Jurnal Respirasi

A Fatal Case of Descending Necrotizing Mediastinitis as a Result of Treatment Delay in Odontogenic Infection: Various Bacterial Infections and Coexisting Lung Tuberculosis

Sat, 31 May 2025 00:00:00 +0700

Introduction: Descending necrotizing mediastinitis (DNM) is a rare but life-threatening complication of oropharyngeal and odontogenic infections. This case report highlighted that DNM is very complex because it causes infection with various types of bacteria, and the presence of pulmonary tuberculosis (TB) in the patient.

Case: A patient with untreated pulp gangrene for three months underwent drainage and tooth extraction surgery. Subsequently, the patient was diagnosed with DNM and underwent cervicotomy and sternotomy for debridement. Postoperative cultures revealed polymicrobial infections. Additionally, a follow-up chest X-ray confirmed active pulmonary TB. The simultaneous presence of multiple bacterial infections and TB necessitated aggressive treatment, including broad-spectrum antibiotics, anti-TB drugs per standard regimens, and close intensive care unit (ICU) monitoring. Over a month of ICU care, the patient’s vital signs and postoperative wounds improved. This case was classified as Endo-Hasegawa IIC DNM caused by odontogenic infection with pulp gangrene, progressing from the submandibular space to the mediastinum. The coexisting pulmonary TB further complicated management. Drainage via cervicotomy and sternotomy allowed for extensive mediastinal exploration. However, delayed diagnosis led to complications, including sepsis and altered consciousness due to uncontrolled bacterial spread. This underscores the importance of early diagnosis and intensive, multidisciplinary management to improve outcomes.

Conclusion: Physicians need to be more aware of DNM as a potential complication of odontogenic infections and the possibility of a wide variety of bacterial and coexisting infections that may complicate treatment.

Successful Treatment of Cor Pulmonale in Drug-Resistant Tuberculosis-Related ARDS: A Case Report

Amalia Sutoyo — Sat, 31 May 2025 00:00:00 +0700

Introduction: One of the biggest challenges in global tuberculosis (TB) control is the spread of drug-resistant TB. Chronic cor pulmonale is confirmed in a pulmonary TB patient through the mechanism of pulmonary hypertension (PH). Tuberculosis is one of the causes of respiratory failure requiring mechanical ventilation. However, cases of TB requiring mechanical ventilation as the primary cause of respiratory failure are rare. Tuberculous acute respiratory distress syndrome (ARDS) is rare, but it has a very poor prognosis when it does occur.

Case: A 48-year-old female arrived with chronic cor pulmonale decompensated symptoms with drug-resistant pulmonary TB diagnosed by echocardiography. The patient developed ARDS during treatment. Initially, the patient was treated with loop diuretics, oxygen treatment, vasodilators, digitalis, anticoagulant medication, bronchodilators, and empirical antibiotics. As her condition deteriorated, the patient was put on mechanical ventilation and anti-TB medication. The patient’s health improved, and she was allowed to return home.

Conclusion: Acute respiratory distress syndrome patients associated with drug-resistant TB may experience decompensated chronic cor pulmonale. In this instance, the main diagnostic method for cor pulmonale is echocardiography. Seldom is drug-resistant pulmonary TB associated with ARDS that results in cor pulmonale being documented. Positive results are linked to early diagnosis and treatment. Following therapy, the patient’s health improved, and the patient was permitted to return home with the prescribed drugs.

Pulmonary Empyema with Possible Tuberculosis Infection: A Case Report

Sat, 31 May 2025 00:00:00 +0700

Introduction: Pulmonary empyema is an infectious disease with mortality and morbidity rates ranging between 3% and 33%. It occurs in approximately 8.9% of patients with tuberculosis (TB), and the associated mortality rate is approximately 20%. If not treated promptly following diagnosis, empyema may result in a poor prognosis. Therefore, this case report presented a patient with pulmonary empyema caused by a possible TB infection.

