Post on 02-Jun-2018
8/11/2019 44975892 Case Report Print
1/38
8/11/2019 44975892 Case Report Print
2/38
CHAPTER II
2.1. Epidemiology
nce!ha$itis is more common in chi$dren and young adu$ts" %bout in 200,000
!eo!$e deve$o! ence!ha$itis each year in the 1nited States" #hi$e anyone can
succumb, chi$dren, the e$der$y, and those 'ith 'eaened immune systems are
more vu$nerab$e"2
3ncidence o& ence!ha$itis throughout the 'or$d is di&&icu$t to determine
because the disease is o&ten underre!orted" %!!roimate$y )0 to (000 cases,
most o& 'hich are mi$d, may occur each year in the 1nited States" 4er!esvirus
accounts &or most cases o& ence!ha$itis in the 1nited States" %rbovira$
ence!ha$itis is more !reva$ent in 'arm c$imates and incidence varies considerab$y
&rom area to area and &rom year to year" St" Louis ence!ha$itis is the most
!reva$ent ty!e o& arbovira$ ence!ha$itis in the 1nited States, and 5a!anese
ence!ha$itis is the most !reva$ent ty!e in other !arts o& the 'or$d" 2
2.2. Deinition
nce!ha$itis is an in&$ammatory !rocess o& the brain !arenchyma that usua$$y is an
acute !rocess, but maybe a !ostin&ectious ence!ha$omye$itis, a chronic
degenerative disease, or a s$o' vira$ in&ection" nce!ha$itis resu$ts &rom
in&$ammation o& the brain !arenchyma, $eading to cerebra$ dys&unction"
nce!ha$itis may be di&&use or $oca$ized" 6rganisms cause ence!ha$itis by one o&
t'o mechansms : " Direct in&ection o& the brain !arenchyma or 2" %n a!!arent
immunemediate res!onse in the 7NS tahat usua$$y begins severa$ days a&ter the
a!!earance o& etraneura$ mani&estations o& the in&ection"2
2.!. Etiology
8iruses are the !rinci!a$ causes o& acute in&ectious ence!ha$itis" nce!ha$itis a$so
may resu$t &rom other ty!es in&ection and metabo$ic, toic, and neo!$astic
2
8/11/2019 44975892 Case Report Print
3/38
disoerder" The most common vira$ causes o& ence!ha$itis in the 1"S" are the
arboviruses, enteroviruses, and her!esviruses" 438 is an im!ortant cause o&
ence!ha$itis in chi$dren and ado$escents and may !resents as an acute &ebri$e
i$$ness, but more common$y is insidious in onset"2
%cute disseminated ence!ha$omye$itis 9%D; is the abru!t deve$o!ment
o& mu$ti!$e neuro$ogic signs re$ated to an in&$ammatory, demye$inating disorder o&
the brain and s!ina$ cord" %cute disseminated ence!ha$omye$itis &o$$o's
chi$dhood vira$ in&ections, such as meas$es and chicen!o or vaccinations" %cute
disseminated ence!ha$omye$itis resemb$es mu$ti!$e sc$erosis"2
Primary nce!ha$itis
8/11/2019 44975892 Case Report Print
4/38
8/11/2019 44975892 Case Report Print
5/38
* astern e-uine
* #estern e-uine
* 8enezue$an e-uine
* St" Louis" Po'asson
* isce$$aneous 7a$i&ornia
8ascu$itis
Tab$e " Pathogens o& nce!ha$itis 3
2.(. P)t*op*y+iology
There are at $east t'o &orms o& in&ection*re$ated ence!ha$itis:!rimary and !ost* or
!arain&ectious" % !rimary ence!ha$itis resu$ts &rom direct 7NS invasion by the
o&&ending agent, and the gray matter o&ten is targeted" % !ostin&ectious or
!arain&ectious ence!ha$itis !resents much $ie a !rimary ence!ha$itis, but the
i$$ness is not caused by direct 7NS in&ection" 3n !ost/!arain&ectious ence!ha$itis,
neuro$ogic e&&ects are the conse-uence o& the host@s immune res!onse, 'hich
o&ten a&&ects the 'hitematter"(
The !athogenesis o& !rimary ence!ha$itis is diverse and incom!$ete$y
understood" 6rganisms in&ecting the brain direct$y &irst must gain entry to the
7NS" Some !athogens such as arboviruses initia$$y cause b$oodstream in&ection,
then enter the 7NS via endothe$ia$ ce$$ in&ection, endothe$ia$ ce$$ trans!ort, or
carriage in ce$$s entering the 7NS" nce!ha$itis tends to be a rare com!$ication
a&ter viremia because entry to the brain is care&u$$y regu$ated at the b$ood*brain
barrier" %n a$ternative mechanism used by
her!es sim!$e virus 94S8;, rabies,and !ossib$y !o$iovirus is retrograde trans!ort in neurons" This strategy may be
success&u$because !athogens trave$ing inside neurons avoid immune survei$$ance"
%n a$ternative mechanism used by the amoebaNaegleria fowleriis entry through
the o$&actory mucosa"(
6nce an organism has entered the brain, a variety o& anatomic sites can
become in&ected" For eam!$e, 4S8 ty!ica$$y in&ects neurons in the tem!ora$
$obe= rabies !redominant$y a&&ects the !ons, medu$$a, cerebe$$um, and
5
8/11/2019 44975892 Case Report Print
