Peran β-glucan dalam diagnosis rinosinusitis kronik jamur

Abstract

Latar Belakang: Rinosinusitis kronik jamur merupakan permasalahan kesehatan terutama dinegara berkembang karena prevalensinya yang semakin meningkat, sulitnya penanganan medis, sertaberdampak besar terhadap penurunan kualitas hidup. Saat ini tengah dikembangkan teknologi untukmembantu penegakan diagnosis tanpa tindakan invasif, yaitu dengan memanfaatkan β-glucan sebagaikomponen terbesar penyusun dinding sel beberapa spesies jamur. Tujuan: Mengetahui hubungan antarakadar β-glucan jaringan sinus dan serum darah untuk diagnosis rinosinusitis kronik jamur. Metode:Penelitian cross sectional ini melibatkan 20 subjek penelitian. Dilakukan pengambilan sampel darah, danpembedahan sinus maksila untuk mengambil jaringan mukosa, yang kemudian dilanjutkan pemeriksaanpolymerase chain reaction (PCR) untuk identifikasi jamur pada mukosa sinus. Bila didapatkan spesiesjamur yang memiliki β-glucan, dilakukan pemeriksaan enzyme-linked immunosorbent assay (ELISA) untukpengukuran kadar β-glucan. Hasil: Aspergillus flavus merupakan jamur yang paling banyak ditemukan.Seluruh subjek melampaui batasan positif β-glucan (≥80 pg/mL) dari spesimen mukosa, dan hanya 1subjek memberikan hasil intermediate (60-79 pg/mL) dari darah. Uji t berpasangan mendapatkan kadarβ-glucan darah tidak berbeda bermakna dengan mukosa sinus (p=0,886), sehingga pemeriksaan β-glucanpada darah dapat menggambarkan kadar β-glucan pada sinus paranasal. Kesimpulan: β-glucan dapatdimanfaatkan untuk membantu memperoleh diagnosis rinosinusitis kronik jamur, sehingga diharapkandiagnosis dapat ditegakkan dengan cepat dan tepat tanpa memerlukan tindakan invasif, namun hasil inimembutuhkan penelitian lebih lanjut, khususnya terkait uji diagnostik. ABSTRACTBackground: Chronic fungal rhinosinusitis is a major health problem particularly in developingcountries due to its increasing prevalence, difficult medical treatment, and also could make a large impacton the quality of life. The current technology to establish diagnosis without invasive procedure is byutilizing β-glucan, the largest component of fungal cell wall in some fungal species. Purpose: To discoverthe correlation of β-glucan level in paranasal sinus tissue and blood serum as a potential diagnosismarker for chronic fungal rhinosinusitis. Methods: A cross sectional study involving 20 subjects. Bloodsampling and maxillary sinus surgery were performed, then fungi identification in the sinus mucosawas done by Polymerase Chain Reaction (PCR). If a fungal species with β-glucan was found, then theexamination was continued with the measurement of β-glucan by Enzyme-Linked Immuno Sorbent Assay(ELISA) technique in sinus and blood. Results: Aspergillus flavus is the most commonly found fungus. Allsubjects passed the positive β-glucan limit (≥80 pg/mL) of the mucosal sample, and only 1 subject hadintermediate results (60-79 pg/mL) from the blood. Paired t-test result showed no significant differencebetween the level of β-glucan in blood and mucosal sinus (p=0.886), so that β-glucan blood examinationcould illustrate β-glucan levels in paranasal sinuses. Conclusion: β-glucan may be used to establishthe diagnosis of fungal chronic rhinosinusitis with one hope that the diagnosis process can be obtainedquickly and accurately without invasive procedure, although it still requires more studies, particularlyrelated to diagnostic test.