Seorang Anak Perempuan Probable Covid-19 dengan Keterlibatan Ginjal (Laporan kasus)

Abstract

Latar belakang: Kasus Probable Covid-19 adalah kasus penderita  dengan gambaran klinis dan pemeriksaan penunjang yang meyakinkan Covid-19 namun tidak terkonfirmasi dengan  pemeriksaan real-time polymerase chain reaction (RT-PCR). Kasus probable  banyak menimbulkan  kekhawatiran karena risiko penularan dan keraguan  dalam tata laksana baik bagi dokter, perawat, dan  penanggung jawab  pasien. Tujuan penulisan artikel ini adalah untuk melaporkan kasus seorang anak dengan probable Covid-19  dan mendiskusikan  kemungkinan diagnosis banding lain sebagai pemikiran di tengah pandemi Covid-19 guna pengelolaan pasien yang lebih optimal.

Kasus:  Anak perempuan 14 tahun 5 bulan dengan keluhan utama batuk selama dua minggu sebelum masuk rumah sakit,  disertai demam, diare dan sesak. Selama perawatan, sesak makin bertambah. Tiga hari perawatan ditemukan oliguria, proteinuria, anemia, leukositosis, trombositopenia, hipersegmentasi neutrofil, limfopenia, peningkatan prokalsitonin, hipoalbuminemia dan penurunan fungsi ginjal (51 ml/menit/1,73 m2). Gambaran rontgen dada menunjukkan bronkopneumonia dan kardiomegali. MSCT dada terdapat gambaran konsolidasi dan ground glass appearance (GGO) di kedua paru mendukung ke arah Covid-19. Pada hari perawatan ke 16 anak mengalami gagal nafas, hemoptoe, penurunan kesadaran  hingga meninggal.   Swab RT-PCR 3 kali negatif (selama perawatan dan post mortem).

Ringkasan : Infeksi Covid-19 adalah penyebab infeksi saluran nafas yang serius dan berat. Telah dilaporkan seorang anak perempuan 14 tahun 5 bulan yang meninggal karena Probable Covid-19. Di tengah pandemi Covid-19 ini seorang dokter  perlu meningkatkan kewaspadaan yang tinggi terhadap infeksi virus atau bakteri lain untuk memperbaiki tata laksana dan luaran  pada penderita.

Kata kunci: Covid-19, probable, ground glass opacity, RT-PCR

Background: Probable Covid-19 cases are patients with clinical features and convincing investigations for covid-19 but there is  not confirmed by real time polymerase chain reaction (RT-PCR). Probable cases raise many concerns because of the risk of transmission and doubt in good management for the doctor / nurse in charge of the patient. The purpose of writing was to report the child with probable Covid-19 and provide a discussion of possible other differential diagnoses as thoughts in the midst of the Covid-19 pandemic for optimal management of sufferers. Case: A girl 14 years 5 months old had a cough for two weeks before admission, accompanied by fever, diarrhea and breathlessness. During treatment, the shortness of breath increased, three days of treatment found oliguria, proteinuria, hematuria, anemia, leukocytosis, thrombocytopenia, neutrophil hypersegmentation, lymphopenia, increased procalcitonin, hypoalbuminemia and decreased renal function (51 ml / min / 1.73 m2). Chest x-ray of bronchopneumonia and cardiomegaly. In the finding of  chest computed tomography scan showed consolidation and ground glass appearance (GGO) in both lungs supporting the diagnose  of Covid-19. On the 16th day of treatment, the child suffered respiratory failure, hemoptoes, decreased consciousness until death. RT-PCR swabs were 3 times negative (during treatment and post mortem). Summary: Covid-19 is a serious and severe cause of respiratory tract infection. It has been reported that a girl of 14 years and 5 months who died of Probable Covid-19 has been reported. During the Covid-19 pandemic, a doctor  may need  to increase high awareness of other viral or bacterial infections to improve management  and outcome of patients in the future.

Key word: Covid-19,  Children,  Ground Glass Opacity, RT_PCR