Perbedaan Kadar Il-17 Serum pada Pasien Kandidiasis Vulvovaginalis Non Komplikata dan Pasien Kandidiasis Vulvovaginalis Komplikata

Pranowo, RM Tri Pradesa Boco and dr. Tantari SHW, Sp.KK(K) and dr. Sinta Murlistyarini, SpKK. (2019) Perbedaan Kadar Il-17 Serum pada Pasien Kandidiasis Vulvovaginalis Non Komplikata dan Pasien Kandidiasis Vulvovaginalis Komplikata. Magister thesis, Universitas Brawijaya.

Abstract

Kandidiasis vulvovaginalis (KVV) merupakan infeksi jamur pada perempuan yang mengganggu dan rekuren. Berdasarkan manifestasi klinis, mikrobiologi, faktor pejamu dan respon terhadap terapi, kandidiasis vulvovaginalis diklasifikasikan menjadi dua tipe, yaitu non komplikata dan komplikata. Kandidasis non komplikata merupakan episode sporadik dengan infeksi ringan yang disebabkan oleh Candida albicans (C. albicans). Kandidiasis komplikata adalah KVV yang disebabkan oleh spesies candida non albicans, KVV dengan gejala klinis berat, kandidiasis vulvovaginalis rekuren (KVVR), KVV selama kehamilan serta KVV berhubungan dengan kondisi imunokompromais. Peran sel T helper 17 (Th17) sebagai sel imun memediasi imunitas terhadap patogen ekstraseluler seperti bakteri ekstraseluler dan jamur. Sel Th17 memproduksi interleukin-17 (IL-17) yang merupakan sitokin penting sebagai perlindungan pejamu terhadap berbagai macam patogen salah satunya spesies Candida dan memainkan peran utama sebagai perlindungan terhadap KVV. Interleukin-17 merupakan salah satu sitokin pro-inflamasi yang paling penting karena kemampuannya memodulasi respon diperantarai neutrofil yang berperan penting dalam kekebalan pejamu. Sekresi dari IL-17 dapat diinduksi oleh patogen jamur dan bakteri Gram negatif, akan tetapi jamur C. albicans sejauh ini merupakan induksi terkuat dari produksi IL-17. Candida albicans mannan merupakan kompenen struktur dinding sel C. albicans yang dapat menginduksi produksi IL-17. Interleukin-17 menginduksi sel-sel kekebalan tubuh seperti sel T, sel B, dan makrofag untuk mempromosikan priming sel T, produksi antibodi, peptida antimikroba, sitokin inflamasi serta aktifasi neutrofil yang kemudian bermigrasi ke sisi inflamasi dimana melawan infeksi jamur. Pada kondisi KVV komplikata terjadi penurunan kadar IL-17 yang dimana berefek menurunnya kemampuan pejamu dalam mengeliminasi infeksi Candida. Penelitian ini bertujuan untuk mengukur kadar IL-17 serum pada kelompok subyek KVV non-komplikata dan kelompok subyek KVV kompllikata. Penelitian dilakukan di RSUD dr. Saiful Anwar (RSSA) Malang dengan desain analitik observasional potong lintang yang dilakukan pada subyek dipilih secara consecutive sampling. Subyek penelitian diambil setelah mendapat persetujuan dari komisi etik penelitian RSUD dr. Saiful Anwar Malang serta memenuhi kriteria inklusi dan eksklusi. Didapatkan jumlah total 22 subyek yang dibagi menjadi 2 kelompok, kelompok KVV non-komplikata 12 subyek dan kelompok KVV komplikata 10 subyek. Masing-masing subyek dilakukan anamnesis, pemeriksaan fisik dan pemeriksaan kadar IL-17 serum. Hasil penelitian didapatkan rerata kadar IL-17 serum kelompok KVV non-komplikata adalah 9,54±0,71 pg/mL sedangkan rerata kadar IL-17 serum pada kelompok KVV komplikata sebesar 8,92±0,52 pg/mL, sehingga disimpulkan bahwa nilai rerata kadar IL-17 serum subyek KVV non-komplikata lebih tinggi dibandingkan pada subyek KVV komplikata. Karena distribusi data tidak normal, analisis data menggunakan uji Mann Whitney dan didapatkan perbedaan yang bermakna secara statistik (p=0,014

English Abstract

Vulvovaginalis candidiasis is (VVC) a disturbing and recurrent fungal infection in female. Based on the clinical manifestation, microbiology, host factor and therapeutical response, VVC is classified into two types, uncomplicated and complicated. Uncomplicated VVC is a sporadic episode of mild infection caused by Candida albicans (C. albicans), while complicated VVC defined as candidiasis infection caused by non albicans candida species, recurrent vulvovaginalis candidiasis, VVC with severe clinical manifestation, in pregnancy and in immunocompromised patient. The role of T helper 17 (Th17) as immune cell is mediating immunity towards extracellular pathogens such as extracellular bacteria and fungi. T helper 17 produce interleukin-17 (IL-17) which act as an important cytokine in host immunity against various pathogen, one of which Candida species and plays the major role in vulvovaginalis candidiasis immunity. Interleukin-17 is the most prominent proinflammatory cytokine as it able to modulate neutrophil-related responses, major mechanism in host immunity. The secretion of IL-17 may be induced by fungal pathogen and Gram negative bacteria. However, to date, C. albicans still known as the strongest inducer of IL-17 production. The structure of C. albicans cell wall known as mannan, is the fungal component that able to provoke the production of Il-17. Interleukin 17 induce immunity cells such as T and B cell, macrophage to promote priming T cell, antibody production, antimicrobial peptide, inflammatory cytokine and also neutrophil activation which then migrate to inflammatory side against fungal infection. In complicated vulvovaginalis candidiasis, IL-17 level is reduced, subsequently reducing the host’s ability to eliminate candidal infection. This research was done to measure the level of Il-17serum in uncomplicated and complicated vulvovaginalis candidiasis subjects. This research was held in dr. Saiful Anwar Regional General Hospital Malang with cross sectional observational analytic design had been done on subjects that being chosen by consecutive sampling method. Research subjects were collected after receiving approval from research ethic committee of dr. Saiful Anwar Regional General Hospital Malang and fulfilling the inclusion and exclusion criterias. Total 22 subjects were divided into two groups, 12 in uncomplicated group and 10 in complicated group. We did history taking, physical examination and IL-17 serum examination in each subject. Our research showed that the average level of IL-17 serum was 9,54±0,71 pg/mL and 8,92±0,52 pg/mL in uncomplicated and complicated vulvovaginal candidiasis group respectively, the average level of IL-17 serum in uncomplicated vulvovaginal candidiasis subjects higher than complicated vulvovaginal candidiasis subjects. Mann Whitney test used as analysis data due to abnormal data distribution and found statistically significant difference between two group (p=0,014).

Other obstract

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Item Type:	Thesis (Magister)
Identification Number:	TES/616.969 3/PRA/p/2019/041902068
Uncontrolled Keywords:	Kata kunci : kandidiasis vulvovaginalis, interleukin-17, serum
Subjects:	600 Technology (Applied sciences) > 616 Diseases > 616.9 Other disease > 616.96 Parasitic diseases and diseases due to fungi (mycoses) / Medical parasitology > 616.969 Diseases due to fungi (mycoses) / Mycoses
Divisions:	Profesi Kedokteran > Spesialis Dermatologi dan Venereologi, Fakultas Kedokteran
Depositing User:	yulia Chasanah
Date Deposited:	08 Sep 2022 02:19
Last Modified:	08 Sep 2022 02:20
URI:	http://repository.ub.ac.id/id/eprint/194043

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