Case Presentation MEASLES

Case PresentationGNApsPreceptor: dr. Ulynar Marpaung, Sp.APresenter: kinetika 1102008131

DEPARTMENT OF PEDIATRIC

RADEN SAID SUKANTO POLICE CENTER HOSPITAL

FACULTY OF MEDICINE YARSI UNIVERSITY

PERIOD DECEMBER 16thMARCH MEY 23rd 2015

Patient Identity

Name : FD

Birth Date: November 14th 2004

Age: 10 years 4 months

Gender: female

Address: Penganten Ali street number 1

Nationality: Indonesian

Religion : Islam

Date of admission: March 30rd 2015

Date of examination: March 30rd 2015

Parents Identity

FatherMotherNameMr. NMrs. LAge34 years old32 years oldJobPoliceHousewifeNationalityIndonesianIndonesiaReligionMoslemMoslemEducationPolice AcademyHigh School (graduated)s Earning/monthApproximately Rp.3.500.000,--AddressPenganten Ali Street number 1

History Taking

Alloanamnesis from patients mother on the date of admission, March 30th 2015.

Chief complain:

swelling of the eyelids before admission to the hospital.

Additional complains:

High frequent urination and the urine is red colour

History of Present Illness

A 10 year old girl weighing 30 kg came to the national police hospital with a main complaint of swollen face and eyes. Previously, the patient have gone to a doctor and did a complete urine test and complete blood test. The laboratory test results showed that there is blood in the urine. The patient also often complaint of frequent urination but it is not accompanied by fever.there is a history of sore throat.

History Of Past Illness

Pharyngitis/Tonsilitis+Bacillary Dysentry-Bronchitis-Amoeba Dysentry-Pneumonia-Diarrhea-Morbilli-Thypoid-Pertussis-Worms-Varicella-Surgery-Diphteria-Brain Concussion-Malaria-Fracture-Polio-Drug Reaction-Enteritis-

Prenatal History

Antenatal care

Antenatal check ups performed at the puskesmas by the midewife. There was no problems during pregnancy.

No maternal illness during pregnancy

Drugs consumption:

Vitamins every antenatal care

Birth History

Labor : Puskesmas

Birth attendants: midwife

Mode of delivery : pervaginam

Gestation: 38 weeks

Infant state : healthy

Birth weight : 2900 grams

Body length: 48 cm

According to the mother, the baby started to cry and the baby's skin is red, no congenital defects were reported

Post Natal History

Examination by midwife

The state of the infant: healthy

Development History

First dentition: 6 months

Psychomotor development

Head Up: 1 month old

Smile: 1 month old

Laughing : 1- 2 month old

Slant : 2,5 months old

Speech Initiation: 5 months old

Prone Position: 5 months old

Food Self : 5 6 months old

Sitting: 6 months old

Crawling: 8 months old

Standing: 1 years old

Walking: 1 years old

Mental Status: Normal

Conclusion: Growth and development status is still in the normal limits and was appropriate according to the patients age

History of Eating

Breast MilkExclusively 6 month..Formula milkBebelac since 1 month agoBaby biscuitsBiscuits regalFruit and vegetablesBanana, CarrotsSolid foods and side dishesRice, Carrots, Potatoes

Immunization History

ImmunizationFrequencyTimeBCG 1 time 1 month oldHepatitis B 3 times 0, 1, 6 months oldDPT 3 times 2, 4, 6 months oldPolio 4 times0, 2, 4, 6 months oldHib4 times 2, 4, 6, 15 months oldMMR1 times15 monthsTifoid1 times24 monthsHepatitis A1 times1 times

Family History

Patients both parents were married when they were 26 years old and 24 years old, and this is their first marriage.

There are not any significant illnesses or chronic illnesses in the family declared.

History of her brothers

ChildbirthGenderAgeAge DiedSumption DiedSpontan pervaginam, gestation atermGirl7 years old--Spontan pervaginam, gestation atermBoys2 years 6 months old--

History of the disease people around the patient

There is no one living around their home known for having the same condition as the patient.

Sosial and Economic History

The patient lived at the house together with father and mother.

There are 1 door at the front side, 1 toilet near the kitchen and 3 rooms, in which 1 room is the bedroom of three of them and 1 room is for guest. There are 4 windows inside the house. The windows are ocassionaly opened during the day.

Hygiene:

The patient changes his clothes everyday with clean clothes.

Bed sheets changed every two weeks.

Physical Examination

Date :March 30rd 2015

General Status

General condition : Compos mentis.

