Virus dengue dapat menyebabkan infeksi pada semua kelompok usia dengan manifestasi klinis beragam mulai dari asimtomatik, ringan, sampai berat yang biasanya merupakan kasus fatal. Dengue berat ditandai dengan kebocoran plasma, hemokonsentrasi, dan gangguan hemostasis. Penelitian ini bertujuan untuk mengetahui karakteristik penderita dengue berat yang dirawat di ruang Pediatric Intensive Care Unit (PICU) RS Dr. Hasan Sadikin Bandung sejak Januari 2009 sampai Desember 2010. Penelitian dilakukan secara retrospektif deskriptif berdasarkan data dari rekam medis penderita. Sebanyak 21 penderita dengue berat dirawat selama 2 tahun, 15/21 penderita perempuan dan 6/21 laki-laki, serta 5/21 anak meninggal dunia selama dirawat dengan sebab kematian tersering sindrom syok dengue (SSD) dan kogagulopati intravaskular diseminata (KID). Sebagian besar penderita berusia 1−5 tahun dengan status gizi baik. Hepatomegali ditemukan pada semua penderita dengan hematokrit rata-rata 38%. Pada penelitian ini, manifestasi klinis dengue berat berupa SSD (15/21), KID (11/21), ensefalopati (6/21), efusi pleura (5/21), miokarditis (3/21), serta acute respiratory distress syndrome (3/21). Simpulan, dengue berat lebih banyak didapatkan pada anak perempuan, usia 1-5 tahun, serta status gizi baik. Manifestasi klinis dengue berat yang dominan berupa syok, koagulasi intravaskular diseminata, dan ensefalopati. [MKB. 2012;44(3):147-51].
AbstrakPada pneumonia berat, terjadi koagulasi intravaskular dan intraalveolar yang merupakan respons proses inflamasi lokal dan sistemik infeksi paru. Konsekuensi klinis dari perubahan koagulasi ini yaitu peningkatan kadar D-dimer plasma sebagai petanda aktivitas koagulasi dan fibrinolisis serta meluasnya disfungsi organ bahkan kematian. Tujuan penelitian ini untuk mengetahui validitas kadar D-dimer plasma yang tinggi sebagai prediktor kematian penderita pneumonia usia 2 sampai 59 bulan. Penelitian ini merupakan penelitian observasional analitik dengan rancangan prospektif yang dilaksanakan di Rumah Sakit Dr. Hasan Sadikin Bandung. Subjek penelitian anak usia 2 sampai 59 bulan yang didiagnosis sebagai pneumonia dan berobat ke Instalasi Gawat Darurat Anak selama bulan Oktober-November 2009. Pemeriksaan D-dimer plasma dilakukan saat penderita datang dan kemudian dilakukan observasi sampai penderita meninggal atau dipulangkan dari rumah sakit. Empat puluh lima anak ikut serta dalam penelitian ini, 15 (33%) di antaranya meninggal selama observasi. Kadar D-dimer plasma menunjukkan hubungan yang bermakna (p=0,04) terhadap kematian penderita pneumonia dengan median dan rentang sebesar 0,60 mg/L (0,1-5,10 mg/L). Cut-off point D-dimer plasma >0,4 mg/L sebagai prediktor kematian penderita pneumonia memberikan sensitivitas 73,3% (IK 95%; 44,9-92,0) dan spesifisitas 70,0% (IK 95%; 50,6-85,2%) dengan akurasi 71,1%. Simpulan, kadar D-dimer plasma yang tinggi dapat memprediksi kematian penderita pneumonia usia 2 sampai 59 bulan. [MKB. 2012;44(1):57-62].Kata kunci: Kadar D-dimer plasma, koagulasi, pneumonia, prediktor kematian Plasma D-Dimer Level as Predictor of Mortality in 2-59-Month-OldPneumonia Patients Abstract Intravascular and intraalveolar coagulation can be found in severe pneumonia as a response to local and systemic inflammation process in severe pneumonia. Clinical consequences of this coagulation changes is an increase of plasma D-dimer levels as a marker of coagulation and fibrinolyis activation, the number of organ dysfunction even death. The aim of this study was to understand the validity of high plasma D-dimer levels as a predictor of mortality in 2 to 59-month-old pneumonia patients. This was a prospective observational analytic study which was held in Dr. Hasan Sadikin Hospital Bandung. The subjects of this study were 2 to 59 months old children who were diagnosed as pneumonia and visited Pediatric Emergency Departement during October-November 2009. Plasma D-dimer assay was performed at admission and observed until the patient died or discharged from the hospital. Forty-five children were included in this study, 15 (33%) died during observation. Plasma D-dimer level showed significant correlations (p=0.04) with the mortality in 2 to 59-month-old pneumonia patients with median and range of 0.60 mg/L (0.1-5.10 mg/L). Plasma D-dimer cut-off point of >0.4 mg/L gave 73.3% sensitivity (CI 95%, 44.9-92.0%), and 70.0% specificity (CI 95%, 50.6-85.2%) with 71.1% accuracy for predicting mortality in 2 to 59-month-ol...
We report a case of a 10-month infant with dual severe infection of COVID-19 and dengue fever who was admitted to the hospital with an influenza-like illness. The patient experienced severe conditions of COVID-19 and dengue fever with shock followed by disseminated intravascular coagulation. The standard of COVID-19 care was given coupled with fluid resuscitation and blood transfusion. The pitfalls of this case are how to differentiate the clinical manifestation of dengue fever in a patient with confirmed COVID-19; the difficulty to monitor the dengue course of illness of the patient in the COVID-19 isolation room; and to differentiate the severe dengue from the multisystem inflammatory syndrome-C when the patient was in critical condition. The infant recovered without sequale, but the management of new probable cases must be improved more thoroughly, especially during dengue peak period in tropical and developing countries such as Indonesia.
Background: Chronic kidney disease (CKD) in children has a long-lived impact, such as an increased risk of bacterial infection. Infection may accelerate disease progression, making early detection crucial. Inflammatory markers typically used for bacterial infection are C-Reactive Protein (CRP) and Procalcitonin (PCT). This study aimed to determine the correlation between levels of neutrophil-to-lymphocyte ratio (NLR) and immature-to-total-neutrophil ratio (I/T ratio) to bacterial infection in children with CKD as indicated by the serum levels of CRP and PCT.Methods: Observational analysis with a cross-sectional design was conducted from January 2019 to November 2021 in children from 3 months to 18 years old with CKD and bacterial infection. Retrospective data were obtained from medical records at Dr. Hasan Sadikin General Hospital, Bandung. Correlation analysis was performed (SPSS program) at a 95% confidence level, and results were considered significant if the p-value <0.05.Results: There were 42 children, and 57% were female; with a median age of 13 years (range 1–17 years). Most patients had normal nutritional status (55%) although 40% were malnourished. Correlation analysis between I/T ratio and NLR with PCT was positive, with r=0.284 (p<0.05) and r=0.265 (p<0.05), respectively, whereas there was no significant correlation of I/T ratio (r=0,154; p>0.05) and NLR (r=0,188; p>0.05) to CRP.Conclusions: NLR and I/T ratios have a significant positive correlation with PCT levels but not with CRP levels. NRL and I/T ratios can be considered as alternative markers for diagnosing CKD in children with a bacterial infection.
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