HASIL PENELITIAN

PENGARUH CUKA APEL (Malus domestica) TERHADAP

PERTUMBUHAN Candida albicans SECARA IN VITRO

Oleh:

ELI ARDIANI

201610330311008

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG

2020

i

Pengaruh Cuka Apel (Malus domestica) Terhadap Pertumbuhan Candida

albicans Secara In Vitro

HASIL PENELITIAN

Ditujukan Kepada

Universitas Muhammadiyah Malang

Untuk Memenuhi Salah Satu Persyaratan

Dalam Menyelesaikan Program Sarjana

Fakultas Kedokteran

Oleh:

ELI ARDIANI

201610330311008

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG

2020

ii

iii

iv

v

KATA PENGANTAR

Assalamualaikum Wr. Wb.

Puji syukur kepada Allah SWT karena atas rahmat dan hidayah-Nya,

penulisan hasil penelitian ini dapat diselesaikan dengan baik. Sholawat serta salam

semoga selalu tercurahkan kepada Rasulullah SAW, keluarga, para sahabat dan

pengikut Beliau hingga akhir zaman.

Penelitian ini yang berjudul “Pengaruh Cuka Apel (Malus domestica)

Terhadap Pertumbuhan Candida albicans Secara In Vitro”. Hasil penelitian ini

diajukan untuk memenuhi persyaratan Pendidikan Sarjana Fakultas Kedokteran

Universitas Muhammadiyah Malang.

Pada kesempatan ini, penulis ingin menyampaikan ucapan terima kasih

yang tak terhingga kepada:

1. Dr. dr. Meddy Setiawan, Sp.PD, selaku Dekan Fakultas Kedokteran

Universitas Muhammadiyah Malang atas dukungannya selama di FK UMM.

2. dr. Moch. Ma’roef, Sp.OG, selaku Wakil Dekan I Fakultas Kedokteran

Universitas Muhammadiyah Malang sekaligus selaku dosen pembimbing I

yang selalu memberikan arahan, membimbing dengan sabar, memberi

dorongan motivasi, dan selalu menyediakan waktu membimbing penulis,

sehingga penulis dapat menyelesaikan tugas akhir ini dengan baik.

3. dr. Sri Adila Nurainiwati, Sp.KK, selaku Wakil Dekan II Fakultas

Kedokteran Universitas Muhammadiyah Malang sekaligus selaku penguji

yang senantiasa memberikan masukan dan saran yang sangat bermanfaat

untuk penulis.

4. dr. Indra Setiawan, Sp.THT-KL, selaku Wakil Dekan III Fakultas

Kedokteran Universitas Muhammadiyah Malang atas dukungannya selama di

FK UMM.

5. dr. Irma Suswati, M.Kes, selaku dosen pembimbing II yang selalu

memberikan arahan, membimbing dengan sabar, memberi dorongan motivasi,

dan selalu menyediakan waktu membimbing penulis, sehingga penulis dapat

menyelesaikan tugas akhir ini dengan baik.

vi

6. Kedua orangtua penulis, Bapak Budiono dan Ibu Marti, serta kakak satu-

satunya Mas Aris, terimakasih sudah menjadi motivasi terbesar penulis

selama menempuh pendidikan ini dan mengerjakan tugas akhir ini.

Terimakasih atas doa, dukungan, dan semangat yang selalu diberikan kepada

penulis. Tugas akhir ini penulis persembahkan untuk kalian.

7. Adhan Karisma, selaku teman sekaligus kekasih yang selalu memberikan doa,

dukungan, dan semangat sehingga penulis dapat menyelesaikan tugas akhir

ini.

8. Teman-teman di FK UMM Nadya, Tansa, Puteri, Sarah, Savira, dan Dian

yang selalu membantu dan memberikan dukungan serta semangat pada

penulis selama menempuh pendidikan dan mengerjakan tugas akhir ini.

9. Staf TU dan Laboran Laboratorium Biomedik Fakultas Kedokteran

Universitas Muhammadiyah Malang, atas bantuannya selama di FK UMM.

10. Semua pihak yang terlibat langsung maupun tidak langsung yang tidak

mampu penulis sebutkan satu per satu, terima kasih atas dukungan dan

doanya.

