Infeksi Akut pada Susunan Saraf Pusat Laporan Kasus Acute Central Nervous System Infection : a Case Report
| Main Authors: | -, Masfiyah, Hapsari, Rebriarina, -, Rahayu, -, Maryani |
|---|---|
| Format: | Article info application/pdf eJournal |
| Bahasa: | eng |
| Terbitan: |
Fakultas Kedokteran, Universitas Islam Sultan Agung (UNISSULA)
, 2013
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| Subjects: | |
| Online Access: |
http://sainsmedika.fkunissula.ac.id/index.php/sainsmedika/article/view/148 http://sainsmedika.fkunissula.ac.id/index.php/sainsmedika/article/view/148/118 |
Daftar Isi:
- Background : Acute central nervous system infection can be rapidly progressive, causing death or permanentdamage in a short period of time. The diagnosis and knowledge of possible etiological agent is critically important.We present a case of a 15-month-old girl with generalized seizures and ecchymosis suspected for meningococcalinfection but there was no proof of the agent of infection.Case report : A 15-month-old girl was admitted with fever of 39,4?C, generalized seizures, and petechiae aftersuffered high fever and cough in previous day. This was her first episode of seizures. She has no past history ofgrowth and developmental disorder. She became rapidly deteriorated after few hours being hospitalized in Kariadi.Brain CT-scan was not done due to her conditions. She had anemia, normal white blood count, monocytosis,thrombocytopenia (4000/mm3), low CD4 count (99 cell/mm3), hipoalbuminemia (1.4 g/dl), increased lactate(2.5 mmol/L) and procalcitonin (>200.00 ng/ml). Cerebrospinal fluid analysis revealed normal cells count andglucose but increased protein level (375.2 mg/dL). Meningococcal infection was suspected due to clinicalappearance, and ceftriaxone was given. Bacteriological and fungal culture of CSF and blood showed no growth.Despite of cardiorespiratory support given, she died after 4 days of admission.Discussion : Features of seizure and general ecchymosis do not belong exclusively to meningococcal infection.There are other possible etiological agent such as Haemophylus influenza, Streptococcal infection and viralinfection. Shortage of available diagnostic tools such as Polymerase Chain Reaction (PCR) made it difficult toconfirm the etiological agent (Sains Medika, 4(2):204-209).Question Remarks : What agent which you think cause the infection?Latar Belakang : Infeksi akut pada susunan syaraf pusat dapat bersifat progresif, menimbulkan kematian, ataukerusakan yang permanen. Penegakan kasus dan penemuan etiologi memegang peranan penting. Laporan kasusakan mengetengahkan anak perempuan berusia 15 bulan dengan kejang umum dan ekimosis dengan dugaansuatu infeksi oleh meningococcus, tetapi tidak ditemukan etiologi.Laporan Kasus : Seorang anak perempuan berusia 15 bulan dengan demam 39,4?C datang ke RSUP Dr. Kariadidengan demam 39,4 C, kejang umum dan petechie, dengan riwayat demam tinggi dan batuk sehari sebelumnya.Riwayat pernah kejang sebelumnya disangkal. Kesan perkembangan sesuai usia dan status gizi baik. Pasienmengalami perburukan setelah beberapa jam dirawat. Hasil laboratorium menunjukkan anemi, monositosis,trombositopenia (4000/mm3), penurunan CD4 (99 sel/mm3), hipoalbuminemia (1,4 g/dl), laktat dan prokalsitoninyang meningkat (2,5 mmol/L dan >200 ng/ml). Hasil analisa LCS menunjukkan angka glukosa yang normal, tetapiterjadi peningkatan protein (375, 2 mg/dL). Secara klinis pasien ini didiagnosa dengan suspek infeksimeningococcal, dan diterapi dengan injeksi ceftriaxon. Hasil kultur bakteri, jamur dari sampel LCS tidak adapertumbuhan bakteri. Pasien meninggal 4 hari setelah perawatan.Diskusi : Gambaran kejang dan ekimosis yang menyeluruh bukan merupakan satu-satunya gambaran klinis karenainfeksi meningococcus dapat juga karena Haemophylus influenza, infeksi Streptococcal, maupun infeksi virus.Keterbatasan alat untuk penegakkan diagnosis misalnya Polymerase Chain Reaction (PCR), menyebabkankonfirmasi etiologi infeksi sulit ditegakkan (Sains Medika, 4(2):204-209).Question Remarks : Menurut anda, apakah penyebab etiologi pasien tersebut??