6/38
hi!!ocam!us= and 5a!anese ence!ha$itis virus a&&ects the brainstem and basa$
gang$ia" Neuro$ogic signs and sym!toms deve$o! a&ter in&ection as the resu$t o&
directneurona$ inAury, the host in&$ammatory res!onse, or both" 4isto$ogica$$y, the
host res!onse can inc$ude !erivascu$ar in&$ammation, g$iosis, and brain edema"
Postin&ectious ence!ha$itis occurs days to 'ees a&ter the onset o& an
in&ection" 7urrent$y in the 1nited States, a minor res!iratory tract in&ection is
$ie$y to be the inciting event" .e&ore the 'ides!read use o& vira$ vaccines, a
distinctive i$$ness such as meas$es or varice$$a 'as $ie$y to be the !receding
event,and ence!ha$itis may &o$$o' these in&ections in regions 'here they remain
common" .ecause the inciting !athogen is not detected in the 7NS in
!ostin&ectious ence!ha$itis, the i$$ness is hy!othesizedto be caused by an aberrant
immune res!onse against brain antigenssuch as mye$in basic !rotein" Subse-uent
demye$ination causes&oca$ or g$oba$ 7NS dys&unction" Postin&ectious ence!ha$itis
o&ten is ca$$ed acute disseminated ence!ha$omye$itis 9%D;"(
2.,. Di)gno+i+
Hi+tory
* %s about a vira$ !rodrome 'ith sym!toms such as u!!er res!iratory
in&ection, cough, coryza, ma$aise, anoreia, decreased entera$ intae, diarrhea,
nausea, and vomiting"
* nce!ha$itis is o&ten hera$ded by headaches, !hoto!hobia, a sti&& nec,
increased s$ee!ing, change in menta$ status, irritabi$ity, con&usion,
ha$$ucinations, seizures"
* Prodroma$ sym!toms can range &rom hours to 'ees= seizures or sudden
$a!se o& consciousness are uncommon as initia$ sym!toms o& ence!ha$itis"
* 3n-uire about recent trave$ history, !ets, and tic or mos-uito bites" 3
P*y+ic)l E-)m
6
8/11/2019 44975892 Case Report Print
7/38
%$though the causes di&&er, the c$inica$ sym!toms o& ence!ha$itis is more or $ess
the same and uni-ue so it can be used as diagnostic criteria" 3n genera$, sym!toms
o& ence!ha$itis triad consisting o& &ever, convu$sions and decreased
consciousness"7
%&ter an incubation !eriod o& a!!roimate$y )*0 days there 'i$$ be a
sudden increase in tem!erature, o&ten occur hi!er!iresia, big headache in
chi$dren, screaming at the chi$d" Found signs o& 7NS stimu$ation 9coma, stu!or,
$ethargy;, sti&& nec, increased tendon re&$ees, tremors, musc$e 'eaness and
sometimes !ara$ysis" 7$inica$ mani&estations o& bacteria$ ence!ha$itis, in the
beginning there are no ty!ica$ sym!toms such as genera$ized in&ection, then
emerged signs o& increased intracrania$ !ressure headache, vomiting, no a!!etite,
&ever, b$urred vision, genera$ or &oca$ seizures and decreased consciousness"
Sym!toms o& crania$ Nervi de&icit, hemi!aresis, increased tendon re&$ees, sti&&
nec, a!hasia, hemiano!ia, nistagmus and ataia"8
7auses o& neuro$ogica$ abnorma$ities 9neuro$ogica$ de&icit; is a direct
invasion and destruction o& brain tissue by a virus that is being breed= nerve tissue
reaction against vira$ antigens that 'i$$ resu$t in demye$ination, vascu$ar damage,
and !aravasu$ar= and because the activation reaction neurotro!hic virus that is
$atent"7
3n vira$ ence!ha$itis ear$y sym!toms o& mi$d headache, &ever, sym!toms o&
u!!er res!iratory in&ections or gastrointestina$ tract &or a &e' days $ater came the
signs o& 7NS in&$ammation, such as sti&& nec, a sign o& !ositive ernig, aniety,
'eaness and di&&icu$ty s$ee!ing" Neuro$ogic de&icits that arise de!ending on
'here the damage" Furthermore, consciousness begins to dec$ine unti$ the coma,
or &oca$ seizures may occur common$y, hemi!aresis, im!aired coordination,
!ersona$ity disorders, disorientation, im!aired s!eech and menta$ disorders"
7$inica$ &indings in ence!ha$itis is determined by 9; 'eight and anatomica$
$oca$ization o& nervous system that $oos 92; !athogenicity agents that attac 9(;
immunity and reactive mechanisms other !atients"6
7
8/11/2019 44975892 Case Report Print
8/38
Di)gno+tic Te+t
Ty!ica$$y, a doctor 'i$$ as &or a b$ood sam!$e and order a $umbar !uncture
9sometimes ca$$ed a s!ina$ ta!;, in 'hich a need$e is inserted into the $o'er bac
and a sma$$ amount o& &$uid 9ca$$ed 7SF or cerebra$*s!ina$ &$uid; is taen &rom the
s!ina$ cana$" Some hos!ita$s are a$so e-ui!!ed to tae a bio!sy, 'here a tiny
amount o& tissue is taen &rom the brain 'hi$e the !atient is under genera$
