Supervisor : dr. Pertin Sianturi, Sp.

A(K)


Anita Fitriani (090100286)
Yoga Ramadhan (090100037)

Meningitis Tuberculosis occurs when tuberculosis bacteria
(Mycobacterium tuberculosis) invade the membranes and
fluid surrounding the brain and spinal cord.
The developing world has 1.3 million
cases of TB and 40,000 TB-related
deaths annually among children
younger than 15 years.
In the developing world, 10-20% of
persons who die of TB are children.
TBM complicates approximately 1 of
every 300 untreated primary TB
infections.
seizures
loss of
consciousness
headache tremor
fever (usually
high)
vomiting
History of recent TB contact
History
taking
presence of extrameningeal TB
Physical
examination
lumbar puncture and CSF
examination
Tuberkulin test
Laboratory
Rifampicin INH Pyrazinamide
Ethambutol
The aim of this paper is to report a case of Meningitis
Tuberculosis on 13 years old and 3 months old girl.

Name : MH
Age : 13 years old and 3 months old
Sex : Female
Date of Admission : May 3rd 2014





History of illness
This has been experienced since 1 week ago and became worse since 1
day ago. she was referred from Sidempuan Hospital by pediatrician with
the main complaint was seizure.
History of seizure was found once when she was in the Sidempuan
Hospital and the duration was 5 minutes. When the seizure comes, the
whole body rigid, the eyes wide opened. When the seizure finished, the
patient lost her conciousness. History of seizure before was not found.
History of fever was found since 1 week ago. The fever was high about
38
0
C and didnt getting better with antipyretic. History of headche (+)
since 1 month ago, history of vomiting (+) since 2 weeks ago frequency
10x/days the volume cup aqua every vomiting, the content of what is in
the eating and drinking. Cough (+) since 3 weeks ago. History of contact
with an infected person coughed (+). History of weight loss since 3 month
ago, however, decreased appetite encountered. Defecation and urine (+)
normal.
History of
medications
Inj. Penicillin,
Ranitidin,
Ondancentron,
Paracetamol.
History of
Labor
he was labored
term with
4500 grams
and 52
centimeters
which helped
by doctor in
hospital
History of
Immunization
patients ever
given
immunization
twice, but it is
not clear
which type of
immunization
given
Present status
Sensorium : GCS 10 (E3 V2 M5)
Temperature : 38,0
o
C
Weight : 22 kg
Height : 110 cm
Dyspnea, cyanosis, icteric, anemic are not found.
Head :
Eyes : Light reflexes are found. Pupils are
isochoric. Pale conjungtiva palpebra inferior is not
found on both eyes. Ear and mouth appearances
are normal. Naso gastric tube is found on nose.
Neck : Enlargement of lymph node is not found.


Thorax : Symmetrical fusiform. Heart rate is 100
beats per minute, regular and no murmur.
Respiratory rate is 20 breaths per minute, regular,
and no rales.
Abdomen : Soepel. Peristaltic is found normal.
Liver and spleen are not palpable.
Extremities : Pulse 100 times per minute, regular.
Tone per volume was adequate. Warm. Capillary
Refill Time not more than 3 minutes.

