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7/17/2019 Laporan Kasus Meningitis Akut
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LAPORAN KASUS MENINGITIS AKUT PADA ANAK DIRUMAH SAKIT UMUM DAERAH TARAKAN
Ketut Suwadiaya P. Adnyana
7/17/2019 Laporan Kasus Meningitis Akut
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Identitas
• Nama : An R
• Tangga a!i" : #$%&%#''(
• Umu" : ) ta!un• *enis +eamin : La+i%a+i
• Agama : Isam
• Pendidi+an : SD• Aamat : Seumit RT ', N- #$ Ta"a+an
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Riwayat Penya+it Se+a"ang
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Riwayat Penya+it Da!uu
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Riwayat Penya+it +eua"ga
• Te"daat "iwayat enya+it /atu+yang ama di +eua"ga asien
Riwayat Ke!iduan s-sia
• Pasien tingga di dae"a! ada endudu+
• Aya! dan i/u asien suda! /e"0e"ai
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Peme"i+saan 1isi+
Peme"i+saan umum
• Keadaan umum : Tama+ sa+it /e"at 2tida+ sada"+an di"i3Kesada"an : Somnolen (E3M5V2)
• Tanda 4ita
1"e+wensi nadi : $&5 67menit Te+anan da"a! : Tida+ diu+u"1"e+wensi na8as : $) 67menit 2"egue"3Su!u tu/u! : &9.&' 2a6ia3
• Data Ant--met"i
;e"at /adan : $) Kg
Tingi /adan : $#' m;/7//5' : ,9<#&= T/7t/5' : 9&<(5=;/7t///5' : 78,2%Kesan : Gizi kurang
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Peme"i+saan 1isi+
Peme"i+saan sistem
• Mata : Pui is-+-" 5mm75mm< refekscahaa langsung !"!
• Teinga : Liang teinga aang7aang< se+"et >• Pa"u
Inse+si : Ret"a+si %Paasi : Tida+ dia+u+an
Pe"+usi : S-n-" simet"isAus+utasi : ;ND 4esi+ua" ?7?< "!-n+i %7
@!eeing %7%
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Peme"i+saan 1isi+
Status Neu"--gis
• ReBe+s 1isi--gis
#$ & 'ier!refeks aa kanan an kiri
*$ & 'ier!refeks aa kanan an kiri
• ReBe+s Meningea#aku kuuk & +
ruzinski - & +
ruzinski -- & +
#ernig & +
• ReBe+s Pat--gis
a.inski & +"+
/haock & +"+
0enheim & +"+
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La/-"at-"ium
$5%'&%#'$5
$emeriksaan 'asil u1ukan
Leu+-sit #$<9 "i/u7mm& %$# "i/u7mm&
Hem-g-/in $'<9 g7d $%$) g7d
M ,'<( 8L )#%9# 8L
MH $9<& g #(%&$ g
T"-m/-sit ,' "i/u7mm& $5'%5'
"i/u7mm&
Gua da"a!sewa+tu
99 mg7d F $' mg7d
7/17/2019 Laporan Kasus Meningitis Akut
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La/-"at-"ium$5%'&%#'$5
$emeriksaan 'asil u1ukan
Nat"ium &<)( mm-7I &<)%5.5'
mm-7I
Kaium $#<' mm-7I $&5%$5 mm-7IK-"ida 9#<# mm-7I 9#<# mm-7I
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Diagn-sa
• Mening-en0!eaitis e0 /a0te"ia dd4i"a
• Hi-nat"emia
• Anemia mi+"-siti+ !i-+"-m
