Meningitis Tb Lapkas ANAK

8/11/2019 Meningitis Tb Lapkas ANAK

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Meningitis Tuberculosis occurs when tuberculosis bacteria

(Mycobacterium tuberculosis) invade the membranes and

fluid surrounding the brain and spinal cord.


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The developing world has 1.3 millioncases of TB and 40,000 TB-relateddeaths annually among childrenyounger than 15 years.

In the developing world, 10-20% ofpersons who die of TB are children.

TBM complicates approximately 1 ofevery 300 untreated primary TBinfections.


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seizuresloss of

consciousness

headache tremor

fever (usuallyhigh)

vomiting


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History of recent TB contactHistorytaking

presence of extrameningeal TBPhysical

examination

lumbar puncture and CSFexamination

Tuberkulin testLaboratory


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Rifampicin INH PyrazinamideEthambutol


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The aim of this paper is to report a case of Meningitis

Tuberculosis on 13 years old and 3 months old girl.


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Name : MH

Age : 13 years old and 3 months old

Sex : Female

Date of Admission : May 3rd 2014


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History of illnessThis has been experienced since 1 week ago and became worse since 1

day ago. she was referred from Sidempuan Hospital by pediatrician withthe main complaint was seizure.

History of seizure was found once when she was in the SidempuanHospital and the duration was 5 minutes. When the seizure comes, thewhole body rigid, the eyes wide opened. When the seizure finished, thepatient lost her conciousness. History of seizure before was not found.

History of fever was found since 1 week ago. The fever was high about380C and didnt getting better with antipyretic. History of headche (+)

since 1 month ago, history of vomiting (+) since 2 weeks ago frequency10x/days the volume cup aqua every vomiting, the content of what is inthe eating and drinking. Cough (+) since 3 weeks ago. History of contact

with an infected person coughed (+). History of weight loss since 3 monthago, however, decreased appetite encountered. Defecation and urine (+)

normal.


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History ofmedications

Inj. Penicillin,Ranitidin,

Ondancentron,Paracetamol.

History ofLabor

he was laboredterm with

4500 gramsand 52

centimeterswhich helpedby doctor in

hospital

History ofImmunization

patients evergiven

immunizationtwice, but it is

not clearwhich type ofimmunization

given


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Present status

Sensorium : GCS 10 (E3 V2 M5)

Temperature : 38,0oC

Weight : 22 kg

Height : 110 cm

Dyspnea, cyanosis, icteric, anemic are not found.


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Head :

Eyes : Light reflexes are found. Pupils are

isochoric. Pale conjungtiva palpebra inferior is not

found on both eyes. Ear and mouth appearancesare normal. Naso gastric tube is found on nose.

Neck : Enlargement of lymph node is not found.


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Thorax : Symmetrical fusiform. Heart rate is 100

beats per minute, regular and no murmur.

Respiratory rate is 20 breaths per minute, regular,

and no rales.

Abdomen : Soepel. Peristaltic is found normal.

Liver and spleen are not palpable.

Extremities : Pulse 100 times per minute, regular.

Tone per volume was adequate. Warm. CapillaryRefill Time not more than 3 minutes.


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Unit Control Result

Hematology

Hemoglobin g% 12,0 - 14,4 11,00

Hematocrit % 35 - 42 27,40

Leukocyte 103/mm3 4,511,0 14,7

Thrombocyte 103/mm3 150450 292

Arterial Blood Gas Analysis

pH 7,35 - 7,45 7,457

pCO2 mmHg 38 - 42 35,2

pO2 mmHg 85 - 100 166,7

Bicarbonate mmol/L 22 - 26 26,4

Total CO2 mmol/L 19 - 25 27,6

BE mmol/L (-2)(+2) 2,4

O2Saturation % 95 - 100 99,4


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Electrolyte

Natrium mEq/L 135-155 130

Kalium mEq/L 3,6-5,5 4,1

Chloride mEq/L 96-106 96

Renal Test

Ureum mg/dL < 50 35.00

Creatinine mg/dL 0,57 - 0,87 0,87


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Radiography Findings :

Seem small nodular infiltrates in both lungfields

Working Diagnosis :

Meningitis + Suspect TB

Planning :

Mantoux test

Gastric Lavage


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S : Loss of Consciousness (+)O : kepala : mata rc +/+, pupil isokor, conj. Palp. Inf. Pucat (-), T : dbn, N : nasal

canul & NGT, E : dbn

Leher : Pembesaran KBG (-)

Thorax : SF, retraksi (-), HR = 100x/i reg desah (-), Sela iga terlihat jelas, RR

= 20x/I

Abdomen : Soepel, peristaltik (+) N

A : Meningitis TB + Poor Nutrition

P : IVFD NaCl 0,9% 21 gtt/i mikro

-IVFD NaCl 3% 5cc/KgBW/12 hrs

-Inj. Phenytoin 20 mg/KgBW/IVFD

-Inj. Ceftriaxone 1 gr/12 hrs/IVFD

-Inj. Ampicillin 1 gr/6 hrs/IVFD

- PCT 3 x 250 mg

Diet SV 100 cc/ 3 hrs with 1540 kkal + 45 gr protein


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S : Loss of Consciousness (+)

O : kepala : mata rc +/+, pupil isokor, conj. Palp. Inf. Pucat (-), T : dbn, N : nasal canul & NGT, E : dbn


Thorax : SF, retraksi (-), HR = 100x/i reg desah (-), Sela iga terlihat jelas, RR = 20x/I



P : - IVFD NaCl 0,9% 41 gtt/i mikro -IVFD NaCl 3% 110cc/KgBW/12 hrs




-PCT 3 x -Etambutol 1 x 350 mg Multivitamin with FE 1x cth I

Inj.Phenitoin 65mg/12 jam in nacl 0,9% 20ccx/20 minute

250 mg



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S : Loss of Consciousness (+)

O : kepala : mata rc +/+, pupil isokor, conj. Palp. Inf. Pucat (-), T : dbn, N : nasal canul & NGT,E : dbn


Thorax : SF, retraksi (-), HR = 100x/i reg desah (-), Sela iga terlihat jelas, RR = 27x/i



P : Meningitis TB + Poor Nutrition

- IVFD NaCl 0,9% 41 gtt/i mikro

-IVFD NaCl 3% 110cc/KgBW/12 hrs






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The developing world has 1.3 million cases

of TB and 40,000 TB-related deaths annuallyamong children younger than 15 yearsA13 years old and 3 months girl

Its manifestations like seizures, loss ofconsciousness, headache, tremor, fever

usually high, and vomiting.

The main complaint was loss ofconciousness which had beenexperienced since 1 week ago.

History of seizure, fever, headache,

and vomiting was found.

On examination of the tuberculin test wasfound bacteria growth

the results of tuberculin testexamination stated that the absenceof bacterial growth not found in the

blood

The treatment of TB in Children includingRifampicin, INH, Pyrazinamide, andEthambutol.

This patient got RHZE regiments


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Meningitis Tb Lapkas ANAK