Laporan Kasus Meningitis Akut

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



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



Riwayat Penya+it Se+a"ang



Riwayat Penya+it Da!uu



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



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



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%



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 & +"+



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



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



Diagn-sa

• Mening-en0!eaitis e0 /a0te"ia dd4i"a

• Hi-nat"emia

• Anemia mi+"-siti+ !i-+"-m



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



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



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'< RR&#67m

• 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



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


• Pneum-nia


• Anemia Ma+"-siti+ Hi-+"-m

Panning

• Te"ai ainnya anut

• Pemasangan intu/asi dan 4entiat-"

• Pa"asetam- #'' mg7 am I

• Ranitidine &6$ amu



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



1-t- T!-"a+s

$9 Ma"et #'$5



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&



Riwayat Pe"+em/angan Penya+it$9 Ma"et #'$5

Assesment


• Atee+tasis ? Pneum-nia


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



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



T S0an#' Ma"et #'$5



Riwayat Pe"+em/angan Penya+it#' Ma"et #'$5

Assesment


• Atee+tasis ? Pneum-nia

• Hid"-0!eaus


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



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



Eti--gi Meningitis

Menigitis



Pat-Jsi--gi Meningitis

Sum/e": L-"ens S. < M0"a+en G. H< ;a0te"ia Meningitis In !ide"n. T!e



Mani8estasi Kinis Meningitis

Riwayat

Diagn-sa Meningitis



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< #'$&



Penataa+sanaan

• Anti/i-ti+a

• Te"ai Adu4ant

Penataa+sanaan



Penataa+sanaanAnti/-ti+a

Sum/e": ;ee+ D.< ;"-uwe" M. < et a. Ad4an0es in t"eatment -8 /a0te"iameningitis. Lan0et #'$# &)': $,9&%('#

Penataa+sanaan



Penataa+sanaanAnti/i-ti+a

": ;ee+ D.< ;"-uwe" M. < et a. Ad4an0es in t"eatment -8 /a0te"ia meningitis. Lan0et #'$# &)': $,



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+



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



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 &#. #'$&

Laporan Kasus Meningitis Akut

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