Page 265 - Abstract Book KONIKA 18

Infection & Tropical Disease

P-ITD-021
Management of Dengue Shock Syndrome as a Co-Infection
in a Child with Coronavirus Disease-2019: A Case Report

Maria Martina Siboe, Giovanni Reynaldo, Bernadina Cynthia Carsantiningrum, Paskalish Caroline
Department of Child Health, St. Carolus Hospital, Jakarta, Indonesia

Abstract
Background Dengue Shock Syndrome (DSS) is a major health problem in tropical countries with estimated
mortality rate of 40%. Increasing cases of Coronavirus Disease 2019 (COVID-19) in Indonesia resulted
in many cases of co-infetion with Dengue. Disseminated Intravascular Coagulation and Multisystem
Inflammatory Syndrome in Children may occur and require appropriate recognition and treatment.
Objective To show diagnosis and treatment for COVID-19 in a child with DSS as a co-infection.
Case A 9-year-old girl was brought to the emergency department with complaints of malaise since the last 4
days. The patient was diagnosed with COVID-19 13 days earlier and underwent self-isolation protocol. The
patient began to experience fluctuating fever, abdominal pain, vomiting since the 9th day of isolation. On
physical examination we found decreased consciousness accompanied by circulatory compromised. Initial
laboratory examination showed hemoglobin 16.3 g/dL, hematocrit 46.9%, platelets 27.000/μL, d-dimer
21,230 ng/mL, procalcitonin 10 ng/ml, and dengue NS1 positive. Repeated PCR examination result was
positive with a CT Value of 32.6, laboratory examination revealed hemoglobin 18.2 g/dL, hematocrit 53.3%
and platelets 16.000/μL. The patient underwent oxygen therapy and fluid resuscitation using crystalloids and
colloids but experienced recurrent shock. Subsequently, she received antibiotic therapy, albumin, steroid,
and intravenous inotropes. Shock was resolved on the first day. Fluids and inotropes were discontinued on
the third day, and the patient was transferred to a non-intensive care unit. Conclusion It is important for
clinician to identify recurrent shock in DSS. Co-infection should always be considered in recurrent or longer
fever pattern in COVID-19 cases.
Keywords: DSS; COVID19; PCR; fluid resuscitation

P-ITD-022
Atypical Pompholyx Presentation with Secondary Staphyloccoccus
and Klebsiella Infections: Report of a Rare Case
Hartantyo Kusuma, Leny Kartina, Dwiyanti Puspitasari, Dominicus Husada, Parwati S Basuki, Ismoedijanto
Department of Child Health, Faculty of Medicine, Universitas Airlangga/Dr.Soetomo General Hospital,
Surabaya, East Java, Indonesia
Abstract
Background Pompholyx refers to pruritic vesicles or bullous rash mainly distributed on the palms and
lateral surfaces of the fingers. In a population study, the one-year prevalence of pompholyx was estimated
to be 0.5%. Although occurs worldwide, it is less common among Asians. In a severe condition, secondary
bacterial infection of pompholyx can happen and result in pain, swelling and pustules on the hands and
feet. Objective To provide a management approach of atypical Pompholyx. Case A 15-year-old girl came
to Dr.Soetomo Hospital's outpatient clinic, Surabaya, with progressive wound and small bumps containing
yellowish pus and crusts only on her hands and feet for 6 months and worsened in the last month before
admission. She also had premorbid of congenital Ebstein anomaly, a cyanotic heart disease complicating this
disease because of poor peripheral perfusion. The pus culture revealed double infections of Staphylococcus
aureus and Klebsiella aerogenes. Wound care consisted of wet dressing with normal saline and applying
moisturizer on crusts. For the secondary infection, double antibiotics for gram positive and negative bacteria,
Cloxacillin and Chloramphenicol had been given for 14 days. Nutritional support was considered a prerequisite
for optimal outcome. At 10 days of hospitalisation the skin lesion showed complete improvement and she
was discharged from the hospital. Conclusion It is important to consider atypical Pompholyx in children
with chronic pruritic vesicle, bullous rash or crusts on hand and foot.
Keywords: Pompholyx; pruritic vesicles, bullous or crusts; only in hand and foot; ebstein anomaly;
staphylococcus aureus; klebsiella aerogene

KONIKA XVIII Abstract Book 217