Dengan segala kerendahan hati, penulis mohon maaf sebesar-besarnya bila

hasil penelitian ini masih jauh dari kata sempurna. Oleh karena itu penulis

membuka diri untuk segala saran dan kritik yang bersifat membangun guna

kesempuranaan dari hasil penelitian ini. Semoga hasil penelitian ini dapat

memberikan manfaat bagi penulis, pembaca, dan menjadi sumbangan yang berarti

bagi perkembangan ilmu pengetahuan kedepan.

Wassalamualaikum Wr.Wb.

Malang, 20 Januari 2020

Penulis

vii

ABSTRAK

Ardiani, Eli. 2020. Pengaruh Cuka Apel (Malus domestica) Terhadap

Pertumbuhan Candida albicans Secara In Vitro. Tugas Akhir, Fakultas

Kedokteran Universitas Muhammadiyah Malang. Pembimbing: (1) Moch.

Ma’roef (2) Irma Suswati

Latar belakang: Candida albicans merupakan satu dari tiga penyebab terbanyak

vulvovaginal candidiasis di Indonesia. Fluconazole sebagai pengobatan lini

pertama vulvovaginal candidiasis juga dilaporkan mengalami resistensi sebesar

7% terhadap Candida spp. Cuka apel merupakan salah satu jenis olahan apel yang

memiliki banyak manfaat, termasuk sebagai antifungi. Hal tersebut disebabkan

karena kandungan asam asetat, flavonoid, dan pektin.

Tujuan: Untuk mengetahui pengaruh cuka apel (Malus domestica) terhadap

pertumbuhan Candida albicans secara in vitro.

Metode penelitian: True experiment dengan posttest-only control group design,

menggunakan dilusi tabung dengan konsentrasi cuka apel 100%, 50%, 25%,

12,5%, 6,25%, 3,125%, 1,56%, 0,78%, 0,39%, 0%. Analisis data menggunakan

uji One Way Anova, uji Post Hoc Games-Howell, dan uji Regresi Linear.

Hasil: KHM 6,25% dan KBM 12,5%. Hasil uji One Way Anova didapatkan nilai

signifikansi sebesar 0,000, menunjukkan terdapat perbedaan antara perlakuan

yang diuji. Hasil uji Post Hoc Games-Howell didapatkan hasil p<0,05 pada

konsentrasi 0,78% hingga 50%, menunjukkan besar penurunan yang signifikan

mulai konsentrasi 0,78% hingga 50%. Hasil uji Regresi Linear didapatkan R

Square sebesar 90,5%, menunjukkan dosis cuka apel berpengaruh terhadap

jumlah koloni C. albicans sebesar 90,5%.

Kesimpulan: Cuka apel (Malus domestica) memiliki pengaruh terhadap

pertumbuhan Candida albicans secara in vitro.

Kata Kunci: Cuka Apel, Candida albicans, KHM, KBM

viii

ABSTRACT

Ardiani, Eli. 2020. The Effect of Apple Cider Vinegar (Malus domestica) on the

Growth of Candida albicans In Vitro. Final Assignment, Medicine Faculty

of Muhammadiyah Malang University. Advisors: (1) Moch. Ma’roef (2)

Irma Suswati

Background: Candida albicans is one of three most common causes of

vulvovaginal candidiasis in Indonesia. Fluconazole as the first-line treatment for

vulvovaginal candidiasis also has reported resistance of 7% against Candida spp.

Apple vinegar is one type of processed apple that has many benefits, including as

an antifungal. This is caused by the content of acetic acid, flavonoids, and pectin

Purpose: To know the effect of apple cider vinegar (Malus domestica) on the

growth of Candida albicans in vitro.

Research Methods: True experiment with posttest-only control group design,

using dilution tube with apple cider vinegar concentration 100%, 50%, 25%,

12,5%, 6,25%, 3,125%, 1,56%, 0,78%, 0,39%, 0%. Data was analyzed using One

Way Anova, Post Hoc Games-Howell, and Regresi Linear.

Results: The MIC was 6,25% and the MFC was 12,5%. One Way Anova test

results obtained a significance value of 0,000, indicating there is a difference

between the treatments tested. The results of the Post Hoc Games-Howell test

showed p <0.05 at 0.78% to 50% concentration, indicating a significant decrease

from 0.78% to 50% concentration. The Linear Regression test results obtained R

Square of 90.5%, showing the dose of apple cider vinegar affects the number of C.

albicans colonies of 90.5%.

