Page 259 - Abstract Book KONIKA 18

Infection & Tropical Disease

P-ITD-009
Infants with Non Typhoidal Salmonella Extraintestinal Infection

Debby Nur Rachmawati, MMDEAH Hapsari
Department of Child Health, Faculty of Medicine, Universitas Diponegoro, Kariadi General Hospital,
Semarang, Central Java, Indonesia
Abstract
Background There are 3 distinct salmonellosis syndromes: non typhoidal Salmonella (NTS) gastroenteritis,
NTS extraintestinal disease, and typhoidal Salmonella (TS) enteric fever. NTS extraintestinal disease is
rare, occurs in high-risk populations. Objective To report two cases about the clinical course and treatment
of NTS extraintestinal disease in infants. Case A 5-month-old female had fever for more than 2 months
and focal seizure. Physiologic reflexes in upper extremities were increased and no pathological reflex.
She was hospitalized in PICU and found leucocytosis (24.700/uL), thrombocytosis (634.000/uL) and high
procalcitonin (27.37 ng/mL). She performed cranial MSCT with contrast, the result was suspected as subdural
empyema. Then she got craniotomy evacuation by neurosurgery. In the blood and empyema wall culture,
there was Salmonella spp. We gave antibiotic ceftriaxone combined with gentamicin and metronidazole
continued for 28 days. The second case, 2-month-old female was diagnosed with bronchopneumonia,
Ohtahara syndrome and TOF. She came with seizure. While hospitalized in HCU, she had fever, shortness
breath, desaturation and spell. Based on lung examination, there was crackles. Laboratory results showed
there was thrombocytopenia (22.000/uL) and high procalcitonin (30 ng/mL). Impression of chest X-Ray
was bronchopneumonia and staining sputum leukocytes was > 25/LPF. Sputum culture was Salmonella spp
resistant ceftriaxone and gentamycin. The antibiotic combination changed to fosfomycin and ampicillin
sulbactam. Both cases experienced clinical improvement. Conclusion Salmonellosis in infants are rare and
severe. Early diagnose and knowing risk factors are crucial to children with salmonellosis. Giving appropriate
antibiotic will make infection resolved.
Keywords: Salmonella extraintestinal infection

P-ITD-010
Severe COVID-19 Case in Infancy: A Case Report from South Sumatera

Desti Handayani, Indra Saputra, Yulia Iriani
Department of Child Health, Faculty of Medicine, Universitas Sriwijaya, Mohammad Hoesin General Hospital,
Palembang, South Sumatera, Indonesia
Abstract
Background Published reports showed the pediatric population infected by SARS-CoV-2 represents less
than 2%; additionally, only a small number of COVID-19 cases in infancy have been reported worldwide.
However, current evidence suggests that infants (age <1 year) might be at increased risk for severe illness
from SARS-CoV-2 infection. Objective To emphasize the time of administration of antiviral and anticoagulant
therapy. Case A 1.5-month-old baby girl came to the emergency room with decreased consciousness, two
days history of watery diarrhea, fever, and vomiting. Physical examination revealed a bodyweight of 3.1
kg, height 52 cm, and wasted nutritional status (<-2 WHZ). She presented drowsiness with deep and rapid
breathing and feeble pulse; showed signs of hypovolemic shock. SARS-CoV-2 antigen testing was reactive,
and RT-PCR confirmed the COVID-19 (CT-value 6.44). Laboratory workup revealed Hb 10.7 mg/dL,
leucocyte 15,920/mm , CRP 6 mg/L, IL-6 17.34 pg/mL, fibrinogen 331mg/dL, aPTT prolonged 1.4 times
3
fold and four-times fold rise in D-dimer levels (1.95 ng/L). The hypovolemic condition was restored with
optimal intravenous fluid therapy, and the antiviral drug was started as the RT-PCR result revealed on the
first week of symptoms onset. Anticoagulant therapy was given when the coagulation markers were elevated.
Conclusion COVID-19 in infancy may be debilitating and increased the odds for critical care. Clinical benefit
is greatest when antiviral treatment is administered early, within the first week of onset. Anticoagulant should
be given when the evidence of hypercoagulation is present and no contraindication.
Keywords: COVID-19; infan;, SARS-CoV-2; anticoagulant; critical care

KONIKA XVIII Abstract Book 211