High ESAT-6 Expression in Granuloma Necrosis Type of Tuberculous Lymphadenitis

Wida Purbaningsih, Djatnika Setiabudi, Herri S. Sastramihardja, Ida Parwati


A granuloma is one of host cellular immune response form to intracellular and persistent pathogens, and result in the aggregation of several activated immune cells. Intracellular pathogens manipulate host immune responses to avoid immune reactions. M. tuberculosis is the intracellular and persister pathogen, which can stimulate granuloma formation. The formation this granulomas still have different opinions, whether it is the body's way to isolate M. tuberculosis, or how these pathogens are to avoid immune responses. Early secretory antigenic target-6 is a typical secretory protein produced by the locus of the gene region of difference (RD) -1 M. tuberculosis virulent isolate H37Rv. Early secretory antigenic target-6 plays a role in the immunopathogenesis of tuberculosis. This study aims to compare ESAT-6 antigen expression from M. tuberculosis between granulomas with necrosis and granulomas without necrosis. This study is an analytic observation study, with a cross-sectional design. Forty-six lymph node paraffin blocks from tuberculous lymphadenitis patients in Department of Anatomical Pathology, Dr. Hasan Sadikin General Hospital in 2017. By anatomic pathologist were made in preparations and stained by hematoxylin eosin to assess the presence of necrosis in granulomas, and immunohistochemical using ESAT-6 antibodies, then it was quantified using histoscore. Histoscore for ESAT-6 not normally distributed that Mann Whitney test used. The results showed that there were 31 granulomas with necrosis, the histoscore mean value was 27.6%, while in 15 granulomas without necrosis was 15.1%, there was a significant difference with p<0.05 (p=0.03). In conclusion, there was a high histoscore ESAT-6 expression in granuloma type of necrosis  tuberculous lymphadenitis.


Ekspresi ESAT-6 Tinggi pada Granuloma Limfadenitis Tuberkulosis Tipe Nekrosis

Granuloma merupakan salah satu bentuk respons imun seluler host terhadap patogen intraseluler. Patogen intraselular memanipulasi respons imun host untuk menghindari reaksi imun. Terbentuknya granuloma masih memberikan pendapat yang berbeda, apakah merupakan cara tubuh untuk mengisolasi patogen, atau cara patogen untuk menghindari respons imun. Penelitian ini bertujuan untuk menganalisis perbedaan ekspresi antigen ESAT dari M. tuberculosis pada granuloma dengan nekrosis dengan granuloma tanpa nekrosis. Penelitian ini merupakan penelitian observasi analitik, dengan desain cross sectional. Blok parafin kelenjar getah bening dari pasien yang didiagnosis limfadenitis tuberkulosis di Departemen Patologi Anatomi, RSUP Dr. Hasan Sadikin Bandung tahun 2017. Blok parafin tersebut dibuat blangko preparat dan diwarnai oleh hematoksilin eosin untuk menilai nekrosis pada granuloma, dan imunohistokimia menggunakan antibodi ESAT-6, kemudian sediaan preparat imunohistokimia tersebut dikuantifikasi menggunakan metode histoskor sehingga mendapatkan data berupa nilai skor dari pewarnaan ESAT-6, kemudia dilakukan uji beda antara histoscore granuloma dengan nekrosis dengan tanpa nekrosis tersebut dianalisis, karena nilai skor ESAT-6 berdistribusi tidak normal sehingga menggunakan Mann Whitney test. Hasil penelitian menunjukkan bahwa, terdapat 31 granuloma dengan nekrosis, nilai rerata histoskor sebesar 27,6, sedangkan pada 15 granuloma tanpa nekrosis sebesar 15,1. Terdapat perbedaan signifikan dengan p<0,05 (p=0,03). Simpulan, ekspresi ESAT-6 tinggi pada granuloma limfadenitis tuberkulosis dengan nekrosis.


ESAT-6; granuloma; necrosis; nekrosis


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DOI: https://doi.org/10.29313/gmhc.v6i2.3987


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