Conclusion: Apple cider vinegar (Malus domestica) had effect on the growth of

Candida albicans in vitro.

Keywords: Apple cider vinegar, Candida albicans, MIC, MFC

ix

DAFTAR ISI

HALAMAN JUDUL .............................................................................................. i

LEMBAR PENGESAHAN .................................................................................. ii

LEMBAR PENGUJIAN ...................................................................................... iii

PERNYATAAN ORISINALITAS ...................................................................... iv

KATA PENGANTAR .......................................................................................... iv

ABSTRAK .......................................................................................................... viii

ABSTRACT ....................................................................................................... viiii

DAFTAR ISI ......................................................................................................... ix

DAFTAR GAMBAR .......................................................................................... xiii

DAFTAR TABEL............................................................................................... xiv

DAFTAR SINGKATAN ..................................................................................... xv

DAFTAR LAMPIRAN ...................................................................................... xvi

PENDAHULUAN .................................................................................................. 1

1.1 Latar Belakang.......................................................................................... 1

1.2 Rumusan Masalah .................................................................................... 4

1.3 Tujuan Penelitian ...................................................................................... 4

1.3.1 Tujuan Umum ................................................................................... 4

1.3.2 Tujuan Khusus .................................................................................. 4

1.4 Manfaat Penelitian .................................................................................... 5

1.4.1 Bidang akademis ............................................................................... 5

1.4.2 Bidang klinis ..................................................................................... 5

1.4.3 Bidang masyarakat. ........................................................................... 5

BAB II .................................................................................................................... 6

TINJAUAN PUSTAKA ........................................................................................ 6

2.1. Apel .......................................................................................................... 6

2.1.1. Taksonomi ......................................................................................... 6

2.1.2. Deskripsi ........................................................................................... 6

2.1.3. Kandungan Apel................................................................................ 8

2.2. Cuka Apel ............................................................................................... 10

2.2.1. Deskripsi ......................................................................................... 10

x

2.2.2. Proses Pembuatan Cuka Apel ......................................................... 11

2.2.3. Kandungan Cuka Apel .................................................................... 13

2.3. Candida albicans .................................................................................... 16

2.3.1. Taksonomi ....................................................................................... 16

2.3.2. Deskripsi ......................................................................................... 16

2.4. Kandidiasis ............................................................................................. 19

2.4.1. Definisi ............................................................................................ 19

2.4.2. Epidemiologi ................................................................................... 19

2.4.3. Faktor Predisposisi .......................................................................... 20

2.4.4. Patogenesis ...................................................................................... 21

2.4.5. Jenis Kandidiasis ............................................................................. 22

2.5. Antifungi................................................................................................. 25

2.5.1. Obat Sistemik untuk Infeksi Sistemik ............................................. 25

2.5.2. Obat Sistemik untuk Infeksi Mukokutis ......................................... 27

2.5.3. Obat Topikal untuk Infeksi Mukokutis ........................................... 27

2.6. Uji Kepekaan terhadap Antifungi ........................................................... 28

2.6.1. Metode Dilusi .................................................................................. 28

2.6.2. Metode Difusi Cakram .................................................................... 29

2.7. Penelitian Penunjang .............................................................................. 30

BAB III ................................................................................................................. 31

KERANGKA KONSEP DAN HIPOTESIS PENELITIAN ............................ 31

3.1. Kerangka Konsep ................................................................................... 31

3.2. Hipotesis Penelitian ................................................................................ 33

BAB IV ................................................................................................................. 34