Case: A 57-year-old female presented with a two-week history of coughing up yellow phlegm and a three-day history of fever. The patient reported an untreated dental cavity in the right lower tooth for the past three weeks. Physical examination revealed decreased vesicular breath sounds in the right hemithorax’s fifth to sixth intercostal space (ICS). Chest X-ray examination suggested pneumonia and right pleural effusion. Laboratory examinations revealed leukocytosis, thrombocytosis, and an increased neutrophil-to-lymphocyte ratio (NLR). The adenosine deaminase (ADA) level was 89 U/L. Ultrasonography (USG) of the right hemithorax confirmed right pleural effusion. A pleural puncture was performed, and a thoracic drainage was inserted. The procedure yielded approximately 1,700 cc of cloudy brown pus. The patient was diagnosed with right pulmonary empyema caused by tuberculous pleurisy. She received antibiotic therapy and a four-drug fixed-dose combination (FDC) of anti-TB therapy. After nine days of treatment, the patient’s symptoms showed improvement.

Conclusion: Empyema is a complex disease with diverse etiologies and multifactorial pathogenesis. Early detection and prompt treatment are essential to minimize the risk of further complications.

Neutrophil to Lymphocyte Ratio in Pulmonary Tuberculosis Patients with and without Diabetes Mellitus and Human Immunodeficiency Virus Co-Infection Comorbidities

Sat, 31 May 2025 00:00:00 +0700

Introduction: Tuberculosis (TB) remains a leading cause of mortality in Indonesia. The presence of diabetes mellitus (DM) and human immunodeficiency virus (HIV) co-infection comorbidities is a double burden. In TB patients, the neutrophil to lymphocyte ratio (NLR) is an inflammatory marker and may indicate disease progression and immune system status. This study aimed to describe the NLR in pulmonary TB patients with and without DM and HIV co-infection comorbidities.

Methods: This study used a quantitative descriptive method with a cross-sectional approach. A total sampling technique was used, resulting in a sample of 159 participants. Data were collected from medical records.

Results: Among 108 newly diagnosed pulmonary TB patients in this study, 42 patients (38.9%) had a normal NLR (0.78-3.53), while 66 patients (61.1%) had an increased NLR (>3.53). Of the 28 TB patients with DM comorbidity, 12 patients (42.9%) had a normal NLR, while 16 patients (57.1%) had an increased NLR. Among the 23 TB patients with HIV co-infection comorbidity, four patients (17.4%) had a normal NLR, while 19 patients (82.6%) had an increased NLR.

Conclusion: The results showed that pulmonary TB patients with and without DM and HIV co-infection comorbidities had a high NLR.

The Effect of Vitamin D3 Supplementation on Interleukin-6 and PRESS Score in Children with Pneumonia and Vitamin D Deficiency

Sat, 31 May 2025 00:00:00 +0700

Introduction: Pneumonia is a significant health issue in children under 5 years old. Vitamin D may help to reduce childhood mortality, morbidity, and interleukin-6 (IL-6) levels in children with pneumonia, but the evidence is still limited and controversial. This study aimed to evaluate the effect of vitamin D3 supplementation on IL-6 levels and clinical manifestations in children with pneumonia and vitamin D inadequacy.

Methods: This was a randomized, placebo-controlled, and double-blinded trial study. Twenty-eight children diagnosed with pneumonia and vitamin D deficiency were enrolled and divided into a supplementation (n=15) or placebo group (n=13). Children were given a single dose (100,000 international units/IU) of vitamin D3 or placebo on the first day of hospitalization. Clinical manifestations were assessed by the Pediatric Respiratory Severity Score (PRESS).

Results: The level of 25-hydroxyvitamin D (25-OH D3), IL-6, and PRESS score at baseline showed no significant difference between groups. Seven days post-supplementation, only the PRESS score showed a significant difference between groups (p=0.025). Analysis of the vitamin D3 group showed a significantly increased 25-OH D3 level and a reduced PRESS score (p=0.039 and p=0.02, respectively).

Conclusion: A single high dose of vitamin D3 supplementation in children with pneumonia and inadequate vitamin D levels helps elevate 25-OH D3 levels and reduce clinical manifestations, as indicated by the PRESS score.

Differentiation of Malignant Pleural Effusions from Lung Squamous Cell Carcinoma and Adenocarcinoma through FTIR Spectroscopy: A Prognostic Approach

Sat, 31 May 2025 00:00:00 +0700

Introduction: Malignant pleural effusion (MPE) is common in cancer patients and is often caused by neoplastic involvement of the pleural surface. This study aimed to determine the utility of Fourier transform infrared spectroscopy (FTIR) spectral analysis and anatomical pathological differentiation in MPE, squamous cell carcinoma (SCC), and lung adenocarcinoma as prognostic predictors.

