Page 270 - Abstract Book KONIKA 18

Infection & Tropical Disease

P-ITD-030
Challenge of Diaagnosing Pediatric Tuberculous Meningitis
on A Girl with Severely Wasted in Limited Resource Areas: A Case Report

Marini Siagian, Armand S. Liwan
Oksibil General Hospital, Pegunungan Bintang, Papua, Indonesia

Abstract
Background Tuberculous meningitis is the most severe form of M. tuberculosis infection and it is associated
with higher rates of mortality and severe morbidity. Tuberculous meningitis is a medical emergency, delay
in treatment is strongly associated with mortality. Undernutrition can increase the risk of tuberculosis (TB)
and TB can cause or worsen undernutrition. Objective This case report describes the challenge of diagnosing
pediatric tuberculous meningitis with severely wasted in limited resource areas. Case A seven years- seven-
month old unvaccinated Papuan girl, weighed 15 kg, height 110cm, BMI (12,3) presented with sudden seizure
with 3 minutes of duration. On admission she had loss of consciousness with glasgow coma scale of 10/15
and neck stiffness. She had headache and recently became irritable since four days prior. She had intermitten
fever, loss of appetite and weight loss since four month ago. She subsequently developed weakness in all four
limbs since two months ago. She had no history of cough, photophobia, nausea, and vomiting or diarrhea.
There was no history suggestive of respiratory, cardiac, or urinary abnormalities. There was no personal or
family history of hypertension, diabetes mellitus, or TB. She was started on antituberculosis with proper
nutritional management. Nevertheless, she had significant improvement, hence continuation to complete 12
months period of therapy. Conclusion Tuberculous meningitis is a medical emergency, delay in treatment is
strongly associated with mortality while TBM remains difficult to diagnose. Tuberculous meningitis should
be considered in patients presenting with acute headache and fever in area with high prevalence of TB.
Keywords: tuberculous meningitis; severely wasted; limited resource

Figure.1 Patient during admission and 30 days after discharge

222 KONIKA XVIII Abstract Book