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CASE REPORT
BRONCHOPNEUMONIA

DENGUE
HEMORRHAGIC
FEVER
Compiled By
Nia Stefani Tambunan Supervisor
(120100093) dr.Hj. Tiangsa br Sembiring,
M.Ked (Ped), Sp. A (K)
Verra Anindya S.R
(120100022) 1

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INTRODUCTION
2

Caused by
INTRODUCTION a variety
of etiology
such as
The main bacteria,
cause of
Broncho
viruses,
death, fungi, and
especially in foreign
children
under five pneumo bodies
years.
nia

3

Click icon to add picture LITERATURE REVIEW 4 .

WHAT IS BRONCHOPNEUMONIA Pneumonia is an The infection inflammation causes of the lungs inflammation Bronchopneumon caused by a in the alveoli ia is a type of variety of in the lungs. pneumonia etiology such causing the as bacteria. alveoli to fill viruses. with pus or and foreign fluid bodies 5 . fungi.

6 .EPIDEMIOLOGY Pneumonia is the number 1 killer among the leading infection disease Source: UNICEF.

EPIDEMIOLOGY

Percentage of deaths among children under-five attributable to pneumoniain 2015

Source: UNICEF,
7

EPIDEMIOLOGY
64.73 65.09 64.81

35.27 34.91 35.19

Infant (<1 year) Children (1-4 years)

Prevalence pneumonia in Indonesia between 2007-2009
Source: Buletin Pneumonia
8 Depkes

WHAT CAUSES
BRONCHOPNEUMONIA?
Age Etiologic agents 3 months – 5 RSV, PIV, Influenza,
0- 3 weeks Group B streptococcus
years Human meta
Gram-negative enteric bacili
pneumovirus, adenovirus,
Cytomegalovirus
rhinovirus
Listeria monocytogenes
Streptococcus pneumonia
Herpes simplex virus
Haemophilus aureus
Treponema pallidum
Staphylococcus aureus
3 weeks – 3 Chlamydia trachomatis
Mycoplasma pneumonia
months Respiratory syncytial virus
Mycobacterium
(RSV)
tuberculossis
Parainfluenza viruses (PIV), 5 years – 15 Mycoplasma pneumonia
especially type 3 years Chlamydophila pneumonia
Streptococcus pneumonia
Bordetella pertussis
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Respiratory syncytial virus years 2. Streptococcus pneumonia 4. Cytomegalovirus 2. Mycoplasma pneumonia 6. Human 2. Treponema pallidum 5. Staphylococcus aureus 6. Group B streptococcus 3 months – 5 1. bacili adenovirus. Influenza. Herpes simplex virus 4. Listeria monocytogenes 3. PIV. Gram-negative enteric years meta pneumovirus. Mycoplasma pneumonia months 2. Mycobacterium tuberculossis 3 weeks – 3 1. rhinovirus 3. Chlamydophila pneumonia (RSV) 3.WHAT CAUSES BRONCHOPNEUMONIA? Age Etiologic agents Age Etiologic agents 0. Parainfluenza viruses (PIV) 10 . RSV. Chlamydia trachomatis 5 years – 15 1. Haemophilus aureus 5.3 weeks 1.

poor Young age breast feeding practices Cold weather or Lack of immunization Low birth weight chilling .WHO IS AT RISK? Pollution Malnutrition.

WHO IS AT RISK? Crowding Vitamin A deficiency High prevalence of nasopharyngeal carriage of pathogenic bacteria .

phagocytosis  Resolution Stadium: neutrophil degeneration. PATHOGEN ESIS Stages:  Red Hepatization Stadium: alveoli consist of leucocyte.erythrocyte. loose of fibrine. fibrine. bacteria  Grey Hepatization Stadium: fibrine deposition. bacterial .

CLASSIFICATION Clinical and Pathog Morphology Epidemiology ens Community. Typical Lobaris acquired peumonia Hospital-acquired Atypical Bronchopneu pneumonia/ monia nosocomial pnuemonia Aspiration   Interstitial pneumonia Immmunocompromi     sed pneumonia 14 .

WHAT ARE THE SYMPTOMS? • Fever • Cough • Shortness of breath • Chest pain • Rapid breathing • sweating • Shaking chills • Malaise • fatique Age Breaths per • Confusion or delirium minute <2 months age >60 breaths per minute 15 2-12 months age >50 breaths per .

lung sound. percussion. dullness. etc Laboratorium: complete blood count (CBC) number of WBC elevated  bacterial infection Chest x ray Sputum test 16 . crackles. retraction.TEST AND DIAGNOSIS Clinical symptoms Physical exam : fever.

