Screening of Pulmonary Tuberculosis in Household Contacts With Acid Fastness Bacteria (AFB) Positive Pulmonary Tuberculosis Patients in Ciwangi Village, Balubur Limbangan Subdistrict, Garut District

Background & Objective Tuberculosis is an infectious disease caused by acid-fast bacteria, namely Mycobacterium tuberculosis , which mainly attacks the lungs. Pulmonary tuberculosis is a global health problem with the second deadliest case after HIV/AIDS infection, and ranks third with the most TB cases after India and China. The main source of transmission is patients with active TB pulmonary tuberculosis who can transmit to people around them. This study aims to determine whether pulmonary TB transmission occurs in people who are in household contact with patients with acid-fast bacteria pulmonary TB active. Method This study is descriptive, using the Ziehl neelsen examination method, with a total sampling technique, conducted on 34 people who are in household contact with pulmonary TB patients in Ciwangi Village, Balubur District, Limbangan. Result Based on the examination results in people who are in contact with people with TB, the results are negative, the presence of the bacteria that cause TB. Conclusion The results of Pulmonary Tuberculosis screening conducted on 34 people from 13 heads of families, it can be concluded that the results of TB microscopy with the Ziehl neelsen technique were negative.


Introduction
Tuberculosis is an infectious disease caused by gram-positive acid-fast bacteria (AFB) Mycobacterium tuberculosis which mainly attacks the lungs (Buntuan, 2014). The main symptoms of pulmonary tuberculosis are cough with phlegm for more than two weeks with additional symptoms of sputum mixed with blood, weakness, shortness of breath, weight loss, decreased appetite and so on (Fristanti, 2020). Tuberculosis is one of the 10 causes of death and the leading cause of infectious agents (Kemenkes, 2019). TB data in Indonesia in 2020 increased to 845,000 with more than 98,000 deaths (Valeska et al., 2022). Active pulmonary TB patients are the main source of transmission where patients in their sputum contain Mycobacterium tuberculosis bacteria, and can spread to others when patients cough, sneeze in the form of sputum splashes (droplet nuclei), infection will occur when someone inhales the sputum splash. One cough and sneeze can produce about 3000 -1,000,000 Mycobacterium tuberculosis (Minister of Health., 2016). Infection is greater in groups closer to the patient, especially in groups living in the same house (Bilqishti et al., 2020). Pulmonary tuberculosis is a prominent infectious disease at the Balubur Limbangan Health Center in 2020, with 215 TB cases, and in 2021 TB cases have decreased by 0.37% with 132 positive TB cases. Because, Puskesmas Balubur Limbangan has an innovation Gak Bete "Movement to Eradicate Tuberculosis" to achieve the target of the Garut Regency Health Office for Balubur Limbangan District, which is 1,109 people suspected of TB and has only reached the findings of 986 AFB positive pulmonary TB. Ciwangi village is the village with the highest population density compared to other villages, totaling 7,146 people with 13 AFB (+) pulmonary TB patients. The TB case finding rate for Balubur Limbangan sub-district is still below the target. The factors causing the achievement are still low. This is due to the lack of coordination between the health center and the existing network in the health center's working area, and the lack of participation of the TB cadres that have been formed. Recording and reporting from TB cadres has not been maximized (Yudiana & Garna, 2022). Risk factors that can trigger the incidence of tuberculosis include the environment, residential density, population density is also a risk factor for triggering TB (Budi et al., 2018). The main source of transmission is patients with AFB (+) pulmonary tuberculosis who can transmit it to people around them (Budi et al., 2018). Therefore, healthy people who live in the same house with patients with positive pulmonary tuberculosis are a group that is very vulnerable to transmission of the disease. Based on the home environment, length of contact, and preventive behavior greatly affects the process of transmission of Pulmonary TB disease (Fristanti, 2020

Objective
This study aims to provide scientific contributions by knowing tuberculosis screening in household contacts with patients with AFB positive pulmonary TB, providing information to patients and families with the dangers of pulmonary TB which is easily transmitted, especially to household contacts.

Method
This study is descriptive, to describe the results of screening in families of patients with positive pulmonary TB. The population used in this study were all family members who were in household contact with positive (+) AFB pulmonary TB patients. The sampling technique used was total sampling of all families of positive pulmonary TB patients who were in contact at home and recorded in the medical records of UPT Puskesmas Balubur Limbangan Garut Regency as many as 13 patients with positive acid-fastness bacteria pulmonary TB with all family members of 34 patients. Laboratory tests with acid-fastness bacterial staining using the Ziehl neelsen technique to determine the presence or absence of Mycobacterium tuberculosis in the sputum. This research was conducted in the laboratory of UPT Puskesmas Balubur Limbangan, March 2022 -April 2022.

Results
The results of research conducted in Ciwangi Village, Balubur Limbangan Subdistrict, Garut Regency, with the number of samples studied as many as 34 samples from a total of 13 heads of families. The following table shows the distribution of respondents based on age and gender:  Based on table 2, the results of the above study show that family members who have household contact are not infected or exposed to Mycobacterium tuberculosis bacteria from patients with acid-fastness (+) pulmonary TB. From the results of the acid-fatness microscopic examination of the patient's family in the same house, the examination results were obtained as presented in table 2, with confirmation based on the controls in figures 1 and 2. The control function is to ensure the validity and reliability of the results of this study, also including AFB positive microscopic control.

Discussion
Based on Microscopic examination of acid-fastness bacteria positive sputum has a high diagnostic value as a support for the diagnosis of clinical patients with pulmonary tuberculosis. The high specificity value of acid-fastness bacteria microscopic examination is the reason that examination is still the best method to help confirm the laboratory diagnosis of tuberculosis. The sensitivity value of acid-fastness microscopic examination in this study is relatively low because to get a positive acid-fastestness microscopic examination value requires the presence of as many as 5000-10,000 bacteria/ml sputum (Ramadhan et al., 2017). A negative acid-fastness bacteria test result cannot rule out a diagnosis of pulmonary TB. This can occur if the patient is unable to remove the sputum properly and can also be due to the development of TB bacteria less than 5000/ml, making it difficult to detect with a microscope directly.

Conclusion
The results of Pulmonary Tuberculosis screening conducted on 34 people from 13 heads of families, can be concluded that the results of AFB microscopy with the Ziehl neelsen technique obtained negative results.