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Penataa+sanaan
Rawat ina di IU
I1D
• DN $ tetes7menit
• K-"e+si am/at Nat"ium: Na &= #'007# am• Manit- 5007) am
Medi+a ment-sa
• Ami0iin $g"7, am
• !-"am!eni0- 5'' mg7, am
• De6amet!as-n &6 mg
• Diaeam '<5 mg7+g// i+a ada +eang
7/17/2019 Laporan Kasus Meningitis Akut
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Riwayat Pe"+em/angan Penya+it$, Ma"et #'$5
Su/e+
Demam ?< mua %< munta! %< +eang %
O/e+ti8
•Kesada"an: S-mn-en 2E&M5#3
• Tanda%tanda 4ita : HR
$'$67m< Tem
&('< RR
#'67m•Mata : Pui is-+-" 5mm75mm< RL %7%
Assesment
•Mening-en0!eaitis e0 /a+te"i dd 4i"a
•Hi-nat"emia daam +-"e+si
•Anemia mi+"-siti+ !i-+"-m Panning
•e8t"ia6-ne $ g"7$# am
•De6amet!as-n &6 mg
•Ren0ana dia+u+an um/a" un0tu"e i+a tida+ ada ai edema
7/17/2019 Laporan Kasus Meningitis Akut
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Riwayat Pe"+em/angan Penya+it$( Ma"et #'$5
Su/e+Demam ?< mua %< munta! %< +eang >
O/e+ti8
• Kesada"an : S--" 2E$M$3
• Tanda%tanda 4ita : HR$''67m< su!u&(<9'< RRCm
• Mata : Pai edema ?7?< ui is-+-"< mid"iasis ma+sima
• T!-"a+s : esi+ua" ?7? "!-n+i ?7?< w!eeing %7%• La/-"at-"ium : Nat"ium .'# mm-7I
Assestment
• Mening-en0!eaitis e0 /a+te"i dd 4i"a
• Pneum-nia
• Hi-nat"emia -st +-"e+si
• Anemia mi+"-siti+ !i-+"-m
Panning
• Tae"ing - Manit- 5007$# am
• Me"-enem &6(5' mg
• Ne/uie" 0-m/i4ent?00 Na '<9=7) am
• De6amet!as-n &6 mg
• Lum/a" un0tu"e tida+ /isa dia+u+an
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Riwayat Pe"+em/angan Penya+it$) Ma"et #'$5
Su/e+Sesa+ ?< demam tinggi<
O/e+ti8
• Kesada"an : S--"-+-ma 2E$M&$3
• Tanda%tanda 4ita : HR$,'67m< Tem&9'< RR,67m
• Mata : Pui is-+-" mid"iasis ma+sima< ReBe+s 0a!aya %7%
• T!-"a+s : esi+ua" ?7? "!-n+i ?7?< w!eeing %7%< Ret"a+si Su/0-sta?
Assesment
• Mening-en0!eaitis e0 /a+te"i dd 4i"a
• Pneum-nia
• Hi-nat"emia -st +-"e+si
• Anemia Ma+"-siti+ Hi-+"-m
Panning
• Te"ai ainnya anut
• Pemasangan intu/asi dan 4entiat-"
• Pa"asetam- #'' mg7 am I
• Ranitidine &6$ amu
7/17/2019 Laporan Kasus Meningitis Akut
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Riwayat Pe"+em/angan Penya+it$9 Ma"et #'$5
Su/e+
Sesa+ ?< demam nai+ tu"un
O/e+ti8
• Kesada"an : S--"-+-ma 2E$M&$3
• Tanda%tanda 4ita : HR$#'67m< Tem&('<RR,67m
• Mata : Pui is-+-" mid"iasis ma+sima<
ReBe+s 0a!aya %7%
• T!-"a+s : esi+ua" ?7? "!-n+i ?7?< w!eeing
%7%< Ret"a+si Su/0-sta ?
• A/d-men : ;ising usus ? n-"ma< Sue
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1-t- T!-"a+s
$9 Ma"et #'$5
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La/-"at-"ium
$9 Ma"et #'$5
$emeriksaan 'asil ilai ru1ukan
Gua da"a!