TREATMENT OPTIONS • Viral bronchopneumonia: normally doesn’t require medical treatment and improves on its own in one to two weeks • Bacterial bronchopneumonia: antibiotic 17 .

Recommendation 1 Children with fast breathing pneumonia with no chest indrawing or general danger sign should be treated with oral amoxicillin: at least 40 mg/kg/dose twice daily (80 mg/kg/day) for 5 days. In areas with low HIV prevalence. Children with fast breathing pneumonia who fail on first line treatment with amoxicillin should have the option or referral to a facility where there is appropriate second line treatment 18 . give amoxicillin for three days.

Recommendation 2 Children age 2-59 months with chest indrawing pneumonia should be treated with oral amoxicillin: at least 40 mg/kg/dose twice daily for five days 19 .

— Ampicillin: 50 mg/kg. 20 . or benzyl penicillin: 50 000 units per kg IM/IV every 6 hours for at least five days — Gentamicin: 7.Recommendation 3 Children aged 2–59 months with severe pneumonia should be treated with parenteral ampicillin (or penicillin) and gentamicin as a first-line treatment.5 mg/kg IM/IV once a day for at least five days Ceftriaxone should be used as a second-line treatment in children with severe pneumonia having failed on the first-line treatment.

21 . ceftriaxone alone is recommended for use as second-line treatment.Recommendation 4 Ampicillin (or penicillin when ampicillin is not available) plus gentamicin or ceftriaxone are recommended as a first-line antibiotic regimen for HIV-infected and -exposed infants and for children under 5 years of age with chest indrawing pneumonia or severe pneumonia. For HIV-infected and -exposed infants and for children with chest indrawing pneumonia or severe pneumonia. who do not respond to treatment with ampicillin or penicillin plus gentamicin.

22 . Empirical cotrimoxazole treatment for Pneumocystis jirovecii pneumonia (PCP) is not recommended for HIV-infected and -exposed children over 1 year of age with chest indrawing or severe pneumonia.Recommendation 5 Empiric cotrimoxazole treatment for suspected Pneumocystis jirovecii (previously Pneumocystis carinii) pneumonia (PCP) is recommended as an additional treatment for HIV-infected and -exposed infants aged from 2 months up to 1 year with chest indrawing or severe pneumonia.

Click icon to add picture CASE REPORT 23 .

Wheezing (-). Not associated with activity or weather. 24 . a 1years 17 days old girl BW: 6 kg BH: 59 cm Main complain : Shortness of breath since 7 days ago . Restlessness due to short of breathing at night (+). CASE REPORT AKZ. Cyanosis (-). History of shortness of breath (-). occurs after coughing. Grunting (+). History of choking (-).

responded to antipyretic drug but it increase again after 2 hours. CASE REPORT Cough. Convulsion (-). History of exposure with people who have lung disease (+) Fever. 2 days ago. 7 days ago. Characteristic of fever is high (>38o C). Shivering (-) Flu (-) Vommiting (-). Sputum (-). Hemoptysis (-). nausea (-) 25 .

CASE REPORT History of medication : azithromycin. Lasal* (salbutamol). L-Bio. Univir* (acyclovir). paracetamol. valproate acid (since 8 months) History of previous disease: ventricular septal defect (VSD) (since 1 month old). ibuprofen. epilepsy (since 8 months old) History of family : none 26 .

Cyanosis (-).4 x/day 3. Ante natal care during pregnancy (+) History of birth :Birth was assisted by a doctor. Cesarean section with indication post-term pregnancy and cried immediately after birth. DM (-). freq: 2. 27 . 6 – 7 months : strained porridge + formula milk. Fever (-). Body length 40 cm. BW: 3500 gram. 0 – 6 months : formula milk freq: 4-6 x/day 2. Medicine consumption (-). head circumference (?) History of feeding : 1. Hypertension (-). 7 months – now : smooth porridge + formula milk.History of pregnancy: during pregnancy mother is 25 y.o.

immunization was complete except measles vaccine 28 .History of growth and development: the patient can not stand. sit. and talk until now History of immunization: according to patient’s mother.

