Heda Melinda D. Nataprawira
Bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjadjaran, Rumah Sakit Hasan Sadikin

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Tuberkulosis Perinatal Bermanifestasi sebagai Tuberkulosis Milier dan Meningitis Nataprawira, Heda Melinda D.; Faisal, Faisal
Majalah Kedokteran Bandung Vol 42, No 3 (2010)
Publisher : Fakultas Kedokteran, Universitas Padjadjaran

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Abstract

Tuberkulosis (TB) perinatal adalah kasus TB yang jarang dilaporkan karena manifestasi klinis tidak spesifik, serta terdapat permasalahan dalam pemeriksaan laboratorium dan radiologis sehingga tidak terdiagnosis. Istilah TB perinatal menjelaskan adanya infeksi Mycobacterium tuberculosis yang terjadi pada masa perinatal baik selama kehamilan, persalinan, maupun pascapersalinan dalam masa neonatus. Seorang bayi laki-laki usia tiga bulan dirujuk ke Emergensi Anak Rumah Sakit Hasan Sadikin dengan riwayat demam lama dan tidak mau menetek. Proses kelahiran tidak ada masalah. Pada pemeriksaan fisis ditemukan letargis, febris, takipnea, dan hepatosplenomegali. Pewarnaan Ziehl Neelsen aspirat lambung menunjukkan basil tahan asam positif. Uji kulit tuberkulin menunjukkan nonreaktif, foto toraks memperlihatkan gambaran milier, dan fungsi lumbal memberikan interpretasi TB meningitis. Berdasarkan penelusuran aktif sumber penularan TB serumah, ternyata ayah dan kakek bayi merupakan sumber penularan. Selain diberikan paduan oral antituberkulosis standar, juga diberikan antibiotik dan prednison. Dalam perjalanan penyakitnya, terjadi syok sepsis serta koagulasi intravaskular diseminata dan bayi meninggal. Dari kultur darah teridentifikasi Staphylococcus haemolyticus. Disimpulkan bahwa walaupun tidak terdapat permasalahan saat kelahiran bayi, diperlukan penelusuran aktif kemungkinan TB perinatal pada keluarga dengan sumber penularan TB positif. Diperlukan kewaspadaan terdapatnya TB pada wanita hamil di negara berkembang dengan jumlah kasus TB tinggi. [MKB. 2010;42(3):135-9].Kata kunci: tuberkulosis perinatal Perinatal Tuberculosis Presenting as Miliary Tuberculosis and MeningitisPerinatal tuberculosis (TB) is rarely reported, because the clinical manifestations are not specific and there is a problem in its laboratory and radiology examination which caused undiagnosed. Perinatal TB is the preferred description that encompasses TB acquired either intra uterine, during or post delivery in early newborn period. A-3- month old baby was transferred to Pediatric Emergency Hasan Sadikin Hospital because of prolong fever and unable to breastfeed. There was no problem with delivery. Lethargic, fever, tachypnea, and hepatosphlenomegali were found on physical examination. Ziehl Neelsen smear of gastric lavage yielded positive acid fast bacilli. Tuberculine test was non reactive, chest x-ray showed a miliary pattern, and cerebral spinal fluid analysis gave tuberculous meningitis interpretation. By active finding, his father and grandfather were detected as a source of TB transmission. In additon to oral antituberculosis regimen, antibiotics and prednison were also given. Septic shock and disseminated intravascular coagulation were occurred during his illness and the baby died. Staphylococcus haemolyticus was identified from blood culture. In conclusion, although there were no problems during labor, active investigation of perinatal TB possibility is required on the family with a source of TB. Caution on TB in pregnant women is necessary at developing country with high rates of TB. [MKB. 2010;42(3):135-9].Key words: Disseminated intravascular coagulation, miliary, meningitis, perinatal tuberculosis
TROMBOEMBOLI PARU PADA ANAK Wulandari, Diah Asri; Nataprawira, Heda Melinda D.