METODE PENELITIAN ................................................................................... 34

4.1. Jenis Penelitian ....................................................................................... 34

4.2. Lokasi dan Waktu Penelitian .................................................................. 34

4.3. Subjek Penelitian .................................................................................... 34

4.3.1. Populasi dan Sampel ....................................................................... 34

4.3.2. Estimasi Besar Sampel .................................................................... 35

4.4. Variabel Penelitian ................................................................................. 35

4.4.1. Variabel bebas. ................................................................................ 35

xi

4.4.2. Variabel terikat ................................................................................ 35

4.4.3. Variabel kontrol .............................................................................. 35

4.5. Definisi Operasional ............................................................................... 36

4.6. Alat dan Bahan Penelitian ...................................................................... 37

4.6.1. Alat-alat dalam penelitian ............................................................... 37

4.6.2. Bahan-bahan dalam penelitian ........................................................ 38

4.7. Prosedur Penelitian ................................................................................. 38

4.7.1. Sterilisasi Alat ................................................................................. 38

4.7.2. Pembuatan Medium Sabouraud Dextrose Agar (SDA) .................. 38

4.7.3. Pembuatan Medium Sabouraud Dextrose Broth (SDB) ................. 39

4.7.4. Identifikasi C. albicans ................................................................... 39

4.7.5. Pembuatan Perbenihan Cair Jamur ................................................. 40

4.7.6. Uji Kepekaan Cuka Apel Terhadap C. albicans ............................. 40

4.8. Alur Penelitian ........................................................................................ 42

4.9. Analisis Data .......................................................................................... 43

BAB V ................................................................................................................... 45

HASIL PENELITIAN ........................................................................................ 45

5.1. Kadar Hambat Minimum Cuka Apel (Malus domestica) terhadap C.

albicans.............................................................................................................. 45

5.2. Kadar Bunuh Minimum Cuka Apel (Malus domestica) terhadap C.

albicans.............................................................................................................. 46

5.3. Analisis Data Kadar Bunuh Minimum Cuka Apel (Malus domestica)

terhadap Pertumbuhan C. albicans .................................................................... 47

5.4.1. Uji Normalitas (Shapiro Wilk Test)................................................. 47

5.4.2. Uji Homogenitas (Levene Test) ....................................................... 48

5.4.3. Uji One Way Anova ......................................................................... 49

5.4.4. Uji Post Hoc Games-Howell ........................................................... 50

5.4.5. Uji Regresi Linier ............................................................................ 50

BAB VI ................................................................................................................. 54

PEMBAHASAN .................................................................................................. 54

BAB VII................................................................................................................ 57

KESIMPULAN DAN SARAN ........................................................................... 57

7.1. Kesimpulan ............................................................................................. 57

xii

7.2. Saran ....................................................................................................... 57

DAFTAR PUSTAKA .......................................................................................... 58

LAMPIRAN ......................................................................................................... 63

xiii

DAFTAR GAMBAR

2.1 Tanaman apel…………………………………………………………...…7

2.2 Persamaan kimia pada proses fermentasi cuka apel…………………..…12

2.3 Struktur dinding C. albicans…………………………...………………...17

2.4 C.albicans secara mikroskopis………………………………………...…18

3.1 Kerangka konsep…………………………………………………………31

5.1 Grafik Uji Regresi Linier……………………………………………...…55

xiv

DAFTAR TABEL

2.1 Kandungan Apel………………………………………………………...…8

2.2 Kandungan Cuka Apel…………………………………………………...13

5.1 Tingkat Kejernihan Tabung Dilusi……………………………………….45

5.2 Pertumbuhan Koloni Jamur C. albicans…………………………...…….46

5.3 Hasil Uji Normalitas Shapiro Wilk Test…………….……………………48

5.4 Hasil Uji Homogenitas Levene Test………………………….…………..48

5.5 Hasil Uji One Way Anova……………………….……………………….49

5.6 Hasil Uji Post Hoc Games-Howell………………………………………50

5.7 Hasil Regresi Linier……………………………………………………...51

xv

DAFTAR SINGKATAN

C. albicans : Candida albicans

CDC : Centers for Disease Control and Prevention

KHM : Kadar Hambat Minimum

KBM : Kadar Bunuh Minimum

ROS : Reactive Oxygen Species

RNA : Ribonucleic Acid

DNA : Deoxyribonucleic Acid

NCCLS : National Committee for Clinical Laboratory Standart

MIC : Minimum Inhibitory Concentration

MFC : Minimum Fungicidal Concentration

S. typhi : Salmonella typhi

SDA : Sebouraud Dextrose Agar

SDB : Sebouraud Dextrose Broth

xvi

DAFTAR LAMPIRAN

1. Penelitian Pendahuluan…………………………………………………….63

2. Penelitian (Pengulangan 1)………………………………………………...70

3. Penelitian (Pengulangan 2)………………………………………………...77

4. Penelitian (Pengulangan 3)………………………………………………...84

5. Analisis Data……………………………………………………………….91

6. Surat Keterangan Lolos Kaji Ilmiah……………………………………….95

7. Keterangan Layak Etik…………………………………………………….96

8. Surat Keterangan Penuntasan Penelitian…………………………………..97

9. Dokumentasi Penelitian……………………………………………………98

10. Hasil Deteksi Plagiasi…………………………………………………….100

11. Kartu Konsultasi Tugas Akhir……………………………………………101

58

DAFTAR PUSTAKA

Aisyah, I., 2019. Multimanfaat cuka apel terhadap kesehatan. Sleman:

Deepublish.