oedema (-/-) 29 . dyspnea (+).1 Kg m HR : 140 x/i reguler.3 SD < Z score < -2 SD RR : 52 x/i BH/A : Z score < 3 SD       BW/BH : . cyanosis (-). murmur BL : 59 cm (+) systolic grade III/6 Linea Mid Claviculari ICS III-IV Temp : 38.2 SD < Z score < -1 SD Anemic (-).5oC BW/A : . icteric (-).Physical Examination Present Status:  Sensoriu : CM (GCS 14 = E4V4M6) BW : 6.

ronchi (+/+). normal morphologic. palpebra edema (-/-) Ear: Both ear lobe in normal morphologic Nose : Septum deviation (-). pale inferior conjungtival palpebra(-/-). epigastric retraction (+). Cyanosis (-) Neck : Lymph node enlargement (-). 30 .L: 3 mm). wheezing (-/-). isochoric pupil (R:3mm . Mouth: Cleft palate (+).HR: 110 bpm. Thorax : Symmetrical fusiform. . regular. regular.Localized Status: Head : Eye: Light reflex (+/+). murmur (+) systolic grade III/6 linea midclavicula sinistra (LMCS) ICS III-IV . bronchial.RR: 52 bpm.

CRT 3”. ies felt warm. oedema (-/-). regular. cyanosis (-). shifting dulless (-) n Liver ad spleen: unpalpable.Localized Status: Abdome : Symmetrical. Soepel. clubbing finger (-). Pulse 110 x/i. normal peristaltic. adequate p/v. clubbing Anogeni : Normal (female) tal 31 . Umbilical hernia (+) Extremit : BP: can’t be measured.

3 % Total CO2 : 24 Basophil : 0.38 Hematocryte : 32.4 mmol/L     Chloride : 101 mmol/L     32 .150 PO2 : 44.6 % Monocyte : 10.5 % PCO2 : 48 mmHg Leukocyte : 17.9 % BF : 2.2 mmHg 103/uL Thrombocyte : 226 103/uL HCO3 : 27.Laboratory Finding : Complete Blood Analysis (28-12-2016 ) Count B loodCell (CBC) AGDA Haemoglobin : 10.5 g/dl PH : 7.9 %     Electrolite Methabolism Natrium : 132 mmol/L Blood glucose : 118 mg/dL Kalium : 4.9 %   Neutrophil : 64.5 mmol/L Limphocyte : 19 % SaO2 : 86.3 mmol/L Eosinophil : 4.

33 .

Bronchopneumonia + VSD + Palatoschisis + epilepsy + umbilical hernia 2. Differensial Diagnosis: 1. Tuberculosis + Atrial septal defect (ASD) + Palatoschisis + epilepsy+ umbilical hernia 3. Fungal lung + Patent Ductus Arteriosus (PDA) + Palatoschisis + epilepsy+ umbilical hernia Working Diagnosis : Bronchopneumonia + Ventricular Septal defect (VSD) + Palatoschisis + Epilepsy + Umbilical Hernia 34 .

Furosemide 6 mg/12h/IV • Spironolactone 2 x 6.6 cc) • Diet F75 100 cc/3 hour + 2 cc mineral mix/oral/NGT • Valproat acid syr 2 x 1 cc • Inj. Therapy : • IVFD D5% NaCL 0.25 mg • Folat acid 1 x 1 mg • Vit.225% 25 gtt/I • Inj. B complex 1 x 1 tab • Vit. Ampicillin 300 mg/6h/IV • Inj. C 1 x 50 mg 35 . Gentamicin 40 mg/24h/IV • Paracetamol drop 3 x 60 mg (0.

Click icon to add picture FOLLOW UP 36 .

bronchial (+/+).L: 3 mm). regular. Cyanosis (-) Neck : Lymph node enlargement (-). Temperature : 38⁰C BB: 6. Thorax : Symmetrical fusiform. hepar. . Nose : Septum deviation (-). Soepel. normal morphologic. Pulse 120 x/i. HR: 120 x/i. wheezing (-/-). oedema (-/-). isochoric pupil (R:3mm . ronchi (+/+). Mouth : Cleft palate/Palatoschisis (+). regular. murmur (+) systolic grade III/6 LMCS ICS III-IV RR: 60x/i. lien : unpalpable.felt warm. regular.29thof December 2016 S : Dyspnea (+). Stridor (-/-) Abdomen : Symmetrical. cyanosis (-). peristaltic (+) normal.1 Kg Head Eye : Light reflex (+/+). Umbilical hernia (+) Extremities: BP: can’t be measured. CRT 3”. epigastricretraction (+).adequate p/v. clubbing finger (-). pale inferior palpebral conj. fever (+) O : Sens : Compos mentis GCS 14 (E3M6V5). cough (+). (-/-) Ears : Both ear lobe in normal morphologic.