sewa+tu
$&# mg7dL F $' mg7d
Kaium &<, mm-7I &<)%5.5' mm-7INat"ium $#<&
mm-7I
$&5%$5 mm-7I
K-"ida 9' mm-7I 9#<# mm-7I
Leu+-sit $)< "i/u7uL %$# "i/u7mm&
Hem-g-/in 9<5 g7dL $%$) g7d
T"-m/-sit 5#$ "i/u7uL $5'%5' "i/u7mm&
7/17/2019 Laporan Kasus Meningitis Akut
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Riwayat Pe"+em/angan Penya+it$9 Ma"et #'$5
Assesment
• Mening-en0!eaitis e0 /a+te"i dd 4i"a
• Atee+tasis ? Pneum-nia
• Hi-nat"emia -st +-"e+si
Panning
• O+sigen sung+u 5 m
• I1D : DN $) tetes7menit
• Manit- 5 007# am
• Medi+a ment-sa:Me"-enem& &6(5' mg
De6amet!as-ne &6 mg
Pa"asetam- #'' mg7 am I
Ranitidine &6$ am Rim0u" $6& ta/
Et!am/ut- $6&'' mg
Ne/uie" 0-m/i4ent ? 00 Na0 '<9=7) am
Reintu/asi
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Riwayat
Su/e+
• Demam ?< sesa+ ?
O/e+ti8
• Kesada"an : S--" 2E$M$3• Tanda%tanda 4ita : HR$,)67m< su!u&)<5'<
RR&,67m
• Mata : Pai edema ?7?< ui is-+-"< mid"iasis
• T!-"a+s : esi+ua" ?7? "!-n+i ?7?< w!eeing %7%<"et"a+si su/0-sta ?
• A/d-men : ;ising usus ? n-"ma< Sue
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T S0an#' Ma"et #'$5
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Riwayat Pe"+em/angan Penya+it#' Ma"et #'$5
Assesment
• Mening-en0!eaitis e0 /a+te"i dd 4i"a
• Atee+tasis ? Pneum-nia
• Hid"-0!eaus
• Hi-nat"emia -st +-"e+si
Panning
• O+sigen nasa +anu $%# ite"
• I1D : DN $) tetes7menit
• Medi+a ment-sa Me"-enem& &6(5' mg
De6amet!as-ne &6 mg
Pa"asetam- #'' mg7 am I
Ranitidine &6$ am Rim0u" $6& ta/
Et!am/ut- $6&'' mg
Ne/uie" 0-m/i4ent ? 00 Na0 '<9=7) am
Pasien meningga +a"ena gaga e"na8asan
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DeJnisi Meningitis
Meningitis adaa! in8e+si a+ut yang/e"at yang te"adi di seaut -ta+yang daat dise/a/+an -e!
/e/e"aa -"ganisme see"ti 4i"us</a+te"i< amu" dan a"asit
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Eti--gi Meningitis
Menigitis
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Pat-Jsi--gi Meningitis
Sum/e": L-"ens S. < M0"a+en G. H< ;a0te"ia Meningitis In !ide"n. T!e
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Mani8estasi Kinis Meningitis
Riwayat
Diagn-sa Meningitis
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Diagn-sa MeningitisCSF Findings in Meningitis
Condition Predominant Cell Type*Protein* Glucose* Specific Tests
Normal CSF All lymphocytes (0–5
cells/μL)
!0 mg/dL > 50 " o# $lood gl%cose None
Bacterial
meningitis
Leukocytes (usually
PMNs), often greatly
increased
Elevated < !" of #lood glucose (may #e
e$tremely lo%)
&ram staining (yield is 'ig' if ! colonyforming units of
#acteria* mL are +resent)
Bacterial culture
P- if availa#le
.iral meningit is Lym+'ocytes (may #e
mi$ed/ PMNs and
lym+'ocytes during t'e
first 01213 ')
Elevated 4sually normal P- (to c'eck for enteroviruses or 'er+es sim+le$, 'er+es
5oster, or 6est Nile virus)
7gM (to c'eck for 6est Nile virus or ot'er ar#oviruses)
89u#erculous
meningitis
PMNs and lym+'ocytes
(usually +leocytosis)
Elevated < !" of #lood glucose (may #e
e$tremely lo%)
:cidfast staining
P-Myco#acterial culture (ideally using a ; sam+le of = !