Majalah Kedokteran Bandung Vol 41, No 1 (2009)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tromboemboli paru dapat terjadi akibat adanya obstruksi pembuluh darah paru oleh trombi. Tromboemboli paru jarang didiagnosis dan dilaporkan pada anak, kebanyakan bahkan tidak terdiagnosis sampai setelah dilakukan otopsi. Penyakit yang pada dewasa meningkatkan risiko terjadinya tromboemboli juga berlaku untuk anak dan remaja. Penderita dengan tromboemboli paru biasanya mempunyai penyakit yang mendasari ataupun faktor pencetus, seperti imobilisasi, penggunaan vena sentral, penyakit jantung, trauma, operasi, infeksi, dehidrasi, keganasan, kelainan hematologi, serta kegemukan. Lokasi anatomis trombus vena pada anak berbeda dengan dewasa yaitu pada vena kranialis dan abdominalis, serta seringkali manifestasi klinisnya tidak jelas. Pada anak, tomboemboli paru harus dipertimbangkan pada beberapa keadaan, antara lain dalam mengevaluasi hipertensi paru yang tidak bisa diterangkan penyebabnya, insufisiensi respirasi, dan koagulasi intravaskular diseminata (KID). Pemeriksaan angiografi paru masih merupakan gold-standard untuk mendiagnosis tromboemboli paru dan merupakan pemeriksaan yang invasif. Pemeriksaan non-invasif multidetector helical/spiral computerized tomography scanning yang mempunyai sensitivitas dan spesifisitas tinggi merupakan teknik yang diharapkan dapat menggantikan pemeriksaan angiografi paru. Protokol pengobatan untuk anak masih belum berkembang, tetapi hingga saat ini antikoagulasi merupakan obat yang digunakan untuk mencegah perluasan bekuan dan rekurensi tromboemboli.Kata kunci: Tromboemboli paru, angiografi paru, multidetector helical/spiral computerized tomography scanning, anakPULMONARY THROMBOEMBOLISM IN CHILDRENPulmonary thromboembolism could be happened because of pulmonary vessel obstruction by thrombi. Pulmonary thromboembolism is rarely diagnosed and reported in children, most of them are not diagnosed before autopsy was done. All adult diseases that increase the risk of thromboembolism occur in children and adolescent as well. Patients with pulmonary thromboembolism usually have serious underlying disorders or precipitating factors, such as immobility, central venous catheterization, heart disease, trauma, surgery, infection, dehydration, malignancies, hematologic disorders, and obesity. The anatomic site of venous thrombi in children differs from those in adult, which more likely to involve cranial or abdominal veins, and often asymptomatic. Pulmonary thromboembolism in children should be considered in the evaluation of unexplained pulmonary hypertension, respiratory insufficiency, and disseminated intravascular coagulation. Pulmonary angiography is considered to be the gold-standard for diagnosis of pulmonary thromboembolism, and it is an invasive procedure. Non-invasif procedure multidetector helical/spiral computerized tomography scanning with high sensitivity and specificity is promising technique may replace pulmonary angiography. Although definitive protocols for treatment of pulmonary thromboembolism in children have not been improved yet, but until now anticoagulation drugs is used to prevent clot extension and recurrent thromboembolim.Key words: Pulmonary thromboembolism, pulmonary angiography, multidetector helical/spiral computerized tomography scanning, children DOI: http://dx.doi.org/10.15395/mkb.v41n1.257
Tuberculosis prevalence among underfive children in household contact with negative acid fast bacilli adult pulmonary tuberculosis Iskandar, Harry; Nataprawira, Heda Melinda D.; Garna, Herry; Djais, Julistio T.B.