225 % 25gtt/I Inj. Ampicillin 300 mg/6h/IV Inj. Gentamicin 40 mg/24h/IV Paracetamol drop 3 x 60 mg (o.6 cc) Diet F100 100 cc/3 hour + 2 cc mineral mix/oral/NGT Valproat acid 2 x 1 cc .A : Bronchopneumonia + Ventricular septal defect (VSD) + palatoschisis + umbilical hernia + epilepsy P : IVFD D 5 % NaCL 0.

L: 3 mm). murmur (+) systolic grade III/6 line midclaviculasinistra ICS III-IV RR: 50x/i. Stridor (-/-) Abdomen : Symmetrical. peristaltic (+) normal. Nose : Normal Ear : Normal Mouth : Palatoschisis Thorax : Symmetrical fusiform. HR: 120 x/i. pale inferior palpebral conj. bronchial (+/+). regular. cough (+). (-/-). isochoric pupil (R:3mm . hepar.8oC BW: 5.9 Kg Head : old man face (-). epigastricretraction (+). Eye : Light reflex (+/+). Head Circumference : 40 cm (microcephaly). lien : unpalpable. Soepel. Umbilical hernia (+) .30-31thof December 2016 S : Dyspnea (+). wheezing (-/-). prominent cheekbones (-). ronchi (+/+). regular. fever (+) O : Sens : CM Temp : 37.

Gentamicin 40 mg/24h/IV  Paracetamol drop 3 x 60 mg (o. Ampicillin 300 mg/6h/IV  Inj. Furosemide 6 mg/12h/IV  Spironolactone 2 x 6.A : Bronchopeumonia + Small VSD + Palatoschisis + microcephaly + Epilepsy P :  IVFD D 5 % NaCL 0.25 mg Planning:  Blood culture and sensitivity  Consultation to the departement of nutrition about diet high calory with fluid retriction .225 % 25gtt/I  Inj.6 cc)  Diet F100 100 cc/3 hour + 2 cc mineral mix/oral/NGT  Valproat acid 2 x 1 cc  Vitamin B-Complex 1 x 1 tab  Vitamin C 1 x 100 mg  Inj.

38 7.37-7.8 50-70/20-40/2-8/1-6/0-1 .81/98/0.5 135-155/3.5/1.2 94-98 % Na/K/CL/C 134/4.1-5.45 mmHg pCO2 49.36 6-17 103//uL Tromb 276 150-440 103/uL N/L/M/E/B 62/23/12. Laboratorium Test Result (31-12-2016) Hb 10.4 22-29 mmol/L BE 2.1/96-106 a Table 3.7/0.Table 2.7 (-2)-3 mmol/L O2 sat 71.70 37-41% Leu 19.20 71-104 mmHg HCO3 28.8 712-16 g/dl Ht 33. Laboratorium Test Result (31-12-2016) AGDA –Electrolite PH 7.0 33-44 mmHg pO2 43.

Fever (+) O : Sensorium : Compos mentis GCS 14 Temp : 38. ronchi (+/+).1stof January 2017 S : Dyspneu (+). Stridor (-/-) Abdomen : Symmetrical. HR: 110 x/i. murmur (+) systolic grade III/6 line midclaviculasinistra ICS III-IV RR: 58x/i. clubbing finger (-). lien : unpalpable. Pulse 115 x/i. regular. cough (+). (-/-) Nose : Normal Ear : Normal Mouth : Palatoschisis Thorax : Symmetrical fusiform. retraction (+). hepar. regular. Umbilical hernia (+) Extremities :BP: can’t be measured. oedema (-/-). peristaltic (+) normal. hyphotrophy muscle (+). vomiting (+). Soepel.adequate p/v.wheezing (-/-). adipose subcutaneous (<<) . isochoric pupil (R:3mm .felt warm. bronchial (+/+). pale inferior palpebral conj. regular.4oC Head : old man face (-).L: 3 mm). CRT 3”. prominent cheekbones (-) Eye : Light reflex (+/+). cyanosis (-).

