CLINICAL CONFERENCE

TROPIC INFECTION DIVISION

(New Case)
September 30th , 2022

Mohamad Jumatman / Presenter

Hardiyanti / Madya

Irwandi Zakaria, Kartika Setiawaty/ Senior Divisi

 PATIENT IDENTITY
AP,
A, 55 Years
years 8old
months (olale)
(female)
994275
MR Number
11/09/2017
Date of Birth
September 27 th,
Admission Date
2022
MEDICAL DIAGNOSIS
Typhoid fever+Network Anoxia+Community Acquired Pneumonia+anemia of chronic
disease+thrombocytopenia+hypoalbuminemia+hyponatremia
PATIENT PICTURE
 HISTORY TAKING
Chief Complain

History of Present Illness

A Girl 5 years old was referred by RSUD Haji Makassar with diagnosis anemia of chronic disease + hypoalbuminemia.
The child was admitted to the hospital with complaints of fever experienced since 2 weeks ago, not continuously, increas
in the afternoon and evening, decrease with antipyretic drugs. No seizures.
There was shortness of breath experienced since 5 days ago, there was cough with white mucus, no blood.
No vomiting, history of vomiting 2 weeks ago for 2 days, frequency 3 times, not spraying, filled with food and liquid.
The child was willed to eat and drink
Urination: Normal
Defecation: Normal
 HISTORY TAKING
History of Past Illness
No history of eating from street food.

There was History of watery diet 2 weeks ago for 4 days, frequency > 5 times, dregs, mucus, no blood

No history of contact with patients with the same complaint at this time.

No history of contact with a long cough or adult TB patien

No history of contact with active smokers in the family

There was history of being treated at the Haji Hospital for 1 week and receiving ampicillin /intravenous for 6 days.
Gentamycine/intravenous for 1 days, Paracetamol/intravenously, zinc/oral.
History of Vaccine
PHYSICAL EXAMINATION
Frequency
Vaccine Not yet given 0 1 2 3 4

Hep B √ √ √ √ √

BCG √
DPT √ √ √ √
Hib √ √ √ √

POLIO √ √ √ √

MMR √

Rotavirus √
Influenza √
Japanese Encephalitis √
PCV √
Varicella √
Hepatitis A √
Tifoid √
 PHYSICAL EXAMINATION
Vital Sign Antropomethry
General condition: Moderate illness/Good
Body weight : 17 kg
Nourished/GCS 15 (E4M6V5)
Length : 104 cm
Blood Pressure: 90/60 mmHg
Head Circumference : 50 cm (Normal: 48-53 cm) normocephal
Heart Rate : 110 times/min
Weight/Height : 17/18 x 100 % = 94% (Good nourished)
Temperature : 38.4 °C
Height/Age : 104/108 x 100 % = 96% (normal stature)
Respiration Rate : 32 times/min
Weight/Age : 17/17 x 100 % = 100 % (normal bodyweight)

SpO2 : 98%

Pain Scale : 1 NRS

Head circumference : 50cm (Normal : 48-53 cm )
Normocephal
Weight/Height : 17/18 x 100 % = 94% (Good nourished)
Height/Age : 104/108 x 100 % = 96% (normal stature)
Weight/Age : 17/17 x 100 % = 100 % (normal bodyweight)
 PHYSICAL EXAMINATION
There was pale, no ikteric
No lymphadenopathy
No dirty tongue. Abdomen
No stomatitis. Peristaltic sound the impression is normal
The pharynx is not hyperemic. The liver was palpable 2 cm below the costal arc
The tonsil of T1-T1 not hyperemic. lien not palpableThere is ascites, shifting dullness (+)
Pulmonary Ekstremities:
Vesicular breath sounds. warm acral, CRT < 2 seconds
Ronchi in both lung fields (minimal)
No wheezing.
Cardiovascular
Pure regular I / II heart sound, no additional sound
 September 26
September 27th
Laboratory 2022 (Haji Normal Value
2022 (Wahidin)
hospital)
Hb 7,6 7,4 LABORATORY FINDING
12.0 – 16.0 gr/dL
WBC 4.900 6,0 4.0 – 10.0/μL
PLT 123.000 116.000 150.000 – 400.000/mm3
HCT 24% 19 37.0 – 48.0 %
MCV 81 73,3 80 -100 μm3
MCH 26 25,7 27 - 32 Pg
NEUT 25.9 43,3 52 – 75 103/μL
LYMPH 45,6 47,1 20 – 40 103/μL
MONO 9,4 9,1 2 – 8 103/μL
GDS 93 - 140 mg/dl
SGOT 26 - < 38 u/l
SGPT 28 - < 41 u/l
UREUM 16 - 10 - 50 mg/dl
CREATININ 0,37 - <1.1 mg/dl
ALBUMIN 3.1 - 3.5 – 5.0 mg/dl
Natrium 134 - 136 – 145 mmol/l
Pottasium 4,5 - 3,5 – 5,1 mmol/l
Clorida 103 - 97 – 111 mmol/l
 LABORATORY FINDING
Laboratory September 27th 2022 (Wahidin) Normal Value
Igm Salmonella Positive / 8 Negative
Ferritine >1200

Urinalysis
Color Yellow
pH 5,5
BJ 1020
Protein +2
Glucose Negative
Bilirubin Negative
Urobilinogen Normal
Keton Negative
Nitrit Negative
Blood Negative
Leukocyte Negative
Leukocyte Sediment 5
Erythrocyte Sediment 1
Thorac Sediment 4
Epithel cell 118
 Peripheral Blood Smear RSWS (September 28th 2022)

Erythrocytes: Normocytic normochrome, anisocytosis, ovalocyte (+), inclusion body (-), normoblast (-)
Leukocytes: Adequate number, PMN > lymphocytes, toxic granulation (+), young cells (-)
Platelets: Decreased number, large platelets (+)
Impression: Normochromic normocytic anemia with leukocytes with signs of infection
Chest X-Ray RADIOLOGY FINDING
(Wahidin Hospital 27/09/2022)
• Simetric position, good photo
condition, less inspiration
• There was consolidation at medial lung
dextra and infiltrat at upper lung
sinistra
• Cor : normal
• Both of diaphragma sinus are normal
• Bones intact
• Surrounding Soft tissues are normal
• Impression :
Bilateral pneumonia
 ASSESMENT
• Typhoid fever
• Network Anoxia
• Community Acquired Pneumonia
• anemia of chronic disease
• Thrombocytopenia
• Hypoalbuminemia
• hyponatremia
 TREATMENT
- Oxygen via nasal cannula Paracetamol/intravenous (if temperature > 38.5°C or pain
- Total bed rest scale > 3NRS)
- Fluid requirement : Holiday fresh - 20% : 1350cc - 20% = Albuforce/oral
1,080 cc/ 24 hours watch for signs of tissue anoxia
- Enteral : 6x100 cc/oral Food diet
- Parenteral : Ringer Lactate Infusion 20
cc/hour/intravenous
- The sodium deficit is fulfilled by giving Ringer's Lactate
20 cc/hour
1) Cefriaxone / intravenous
2) Gentamicin / intravenous
 PLANNING
- Consult to hematoncology division
- Consult to Respirology division
THANK YOU