mL)
7nterferon? tests of serum and (if availa#le) ;
ungal meningitis 4sually lym+'ocytes Elevated < !" of #lood glucose (may #e
e$tremely lo%)
ry+tococcal antigen test
;erologic tests for Coccidioides immitis or Histoplasma s+
antigen, es+ecially if +atients 'ave recently s+ent time in
an endemic area
ungal culture (ideally using a ; sam+le of = ! mL)7ndia ink (for Cryptococcus s+)
@'anges in cell count, glucose, and +rotein may #e minimal in severely immunocom+romised +atientsA
87n tu#erculous meningitis, ; acidfast staining can #e insensitive, sensitivity of P- is only a#out !", and culture reuires u+ to 3 %kA Positive ; interferon?
tests indicate tu#erculous meningitis, #ut serum interferon? tests may only indicate +rior infectionA 9'us, confirming a diagnosis of tu#erculous meningitis is difficult, and
if it is strongly sus+ected, even if not confirmed, it is treated +resum+tivelyA
C : small num#er of cells may #e +resent normally in neonates or after a sei5ureA
P- D +olymerase c'ain reaction/ PMNs D +olymor+'onuclear neutro+'ilsA
Sum/e": T!e Me"+s Manua< A0ute ;a0te"ia Menigitis< #'$&
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Penataa+sanaan
• Anti/i-ti+a
• Te"ai Adu4ant
Penataa+sanaan
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Penataa+sanaanAnti/-ti+a
Sum/e": ;ee+ D.< ;"-uwe" M. < et a. Ad4an0es in t"eatment -8 /a0te"iameningitis. Lan0et #'$# &)': $,9&%('#
Penataa+sanaan
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Penataa+sanaanAnti/i-ti+a
": ;ee+ D.< ;"-uwe" M. < et a. Ad4an0es in t"eatment -8 /a0te"ia meningitis. Lan0et #'$# &)': $,
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Penataa+sanaan
Te"ai Adu4ant
• De+samet!as-n 2 Pem/e"ian -/at ini masi! menadi "- dan
+-nt"a
2 -0!"ane meta%anaysis
Tida+ menu"un+anang+a m-"taitas< !anya mengu"angi suee
2 Peneitian di Ame"i+a atin dan Maawi tida+memunyai e8e+ te"!ada asien denganmeningitis
2 Di/e"i+an seama !a"i dengan d-sis '<,mg7+g// se0a"a int"a4ena. Se/eum atau/e"samaan anti/i-ti+
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Penataa+sanaan
Te"ai Adu4ant
• Gy0e"- 2 ai"an !ie"-sm-a" yang diguna+an untu+
menu"un+an te+anan int"a 0"ania
2 Gy0e"- memunyai !asi yang daatdi/u+ti+an man8aatnya se0a"a statisti+ i+adi+-m/inasi dengan g--ngan anti/i-ti00e!a-s-"in gene"asi &.
2 Di/e"i+an dengan d-sis ,mL7+g7d id< denganma+simum em/e"ian #5 mL7d-se. tida+daat di/e"i+an ada asien yang suda! )
am setea! te"diagn-sa mengaami meningitis
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Da8ta" Pusta+a
$. Nasi" A. I< M-!amed 1. M< asu8 N.N< et a. T!e O4e"4iew -8Meningitis And Its T"eatment. @e/med ent"a. #'$$
#. Aam. A. Keadian Meningitis ;a+te"ia Pada Ana+ Usia $,%$) ;uan ang Mengaami Keang Demam Pe"tama. Sa"i Pediat"i. #'$'$&23: #9&%)
&. L-"ens . S< M0"a0en G. H. ;a+te"ia Meningitis In !id"en. T!eLan0et 4-ume &$. #''& &,$: #$&9%)
. ;ee+ D.< ;"-uwe" M. < et a. Ad4an0es in t"eatment -8 /a0te"iameningitis. Lan0et #'$# &)': $,9&%('#
5. M-yneu6 E< Ni"ammadi *. P"e4enti-n and T"eatment -8 ;a0te"iaMeningitis in Res-u"0e P--" Settings. T!e Pediat"i0s In8e0ti-usDisease *-u"na -ume &. #'$5
,. Pet-a H< Lei/ S. L. Pe8-"man0e -8 Adun0ti4e T!e"ay in ;a0te"iaMeningitis Deens On i"0umstan0es. T!e Pediat"i0s In8e0ti-usDisease *-u"na -ume &#. #'$&
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