Furosemide 6 mg/12h/IV  Spironolactone 2 x 6. Ampicillin 300 mg/6h/IV  Inj. Gentamicin 40 mg/24h/IV  Paracetamol drop 3 x 60 mg (o.225 % 25gtt/I  Inj.25 mg  Diet F100 100 cc/3 hour + 2 cc mineral mix/oral/NGT  Salbutamol 3 x 0.A : Brochopeumonia + small VSD + palatoschisis + epilepsy + microcephaly + umbilical hernia P :  IVFD D 5 % NaCL 0.5 mg .6 cc)  Valproat acid 2 x 1 cc  Vitamin B-Complex 1 x 1 tab  Vitamin C 1 x 100 mg  Inj.

Laboratorium Test Result (01-01-2017) Hb 10.000 Tromb 254000 150. Laboratorium Test Result (01-01-2017) AGDA – Electrolite PH 7.5 33-44 mmHg pO2 64.9/19.000-17.00% 37-41 Leu 20.8/10.840 6.1/96-106 Table 5.45 mmHg pCO2 45.4 (-2)-3 mmol/L O2 sat 92 94-98 % Na/K/CL 132/3.3/0.6 71-104 mmHg HCO3 27.5 22-29 mmol/L BE 4.31/94 135-155/3.4 g/dl 12-16 Ht 32.37-7.Table 4.000-440.000 N/L/M/E/B 68.1-5.6/0.42 7.4 50-70/20-40/2-8/1-6/0-1 .

isochoric pupil (R:3mm .L: 3 mm). bronchial (+/+). lien : unpalpable. regular. Umbilical hernia (+) Extremities :BP: can’t be measured. Soepel. Stridor (-/-) Abdomen : Symmetrical. vomitting (-) O : Sens : Compos mentis GCS 14. Pulse 110 x/i. (-/-) Nose : Normal Ear : Normal Mouth : Palatoschisis Thorax : Symmetrical fusiform. cough (+). ronchi (+/+).adequate p/v.2ndof January 2017 S : Fever (+). Temperature : 39⁰C Head : old man face (-).felt warm. regular. retraction (+). HR: 110 x/i. murmur (+) systolic grade III/6 line midclaviculasinistra ICS III-IV RR: 50x/i. pale inferior palpebral conj.wheezing (-/-). hepar. . dyspnea (+). regular. prominent cheekbones (-) Eye : Light reflex (+/+). peristaltic (+) normal.

6 cc)  Valproat acid 2 x 1 cc  Vitamin B-Complex 1 x 1 tab  Vitamin C 1 x 100 mg  Inj. Gentamicin 40 mg/24h/IV  Paracetamol drop 3 x 60 mg (o. Ampicillin 300 mg/6h/IV  Inj.A : Brochopeumonia + small VSD + palatoschisis + epilepsy + microcephaly + umbilical hernia P :  IVFD D 5 % NaCL 0.225 % 25gtt/I  Inj.25 mg  Salbutamol 3 x 0. Furosemide 6 mg/12h/IV  Spironolactone 2 x 6.5 mg  Diet F100 60 cc/3 hour + 2 cc mineral mix/oral/NGT  Folat acid 1 x 1 mg .

Stridor (-/-) Abdomen : Symmetrical.wheezing (-/-).adequate p/v. regular. cough (+). pale inferior palpebral conj. regular. fever (+) O : Sensorium : Compos mentis GCS 14 Temp : 37. isochoric pupil (R:3mm .L: 3 mm). Soepel.9 Kg  Head : old man face (-). (-/-). murmur (+) systolic grade III/6 line mid clavicula sinistra ICS III-IV RR: 52x/i.3th of January 2017 S : Dyspneu (+).9oC BW: 5. Pulse 110 x/i. lien : unpalpable. HR: 132 x/i. hepar. Umbilical hernia (+) Extremities : BP: can’t be measured. prominent cheekbones (-) Eye : Light reflex (+/+). retraction (+). peristaltic (+) normal.felt . ronchi (+/+). Nose : Normal Ear : Normal Mouth : Palatoschisis Thorax : Symmetrical fusiform. bronchial (+/+). regular.

