IgG Anti-Toxoplasma pada Cairan Otak Pasien Terinfeksi HIV dan AIDS dengan Meningitis:

Anti-Toxoplasma IgG in Cerebrospinal Fluid (CSF) ofHIV/ AIDS infected patients with Meningitis

Abstract

Toksoplasmosis diperkirakan telah menginfeksi sepertiga populasi dunia dan dapat mengancam jiwa pasien dengan imunokompromi. Ensefalitis toksoplasma (ET) terjadi akibat reaktivasi infeksi laten T. gondii yang sering terjadi pada pasien AIDS, terutama stadium akhir. Untuk menegakkan diagnosis pasti pada pasien AIDS dengan kelainan SSP sangatlah sulit. Diagnosis ET ditegakkan hanya berdasarkan asumsi dari gejala klinis, gambaran radiologi, dan respon terhadap terapi yang diberikan. Pemeriksaan kadar IgG dari cairan organ masih jarang dilakukan. Sampel cairan otak diperoleh dari 50 pasien HIV dan AIDS yang dikumpulkan sejak Januari 2013 hingga 2014 di Laboratorium Parasitologi FKUI. Kadar CD4+, gejala klinis, hasil radiologi, diagnosis klinis, riwayat terapi profilaksis ko-trimoksazol, dan analisis cairan otak, diperoleh dari rekam medik.Dari 50 sampel, diperoleh hasil 24 (48%) positif dan 26 (52%) negatif IgG anti-Toxoplasma. Dari IgG positif, terdapat 5 (20,83%) dengan kadar tinggi, dan 19 (79,17%) dengan kadar IgG rendah. Tidak ada perbedaan bermakna antara kadar IgG antiToxoplasma dengan hasil radiologi, diagnosis klinis, maupun riwayat terapi profilaksis ko-trimoksazol. Diperoleh korelasi negatif antara kadar CD4+ dan IgG anti-Toxoplasma, walaupun kekuatannya sangat lemah. Berdasarkan hasil radiologi, diperoleh sensitivitas 56%, spesifisitas 57%, nilai duga positif 41%, dan nilai duga negatif 71%.

Toxoplasmosis is estimated to infect a third of the world's population and can be life-threatening to human immunocompromised system . Toxoplasma Encephalitis (TE) is caused by reactivation of latent T. gondii infection that often occurs in AIDS patients especially those with end-stage . To establish a definite diagnosis in AIDS patients with Central Nervous System (CNS)disorders is very difficult. The diagnosis of TE is only based on the assumptions of clinical symptoms, radiological features, and responses to the therapy given. Examination of IgG levels from organ fluids is still rare. CSF samples were taken from 50 HIV/AIDS patients collected from January 2013 to 2014 at the Parasitology Laboratory at FKUI (Medical Departement of University of Indonesia). CD4 levels, clinical symptoms, radiological results, clinical diagnosis, history of co-trimoxazole prophylaxis, and SCF analysis were obtained from medical records. The results showed that IgG-anti Toxoplasma was positive in 24 patients (48%) and negative in 26 patients (52%). From the positive IgG, there were 5 patients(20.83%) with high IgG levels, and 19 patients(79.17%) with low IgG levels. There was no significant difference between the levels of IgG anti-toxoplasma and the results of radiology, clinical diagnosis, and a history of co-trimoxazole prophylactic therapy. There was a weak negative correlation between CD4 + and IgG anti-Toxoplasma levels, The results of radiology showed values of sensitivity 56%, specificity 57%, positive predictive value 41%, and negative predictive value 71%.