TD = 130/100 mmHg

Heart rate = 100 x/min

Respiratory rate = 24x/min

Temperature = 37C

Cardio : S1/S2, reguler, no murmur, no gallop

Pulmonary : vesiculer +/+, rhonchi -/-, wheezing -/-

17

Physical Examination (contd)

Antropometry Status

Weight: 30 kilogram

Height: 150 cm

Nutritional Status based NCHS (National Center for Health Statistics) year 2000:

WFA (Weight for Age): 30/30x 100 % = 100 % ( good nutrition)

HFA (Height for Age): 150/150 x 100 % = 100 % (good nutrition)

WFH (Weight for Height): 30/30x 100 % = 100 % (normal)

Conclusion: The patient has good nutritional status.

Systematic Physical Examination

HeadNormocephaly, hair (black, normal distributon, not easily removed ) sign of trauma (-), large fontanelle closed.EyesIcteric sclera -/-, pale conjunctiva -/-, hyperaemia conjunctiva -/- , lacrimation -/-, sunken eyes -/-, swelling eyes +/+ pupils 3mm/3mm isokor, Direct and indirect light response ++/++EarsNormal shape, no wound, no bleeding ,secretion or serumenMouth Lips: Teeth: Mucous: Tongue: Tonsils: Pharynx:dryno cariesmoistNot dirtyT1/T1, No hyperemia No hyperemiaNeckLymph node enlargement (-), scrofuloderma (-)

20

ThoraxInspection:Symmetric when breathing , no retraction, ictus cordis is not visiblePalpation:mass (-), tactile fremitus +/+Percussion:sonor on left lungs and sonor on right lungsAuscultationCor: Pulmo:regular S1-S2, murmur (-), gallop (-)vesicular +/+, Wheezing -/- , Rhonchy -/-Abdomen:Inspection:Convex, epigastric retraction (-), there is no a widening of the veins, no spider nevi.Palpation:supple, liver and spleen not palpable, fluid wave (-), abdominal mass (-)Percussion:The entire field of tympanic abdomen, shifting dullness (-)Auscultation: normal bowel sound, bruit (-)

AnusNormalExtremitieswarm, capillary refill time less 2 second, edema(+)SkinGood turgor, edema (+)

Laboratory InvestigationHematology (March 30rd 2015)

Serology/ImmunologyResultsNormal ValueC-Reactive Protein Non Reactive Non ReactiveASTO Reactive 1,8 Non Reactive

WORKING DIAGNOSIS

Susp. GNAps

DD/ Nefrotik Syndrome

MANAGEMENT

IVFD RL 16dpm

Inj. Ceftriaxone 2x1 amp

Inj. Lasix 1x20 mg

PROGNOSIS

Quo ad vitam: dubia ad bonam

Quo ad functionam: dubia ad bonam

Quo ad sanactionam : dubia ad bonam

Follow Up March30th 2015.

SFever night (+)Cough (+) Urine(Red)swelling eyes (+/+) The urine red (+) OGeneral condition: Compos mentis.TD = 130/100 mmHgHeart rate = 100 x/minRespiratory rate = 24x/minTemperature = 37CCardio : S1/S2, reguler, no murmur, no gallopPulmonary : vesiculer +/+, rhonchi -/-, wheezing -/-ASusp. GNAps DD/ Nefrotik Syndrome PIVFD RL 16dpm Inj. Ceftriaxone 2x1 amp Inj. Lasix 1x20 mg

Serology/ImmunologyResultsNormal ValueC-Reactive Protein Non Reactive Non ReactiveASTO Reactive 1,8 Non Reactive

Follow Up March 31th 2015.

SCough (-)Fever night(+)The urine red (+) Low back pain radiating backward(+)OGeneral condition: Compos MentisTD = 120/90 mmHgHeart rate = 100 x/minRespiratory rate = 26x/minTemperature = 37CCardio : S1/S2, reguler, no murmur, no gallopPulmonary : vesiculer +/+, rhonchi -/-, wheezing -/-AGNAps PInj. Ceftriaxone 2x1 amp Inj. Lasix 1x20 mg

Hematology Results Normal Value Haemoglobin 10,3 g/dL 13-16 g/dL Leukocytes 6.400L 5,000 10,000/L Hematocrits 30 % 40 48 % Trombocytes 343.000 L 150,000 400,000/L UreumCreatininElektrolit *Natrium *Kalium *Chlorida 49 mg/dl 1,3 mg/dl 140 mmol/l 4,4 mmol/l 105 mmol/l 10-50 mg/dl0,5-1,3 mg/dl135-145 mmol/l3,8-5,0 mmol/l98-106 mmol/l

Follow Up March 1th 2015.

SWeakness (+) Fever night (+)swelling eyes (+/+)The urine red(+)OGeneral condition: Compos mentis.TD = 110/90 mmHgHeart rate = 102 x/minRespiratory rate = 26x/minTemperature = 37CCardio : S1/S2, reguler, no murmur, no gallopPulmonary : vesiculer +/+, rhonchi -/-, wheezing -/-AGNAps PInj. Ceftriaxone 2x1 amp Inj. Lasix 1x20 mgNefedipine 2x10 mg

Follow Up March 2th 2015.