5 cc/8 hour  Folat acid 1 x 1 mg .6 cc)  Valproat acid 2 x 1 cc  Vitamin B-Complex 1 x 1 tab  Vitamin C 1 x 100 mg  Inj. Furosemide 6 mg/12h/IV  Spironolactone 2 x 6.5 mg tab  Diet F100 60 cc/3 hour + 2 cc mineral mix/oral/NGT  Nebule ventolin 1 resp + NaCl 0.25 mg  Salbutamol 3 x 0. Gentamicin 40 mg/24h/IV  Paracetamol drop 3 x 60 mg (o.9% 2. Ampicillin 300 mg/6h/IV  Inj.A : Brochopeumonia + small VSD + palatoschisis + epilepsy + microcephaly + umbilical hernia P :  IVFD D 5 % NaCL 0.225 % 25gtt/I  Inj.

9/26.8/0/1.4 g/dl 12-16 Ht 31.4 50-70/20-40/2-8/1-6/0-1 .000-440.000-17.Table 6.000 Tromb 194000 150.9/6. Laboratorium Test Result ( 03-01-2017) Hb 10.720 6.10% 37-41 Leu 19.000 N/L/M/E/B 64.

Umbilical hernia (+) Extremities : BP: can’t be measured.felt . HR: 124 x/i. Soepel. Stridor (-/-) Abdomen : Symmetrical.wheezing (-/-). pale inferior palpebral conj. Pulse 110 x/i. hepar.4-7th of January 2017 S : Dyspneu (+). prominent cheekbones (-) Eye : Light reflex (+/+). regular. bronchial (+/+). peristaltic (+) normal. fever (+) O : Sensorium : Compos mentis GCS 14 Temp : 37. lien : unpalpable. retraction (-). cough (+). regular. isochoric pupil (R:3mm .L: 3 mm). (-/-) Nose : Normal Ear : Normal Mouth : Palatoschisis Thorax : Symmetrical fusiform. ronchi (+/+).9 Kg Head : old man face (-). murmur (+) systolic grade III/6 line midclaviculasinistra ICS III-IV RR: 40x/i.adequate p/v. regular.2oC BB: 5.

Furosemide 6 mg/12h/IV  Spironolactone 2 x 6.A : Brochopeumonia + small VSD + palatoschisis + epilepsy + microcephaly + umbilical hernia P:  IVFD D 5 % NaCL 0.9% 2.5 cc/8 hour  Folat acid 1 x 1 mg  Diet nutridrink 100 cc/3hour  Physiotherapy Microbiology Result: Bacteria is not found  THORAX PA/LATERAL DEXTRA Pneumonia  DD Tuberculosis   .25 mg  Salbutamol 3 x 0. Ceftriaxone 300 mg/12h/IV  Paracetamol drop 3 x 60 mg (o.5 mg pulv  Nebuleventolin 1 resp + NaCl 0.6 cc)  Valproat acid 2 x 1 cc  Vitamin B-Complex 1 x 1 tab  Vitamin C 1 x 100 mg  Inj.225 % 25gtt/I  Inj.

wheezing (-/-). peristaltic (+) normal. lien : unpalpable. Pulse 140 x/i. Soepel. cough (<<). Stridor (-/-) Abdomen : Symmetrical. regular. pale inferior palpebral conj. regular.felt . (-/-).L: 3 mm). Nose : Normal Ear : Normal Mouth : Palatoschisis Thorax : Symmetrical fusiform. bronchial (+/+).3oC BB: 6. Umbilical hernia (+) Extremities : BP: can’t be measured. fever (+) fluctuative O : Sensorium : Compos mentis GCS 14 Temp : 37. regular.0 Kg Head : old man face (-). ronchi (-/-). murmur (+) systolic grade III/6 line midclaviculasinistra ICS III-IV RR: 38x/i. retraction (-). hepar. prominent cheekbones (-) Eye : Light reflex (+/+). isochoric pupil (R:3mm .8-9th of January 2017 S : Dyspneu (<<). HR: 140 x/i.adequate p/v.

225 % 25gtt/I  Inj.9% 2.A : Bronchopneumonia + small VSD + epilepsy + Palatoschisis + microcephaly + umbilical hernia P :  IVFD D 5 % NaCL 0.5 mg pulv  Nebuleventolin 1 resp + NaCl 0. Furosemide 6 mg/12h/IV  Spironolactone 2 x 6.6 cc)  Valproat acid 2 x 1 cc  Vitamin B-Complex 1 x 1 tab  Vitamin C 1 x 100 mg  Inj. Ceftriaxone 300 mg/12h/IV  Paracetamol drop 3 x 60 mg (o.25 mg  Salbutamol 3 x 0.5 cc/8 hour  Folat acid 1 x 1 mg  Diet nutri drink 100 cc/3hour .

