are respectively 86,7%, 92,9%, 95,4%, 100% and 100%. Conclusions: The Rapid diagnostic test (dipstick) ICT has sensitivity 90,51%. This is good enough to detect the existence of the falciparum malaria so that can be used as an alternative for screening and diagnostic method in endemic area.

Kata Kunci : Diagnosis Laboratoris Malaria,QBC Rapid Diagnostic Test, Malaria falciparum, - Immunochromatography, - Microscopic, - Dipstick