Heda Melinda Nataprawira

Critical Pertussis in a Young Infant Requiring Mechanical Ventilation

Pertussis may likely be misdiagnosed in its initial or catarrhal phase as a common respiratory infection. The earlier diagnosis of pertussis really depends on the capability of the medical professional especially in the first line public health services. The lack of awareness in diagnosis of severe pertussis as one of the causes of severe respiratory problems may likely misdiagnose pertussis as respiratory failure or even septic shock. In fact, pertussis may manifest as a critical pertussis which can be fatal due to the respiratory failure that require pediatric intensive care unit using mechanical ventilation. We reported a confirmed pertussis case of a 7-weeks-old female infant referred to our tertiary hospital with gasping leading to respiratory failure and septic shock requiring mechanical ventilation, aggressive fluid therapy, and antibiotics. Pertussis was diagnosed late during the course of illness when the patient was hospitalized. Improvement was noted after administering macrolide which gave a good response. Bordetella pertussis isolation from Bordet-Gengou media culture yielded positive result.

Pertussis in Children: Problems in Indonesia

The burden of pertussis cases has dramatically resurged and increased in highly immunized countries. However, in Indonesia those cases are still under diagnosed because of lack of awareness and laboratory support to confirm pertussis diagnoses. This review article will discuss about pertussis in children, the magnitude problems in Indonesia. We searched databases including Pubmed/MEDLINE database, Elsevier, and also official website for the following keywords: Pertussis, whooping cough, children, diagnosis and treatment, problem, Indonesia. We reviewed the most recent algorithm, case classification, and guidelines by World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) and also some problems in Indonesia in diagnose and treat children with pertussis. In Indonesia most cases are diagnosed as having bronchopneumonia while later known as probable pertussis. To understand this disease and its problems in Indonesia, it is important to enhanced awareness of diagnose and treat pertussis in children.

Peran Asthma Control Test (ACT) dalam Tata laksana Mutakhir Asma Anak

Asma adalah penyakit kronik yang sampai saat ini belum dijumpai obat yang bisa menyembuhkannya. Maka tidak ada istilah sembuh untuk asma, namun asma dapat terkontrol. Strategi tata laksana asma saat ini lebih menitikberatkan pada mengontrol asma secara klinis daripada menentukan klasifikasi derajat penyakit serta tata laksana serangan akut. Untuk mengontrol asma diperlukan suatu alat sederhana dan praktis yang dapat digunakan dalam praktek sehari-hari dan salah satunya adalah asthma control test (ACT). Untuk anak usia 4-11 tahun, ACT memuat empat pertanyaan yang dapat diisi oleh anak dan tiga pertanyaan yang diisi orangtua apabila skor >20 dinyatakan asma terkontrol. Untuk usia >12 tahun terdapat lima pertanyaan yang diisi oleh anak. Skor 25 berarti asma anak terkontrol total, sedangkan skor 20-24 dinyatakan on target yang berarti asma terkontrol baik tetapi belum mencapai terkontrol total. Apabila skor <20 menunjukkan off target yang berarti asma tidak terkontrol. Setelah asma terkontrol, pengawasan secara berkala tetap diperlukan.

Meningoencephalitis tuberculosis as a paradoxical response to anti-tuberculous therapy in a child with pulmonary tuberculosis - a case report

This paper reports a case of meningoencephalitis tuberculosis as a paradoxical response to anti-tubercu- lous therapy in a child with pulmonary tuberculosis.

BNP as Predictor of Pediatric Severe Sepsis Fluid Responsiveness in Limited Resource Setting Country

Fluid responsiveness is an important aspect in severe sepsis management, assessed by static and dynamic parameter tools. Unfortunately, they are not widely used in limited resource setting. Brain natriuretic peptide is cardiac hormone correlated with CVP measurement as one of the static parameter, but its associations with dynamic parameter has not studied yet. Objective: To investigate whether BNP might predict fluid responsiveness based on clinical and inferior vena cava index criteria. Study Design: A cross sectional study was conducted on 59 severe sepsis subjects aged 1–14 years who met the inclusion criteria enrolled through consecutive sampling during October 2013 to March 2014. Patients were given fluid resuscitation based on 2012 Surviving Sepsis Campaign. BNP measurements were performed at 0 and 1 hour after fluid resuscitation. Responder and non-responder groups were classified based on clinical and IVC index criteria. Ultrasound using M Mode was performed to calculate IVC index. Unpaired t test and receiver operating characteristic curves were generated for BNP to predict fluid responsiveness. Results: Baseline characteristics between responder and non-responder groups were almost similar. Initial BNP between groups using both criteria were not significantly different (p>0.05). The area under curve of BNP0 was 0.04. The best cut off values of log BNP to predict fluid responsiveness was 1.9pg/mL. BNP ≤1.9 pg/mL has a sensitivity, specificity, negative predictive value and positive predictive value of each were 50%, 50%, 50%, 50%, respectively. Conclusion: BNP cannot reflect and accurately predict fluid responsiveness due to multifactorial factors of raising BNP and mostly subject were spontaneous breathing which more difficult to predict.

A retrospective study of acute pertussis in Hasan Sadikin Hospital–Indonesia

Abstract Objective To describe the representation of pertussis diagnosis in children. Methods A retrospective observational study was performed on pediatric pertussis and pertussis-like syndrome registry for children Bordetella pertussis ( B. pertussis ) culture, complications, and outcome were recorded. Results Sixty-one probable and two confirmed pertussis were documented. Male and female ratio was 1:1, mostly presented with shortness of breath, 24 (38%) subjects had posttussive vomiting, 10 (16%) had whooping-cough. Ten patients (16%) were reported to have adult possible pertussis contact. Only 2 infants had previous pertussis vaccination. All subjects presented in the second week of illness were all diagnosed as bronchopneumonia but two. The mean age was 6 months, ranging from 0–50 months. One subject required mechanical ventilation. B. pertussis culture was performed only in 35 (56%) subjects but positive only in two. There were no fatal cases, 55 (87%) including the subject who need mechanical ventilation had good outcome. Conclusions Mostly patients were admitted on paroxysmal phase when no more active B. pertussis could be found from nasopharyngeal secret. A rigorous history taking particularly excessive cough, posttussive vomitting, and pertussis vaccination status need to be taken into account.