SWeakness (+) Fever night (+)swelling eyes (+/+)The urine red(+)OGeneral condition: Compos mentis.TD = 120/90 mmHgHeart rate = 110 x/minRespiratory rate = 26x/minTemperature = 37CCardio : S1/S2, reguler, no murmur, no gallopPulmonary : vesiculer +/+, rhonchi -/-, wheezing -/-AGNAps PInj. Ceftriaxone 2x1 amp Inj. Lasix 1x20 mgNefedipine 2x10 mg

Follow Up March 2th 2015.

Thorax

the images of the thorax : Normal

Follow Up March 3th 2015.

SFever(-)Weakness(-)The urine red(+)OGeneral condition: Compos mentis.TD = 120/100 mmHgHeart rate = 100 x/minRespiratory rate = 26 x/minTemperature = 36CCardio : S1/S2, reguler, no murmur, no gallopPulmonary : vesiculer +/+, rhonchi -/-, wheezing -/-AGNAps PInj. Ceftriaxone 2x1 amp Inj. Lasix 1x20 mgNefedipine 2x10 mg

Kimia clinicResultsNormal ValueUreum 4,5 mg/dl 10-50 mg/dlCreatinin 1,1 mg/dl 0,5-1,3 mg/dl

Follow Up March 4th 2015.

SFever(-)Weakness(-)The urine red(+)OGeneral condition: Compos mentis.TD = 110/90 mmHgHeart rate = 90 x/minRespiratory rate = 22x/minTemperature = 36CCardio : S1/S2, reguler, no murmur, no gallopPulmonary : vesiculer +/+, rhonchi -/-, wheezing -/-AGNAps PInj. Ceftriaxone 2x1 amp Inj. Lasix 1x20 mgNefedipine 2x10 mg

Follow Up March 5th 2015.

SFever(-)Weakness(-)The urine red(+)OGeneral condition: Compos mentis.TD = 110/70 mmHgHeart rate = 94 x/minRespiratory rate = 24x/minTemperature = 36CCardio : S1/S2, reguler, no murmur, no gallopPulmonary : vesiculer +/+, rhonchi -/-, wheezing -/-AGNAps PNefedipine 2x10 mg

Kimia clinicResultsNormal ValueUreum 35 mg/dl 10-50 mg/dlCreatinin 0,8 mg/dl 0,5-1,3 mg/dl

Follow Up March 6th 2015.

SFever(-)Weakness(-)The urine red(+)OGeneral condition: Compos mentis.TD = 100/70 mmHgHeart rate = 94 x/minRespiratory rate = 24x/minTemperature = 36CCardio : S1/S2, reguler, no murmur, no gallopPulmonary : vesiculer +/+, rhonchi -/-, wheezing -/-AGNAps PNefedipine 2x10 mgCotrimoksazole 2x1mg

Results Normal Value UrineColourKejernihanReaksi/PHBerat jenisProteinBilirubinGlukosaKetonBlood/HbNitritUrobilinogenLekositSedimen : *Leukosit *Eritrosit *Sel Epitel *Silinder : *Kristal :Lain-lain YellowCloudy7,01.015+---+++-0,1-2-3 /LPBFull/LPB+-5-8,51.000-1.030NgeativeNegativeNegativeNegativeNegativeNegative0,1-1,0Negative

40

LITERATURE REVIEW

DEFINITION

Acute nephritic syndrome is classically defined by

symptoms of oliguria,oedem,hypertension and also urinalysis abnormality such as proteinuria less than 2grams/day,hematuria,or finding of erytrocite silinder in the urine.

Diagnosis

1. there is a latency period,the period between the entry streptococcus until the onset of symptoms or signs GNAPS, ranging from 10-21 days.

2. hematuria without pain

3. edema

4. oliguria or anuria

5. hypertension, can be accompanied by convulsions, decreased consciousness.

6. signs of congestive heart failure

Supporting Investigation:

1.Urinalisis: found proteinuria + through ++++, hematuria, leukosituria, cylinder erythrocytes.

2.Blood :

Peripheral blood: mild anemia can be found

creatinine and urea are generally increased

3.Level complement C3 will decrease, and return to normal 8-10 weeks

4.Level antibodies against streptococci as ASTO.antihialuronidase, anti-DNase B generally increased.

5.Creatinine clearance and urea clearance generally declining

Culture and throat swab specimens or skin

6.Other investigations on indications

Therapy

General

1.Explanation to the patient or the patient's parents about the disease and the measures to be taken for the treatment of patients.

2.Bedrest until hiperttensi and edema improved, real hematuria disappeared

3.Low-salt diet (