Page 271 - Abstract Book KONIKA 18

Infection & Tropical Disease

P-ITD-031
Treatment of Mucormycosis Infection in Acute Lymphoblastic Leukemia
Children: A Case Report

Marissa Anggraeni, Miranti Fristy Medyatama, Fitri Primacakti, Ari Prayitno
Department of Child Health, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital,
Jakarta, Indonesia

Abstract
Background Mucormycosis is an invasive fungal infection usually occurred in immunocompromised
patients including haematological malignancy. Prevalence of mucormycosis in children with haematological
malignancy is approximately 2% - 36.5%, with mortality rate of 9.5-63%. Objective To describe the
management of mucormycosis infection in pediatric ALL patients. Case A 6-year-old boy, diagnosed with ALL
standard risk on chemotherapy induction phase week-3, was admitted to our hospital due to febrile neutropenia,
sepsis, and severe malnutrition. Fever persisted despite adequate antibiotics administered in accordance with
the blood culture results, antifungal therapy, granulocyte colony stimulating factor and adequate nutrition
management. On the 24th day of hospitalization, he was suspected to suffer from mucormycosis infection due
to the blackish white plaque 3 cm x 6 cm covering perforation on the hard palate extending to soft palate. He
received amphotericin B as empiric first-line treatment with scrutinized renal function monitoring. The patient
was consulted to Ear Nose Throat Department to undergo nasoendoscopy, lesion biopsy, and debridement.
The biopsy revealed mucormycosis (Rhizopus sp) sensitive with amphotericin B. Mucormycosis lesion was
not found in other sites based on chest X-ray examination, Esophagogastroduodenoscopy, and brain CT scan.
Antifungal treatment was continued for 3 months, and chemotherapy was started once the biopsy showed
negative result for mucormycosis infection. Conclusion Management of mucormycosis should be carried out
aggressively including early diagnosis to prevent further invasion, early treatment with specific antifungal
therapy, debridement to remove all infected tissue and treatment of ALL as the underlying predisposing
factor of immunodeficiency.
Keywords: mucormycosis; malignancy; acute lymphoblastic leukemia; amphotericin B

P-ITD-032
Meningococcal Infection in Children

Rahmawan Sakup Mapianto, Lina Purnamasari, Edi Hartoyo
Department of Child Health, Ulin General Hospital, Faculty of Medicine, Universitas Lambung Mangkurat,
Banjarmasin, South Borneo Indonesia

Abstract
Background Meningococcal infection is a rare but serious bacterial infection. The most common etiology is
Neisseria meningitis which could lead to invasive meningococcal disease (IMD). Attack rate of meningococcal
disease in pediatric population is 2,74/100.000 with peak incidence mainly in child younger than 12 months.
High mortality and deficit neurology are major complication. In pediatric population, mortality rate caused
by this disease reach 5-10% case, 10-20% case had neurological deficit (hearing loss, limb loss). Objective
To demonstrate determination diagnosis of meningococcal infection based on clinical manifestation and
gold standard. Case A 12 years old boy transferred to our hospital with chief complain redness in whole
skin body since 8 hours before admission. Additional complain were fever, headache, sore throat, and loss of
consciousness. After 7 hours, painful petechiae appear in both hands, legs, body, spine, and face with various
diameter. Urinary frequency and urine output decreasing less than 2 times per day. Physical examination
revealed non palpable, tenderness, redness, and generalization purpura and ecchymosis with necrosis.
Laboratory findings were leukocytosis, thrombocytopenia, high level of urea and creatinine, prolonged PT/
APTT, high D-dimer level, electrolyte imbalance, and high CRP with proteinuria and leukocyturia. Head CT-
Scan showed enhancement appearance suggested meningitis. Throat swab examination showed positive for
diplococcus bacil gram negative. Ceftriaxone, methylprednisolone, omeprazole, vitamin K, diphenhydramine,
and furosemide injection were given. Patient was diagnosed with meningoccaemia, meningoencephalitis
meningococcal, acute kidney injury, and disseminated intravascular coagulation (DIC). After 10 days
hospitalization, patient showed improvement. Conclusion Meningococcal infection can affect various organs
including intracranial and kidney. A fast diagnosis process can reduce the severity of the disease.

Keywords: meningococcal infection; meningoencephalitis meningococcal; AKI; DIC

KONIKA XVIII Abstract Book 223