Paediatrica Indonesiana Vol 48 No 1 (2008): January 2008
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi48.1.2008.18-22

Abstract

Background Risk of tuberculosis (TB) transmission is greatest if achild has household contact with positive acid fast bacilli (AFB)adult pulmonary TB. Risk of TB transmission from negative AFBadult pulmonary TB to underfive children is unknown.Objective To find out the prevalence of TB infection and diseaseamong underfive children in household contacts with negativeAFB adult pulmonary TB.Methods The study was performed at Balai Kesehatan ParuMasyarakat (BKPM) Bandung on underfive children who live inthe same house with negative AFB adult pulmonary TB fromFebruary to July 2006. History taking, physical examination,anthropometric measurement, chest radiographs, and tuberculinskin test were performed to all study subjects. Subjects were thencategorized as TB infection(positive tuberculin test only) or disease(defined based on Pulmonology Workgroup of IndonesianPaediatrics Council criteria, 2005).Results Sixty one children (32 males and 29 females) had contactwith 54 negative AFB adults pulmonary TB. Tuberculosis infectionwas found in six (10%), while disease was found in 10 (16%)children. The prevalence of TB infection was 10% (95% CI2.3;17.3) while prevalence of TB disease was 16% (95% CI7.1;24.7).Conclusion Tuberculosis infection and disease prevalence isconsiderably high in household contact with negative EFB adultpulmonary TB.
TROMBOEMBOLI PARU PADA ANAK Wulandari, Diah Asri; Nataprawira, Heda Melinda D.
Majalah Kedokteran Bandung Vol 41, No 1
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tromboemboli paru dapat terjadi akibat adanya obstruksi pembuluh darah paru oleh trombi. Tromboemboli paru jarang didiagnosis dan dilaporkan pada anak, kebanyakan bahkan tidak terdiagnosis sampai setelah dilakukan otopsi. Penyakit yang pada dewasa meningkatkan risiko terjadinya tromboemboli juga berlaku untuk anak dan remaja. Penderita dengan tromboemboli paru biasanya mempunyai penyakit yang mendasari ataupun faktor pencetus, seperti imobilisasi, penggunaan vena sentral, penyakit jantung, trauma, operasi, infeksi, dehidrasi, keganasan, kelainan hematologi, serta kegemukan. Lokasi anatomis trombus vena pada anak berbeda dengan dewasa yaitu pada vena kranialis dan abdominalis, serta seringkali manifestasi klinisnya tidak jelas. Pada anak, tomboemboli paru harus dipertimbangkan pada beberapa keadaan, antara lain dalam mengevaluasi hipertensi paru yang tidak bisa diterangkan penyebabnya, insufisiensi respirasi, dan koagulasi intravaskular diseminata (KID). Pemeriksaan angiografi paru masih merupakan gold-standard untuk mendiagnosis tromboemboli paru dan merupakan pemeriksaan yang invasif. Pemeriksaan non-invasif multidetector helical/spiral computerized tomography scanning yang mempunyai sensitivitas dan spesifisitas tinggi merupakan teknik yang diharapkan dapat menggantikan pemeriksaan angiografi paru. Protokol pengobatan untuk anak masih belum berkembang, tetapi hingga saat ini antikoagulasi merupakan obat yang digunakan untuk mencegah perluasan bekuan dan rekurensi tromboemboli.Kata kunci: Tromboemboli paru, angiografi paru, multidetector helical/spiral computerized tomography scanning, anakPULMONARY THROMBOEMBOLISM IN CHILDRENPulmonary thromboembolism could be happened because of pulmonary vessel obstruction by thrombi. Pulmonary thromboembolism is rarely diagnosed and reported in children, most of them are not diagnosed before autopsy was done. All adult diseases that increase the risk of thromboembolism occur in children and adolescent as well. Patients with pulmonary thromboembolism usually have serious underlying disorders or precipitating factors, such as immobility, central venous catheterization, heart disease, trauma, surgery, infection, dehydration, malignancies, hematologic disorders, and obesity. The anatomic site of venous thrombi in children differs from those in adult, which more likely to involve cranial or abdominal veins, and often asymptomatic. Pulmonary thromboembolism in children should be considered in the evaluation of unexplained pulmonary hypertension, respiratory insufficiency, and disseminated