anesthesia" Doctors a$so &re-uent$y order a 7T scan or agnetic ?esonance 3mage
9?3;, in 'hich com!uterized images o& the brain are obtained that sho' the
etent o& the s'e$$ing and damage to the brain" %nother test sometimes used to
he$! con&irm a diagnosis is an e$ectroence!ha$ogram 9>;, 'hich records
e$ectrica$ events in the brain"6
2.. Dierenti)l Di)gno+i+
* eningitis
* nce!ha$o!athy
* .rain %bscess
* Subarachnoid hemorrhage
* .rain tumor" 6
2./. Complic)tion
Neuro$ogica$ com!$ications that may be !ermanent or im!rove as the in&ection
runs its course inc$ude the &o$$o'ing= %$tered menta$ state 9e"g", disorientation,
!ersona$ity changes;, convu$sions, droo!ing eye$ids 9!tosis;, doub$e vision
9di!$o!ia;, crossed eyes 9strabismus;, hy!eractive dee! tendon re&$ees, increased
intracrania$ !ressure, $oss o& consciousness, menta$ retardation, motor
dys&unction, !artia$ !ara$ysis 9!aresis; o& the etremities, !roAecti$e vomiting,
!u!i$ irregu$arities, rest$essness, seizures and tremor"3
8
8/11/2019 44975892 Case Report Print
9/38
2./. Tre)tment
Treatment &or ence!ha$itis de!ends on the cause" Some cases o& vira$ ence!ha$itis
can be treated success&u$$y i& medication is started as soon as !ossib$e" 3& her!es
sim!$e ence!ha$itis is sus!ected, antivira$ medication such as acyc$ovir
9BoviraC; or ribavirin 98irazo$eC; is o&ten administered immediate$y to im!rove
chances &or recovery and !revent com!$ications" Side e&&ects o& these medications
inc$ude nausea, vomiting, and headache" Treatment &or vira$ ence!ha$itis a$soinc$udes !a$$iative care" There is no cure &or arbovira$ ence!ha$itis and the goa$ o&
treatment is to re$ieve sym!toms 9!a$$iative;"2,3,6
Pa$$iative care may inc$ude intravenous &$uids 9to !revent dehydration;,
antibiotics 9to !revent secondary in&ections;, and other medications 9to !revent
com!$ications;" Diuretics 9e"g", &urosemide, mannito$; may be administered to
reduce intracrania$ !ressure and benzodiaze!ines 9e"g", $oraze!am %tivanCE; may
be administered to !revent seizures"2,3,6
Ne' !atients 'ith !ossib$e ence!ha$itis shou$d be hos!ita$ized unti$ the
disa!!earance o& neuro$ogic sym!toms" anagement obAective is to maintain
organ &unction by $aboring air'ay remains o!en, entera$ or !arentera$ &eeding,
maintaining &$uid and e$ectro$yte ba$ance and acid*base disorders correction o&
b$ood" >overnance is done as &o$$o's 4:
" 6vercoming cram!s are vita$ action, because seizures in ence!ha$itis is usua$$y
severe" >iving Phenobarbita$ mg/g../2 )* hours" 3& seizures occur &re-uent$y,
shou$d be given diaze!am 90" to 0"2 mg / g; 38, in the &orm o& in&usion &or (
minutes"
2" 3m!roving homeostasis, 'ith intravenous &$uids D) * / 2 S or D) * / S
9de!ending on age; and oygen de$ivery"
(" ?educe cerebra$ edema and to reduce the im!act by anosia cerebra$ 'ith
deamethasone 0") to "0 mg / g / day iv divided into ( doses"
9
8/11/2019 44975892 Case Report Print
10/38
" Lo'ering the intracrania$ !ressure rises 'ith annito$ is given intravenous$y at
a dose o& ") to 2"0 g / g &or (0*G0 minutes" >iving can be re!eated every *2
hours" >$ycero$ can a$so, through the !i!e nasogastri, 0") to "0 m$ / g di$uted
'ith t'o !arts orange Auice" This materia$ is not toic and can be re!eated every G
hours &or a $ong time"
)"7ausative treatment"
.e&ore eti$ogi got rid o& bacteria, es!ecia$$y brain abscess 9bacteria$ ence!ha$itis;,
it must be given !arentera$ antibiotic treatment" Treatment &or ence!ha$itis due to
her!es sim!$e virus in&ection %cyc$ovir is given intravenous$y, 0 mg / g to (0
mg / g !er day &or 0 days" 3& there is to$erance then given %denine arabinose
9vidarabin;" So a$so 'hen there is recurrence a&ter treatment 'ith %cyc$ovir" #ith
the ece!tion o& the use o& %denine arabinosid to !atients by her!es sim!$e
ence!ha$itis, the treatment is done is non*s!eci&ic and em!irica$ in order to sustain
$i&e and su!!ort every organ system a&&ected" The e&&ectiveness o& various
treatments are recommended not been assessed obAective$y"
G" Physiothera!y and rehabi$itative e&&orts a&ter the !atient recovered
H" Foods high in !rotein ca$orie diet thera!y"
" 6ther, better treatment, ear$y consu$ting 'ith an anesthesio$ogist to antici!ate
the need &or arti&icia$ res!iration
2.0. Progno+i+
The !rognosis &or ence!ha$itis varies de!ends on the ty!e o& ence!ha$itis, the