Nose : Normal Ear : Normal Mouth : Palatoschisis Thorax : Symmetrical fusiform. regular. HR: 110 x/i. peristaltic (+) normal.felt warm. Soepel. cough (<<). clubbing finger (-). cyanosis (-). retraction (-). prominent cheekbones (-) Eye : Light reflex (+/+). (-/-). isochoric pupil (R:3mm . Stridor (-/-) Abdomen : Symmetrical. Umbilical hernia (+) Extremities : BP: can’t be measured.adequate p/v.3oC BB: 5. CRT 3”. regular. fever (+) fluctuative O : Sensorium : Compos mentis GCS 14 Temp : 37.10th of January 2017 (OUT FROM HOSPITAL) S : Dyspneu (<<). Pulse 140 x/i. hepar. lien : unpalpable. murmur (+) systolic grade III/6 line midclaviculasinistra ICS III-IV RR: 50x/i.L: 3 mm).8 Kg Head : old man face (-). . regular. ronchi (-/-).wheezing (-/-). oedema (-/-). pale inferior palpebral conj.

225 % 25gtt/I  Inj.5 mg pulv  Nebule ventolin 1 resp + NaCl 0.5 cc/8 hour  Folat acid 1 x 1 mg  Diet nutridrink 100 cc/3hour . Ceftriaxone 300 mg/12h/IV  Paracetamol drop 3 x 60 mg (o. Furosemide 6 mg/12h/IV  Spironolactone 2 x 6.25 mg  Salbutamol 3 x 0.9% 2.A : Bronchopneumonia + small VSD + epilepsy +Palatoschisis + microcephaly + umbilical hernia P :  IVFD D 5 % NaCL 0.6 cc)  Valproat acid 2 x 1 cc  Vitamin B-Complex 1 x 1 tab  Vitamin C 1 x 100 mg  Inj.

2 g/dl 12-16 Ht 30.000-17.000-440.Table 7.6/42.710 6.000 N/L/M/E/B 44.5/3. Laboratorium Test Result(10-01-2017) Hb 10.4% 37-41 Leu 10. 50-70/20-40/2-8/1-6/0-1 2 .000 Tromb 447000 150.5/8.2/1.

Click icon to add picture DISCUSSION 57 .

and foreign bodies. especially in infants 1-4 years. fungi. DISCUSSION Theory Cases Definition: - Pneumonia is an inflammation of the lungs caused by a variety of etiology such as bacteria.1 Pneumonia is a form of acute respiratory infection that affects the lungs Epidemiology: The patient was a girl. pneumonia is the leading diagnose bronchopneumonia. 58 . 1 year 17 days with In Indonesia. viruses. cause of death.3 Prevalence of pneumonia from 2007 until 2009 among children between 1-4 years is more common than infants (<1 years) and percentage of deaths among children under-five in 2015 in Indonesia is 15-19%.

the patient is 1 years 17 days old.Lack of 65 or older. Their immune system are weak rather than adult. when there are two or more .Low birth weight recurrent pneumonia i.Crowded months of age that predispose to bronchopneumonia. Infants from .  Specific risk factors: • Lung disease • Anatomic problems • GERD • Some congenital heart disease (CHD) • etc 59 . as are indiviuals age . immunization .Vitamin A deficiency pneumonia episodes in a year.Young age birth to age two are at risk for pneumonia.DISCUSSION Theory Cases Risk factor: • In this case.Pollution previous reports identified CHD as an underlying cause of . Most .Malnutrition • Patient have a small ventricular septal defect (VSD) since 1 .e.

and the leukocyte increase again Human meta become 19.DISCUSSION Theory Cases Etiology: multiple • Routine laboratory test may be helpful for diagostic purpose. microbes. High pneumovirus.000) (28-12-2016). Blood culture are infant and children ( 3 positive in 5-14% of cases. predominantly A complete blood count (CBC) may show a high white blood viruses and bacteria. white blood cell count may suggest bacterial infection. PIV.150 (N:6. 17. cause pneumonia in Leucopenia may suggest viral pneumonia. indicating the presence of bacterial infection.000- • RSV. We adenovirus. Influenza. cell count.360 (31-12-2016) and 20. months – 5 years): • In this patient we found that Leukocyte 17.840 (1-1-2017). rhinovirus have do the culture test. but because of lack of blood. the • Streptococcus result is negative. pneumonia • Haemophilus aureus • Staphylococcus aureus • Mycoplasma pneumonia • Mycobacterium tuberculossis 60 .