Akanksha, S. & Sunita, M., 2017. Study about the nutritional and medicinal

properties of apple cider vinegar. Asian Journal of Science and Technology.

Alizadeh, M. et al., 2017. Identification of Candida species isolated from

vulvovaginitis using matrix assisted laser desorption ionization-time of

flight mass spectrometry. Current Medical Mycology, pp.21-25.

American Thoracic Society, 2012. Candida Infection of the Bloodstream-

Candidemia.

Anggraini, T., 2011. Catechin Content and Antioxidant Activity of Some Brewed

Temperature of Black Tea Syrup. Jurnal Litbang Industri, Vol. 1 No. 1,

pp.8-14.

Atro, R.A., Periadnadi & Nurmiati, 2015. Keberadaan Mikroflora Alami Dalam

Fermentasi Cuka Apel Hijau (Malus sylvestris Mill.) Kultivar Granny

Smith. Jurnal Biologi Universitas Andalas, p.158.

Behzad, S. et al., 2017. Health effects of phloretin: from chemistry to medicine.

Phytochem Rev, 16, p.527–533.

Berlian, Z., Aini, F. & Lestari, W., 2016. Aktivitas antifungi ekstrak daun kemangi

(Ocimum americanum L.) terhadap fungi Fusarium oxysporum Schlecht.

Jurnal Biota Vol. 2 No. 1 , pp.99-105.

CDC, 2016. Antifungal Resistance.

Costa, A.R. et al., 2010. Candida clinical species identification: molecular and

biochemical methods. Ann Microbiol, 60, pp.105-12.

Daoud, Z., Sura, M. & Abdel-Massih, R.M., 2013. Pectin shows antibacterial

activity against Helicobacter pylori. Advances in Bioscience and

Biotechnology, pp.273-77.

Dorland, W.A.N., 2012. Kamus Saku Kedokteran Dorland. 28th ed. Jakarta: EGC.

Eccher, G. et al., 2014. Apple (Malus domestica L. Borkh) as an emerging model

for fruit development. Department of Agronomy, Food, Natural Resources,

Animals and Environment (DAFNAE), University of Padova.

Fallahi, A.A. et al., 2013. Candida Species in Cutaneous Candidiasis Patients in

the Guilan Province in Iran; Identified by PCR-RFLP Method. Acta Medica

Iranica, Vol. 51, No. 11, pp.799-804.

59

Fernandes, F.H.A. & Salgado, H.R.N., 2016. Gallic Acid: Review of the Methods

of Determination and Quantification. Critical Reviews in Analytical

Chemistry Vol. 46, No. 3, p.257–265.

Filho, A.A.d.O. et al., 2015. Antifungal Effect of Flavonoid 5, 7, 4’-

Trimethoxyflavone against Candida krusei Strains. International Journal of

Tropical Disease and Health, pp.136-40.

Frilasari, H., 2016. Derajat Diaper Rash Pada Bayi Usia 0-12 Bulan di RSUD

Wahidin Sudiro Husodo Kota Mojokerto. Surya Vol. 08, No. 03, pp.16-20.

Global Salm-Surv, 2003. MIC determination by broth dilution using Sensititre.

Laboratory Protocols, pp.1-11.

Hakimi, M., 2014. Radang dan Beberapa Penyakit Lain pada Alat Genital. In

Prawirohardjo, S. Ilmu Kandungan Edisi Ketiga. Jakarta: Bina Pustaka

Sarwono Prawirohardjo. p.223.

Hakim, L. & Ramadhian, R., 2015. Kandidiasis Oral. Majority Volume 4 Nomor

8, pp.53-57.

Harnindya, D. & Agusni, I., 2016. Studi Retrospektif: Diagnosis dan

Penatalaksanaan Kandidiasis Vulvovaginalis. BIKKK – Berkala Ilmu

Kesehatan Kulit dan Kelamin – Periodical of Dermatology and

Venereology, pp.42-48.

Hassan, R., El-Kadi, S. & Sand, M., 2015. Effect of some organic acids on some

fungal growth and their toxins production. International Journal of

Advances in Biology, pp.1-11.