!atientIs age, overa$$ hea$th, and status o& the immune system" Some cases are
mi$d, short and re$ative$y benign and !atients have &u$$ recovery" 6ther cases are
severe, and !ermanent im!airment or death is !ossib$e" The acute !hase o&
ence!ha$itis may $ast &or to 2 'ees, 'ith gradua$ or sudden reso$ution o& &ever
and neuro$ogica$ sym!toms" Neuro$ogica$ sym!toms may re-uire many months
be&ore &u$$ recovery" #ith ear$y diagnosis and !rom!t treatment, most !atients
10
8/11/2019 44975892 Case Report Print
11/38
recover &rom meningitis" 4o'ever, in some cases, the disease !rogresses so
ra!id$y that death occurs during the &irst hours, des!ite ear$y treatment" 2,4,9
2.. O3ecti4e
The aim o& this !a!er is to re!ort a case o& nce!ha$itis in a boy aged years and
J months o$d"
11
8/11/2019 44975892 Case Report Print
12/38
CHAPTER III
!.1. C)+e Report
?, a year and J months o$d boy, 'eight Hg 'ith the height o& JJcm 'as
admitted to 4" %dam a$i 4os!ita$ on Se!tember J th 200, 'ith the chie&
com!$ain is unconsciousness" This has been e!erienced by the !atient since $ast 2
days" This !atient been having seizure H days in a ro', &recuency K( times !er day
&or 0*20 minutes" 4istory o& seizure be&ore 9M;"Fever 'as &ound since 2 'ees
ago" 3t 'as very high &ever but shiverring 'as not &ound" 7ough 9*;, &$u 9*;"
1rination and de&ecation 'as norma$" 4istory o& contact 'ith T.7 !atients
negati&" There is ye$$o'ish &$uid, thic and no odor 'as &ound &rom $e&t ear since (
'ees ago"
4istory o& de$ivery 'as norma$ and aided by a mid'i&e, crying s!ontaneous$y,
and cyanosis 'as not &ound, her 'ight is 2)00 gram and $enght 'as &orgotten"4istory o& !regnancy 'as norma$" 4istory o& immunization 'as com!$ete"
Feeding history : 0*) months 'ith breast mi$"
.e&ore she 'as admitted to 4% >enera$ 4os!ita$, she 'as consu$ted &rom
!usesmas arang ?eAo" The !atient 'as initia$$y diagnosed 'ith high &ever and
seizure"
P*y+ic)l e-)min)tion
6n !hysica$ eamination, the &o$$o'ing &indings 'ere con&irmed"
% boy, 'ith body 'eight H g, body $ength 'as JJ cm, and 3D inde 'as 2,()
+, nutritiona$ status 'as normo'eight= body tem!erature 'as (H,(O 7" The $eve$
o& consciousness o& this !atient 'as >S7 982);, anemia 9*; dys!noe 9*;,
edema 9*;, cyanotic 9*;, Aaundice 9*;"
4ead :
12
8/11/2019 44975892 Case Report Print
13/38
ye : $ight re&$ees 9M/M;, isochoric !u!i$" Pa$e in&erior !a$!ebra
conAunctive 9*/*;
ars : norma$
Nose : norma$
outh : u$cus 9M; in mucosa and $i!s
Nec : norma$, no $ym!h nodes en$argement
7hest : Symmetrica$ &usi&orm, retraction 9M; e!igastria$, su!rasterna$
4? : G b!m, regu$ar, no murmur
?? : 20 t!m, regu$ar, no ra$es
%bdomina$ : soe!e$, !erista$tic 'as norma$" 4/L : im!a$!ab$e
tremities : Pu$se 'as G t!m, regu$ar, norma$ tone and vo$ume
S!astic 9M; at &our etremities
Lym!h nodes en$argement 'as not &ound
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;,
eningea$ ?e&$e: 9*;
>enita$ia : .oy, there 'ere no abnorma$ities !resent
L)or)tory inding+ 5Septemer 6 271789
?outine .$ood amination
* #.7: )") 0(/uL * ?.7 : "H) 0G/uL
13
8/11/2019 44975892 Case Report Print
14/38
* 4b : 2"0 g/dL * PLT : 2J( 0(/uL
.$ood $ectro$ic
* Na : ( m-/L
* : (, m-/L
* 7$ : 0 m-/L
Liver Pro&i$e
* S>6T 9%ST; : 2H u/L
* S>PT 9%LT; : 2( u/L
idney Pro&i$e
* 1reum : mg/d$
* 7reatinine : 0,G mg/d$
%rteria$ .$ood >as
* !4 : H"H * Pco2 : 2J"0 mm4g
* Po2 : JG") mm4g * .icarbonate : 20"H
* Tota$ 762 : 2,) * .ase es : *"J
* 62 Saturation : JJ,H +
:or;ing Di)gno+i+ 9
* nce!ha$itis
* eningoence!ha$itis
* eningitis
14
8/11/2019 44975892 Case Report Print
15/38
'urt*er E-)min)tion+ 9
* 7om!$ete b$ood, LFT, ?FT, $ectro$it, %>D%
* LP
* Q*ray
* 4ead 7T scan
#edic)tion 9
* 4ead e$evated (0R
* 62*2 L/i
* 38FD D)+ Na7$ 0,J+ = gtt/i micro
* 3nA" 7e&otaim G)0mg / G hours / 38
* 3nA" Phenytoin $oading dose 20mg/gbb in 20 cc Na7$ 0,J+ 9i& seizure;
* ena$og in orabase 2 a!!$ic
* >entamycin za$& ( a!!$ic
* Diet S8 )G0 a$ M 2G gr !rotein
15
8/11/2019 44975892 Case Report Print
16/38
!.2. D)ily 'ollo< &p
Fo$$o' 1! Septemer 17t*6 2717
S 9 1nconciousness 9M;, Seizure 9*;, Fever 9*;
O 9Sens: >S7 G 98;, T: (H,(7, .#: (g, .L: J2cm .#/.L:JG,2J+
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : norma$
outh : u$cus 9M; at $i!s and mouth
Nec : Lym!h nodes en$argement 9*;
%i$$a : !ustu$e 9M;