Methods: This study used a cross-sectional design at Ulin General Hospital, Banjarmasin, involving advanced lung cancer patients with MPE. A non-probability sampling technique was used to recruit 30 patients. Fourier transform infrared spectroscopy was analyzed to evaluate anatomical pathology differentiation.

Results: Differences were observed in the FTIR spectral ratios A1080/A1243 and A1080/A1170 between SCC and adenocarcinoma, with p-values of 0.026 and 0.022, respectively. Significant differences were also found in the A2959/A1545 ratio between well-differentiated and poorly differentiated adenocarcinomas, with a p-value of 0.023. The receiver-operating characteristic curve (ROC) indicated good predictive value for poorly differentiated adenocarcinoma at a cut-off value of 0.944, with a sensitivity of 50% and specificity of 100%. However, no significant correlation was found between FTIR absorbance and anatomical pathology differentiation in MPE due to SCC and lung adenocarcinoma.

Conclusion: The FTIR spectral ratios A1080/A1243 and A1080/A1170 differentiate SCC from adenocarcinoma. Fourier transform infrared spectroscopy may be an adjunct to cytology, offering a more rapid and cost-effective method for differentiating MPE.

The Changes of Immunohistochemistry in Lung Tissues, Surfactant Protein-D, eNOS, and NO in Mice Exposed to Essential Oil Vapor

Sat, 31 May 2025 00:00:00 +0700

Introduction: The use of essential oils in aromatherapy is widespread. However, few studies have explored the effects of smoke from the evaporation of commonly used essential oils. While essential oils are promoted for various benefits, prolonged exposure to inhaled particles from essential oil smoke may pose potential health risks. This study aimed to examine the effects of essential oil vapors on mice.

Methods: This was an experimental study investigating the effects of different treatments on lung immunohistopathology, endothelial nitric oxide synthase (eNOS) expression, serum nitric oxide (NO) levels, and serum surfactant protein-D (SP-D) as an inflammation marker in mice. A total of 40 adult male Mus musculus mice (25–30 g) were randomly divided into four groups. Inflammation models were established by exposing the mice to a gas mixture containing vegetable glycerin, propylene glycol, and vitamin E acetate solution. Following inflammation induction, the mice received seven-day interventions with 0.9% NaCl solution, Eucalyptus globulus essential oil (EgEO), and citronella essential oil (CtEO), alongside an untreated inflammatory group.

Results: The CtEO group intervention showed significant increases in eNOS expression (P=0.001) but no significant increase in NO compared to the other groups. The correlation analysis of eNOS expression in lung cells, serum NO, and SP-D levels was not significant, P>0.05 (p=0.160; p=0.115; p=0.234).

Conclusion: Gas intervention containing 100% oxygen (O₂) and CtEO steam increased eNOS expression on the immunohistochemistry (IHC) examination of mice.

Prevalence and Affecting Factors of Arrhythmias in Stable Chronic Obstructive Pulmonary Disease at a Tertiary Hospital in Indonesia

Sat, 31 May 2025 00:00:00 +0700

Introduction: Chronic obstructive pulmonary disease (COPD) represents an increasing global health burden. Among its significant comorbidities, cardiovascular complications, particularly arrhythmias, are of significant concern. Chronic obstructive pulmonary disease and arrhythmias share common risk factors, including advanced age and smoking. This study investigated the prevalence and contributing factors of arrhythmias in stable COPD patients.

Methods: This cross-sectional study was conducted among stable COPD patients attending the Asthma-COPD Clinic at Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia, from January to April 2018. The inclusion criteria encompassed a clinical diagnosis of COPD and voluntary participation with written informed consent. Each participant underwent laboratory evaluation, electrocardiography (ECG), blood pressure measurement, and a structured interview. Patients were excluded if they had experienced acute COPD exacerbations during the assessment, had a history of other chronic lung diseases, suffered a recent myocardial infarction, had structural heart disease, were diagnosed with fibrillation, or declined to participate.