Unit Control Result
Hematology
Hemoglobin g% 12,0 - 14,4 11,00
Hematocrit % 35 - 42 27,40
Leukocyte 10
3
/mm
3
4,5 11,0 14,7
Thrombocyte 10
3
/mm
3
150 450 292
Arterial Blood Gas Analysis
pH 7,35 - 7,45 7,457
pCO
2
mmHg 38 - 42 35,2
pO
2
mmHg 85 - 100 166,7
Bicarbonate mmol/L 22 - 26 26,4
Total CO
2
mmol/L 19 - 25 27,6
BE mmol/L (-2) (+2) 2,4
O
2
Saturation % 95 - 100 99,4
Electrolyte
Natrium mEq/L 135-155 130
Kalium mEq/L 3,6-5,5 4,1
Chloride mEq/L 96-106 96
Renal Test
Ureum mg/dL < 50 35.00
Creatinine mg/dL 0,57 - 0,87 0,87
Radiography Findings :
Seem small nodular infiltrates in both lung
fields
Working Diagnosis :
Meningitis + Suspect TB
Planning :
Mantoux test
Gastric Lavage
S : Loss of Consciousness (+)
O : kepala : mata rc +/+, pupil isokor, conj. Palp. Inf. Pucat (-), T : dbn, N : nasal
canul & NGT, E : dbn
Leher : Pembesaran KBG (-)
Thorax : SF, retraksi (-), HR = 100x/i reg desah (-), Sela iga terlihat jelas, RR
= 20x/I
Abdomen : Soepel, peristaltik (+) N
A : Meningitis TB + Poor Nutrition
P : IVFD NaCl 0,9% 21 gtt/i mikro
-IVFD NaCl 3% 5cc/KgBW/12 hrs
-Inj. Phenytoin 20 mg/KgBW/IVFD
-Inj. Ceftriaxone 1 gr/12 hrs/IVFD
-Inj. Ampicillin 1 gr/6 hrs/IVFD
- PCT 3 x 250 mg
Diet SV 100 cc/ 3 hrs with 1540 kkal + 45 gr protein
S : Loss of Consciousness (+)
O : kepala : mata rc +/+, pupil isokor, conj. Palp. Inf. Pucat (-), T : dbn, N : nasal canul & NGT, E : dbn
Leher : Pembesaran KBG (-)
Thorax : SF, retraksi (-), HR = 100x/i reg desah (-), Sela iga terlihat jelas, RR = 20x/I
Abdomen : Soepel, peristaltik (+) N
A : Meningitis TB + Poor Nutrition
P : - IVFD NaCl 0,9% 41 gtt/i mikro
-IVFD NaCl 3% 110cc/KgBW/12 hrs
-Inj. Phenytoin 55 mg/KgBW/IVFD
-Inj. Ceftriaxone 1 gr/12 hrs/IVFD
-Inj. Ampicillin 1 gr/6 hrs/IVFD
-PCT 3 x -Etambutol 1 x 350 mg
Multivitamin with FE 1x cth I
Inj.Phenitoin 65mg/12 jam in nacl 0,9% 20ccx/20 minute
250 mg
Diet SV 100 cc/ 3 hrs with 1540 kkal + 45 gr protein
S : Loss of Consciousness (+)
O : kepala : mata rc +/+, pupil isokor, conj. Palp. Inf. Pucat (-), T : dbn, N : nasal canul & NGT,
E : dbn
Leher : Pembesaran KBG (-)
Thorax : SF, retraksi (-), HR = 100x/i reg desah (-), Sela iga terlihat jelas, RR = 27x/i
Abdomen : Soepel, peristaltik (+) N
A : Meningitis TB + Poor Nutrition
P : Meningitis TB + Poor Nutrition
- IVFD NaCl 0,9% 41 gtt/i mikro
-IVFD NaCl 3% 110cc/KgBW/12 hrs
-Inj. Phenytoin 55 mg/KgBW/IVFD
-Inj. Ceftriaxone 1 gr/12 hrs/IVFD
-Inj. Ampicillin 1 gr/6 hrs/IVFD
Diet SV 100 cc/ 3 hrs with 1540 kkal + 45 gr protein
The developing world has 1.3 million cases
of TB and 40,000 TB-related deaths annually
among children younger than 15 years
A 13 years old and 3 months girl
Its manifestations like seizures, loss of
consciousness, headache, tremor, fever
usually high, and vomiting.
The main complaint was loss of
conciousness which had been
experienced since 1 week ago.
History of seizure, fever, headache,
and vomiting was found.
On examination of the tuberculin test was
found bacteria growth
the results of tuberculin test
examination stated that the absence
of bacterial growth not found in the
blood
The treatment of TB in Children including
Rifampicin, INH, Pyrazinamide, and
Ethambutol.
This patient got RHZE regiments


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