7hest : Symmetrica$ &usi&ormic, 4? : 0 b!m, regu$ar$y, murmurs 9*;
?? : t!m, regu$ar$y, ra$es 9*;,
stridor 9M;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 0 b!m, regu$ar$y, Pressure/8o$ume 'as ade-uate"
S!astic 9M; at etremities, !ustu$e 9M;
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M stomatitis M im!etigo bu$osa
*eningoence!ha$itis M stomatitis M im!etigo bu$osa
*eningitis M stomatitis M im!etigo bu$osa
P 9 * 4ead e$evated (0R
16
8/11/2019 44975892 Case Report Print
17/38
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* 3nA" 7e&otaim G)0 mg/G Aam/38
* 3nA" %m!ici$$in G)0 mg/G Aam/38, sin test
* !henytoin $oading dose 2G0 mg in (0 cc Na7$ 0,J+ in (0 minutes,
2 hours $ater maintenance () mg/2 Aam/38 in 0 cc Na7$ 0,J+ in (0
minutes"
* ena$og inorabase 2 a!!$ic
* >entamycin Ba$& ( a!!$ic
* Diet S8 )0 a$ dengan 20 gr !rotein da$am J00cc cairan
9)0cc/ Aam/N>T;
Fo$$o' 1! Septemer 11t* = 1(t*6 2717
S 9 1nconciousness 9M;, Seizure 9*;, Fever 9*;
O 9Sens: >S7 0 9(82);, T: (G,7, .#: (g, .L: J2cm .#/.L:JG,2J+
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : norma$
outh : u$cus 9M; at $i!s and mouth
Nec : Lym!h nodes en$argement 9*;
%i$$a : !ustu$e 9M;
7hest : Symmetrica$ &usi&ormic, 4? : G b!m, regu$ar$y, murmurs 9*;
17
8/11/2019 44975892 Case Report Print
18/38
?? : t!m, regu$ar$y, ra$es 9*;,
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se G b!m, regu$ar$y, Pressure/8o$ume 'as ade-uate"
S!astic 9M; at etremities, !ustu$e 9M;
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M stomatitis M im!etigo bu$osa
*eningoence!ha$itis M stomatitis M im!etigo bu$osa
*eningitis M stomatitis M im!etigo bu$osa
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* 3nA" 7e&otaim G)0 mg/G Aam/38
* 3nA" %m!ici$$in G)0 mg/G Aam/38, sin test
* Phenytoin maintenance () mg/2 Aam/38 dienceran da$am 0 cc Na7$
0,J+ habis da$am (0 menit 9i& seizure;
* ena$og inorabase 2 a!!$ic
* >entamycin Ba$& ( a!!$ic
* Diet S8 )0 a$ 'ith 20 gr !rotein in J00cc &$uid
9)0cc/ Aam/N>T;
>=R)y Re+ult
%bnorma$ity radio$ogica$ o& the heart and $ung 'ere not &ound
LCS Re+ult
18
8/11/2019 44975892 Case Report Print
19/38
* 7o$our : c$ear
* LD4 : 1/L
* Protein : 0,0 mg/dL
* Tota$ o& ce$ : ,0 mm(
* >$ucose : )H,0 mg/dL
* !4 : H
* PN : di&&icu$t to ana$ize
* N : di&&icu$t to ana$ize
* 7u$ture : Sta!hy$ococcus Sa!ro!hyticus
#)ntou- Te+t Re+ult
3nduration 9*;
4i!eremis 9*;
?esu$t : 9*;
Fo$$o' 1! Septemer 1,t* ? 1t*6 2717
S 9 1nconciousness 9M;, Seizure 9M;, Fever 9*;
O 9Sens: >S7 0 9(82);, T: (H,(7, .#: (g, .L: J2cm .#/.L:JG,2J+
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : N>T
outh : u$cus 9M; at $i!s and mouth
19
8/11/2019 44975892 Case Report Print
20/38
Nec : Lym!h nodes en$argement 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 0 b!m, regu$ar$y, murmurs 9*;
?? : t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 0 b!m, regu$ar$y, Pressure/8o$ume 'as ade-uate"
S!astic 9M; at etremities, !ustu$e 9M;
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra M Stomatitis
*eningoence!ha$itis M i$iaria ?ubra M Stomatitis
*eningitis M i$iaria ?ubra M Stomatitis
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* 3nA" 7e&otaim G)0 mg/G Aam/38
* 3nA" %m!ici$$in G)0 mg/G Aam/38, sin test
* 5ia eAang !henytoin $oading dose 2G0 mg dienceran da$am (0
cc Na7$ 0,J+ habis da$am (0 menit, 2 Aam emudian maintenance ()
mg/2 Aam/38 dienceran da$am 0 cc Na7$ 0,J+ habis da$am (0 menit"
* ena$og inorabase 2 a!!$ic
* >entamycin Ba$& ( a!!$ic
* Diet S8 )0 a$ dengan 20 gr !rotein da$am J00cc cairan
9)0cc/ Aam/N>T;
20
8/11/2019 44975892 Case Report Print
21/38
Fo$$o' 1! Septemer 1/t* ? 1t*6 2717
S 9 1nconciousness 9M;, Seizure 9M;, Fever 9*;
O 9Sens: >S7 982);, T: (H,)7, .#: 2g, .L: J2cm .#/.L:,+
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : N>T
outh : u$cus 9M; at $i!s and mouth
Nec : Lym!h nodes en$argement 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 0 b!m, regu$ar$y, murmurs 9*;
?? : t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 0 b!m, regu$ar$y, Pressure/8o$ume 'as ade-uate"
S!astic 9M; at etremities, !ustu$e 9M;
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
*eningoence!ha$itis M i$iaria ?ubra
*eningitis M i$iaria ?ubra
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
21
8/11/2019 44975892 Case Report Print