Results: The prevalence of arrhythmias in stable COPD patients was 24.1%. The types included sinus bradycardia (2.41%), premature atrial contractions/PACs (3.61%), premature ventricular contractions/PVCs (8.43%), and sinus tachycardia (9.64%). The majority of arrhythmic patients were males, with an average age of 68 years old. These patients also had a history of heart disease, exhibited severe COPD symptoms, and demonstrated significant airflow obstruction (average pCO₂ of 36 mmHg).

Conclusion: Decreased chloride levels were associated with an increased incidence of arrhythmias. However, no significant associations were observed with airflow limitation, sex, age, bronchodilator use, or arterial blood gas parameters.

Prognosis of Tyrosine Kinase Inhibitor Therapy for Non-Small Cell Lung Cancer

Sat, 31 May 2025 00:00:00 +0700

Introduction: Non-small cell lung cancer (NSCLC) was the primary cause of death in lung cancer. Tyrosine kinase inhibitors (TKIs) were one of the management options for NSCLC. Meanwhile, serum carcinoembryonic antigen (CEA) plays a crucial role in the diagnosis and prognosis of NSCLC patients. This study aimed to determine the effectiveness of epidermal growth factor receptor (EGFR)-TKI based on progression-free survival (PFS) and overall survival (OS) in NSCLC patients with common EGFR mutations.

Methods: This retrospective cohort study used a total sampling method. The serum CEA level was measured before the initial treatment. Tyrosine kinase inhibitors therapy was monitored with PFS and OS. Statistical analysis for comparing prognosis in NSCLC among TKI groups used Kruskal-Wallis, analysis of variance (ANOVA), Mann-Whitney, and Spearman’s rho tests. A significant analysis referred to a p-value of <0.05.

Results: The participants were 189 patients, consisting of 106 on gefitinib, 43 on erlotinib, and 40 on afatinib. The average PFS values in the gefitinib, erlotinib, and afatinib groups were 9.9±5.25, 8.77±4.53, and 12.83±7.02 months, respectively (p=0.016). Furthermore, there were no significant OS among the gefitinib (14.91±7.61 months), erlotinib (14.54±7.64 months), and afatinib group (15.51±8.13 months, p=0.867). There was a significant correlation between CEA levels and PFS (r=0.146; p=0.046) and between CEA levels and OS (r=0.223; p=0.004).

Conclusion: Although afatinib may prolong PFS compared with gefitinib and erlotinib, it did not significantly impact OS. Increased serum CEA levels before treatment significantly improved PFS and OS. However, elevated CEA levels are usually associated with a poor prognosis in NSCLC.

The Effectiveness of Lactobacillus rhamnosus Administration on the Growth of Klebsiella pneumoniae in Mice (Mus musculus)

Sat, 31 May 2025 00:00:00 +0700

Introduction: Klebsiella pneumoniae is a bacterium from the Enterobacteriaceae family and is considered one of the most dangerous pathogens. Antibiotics are crucial for treating acute bacterial infections. Using probiotics has become one of the supportive and curative efforts in managing the growth of K. pneumoniae. One probiotic derived from microorganisms is Lactobacillus rhamnosus. This study aimed to determine the effectiveness of L. rhamnosus on the growth of K. pneumoniae in mice (Mus musculus).

Methods: This was an experimental post-test study. The study population consisted of mice aged 3 to 4 months, weighing 20 to 40 grams, determined using Federer’s formula. Mice were given standard feed and sterile distilled water. A total of 30 mice were tested and divided into five treatment groups. The distribution colony count test was used for evaluation.

Results: Among the five groups studied, probiotic intervention in the group receiving a combination of L. rhamnosus and the antibiotic ceftriaxone showed effective results (p<0.05), as did the group given only the probiotic L. rhamnosus (p<0.05). In contrast, the other groups did not show effective results (p>0.05).

Conclusion: The administration of L. rhamnosus is effective as a supportive and curative treatment, but it is not effective as a preventive measure against the growth of K. pneumoniae in mice.

