Line probe assay test in new cases of tuberculosis with rifampicin resistance not detected by Xpert MTB/RIF.

Background: In Indonesia, the National guideline for tuberculosis only recommended taking the DST to check INH resistance only for re-treatment cases of rifampicin-susceptible TB (RS-TB) detected by Xpert MTB/RIF. This study was conducted mainly to evaluate the proportion of isoniazid resistance in new cases of RS-TB according to the Xpert MTB/RIF. Methods: This was an observational descriptive study in RS-TB new patients diagnosed by Xpert MTB/RIF. Sputum samples were examined using first-line LPA and evaluated by culture-based DST. Results of first-line LPA and culture-based DST were compared and presented. Results: Fifty-four new cases of RS-TB (according Xpert MTB/RIF) were enrolled in this study. INH resistance was detected in 4 (7.4%) using FL-LPA and in 5 (9.3%) using culture-based DST. RIF resistance was also found in 1 (1.9%) using FL-LPA and in 2 (3.7%) using culture-based DST. Ethambutol resistance was also detected in 4 (7.4%) using culture-based DST. Conclusion: First-line LPA successfully revealed 4 (7.4%) of Hr-TB in new RS-TB cases detected by the Xpert MTB/RIF. In new cases with RS-TB detected by the Xpert MTB/RIF, FL- LPA can be used as rapid molecular DST to detect RIF and INH resistance followed by culture-based DST to examine other drug resistance.

Association of TNF-α, TGF-ß1, amphiregulin, IL-2, and EGFR WITH pulmonary fibrosis in COVID-19.

Pulmonary fibrosis is a well-recognized sequela associated with coronavirus disease 2019 (COVID-19), however the mechanism is yet to be clearly understood. The study was designed to evaluate the association of TNF-α, TGF- ß1, amphiregulin, IL-2, and EGFR with pulmonary fibrosis after COVID-19 pneumonia. Non-severe, severe, and critical COVID-19 pneumonia patients were included in this study after the patients agreed and gave written informed consent. Blood samples were analyzed with the ELISA method for cytokine examination. The non-contrast chest CT scan was performed after patients were discharged from hospital. Seventy-nine patients with a mean age of 54 years (57 % men, 43 % women) were fully evaluated. Pulmonary fibrosis was found in 74 patients (93.7 %). Serum levels of TGF-ß1 60.55 pg/mL (11.42-2001.16), TNF-α 13.31 pg/mL (3.54-200.32), EGFR 14.9 pg/mL(6.4-53.6), IL-2 12.41 pg/mL(11-14.13), amphiregulin 156.5 pg/mL (21.7-1234). Serum levels of TNF-α increase according to the severity of clinical classification. A significant association between serum levels of TGF-ß1, TNF- α, and pulmonary fibrosis with rs-0.247, p = 0.027; rs 0.259, p = 0.046 was found. According to this study, TNF-α and TGF-ß1 potentially participate in the process of pulmonary fibrosis in COVID-19.

Interstitial lung disease in Indonesian adult with systemic sclerotic: A rare case.

BACKGROUND: Systemic Sclerotic (SSc) with interstitial lung disease (ILD) is a rare autoimmune case. In Indonesia, SSc-ILD cases are still not widely reported. CASE PRESENTATION: A 43-year-old female complained fever, yellow phlegm, and shortness of breath for 1 week. The evaluation results based on the American College of Rheumatology and European League Against Rheumatism (ACR EULAR) classification criteria for systemic sclerosis showed a score of 17. The patient received Methylprednisolone 8 mg tab/8 hours, Meropenem 1 gr/8 hours, Ranitidine 50 mg/12 hours, Metoclopramide 10 mg/8 hours, KSR 600 mg tab/8 hours, Paracetamol 500 mg tab/8 hours, VIP albumin 500 mg tab/8 hours, and Folic acid 400 mg tab/8 hours. The patient underwent high resolution computer tomography (HRCT). A chest scan obtained SSc-ILD. Sputum culture results did not reveal Mycobacterium tuberculosis. DISCUSSION: SSc-ILD patients in endemic tuberculosis need to be examined for GeneXpert and sputum culture. The HRCT scan is more helpful in diagnosing SSc-ILD than bronchoalveolar lavage (BAL). CONCLUSION: The HRCT is one of the gold standards in establishing the diagnosis of SSc-ILD.

Management of severe COVID-19 patient with negative RT-PCR for SARS-CoV-2: Role of clinical, radiological, and serological diagnosis.

A real-time reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard in diagnosis for infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the false-negative result is the problem in the prevention and control the pandemic of coronavirus disease 2019 (COVID-19). A false-negative of RT-PCR test needs to be evaluated when the patient showed a high clinical suspicion for COVID-19. We report a 36-year-old man with 4 times negative RT-PCR results, but clinical, radiological (chest X-ray and chest CT scan), and serological examinations showed a high suspicion of COVID-19. History of close contacted with COVID-19 confirmed patient was reported, and the wife of our case was also RT-PCR tested positive for SARS-CoV-2 in the next few days strengthen the COVID-19 diagnosis of our case patient. It is important to use the combination of RT-PCR, chest X-ray, chest CT scan, clinical manifestations, antibodies test, and exposure history of patients to diagnose COVID-19 and decide the early isolation and appropriate treatment.

Immunoregulatory Property of C-Type Lectin-Like Receptors in Fibrosing Interstitial Lung Diseases.

The innate immune system identifies exogenous threats or endogenous stress through germline-encoded receptors called pattern recognition receptors (PRRs) that initiate consecutive downstream signaling pathways to control immune responses. However, the contribution of the immune system and inflammation to fibrosing interstitial lung diseases (ILD) remains poorly understood. Immunoreceptor tyrosine-based motif-bearing C-type lectin-like receptors (CTLRs) may interact with various immune cells during tissue injury and wound repair processes. Dectin-1 is a CTLR with dominant mechanisms manifested through its intracellular signaling cascades, which regulate fibrosis-promoting properties through gene transcription and cytokine activation. Additionally, immune impairment in ILD facilitates microbiome colonization; hence, Dectin-1 is the master protector in host pulmonary defense against fungal invasion. Recent progress in determining the signaling pathways that control the balance of fibrosis has implicated immunoreceptor tyrosine-based motif-bearing CTLRs as being involved, either directly or indirectly, in the pathogenesis of fibrosing ILD.