22/38
* 3nA" 7e&otaim G)0 mg/G Aam/38
* 3nA" %m!ici$$in G)0 mg/G Aam/38, sin test
* 5ia eAang !henytoin $oading dose 2G0 mg dienceran da$am (0
cc Na7$ 0,J+ habis da$am (0 menit, 2 Aam emudian maintenance ()
mg/2 Aam/38 dienceran da$am 0 cc Na7$ 0,J+ habis da$am (0 menit"
* 3nA" anito$ 20+ 0,) gr/g..(0cc/2 Aam
* ena$og inorabase 2 a!!$ic
* >entamycin Ba$& ( a!!$ic
* Diet S8 )0 a$ dengan 20 gr !rotein da$am J00cc cairan
9)0cc/ Aam/N>T;
He)d CT Sc)n re+ult
%tro&i cerebra$ corte, hidrose&a$us comunicans, ischemic, and in&ar
bi$atera$occi!ita$ $obes e"c meningitis
Fo$$o' 1! Septemer 27t* 6 2717
S 9 1nconciousness 9M;, Seizure 9*;, Fever 9*;
O 9Sens: >S7 982);, T: (G,)7, .#: g, .L: J2cm
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : N>T
outh : norma$
22
8/11/2019 44975892 Case Report Print
23/38
Nec : Lym!h nodes en$argement 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 2G b!m, regu$ar$y, murmurs 9*;
?? : t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 0 b!m, regu$ar$y, Pressure/8o$ume 'as ade-uate"
S!astic 9M; at etremities, !ustu$e 9M;
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
*eningoence!ha$itis M i$iaria ?ubra
*eningitis M i$iaria ?ubra
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* 3nA" 7e&otaim G)0 mg/G Aam/38
* 3nA" %m!ici$$in G)0 mg/G Aam/38, sin test
* 3nA" anito$ 20+ 0,) gr/g..(0cc/2 Aam 94(a&&;
* Phenytoin 2 )0 mg
* ena$og inorabase 2 a!!$ic
* >entamycin Ba$& ( a!!$ic
* ?es!eridon 0,(mg 9night; &or ( days
* Diet S8 )0 a$ dengan 20 gr !rotein da$am J00cc cairan
9)0cc/ Aam/N>T;
23
8/11/2019 44975892 Case Report Print
24/38
Fo$$o' 1! Septemer 21t* ? 2!t*6 2717
S 9 1nconciousness 9M;, Seizure 9*;, Fever 9*;
O 9Sens: >S7 982);, T: (G,)7, .#: g, .L: J2cm
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : N>T
outh : norma$
Nec : Lym!h nodes en$argement 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 2G b!m, regu$ar$y, murmurs 9*;
?? : t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 0 b!m, regu$ar$y, Pressure/8o$ume 'as ade-uate"
S!astic 9M; at etremities, !ustu$e 9M;
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* 3nA" 7e&otaim G)0 mg/G Aam/38
* 3nA" %m!ici$$in G)0 mg/G Aam/38
24
8/11/2019 44975892 Case Report Print
25/38
* Phenytoin 2 )0 mg
* 1rda&a$ (0 mg
* ?es!eridon 0,(mg 9night; &or ( days
* Diet S8 200 a$ dengan 20 gr !rotein da$am J00cc cairan
9)0cc/ Aam/N>T;
* Fisiotera!i
EE$ Re+ult
Norma$
.anya diAum!ai arte&a 7>
Fo$$o' 1! Septemer 2(t* ? 2t*6 2717
S 9 1nconciousness 9M;, Fever 9*;, 1ncontro$$ed movement 9M;
O 9Sens: >S7 ( 98);, T: (G,7, .#: g, .L: J2cm
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : N>T
outh : norma$
Nec : Lym!h nodes en$argement 9*;, nec sti&ness 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 2 b!m, regu$ar$y, murmurs 9*;
?? : 2G t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
25
8/11/2019 44975892 Case Report Print
26/38
tremities: Pu$se 2 b!m, regu$ar$y, Pressure/8o$ume 'as ade-uate"
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* 3nA" 7e&otaim G)0 mg/G Aam/38
* 3nA" %m!ici$$in G)0 mg/G Aam/38, sin test
* Phenytoin 2 )0 mg
* ?es!eridon 0,(mg 9night; &or ( days
* >entamycin Ba$&
* 1rda&a$ (0mg 94;
* Diet S8 )0 a$ dengan 20 gr !rotein da$am J00cc cairan
9)0cc/ Aam/N>T;
Fo$$o' 1! Septemer 2/t*6 2717
S 9 1nconciousness 9M;, Fever 9*;, 1ncontro$$ed movement 9M;
O 9Sens: >S7 2 98();, T: (H,(7, .#: g, .L: J2cm
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
26
8/11/2019 44975892 Case Report Print
27/38
Nose : N>T
outh : u$cus 9M; at $i!s and mouth
Nec : Lym!h nodes en$argement 9*;, nec sti&ness 9*;
7hest : Symmetrica$ &usi&ormic, 4? : G b!m, regu$ar$y, murmurs 9*;
?? : (G t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 2 b!m, regu$ar$y, Pressure/8o$ume 'as ade-uate"
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* 3nA" 7e&otaim G)0 mg/G Aam/38
* 3nA" %m!ici$$in G)0 mg/G Aam/38, sin test
* Phenytoin 2 )0 mg
* ?es!eridon 0,(mg 9night; &or ( days
* >entamycin Ba$&
* 1rda&a$ (0mg 94;
* Diet S8 )0 a$ dengan 20 gr !rotein da$am J00cc cairan
9)0cc/ Aam/N>T;
Fo$$o' 1! Septemer 20t*@ !1t*6 2717
27
8/11/2019 44975892 Case Report Print
28/38
S 9 1nconciousness 9M;, Fever 9M;, 1ncontro$$ed movement 9M;
O 9Sens: >S7 2 98();, T: (,07, .#: g, .L: J2cm
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : N>T