5oC since 7 days ago. respons to antipyretic drug • Fever but increase again. • Cough • Rapid breathing : 52 x/I (tachypnea: >40x/I for 12 months-5 • Shortness of breath years) • Chest pain • Cough with sputum (but patient can not cough up the • Rapid breathing sputum in her chest) • sweating • Shaking chills • Malaise • fatique • Confusion or delirium 61 .DISCUSSION Theory Cases Diagnostic: In this patient. we found: Symptoms: • Fever : 38.

DISCUSSION Theory Cases General examination: In this patient. we found: • Fever • HR: 140 x/I • Rapid breathing • Murmur (+) systolic grade III/6 LMCS III-IV • Cyanosis • RR: 42 x/I • Retraction • Temp: 38.5oC • Chest indrawing • Bronchial • grunting • Crackles • Decrease breath • Retraction sounds • Grunting • Crackles (rales) • Egophony on • Umbilical hernia auscultation • Pleural frictian rub • Dullness of the chest to percussion • Altered mental stataus 62 .

6% (<90%)  may indicated decrease: viral respiratory distress and hypoxemia pneumonia. increase: • Infiltrate in the lungs with patchy appearance bacterial pneumonia • Infiltrates.150. 20. bronchopneumonia: infiltrate with patchy appearance 63 .DISCUSSION Theory Cases Laboratory test and In this patient.360. 19.840) • Leukocyte : normal or • Saturation oxygen 86. we found: radiology: • Leukocytosis (17. Lobar pneumonia: an ill defined area of increase density.

2017. we gave the patient with: • Bed rest • Inj. B complex 1x1 tab and vit. • Anti-seizure use of valproic acid syr 2 x 1 cc • Sup vit.6 cc) dyspneu. 6hr / iv and inj. and fever not improve. Ampicillin 300 mg / cultures. 64 . Ampicillin 300 mg/6hr/IV and Inj. On the 29th December 2016 until 3th January severe pneumonia. cough. but the patient paracetamol drop 3 x 60 did not respond to the drug.c 1x50 mg tab. Gentamicin 30 • Medical form of antibiotic mg/24hr/IV for antibiotics while waiting for blood inj. The symptoms such as mg (0.Gentamicin • Paracetamol drop 3 x 60 mg 30 mg / 24hr / iv • valproic acid syr 3 x 1 cc • Antipyretic use • and the supplements vitamin B and C.DISCUSSION Theory Cases Treatment based on The treatment started from 29th December 2016 until 10th classification: January 2017.

000). Ceftriaxone 300 mg. the blood culture result is a second-line treatment in negative. and the patient have improvement in symptoms.DISCUSSION Theory Cases Ceftriaxone should be used as On the 4th January 2017. 65 . a negative blood children with severe result is almost inevitable for a large proportion of blood pneumonia having failed on cultures because of submission of an inadequate volume of the first-line treatment. The lab result for leukocytes is more than normal (6.000-17. we assumed that the cause of pneumonia in this patient is bacteria. blood. But in routine clinical practice.12hr/IV on 4th January 2017. We change the treatmet with • Inj.

66 .45 PM. a 1 year 17 days old girl. Her main complaint was shortness of breath and diagnosed with Bronchopneumonia + Ventricular Septal Defect (VSD) + Palatoschizis + Epilepsy + Umbilical Hernia and got fluids IVFD D5% NaCl 0.6 cc). anti-seizure use of valproic acid syr 2 x 1 cc. SUMMARY AKZ. and form of supplements vit. came to USU Hospital on December 28th at 02. antipyretic use paracetamol drop 3 x 60 mg (0. BW 6 kg BH 59 cm.c 1x50 mg tab.Gentamicin 30 mg / 24hr / iv.225% and medical form of antibiotic inj. B complex 1x1 tab and vit. Ampicillin 300 mg / 6hr / iv and inj.

THANK YOU! 67 .