Front Matter Vol 11 No 2, 2025

Front Matter — Sat, 31 May 2025 00:00:00 +0700

Bronchial Artery Embolization in Hemoptysis

Sat, 31 May 2025 00:00:00 +0700

Hemoptysis, characterized by bleeding from the lower airways, is classified as mild, moderate, or massive, with massive hemoptysis carrying a mortality rate of 6.5–38%. Tuberculosis (TB) remains the most common cause globally. Management strategies include invasive and noninvasive options, with bronchial artery embolization (BAE) emerging as a cornerstone of noninvasive treatment since its introduction in the 1970s. Bronchial artery embolization provides rapid bleeding control and high success rates for both short- and long-term outcomes. Despite these advantages, recurrence rates range widely from 10–55%, often due to incomplete embolization, vessel recanalization, and collateral vessel development. The procedure employs embolic agents such as polyvinyl alcohol (PVA) particles, gelatin sponges, and tris-acryl gelatin microspheres, with minimal complications such as spinal cord infarction or broncho-esophageal fistulas. Diagnostic tools like computed tomography (CT) and bronchoscopy complement BAE by localizing the bleeding sites, stabilizing the airway, and aiding in definitive management. Bronchoscopy serves diagnostic and therapeutic purposes, employing techniques such as vasoconstrictor instillation, laser therapy, and balloon tamponade to control bleeding. Bronchial artery embolization is particularly effective for patients with life-threatening or recurrent hemoptysis who are unsuitable for surgery, often acting as a bridge to elective interventions. This literature review highlighted the pathophysiology, diagnostic modalities, BAE techniques, outcomes, and challenges involved in managing hemoptysis, emphasizing the role of BAE as a vital, minimally invasive therapeutic option.

Monitoring and Evaluation of Therapy Response in Advanced-Stage Lung Cancer Treated with Systemic Therapy

Ibrahim Syamsuri, Anna Febriani, Laksmi Wulandari, Farah Fatma Wati — Sat, 31 May 2025 00:00:00 +0700

Lung cancer is the second most commonly diagnosed malignancy, with the highest mortality rate in the world. In Indonesia, lung cancer ranks third with 34,783 cases, contributing to the highest number of deaths due to cancer. Most patients are diagnosed at an advanced stage, requiring systemic therapy. Therapeutic modalities for lung cancer patients can include surgery, radiotherapy, and systemic therapy, with the choice of therapy determined by the histological type, disease stage, laboratory results, performance status (PS), and comorbidities. This situation requires regular monitoring and evaluation to reduce the symptoms and improve the patient’s quality of life (QoL). Therapy response in systemic therapy patients can be evaluated through subjective, semi-subjective, and objective evaluations. Subjective evaluation involves monitoring QoL, focusing on cancer outcomes, and patients’ well-being. Semi-subjective evaluation consists of monitoring the patient’s weight and PS. Objective evaluation uses imaging equipment, such as computed tomography (CT) scans, fluoroscopy, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans to monitor tumor progression.

Improving Pulmonary Function and Functional Ability through Pulmonary Rehabilitation in Patients with Pleural Effusion: A Literature Review

Sat, 31 May 2025 00:00:00 +0700

Introduction: Pleural effusion (PE) is characterized by reduced lung distensibility and expansion, resulting in decreased lung volume. Pleural effusion patients often experience respiratory symptoms that impair quality of life (QoL) and daily activities. Pulmonary rehabilitation (PR) has been developed to enhance functional capacity, alleviate symptoms, improve exercise tolerance, and reduce health service utilization. However, data on the specific implementation and benefits of PR in PE patients are limited.

Methods: This literature review synthesized data from a search using Public Medline (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar databases. The search was based on keywords relevant to study objectives and comprised various article types, ranging from review papers to original research. Articles with titles and abstracts relevant to the study objectives proceeded to a full-text evaluation.

Results: A narrative review discussing PE from pathology to rehabilitation management was formulated from 12 articles that elucidated various aspects of functional impairment in PE patients and 24 sources that discussed rehabilitation management.

Conclusion: Rehabilitation interventions, especially mobilization programs and lung expansion techniques, have shown effectiveness in improving pulmonary function and functional activities. Data regarding the role of inspiratory muscle training and aerobic exercise specific to PE remain limited. Given the functional impairments associated with PE, both before and after the removal of pleural fluid, PR programs are crucial in improving symptoms, pulmonary function, and overall functional ability in these patients.

Back Matter Vol 11 No 2, 2025

Back Matter — Sat, 31 May 2025 00:00:00 +0700