outh : norma$
Nec : Lym!h nodes en$argement 9*;, nec sti&ness 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 2 b!m, regu$ar$y, murmurs 9*;
?? : (0 t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 2 b!m, regu$ar$y, Pressure/8o$ume 'as ade-uate"
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* 3nA" 7e&otaim G)0 mg/G Aam/38a&&
* 3nA" %m!ici$$in G)0 mg/G Aam/38a&&
* Phenytoin 2 )0 mg
* ?es!eridon 0,(mg 9night; &or ( days
* >entamycin Ba$&
28
8/11/2019 44975892 Case Report Print
29/38
* 1rda&a$ (0mg 94;
* Diet S8 )0 a$ 'ith 20 gr !rotein in J00cc &$uid
9)0cc/ Aam/N>T;
* Fisiotera!i
Fo$$o' 1! Octoer 1+t 6 2717
S 9 1nconciousness 9M;, Fever 9M;, 1ncontro$$ed movement 9M;
O 9Sens: >S7 2 98();, T: (H,J7, .#: (,)g, .L: J2cm
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : N>T
outh : u$cus 9M; at $i!s and mouth
Nec : Lym!h nodes en$argement 9*;, nec sti&ness 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 20 b!m, regu$ar$y, murmurs 9*;
?? : 2 t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 20 b!m, regu$ar$y, .P : 00/G0 mmhg, Pressure/8o$ume'as ade-uate"
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
P 9 * 4ead $evated (0R
29
8/11/2019 44975892 Case Report Print
30/38
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* Phenytoin 2 )0 mg
* ?es!eridon 0,(mg 9night; &or ( days
* >entamycin Ba$&
* 1rda&a$ (0mg 94;
* 7etrizin tab
* 4ydrocortison cream 2,)+
* Diet S8 )0 a$ dengan 20 gr !rotein da$am J00cc cairan
9)0cc/ Aam/N>T;
* Fisiotera!i
Fo$$o' 1! Octoer 2nd@ t*6 2717
S 9 1nconciousness 9M;, Fever 9M;, 1ncontro$$ed movement 9M;
O 9Sens: 7, T: (H,07, .#: g, .L: J2cm
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : N>T
outh : norma$
Nec : Lym!h nodes en$argement 9*;, nec sti&ness 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 20 b!m, regu$ar$y, murmurs 9*;
?? : (0 t!m, regu$ar$y, ra$es 9*;
30
8/11/2019 44975892 Case Report Print
31/38
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 20 b!m, regu$ar$y, .P : 00/G0 mmhg, Pressure/8o$ume
'as ade-uate"
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* Phenytoin 2 )0 mg
* ?es!eridon 0,(mg 9night; &or ( days
* >entamycin Ba$&
* 7etrizin tab
* 7a$adin cream
* 4ydrocortison cream 2,)+
* 1rda&a$ (0mg
R% 9* Physiothera!y (/minggu
L) 'inding Octoer ,t*6 2717
?outine .$ood amination
* #.7: ("HH 0(/uL * ?.7 : ("JH 0G/uL
* 4b : J"H g/dL * PLT : 2GJ 0(/uL
31
8/11/2019 44975892 Case Report Print
32/38
Fo$$o' 1! Octoer 2nd@ t*6 2717
S 9 1nconciousness 9M;, Fever 9M;, 1ncontro$$ed movement 9M;
O 9Sens: 7, T: (H,07, .#: g, .L: J2cm
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : N>T
outh : norma$
Nec : Lym!h nodes en$argement 9*;, nec sti&ness 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 20 b!m, regu$ar$y, murmurs 9*;
?? : (0 t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 20 b!m, regu$ar$y, .P : 00/G0 mmhg, Pressure/8o$ume
'as ade-uate"
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
P 9 * $evasi e!a$a (0R
* 38FD D)+ Na7$ 0,J+ (G gtt/i miro
* Phenytoin 2 )0 mg
* ?es!eridon 0,(mg 9night; &or ( days
* >entamycin Ba$&
32
8/11/2019 44975892 Case Report Print
33/38
* 7etrizin tab
* 7a$adin cream
* 4ydrocortison cream 2,)+
* 1rda&a$ (0mg
R% 9* Physiothera!y (/minggu
Fo$$o' 1! Octoer /t*@ 0t*6 2717
S 9 1nconciousness 9M;, Fever 9M;, Seizure 9M;, genera$ized, &re- 2, duration )
inutes, !a!u$e erythema 9M;
O 9Sens: >7S G 92822;, T: (,27, .#: g, .L: J2cm
4ead :
yes: $ight re&$ees 9M/M;, isochoric !u!i$, $o'er eye$ids !a$e 'ere not
con&irmed"
ars : norma$
Nose : norma$, N>T 9M;
outh : norma$
Nec : Lym!h nodes en$argement 9*;, nec sti&ness 9*;
7hest : Symmetrica$ &usi&ormic, 4? : 0 b!m, regu$ar$y, murmurs 9*;
?? : 2 t!m, regu$ar$y, ra$es 9*;
%bdomen : Soe!e$, norma$ !erista$tic" 4/L : in!a$!ab$e
tremities: Pu$se 20 b!m, regu$ar$y, .P : 00/G0 mmhg, Pressure/8o$ume
'as ade-uate"
Physio$ogy ?e&$e: %P? M/M = P? M/M
Patho$ogic ?e&$e: .abinsy 9*;, 6!!enheim 9*;, >ordon 9*;
33
8/11/2019 44975892 Case Report Print
34/38
eningea$ ?e&$e : 9*;
A 9 *nce!ha$itis M i$iaria ?ubra
P 9 * 4ead e$evated (0R
* 38FD D)+ Na7$ 0,J+ 20 gtt/i miro
* Phenytoin $oading dose 20mg in 2cc Na7$ 0,J+maintenance inA"
Phenytoin )0mg/2 Aam in )cc Na7$ 0,J+
* ?es!eridon 0,(mg 9night; &or ( days
* 7armabaze!in )mg/g..
