Pola Resistensi Obat pada Tuberkulosis Paru dan Ekstra Paru: Dampak Komorbiditas Diabetes Melitus

Sabrina Aziza Putri Herva; Usep Abdullah Husin; Julia Hartati

doi:10.29313/bcsms.v5i1.17634

Sabrina Aziza Putri Herva Prodi Pendidikan Dokter, Fakultas Kedokteran, Universitas Islam Bandung, Indonesia
Usep Abdullah Husin Prodi Pendidikan Dokter, Fakultas Kedokteran, Universitas Islam Bandung, Indonesia
Julia Hartati Prodi Pendidikan Dokter, Fakultas Kedokteran, Universitas Islam Bandung, Indonesia

DOI: https://doi.org/10.29313/bcsms.v5i1.17634

Keywords: Tuberculosis, Diabetes Melitus, Drug Resistance

Abstract

Abstract. Tuberculosis (TB) is an infectious disease that poses a significant global health challenge, especially in patients with diabetes mellitus (DM) comorbidity. DM can exacerbate TB treatment by increasing the risk of drug resistance, including monoresistance, multidrug-resistant TB (MDR), and extensively drug-resistant TB (XDR). This study aims to analyze drug resistance patterns in pulmonary and extrapulmonary TB patients with DM comorbidity. The research used a descriptive observational design with medical record data analysis. The results show that DM comorbidity influences TB drug resistance patterns, complicating treatment and reducing the effectiveness of anti-TB therapy. Factors such as blood glucose control, types of anti-TB drugs used, and interactions with diabetes medications play a critical role in treatment success. Therefore, a multidisciplinary approach is required to manage patients with DM comorbidity, including strict blood glucose monitoring and patient education to enhance adherence to therapy.

Abstrak. Tuberkulosis (TB) adalah penyakit infeksi yang menjadi tantangan kesehatan global, terutama pada pasien dengan komorbid diabetes melitus (DM). DM dapat memperburuk pengobatan TB dengan meningkatkan risiko resistensi obat, termasuk monoresistensi, multidrug-resistant TB (MDR), dan extensively drug-resistant TB (XDR). Penelitian ini bertujuan untuk menganalisis pola resistensi obat pada pasien TB paru dan TB ekstra paru dengan komorbid DM. Penelitian menggunakan desain deskriptif observasional dengan analisis data rekam medis. Hasil penelitian menunjukkan bahwa komorbid DM memengaruhi pola resistensi obat TB, yang dapat memperumit pengobatan dan mengurangi efektivitas terapi anti-TB. Faktor seperti kontrol gula darah, jenis obat anti-TB yang digunakan, dan interaksi dengan obat diabetes memainkan peran penting dalam keberhasilan pengobatan. Oleh karena itu, diperlukan pendekatan multidisiplin untuk mengelola pasien dengan komorbid DM, termasuk pemantauan gula darah yang ketat dan edukasi pasien untuk meningkatkan kepatuhan terhadap terapi.