intravascular coagulation. Pulmonary angiography is considered to be the gold-standard for diagnosis of pulmonary thromboembolism, and it is an invasive procedure. Non-invasif procedure multidetector helical/spiral computerized tomography scanning with high sensitivity and specificity is promising technique may replace pulmonary angiography. Although definitive protocols for treatment of pulmonary thromboembolism in children have not been improved yet, but until now anticoagulation drugs is used to prevent clot extension and recurrent thromboembolim.Key words: Pulmonary thromboembolism, pulmonary angiography, multidetector helical/spiral computerized tomography scanning, children DOI: http://dx.doi.org/10.15395/mkb.v41n1.257
Tuberkulosis Perinatal Bermanifestasi sebagai Tuberkulosis Milier dan Meningitis Nataprawira, Heda Melinda D.; Faisal, Faisal
Majalah Kedokteran Bandung Vol 42, No 3
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Tuberkulosis (TB) perinatal adalah kasus TB yang jarang dilaporkan karena manifestasi klinis tidak spesifik, serta terdapat permasalahan dalam pemeriksaan laboratorium dan radiologis sehingga tidak terdiagnosis. Istilah TB perinatal menjelaskan adanya infeksi Mycobacterium tuberculosis yang terjadi pada masa perinatal baik selama kehamilan, persalinan, maupun pascapersalinan dalam masa neonatus. Seorang bayi laki-laki usia tiga bulan dirujuk ke Emergensi Anak Rumah Sakit Hasan Sadikin dengan riwayat demam lama dan tidak mau menetek. Proses kelahiran tidak ada masalah. Pada pemeriksaan fisis ditemukan letargis, febris, takipnea, dan hepatosplenomegali. Pewarnaan Ziehl Neelsen aspirat lambung menunjukkan basil tahan asam positif. Uji kulit tuberkulin menunjukkan nonreaktif, foto toraks memperlihatkan gambaran milier, dan fungsi lumbal memberikan interpretasi TB meningitis. Berdasarkan penelusuran aktif sumber penularan TB serumah, ternyata ayah dan kakek bayi merupakan sumber penularan. Selain diberikan paduan oral antituberkulosis standar, juga diberikan antibiotik dan prednison. Dalam perjalanan penyakitnya, terjadi syok sepsis serta koagulasi intravaskular diseminata dan bayi meninggal. Dari kultur darah teridentifikasi Staphylococcus haemolyticus. Disimpulkan bahwa walaupun tidak terdapat permasalahan saat kelahiran bayi, diperlukan penelusuran aktif kemungkinan TB perinatal pada keluarga dengan sumber penularan TB positif. Diperlukan kewaspadaan terdapatnya TB pada wanita hamil di negara berkembang dengan jumlah kasus TB tinggi. [MKB. 2010;42(3):135-9].Kata kunci: tuberkulosis perinatal Perinatal Tuberculosis Presenting as Miliary Tuberculosis and MeningitisPerinatal tuberculosis (TB) is rarely reported, because the clinical manifestations are not specific and there is a problem in its laboratory and radiology examination which caused undiagnosed. Perinatal TB is the preferred description that encompasses TB acquired either intra uterine, during or post delivery in early newborn period. A-3- month old baby was transferred to Pediatric Emergency Hasan Sadikin Hospital because of prolong fever and unable to breastfeed. There was no problem with delivery. Lethargic, fever, tachypnea, and hepatosphlenomegali were found on physical examination. Ziehl Neelsen smear of gastric lavage yielded positive acid fast bacilli. Tuberculine test was non reactive, chest x-ray showed a miliary pattern, and cerebral spinal fluid analysis gave tuberculous meningitis interpretation. By active finding, his father and grandfather were detected as a source of TB transmission. In additon to oral antituberculosis regimen, antibiotics and prednison were also given. Septic shock and disseminated intravascular coagulation were occurred during his illness and the baby died. Staphylococcus haemolyticus was identified from blood culture. In conclusion, although there were no problems during labor, active investigation of perinatal TB possibility is required on the family with a source of TB. Caution on TB in pregnant women is necessary at developing country with high rates of TB. [MKB. 2010;42(3):135-9].Key words: Disseminated intravascular coagulation, miliary, meningitis, perinatal tuberculosis DOI: http://dx.doi.org/10.15395/mkb.v42n3.25