Himedia, 2018. Sabouraud Dextrose Agar. Technical Data.

Himedia, 2018. Sabouraud Dextrose Broth (Sabouraud Liquid Medium).

Technical Data.

Kawilarang, M.S.A., Mongan, A.E. & Memah, M., 2016. Gambaran kadar serum

magnesium pada pasien penyakit ginjal kronik stadium 5 non dialisis di

Manado. Jurnal e-Biomedik (eBm), 4, pp.210-17.

Khanbabaee, K. & Ree, T.v., 2001. Tannins: Classification and Definition. The

Royal Society of Chemistry, 18, p.641–649

Kurniawati, A., Mashartini, A. & Fauzia, I.S., 2016. Perbedaan khasiat anti

jamur antara ekstrak etanol daun Kersen (Muntingia calabura L.) dengan

nistatin terhadap pertumbuhan Candida albicans. Jurnal PDGI 65 (3),

pp.74-77.

Lee, C.Y., 2012. Common Nutrients and Nutraceutical Quality of Apples. New

York Fruit Quarterly, 20, pp.1-6.

60

Mathur, A. et al., 2011. Pectin content as an index for screening different varieties

of apple (Pyrus Malus L.) of Kashmir (J&K) on the basis of antimicrobial

activity. J. Chem. Pharm. Res., pp.886-91.

Menshikov, D. et al., 2017. Antimicrobial properties of pectins and their effects

on antibiotics. NCBI, pp.5-10.

Mohanty, S., Ramesh, S. & Muralidharan, N.P., 2017. Antimicrobial efficacy of

apple cider vinegar against Enterococcus faecalis and Candida albicans:

An in vitro study. Journal of Advanced Pharmacy Education & Research,

pp.137-41.

Morgan, J. & Mosawy, S., 2016. The Potential of Apple Cider Vinegar in the

Management of Type 2 Diabetes. International Journal of Diabetes

Research, pp.129-34.

Mursinah, Ibrahim, F. & Wahid, M.H., 2016. Profil Candida penyebab

kandidemia dan pola kepekaan terhadap anti jamur pada pasien sakit kritis

di Rumah Sakit Cipto Mangunkusumo. Jurnal Biotek Medisiana Indonesia,

5, pp.105-11.

Mutiawati, V.K., 2016. Pemeriksaan Mikrobiologi pada Candida albcans. Jurnal

Kedokteran Syiah Kuala Volume 16 Nomor 1, pp.53-63.

Nelwan, E.J., 2014. Kandidiasis. In PAPDI Buku Ajar Ilmu Penyakit Dalam Edisi

6. Jakarta: Interna Publishing. p.755.

Nur’aeny, N. et al., 2017. Profil oral candidiasis di bagian ilmu penyakit mulut

RSHS Bandung periode 2010-2014. Majalah Kedokteran Gigi Indonesia,

pp.23-28.

Pankaj, R., Punga, R., Dalal, V. & Rathod, D., 2015. Oral Candidiasis - Widely

Prevalent, Frequently Missed. International Journal of Scientific Study,

p.193.

Patel, V., Kaswala, R., Chakraborty, M. & Kamath, J.V., 2015. Phytochemical

and Pharmacological Profile of Malus Domestica: An Overview.

International Journal of Current Biomedical and Pharmaceutical Research.

Pavun, L.U.-M.S.J.-S.M., Dikanovic, D. & Durdevic, P., 2018. Determination of

Flavonoids and Total Polyphenol Contents in Commercial Apple Juices.

Food Analysis, Food Quality and Nutrition, pp.233-38.

Polii, S.V.G., Pandaleke, H.E.J. & Kapantow, M.G., 2016. Profil kandidosis

intertriginosa di Poliklinik Kulit dan Kelamin RSUP Prof. Dr. R. D. Kandou

Manado periode Januari - Desember 2013. Jurnal e-Clinic (eCl), Volume 4,

Nomor 1, pp.446-51.

61

Pratama, R.I., Husin, U.A. & Trusda, S.A.D., 2015. Efek Antibakteri Cuka Sari

Apel Terhadap Salmonella Typhi. Prosiding Penelitian Sivitas Akademika

Unisba (Kesehatan), pp.601-06.