* >entamycin Ba$&
* 7etrizin tab
* 7a$adin cream
* 4ydrocortison cream 2,)+
* 1rda&a$ 20mg
R% 9* Physiothera!y (/minggu
L) 'inding+ Octoer t*6 2717
%rteria$ .$ood >as
* !4 : H"2(0 * Pco2 : 2)"0 mm4g
* Po2 : (2"0 mm4g * .icarbonate : 0
* Tota$ 762 : "0 * .ase es : *)
* 62 Saturation : JG"0 +
.$ood $ectro$ic
34
8/11/2019 44975892 Case Report Print
35/38
* Na : )H m-/L
* : (,( m-/L
* 7$ : 2) m-/L
>$ucose
* .$ood : (2 mg/dL
* 1rine : *
T*e p)tient p)++ed )
8/11/2019 44975892 Case Report Print
36/38
3n&ection is usua$$y does not !roduce sym!toms 9ca$$ed asym!tomatic; or causes
&$u*$ie sym!toms such as &ever, headache, and ma$aise"
3n this case, the diagnosis is estab$ished based on historica$ taing and c$inica$
eamination that $ead to ence!ha$itis" 4istorica$ taing gained an unconsciousness
that has been e!erienced by the !atient since $ast 2 days" Fever 'as &ound 'ith
the tem!erature around (H,) *(,)O7" This !atient been having seizure H days in a
ro' be&ore admitted, &re-uency K( times !er day &or 0*20 minutes, rigid hand
'as &ound" 6ther then that, the !hysio$ogy re&$ees o& this !atient are higher then
usua$"
To con&irm the diagnosis a doctor 'i$$ as &or a b$ood sam!$e and order a $umbar
!uncture, in 'hich a need$e is inserted into the $o'er bac and a sma$$ amount o&
&$uid 9ca$$ed 7SF or cerebra$*s!ina$ &$uid; is taen &rom the s!ina$ cana$" Some
hos!ita$s are a$so e-ui!!ed to tae a bio!sy, 'here a tiny amount o& tissue is taen
&rom the brain 'hi$e the !atient is under genera$ anaesthesia" Doctors a$so
&re-uent$y order a 7T scan or agnetic ?esonance 3mage 9?3;, in 'hich
com!uterized images o& the brain are obtained that sho' the etent o& the s'e$$ing
and damage to the brain" %nother test sometimes used to he$! con&irm a diagnosis
is an e$ectroence!ha$ogram 9>;, 'hich records e$ectrica$ events in the brain"
For this !atient 'e had done severa$ !rocedures such as LFT, .$ood cu$ture,
Lumbar Puncture, mantou test, Q*ray, >, and 4ead 7T scan" The resu$t &or
the $umbar !uncture is L7S ana$ize 'ithin norma$ $imits" The resu$t &or > is
norma$" For radio$ogy the resu$t is norma$ and antou test 'as negati&" Fina$$y
4ead 7T resu$t are atro&i cerebra$ corte, hidrose&a$us comunicans, ischemic, and
in&ar bi$atera$occi!ita$ $obes e"c meningitis"
Treatment &or vira$ ence!ha$itis a$so inc$udes !a$$iative care" There is no cure &or
arbovira$ ence!ha$itis and the goa$ o& treatment is to re$ieve sym!toms 9!a$$iative;"
Pa$$iative care may inc$ude intravenous &$uids 9to !revent dehydration;, antibiotics
9to !revent secondary in&ections;, and other medications 9to !revent
com!$ications;" Diuretics 9e"g", &urosemide, mannito$; may be administered to
36
8/11/2019 44975892 Case Report Print
37/38
reduce intracrania$ !ressure and benzodiaze!ines 9e"g", $oraze!am %tivanCE; may
be administered to !revent seizures"
The !atient 'as given oygen, 38FD D)+ Na7$ 0,22)+, 3nA" 7e&otaime, inA"
%m!ici$$in, inA" Phenytoin, 3nA" anito$, Paracetamo$ tab$et, ?is!eridon tab$et, and
7etrizine tab$et"
(.2. Summ)ry
3t has been re!orted a case o& a boy, year and J months years o$d 'ith
ence!ha$itis" The diagnosis 'as estab$ished based on anamnesis, c$inica$ sign,
sym!toms, and !hysica$ eamination" The !rognostic o& this !atient 'as not good"
Fina$$y, the !atient !assed a'ay on the J tho& march 200 at H") 'ith cause o&
death being metabo$ic asidosis"
RE'ERENCES
"
2" $iegman, 5enson, arcdante, .ehrman 200G, ssentia$s o& !ediatrics,
Fi&th edition, 4 : (*G, Ste00, Phi$ade$!hia"
3. Le'is, P" >$aser, 7%, Pediatrics in revie', nce!ha$itis" 6&&icia$ 5ourna$
6& The %merican %cademy 6& Pediatrics" 200)"
4. %nonim J), nse&a$itis da$am 4asan ?", 3$mu esehatan %na, h : G22*
G2, Fau$tas edoteran 1niversitas 3ndonesia" 5aarta"
5. >ondim, F%%" 6$iveira, >" Thomas, FP" 8ira$ nce!ha$itis cited 200
6ctober E" %vai$ab$e &rom: 1?L:
htt!://emedicine"medsca!e"com/artic$e/GGJ*overvie' "
%ccessed 6ctober 2), 200
6. Ne$son, d" eningoense&a$itis 8irus, 3$mu esehatan %na Ne$son, h :
2*" 7>" 5aarta
37
http://emedicine.medscape.com/article/1166498-overviewhttp://emedicine.medscape.com/article/1166498-overview8/11/2019 44975892 Case Report Print
38/38
7. %nonim 2000, nse&a$itis da$am %ri& , a!ita Se$eta edoteran, disi
(, 5i$id 2, h: G0*GG, edi %escu$a!ius F 13, 5aarta"
" em!e, 7"4", J2, 3n&ections, bacteria$ and S!irochaeta$ 3n 5erry L" $$er,
7urrent Pediatric Diagnosis and Treatment, H ed", ! : H(2*H((, Lange
edica$ Pub$ications, Los %t$os, 7a$i&ornia"