References

1. WHO. Global tuberculosis report 2023 https://pesquisa.bvsalud.org/portal/resource/pt/who-3738282023 [Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023.
2. Triasih R, Robertson C, Duke T, Graham SM. Risk of infection and disease with Mycobacterium tuberculosis among children identified through prospective community‐based contact screening in Indonesia. Tropical Medicine & International Health. 2015;20(6):737-43.
3. Indonesia KKR. Laporan Tahunan Program TBC Nasional 2022 Jakarta: Kementerian Kesehatan RI; 2023 [Tahun 2022:[Available from: https://p2p.kemkes.go.id/laporan-tahunan-tbc/#flipbook-df_10814/1/.
4. Kesehatan D. Jumlah Orang Terduga Menderita Tuberkulosis yang Mendapatkan Pelayanan Sesuai Standar 2021/2022 [Available from: https://satudata.bandungkab.go.id/dataset/jumlah-orang-terduga-menderita-tuberkulosis-yang-mendapatkan-pelayanan-sesuai-standar.
5. Barat PJ. Jumlah Terduga Tuberkulosis Berdasarkan Kabupaten/Kota di Jawa Barat Periode 2019: Provinsi Jawa Barat; 2019 [26 February 2024]. Available from: https://opendata.jabarprov.go.id/id/dataset/jumlah-terduga-tuberkulosis-berdasarkan-kabupatenkota-di-jawa-barat.
6. Ihsan aRA. 10 Besar Penyakit Rawat Jalan Triwulan I Tahun 2021 Bandung2021 [Available from: https://rsudalihsan.jabarprov.go.id/posting/read/1572-10-Besar-Penyakit-Rawat-Jalan-Triwulan-I-Tahun-2021.
7. Sari MN, Rahardiantini I, Suheriani D. Pengaruh Tehnik Pursed Lip Breathing terhadap Nilai Saturasi Oksigen Pasien Tuberkulosis Paru di RSUD Raja Ahmad Tabib Provinsi Kepulauan Riau. Journal Of Health Science (Jurnal Ilmu Kesehatan). 2021;6(2):74-80.
8. Yang N, He J, Li J, Zhong Y, Song Y, Chen C. Predictors of death among TB/HIV co-infected patients on tuberculosis treatment in Sichuan, China: A retrospective cohort study. Medicine. 2023;102(5).
9. Fukui M, Shinjo K, Umemura M, Shigeno S, Harakuni T, Arakawa T, et al. Enhanced effect of BCG vaccine against pulmonary Mycobacterium tuberculosis infection in mice with lung Th17 response to mycobacterial heparin binding hemagglutinin adhesin antigen. Microbiology and immunology. 2015;59(12):735-43.
10. Jiang D, Wang GQ, Liu X, Zhang Z, Feng LS, Liu ML. Isatin derivatives with potential antitubercular activities. Journal of Heterocyclic Chemistry. 2018;55(6):1263-79.
11. Khatri GD, Krishnan V, Antil N, Saigal G. Magnetic resonance imaging spectrum of intracranial tubercular lesions: one disease, many faces. Polish journal of radiology. 2018;83:628-39.
12. Mete Yesil A, Yalcin E, Ademhan Turhal D, Emiralioglu N, Dogru D, Ozcelik U, et al. From diagnosis to treatment of pediatric tuberculosis: ten years experience in a single institution. Clinical Pediatrics. 2020;59(4-5):476-82.
13. Ryu YJ. Diagnosis of pulmonary tuberculosis: recent advances and diagnostic algorithms. Tuberculosis and respiratory diseases. 2015;78(2):64-71.
14. Padda IS, Reddy KM. Antitubercular medications. Antitubercular Medications. 1 ed. Seattle: StatPearls Publishing; 2022.
15. Ri K. Pedoman Nasional Pelayanan Kedokteran: Tatalaksana Tuberkulosis. Jakarta: Kementerian Kesehatan Republik Indonesia. 2020.
16. Organization WH. Definitions and reporting framework for tuberculosis–2013 revision: updated December 2014 and January 2020. World Health Organization; 2013. Report No.: 9241505346.
17. Pang Y, An J, Shu W, Huo F, Chu N, Gao M, et al. Epidemiology of extrapulmonary tuberculosis among inpatients, China, 2008–2017. Emerging infectious diseases. 2019;25(3):457.
18. Adetifa IM, Kendall L, Donkor S, Lugos MD, Hammond AS, Owiafe PK, et al. Mycobacterium tuberculosis infection in close childhood contacts of adults with pulmonary tuberculosis is increased by secondhand exposure to tobacco. The American journal of tropical medicine and hygiene. 2017;97(2):429.
19. Bussi C, Gutierrez MG. Mycobacterium tuberculosis infection of host cells in space and time. FEMS microbiology reviews. 2019;43(4):341-61.
20. Herath S, Lewis C. Pulmonary involvement in patients presenting with extra-pulmonary tuberculosis: thinking beyond a normal chest x-ray. Journal of primary health care. 2014;6(1):64-8.
21. Fishman’s Pulmonary Diseases and Disorders, Sixth Edition. Michael A. Grippi M, editor. United States of America: McGraw Hill LLC; 2023.
22. Sahal YP, Afghani A, Nilapsari R. Hubungan jumlah sel limfosit dengan usia dan status nutrisi pada penderita tuberkulosis. Global Medical and Health Communication. 2014;2(2):73-8.
23. Raviglione MC, Gori A. Tuberculosis. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson JL, editors. Harrison's Principles of Internal Medicine, 21e. New York, NY: McGraw-Hill Education; 2022.
24. Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics. 2019;39(7):2023-37.
25. Cohen KA, Manson AL, Desjardins CA, Abeel T, Earl AM. Deciphering drug resistance in Mycobacterium tuberculosis using whole-genome sequencing: progress, promise, and challenges. Genome medicine. 2019;11:1-18.
26. Zaynabila Heriqbaldi A, Juniati Setiabudi R, Yudhawati R. First-Line Anti-Tuberculosis Drug Resistance Pattern. Jurnal Respirasi. 2022;8(2).
27. Sutanto YS, Sutanto MS, Harti AS. Anti-Tuberculosis Drugs against the Resistance Level of Mycobacterium tuberculosis isolates. Jurnal Kesehatan Masyarakat. 2021;17(1):14-23.
28. Khawbung JL, Nath D, Chakraborty S. Drug resistant Tuberculosis: A review. Comparative immunology, microbiology and infectious diseases. 2021;74:101574.
29. Broden NJ, Flury S, King AN, Schroeder BW, Coe GD, Faulkner MJ. Insights into the function of a second, nonclassical Ahp peroxidase, AhpA, in oxidative stress resistance in Bacillus subtilis. Journal of Bacteriology. 2016;198(7):1044-57.
30. Naluyange R, Mboowa G, Komakech K, Semugenze D, Kateete DP, Ssengooba W. High prevalence of phenotypic pyrazinamide resistance and its association with pncA gene mutations in Mycobacterium tuberculosis isolates from Uganda. PloS one. 2020;15(5):e0232543.
31. Hartkoorn RC, Uplekar S, Cole ST. Cross-resistance between clofazimine and bedaquiline through upregulation of MmpL5 in Mycobacterium tuberculosis. Antimicrob Agents Chemother. 2014;58(5):2979-81.
32. Anasulfalah H, Tamtomo DG, Murti B. Effect of Diabetes Mellitus Comorbidity on Mortality Risk in Tuberculosis Patients who Received Tuberculosis Treatment: A Meta-Analysis. Journal of Epidemiology and Public Health. 2022;7(4):441-53.
33. Chiang CY, Bai KJ, Lin HH, Chien ST, Lee JJ, Enarson DA, et al. The influence of diabetes, glycemic control, and diabetes-related comorbidities on pulmonary tuberculosis. PloS one. 2015;10(3):e0121698.
34. Samuels JP, Sood A, Campbell JR, Ahmad Khan F, Johnston JC. Comorbidities and treatment outcomes in multidrug resistant tuberculosis: a systematic review and meta-analysis. Scientific reports. 2018;8(1):4980.
35. Tao N-n, Li Y-f, Song W-m, Liu J-y, Zhang Q-y, Xu T-t, et al. Risk factors for drug-resistant tuberculosis, the association between comorbidity status and drug-resistant patterns: a retrospective study of previously treated pulmonary tuberculosis in Shandong, China, during 2004–2019. BMJ open. 2021;11(6).