Rahmawati, N., 2015. Pengaruh Pemberian Cuka Apel Anna terhadap Kadar

MDA Hepar Tikus Jantan Galur Winstar (Rattus norvegicus) yang

Diinduksi Parasetamol Dosis Toksik. Skripsi.

Redha, A., 2010. Flavonoid: Struktur, Sifat Antioksidatif Dan Peranannya Dalam

Sistem Biologis. Jurnal Belian Vol. 9 No. 2, pp.196-202.

Ruchiyyih, 2012. Salmonella typhi.

Santana-Gálvez, J., Cisneros-Zevallos, L. & Jacobo-Velázquez, D.A., 2017.

Chlorogenic Acid: Recent Advances on Its Dual Role as a Food Additive

and a Nutraceutical against Metabolic Syndrome. Molecules , pp.1-21.

Santolaya, l.E. et al., 2013. Recommendations for the management of candidemia

in neonates in Latin America. Elsevier, pp.1130-406.

Sekhavat, L., Tabatabaii, A. & Tezerjani, F.Z., 2011. Oral fluconazole 150mg

single dose versus intra-vaginal clotrimazole treatment of acute

vulvovaginal candidiasis. Journal of Infection and Public Health Elsevier,

pp.195-99.

Serdaroğlu, S. & Üstünbaş, T.K., 2010. Diaper Dermatitis (Napkin Dermatitis,

Nappy Rash). Journal of the Turkish Academy of Dermatology, pp.1-4.

Serpa, R. et al., 2012. In vitro antifungal activity of the flavonoid baicalein

against Candida species. Journal of Medical Microbiology, pp.1704-08.

Sheppard, D. & Lampiris, H.W., 2014. Obat Antijamur. In R. Soeharsono, P.

Heriyanto, M. Iskandar & H. Octavius, eds. Farmakologi Dasar & Klinik.

12th ed. Jakarta: EGC. pp.961-71.

Sudhan, S.S., Sharma, P., Sharma, M. & Shrivastava, D., 2016. Identification of

Candida Species in the Clinical Laboratory: A Review of Conventional,

Commercial and Molecular Techniques. International Journal of Medical

Research Professionals, 2, pp.1-8.

Sudrajad, H., Hendradewi, S. & Sinaga, Y., 2018. Efektifitas asam asetat 2%

dalam alkohol 70% dibanding ketokonazol 2% topikal pada terapi

otomikosis. ORLI, 48 No. 1, pp.26-33.

Tasik, N.L., Kapantow, G.M. & Kandou, R.T., 2016. Profil kandidiasis

vulvovaginalis di Poliklinik Kulit dan Kelamin RSUP Prof. Dr. R. D.

Kandou Manado periode Januari – Desember 2013. Jurnal e-Clinic (eCl),

Volume 4, Nomor 1, pp.207-14.

62

Tavallaee, M. & Rad, M.M., 2009. Fixed drug eruption resulting from fluconazole

use: a case report. Journal of Medical, pp.1-4.

Tiwari, A.K. et al., 2011. A comparative novel method of antifungal susceptibility

for Malassezia furfur and modification of culture medium by adding lipid

supplement. Journal of Phytology, 3, pp.44-52.

Tjitrosoepomo, G., 1993. Taksonomi Umum. Yogyakarta: Gajah Mada University

Press.

Tulungnen, R.S., Sapulete, I.M. & Pangemanan, D.H.C., 2016. Hubungan Kadar

Kalium dengan Tekanan Darah pada Remaja di Kecamatan Bolangitang

Barat Kabupaten Bolang Mongondow Utara. Jurnal Kedokteran Klinik

(JKK), 1, pp.37-45.

Widaty, S., 2016. Kandidosis. In FKUI Ilmu Penyakit Kulit dan Kelamin. Jakarta:

Badan Penerbit FKUI. pp.117-20.

Yagnik, D., Serafin, V. & Shah, A.J., 2018. Antimicrobial activity of apple cider

vinegar against Escherichia coli, Staphylococcus aureus and Candida

albicans; downregulating cytokine and microbial protein expression.

Scientific Reports, pp.1-12.

Zubaidah, E. & Nuril, I., 2015. Efek Cuka Apel dan Cuka Salak terhadap

Penurunan Glukosa Darah dan Histopatologi Pankreas Tikus Wistar

Diabetes. Jurnal Kedokteran Brawijaya, Vol. 28, No. 4, pp.297-301.

63