Page 278 - Abstract Book KONIKA 18

Infection & Tropical Disease

P-ITD-045
Role of the Neutrophil Lymphocyte Count Ratio in Differentiating Diagnosis
between Pulmonary Tuberculosis and Bacterial Pneumonia
in Pediatric Population

Gilbert Sterling Octavius, Tan, Gabriella Heidina Handoko, Andry Juliansen
Department of Child Health, Faculty of Medicine, Universitas Pelita Harapan, Karawaci, Tangerang,
Banten, West Java, Indonesia
Abstract
Background Differentiating between pulmonary tuberculosis and bacterial pneumonia is often challenging.
Neutrophil to lymphocyte ratio (NLR) is a simple parameter to assess the inflammatory status and has been
demonstrated to be a valuable biomarker for predicting bacteremia. Objective To investigate the usefulness of
the NLR for discriminating pulmonary tuberculosis and bacterial pneumonia. Methods This was a quantitative
research with a cross-sectional study by using medical records. The NLR was calculated from the complete
blood count panel (form peripheral blood sample) by dividing the number of neutrophils by the lymphocyte
number. The objective was to find the NLR cut-off point to differentiate pulmonary tuberculosis and bacterial
pneumonia. Results There are 72 samples in this study, of which there are 28 females (38.9%) and 44 males
(61.1%), with 32 cases of pulmonary tuberculosis (44.4%) and 40 cases of bacterial pneumonia (55.6%).
The mean duration of stay for tuberculosis patients is 6.5 days, with the length of fever is 12 days. As for
bacterial pneumonia, the mean duration stay is 4.7 days and the length of fever 6.7 days. The mean total
white blood count is 15.190, and the mean NLR is 3.12. The cut-off point of optimal NLR to distinguish
pulmonary tuberculosis and bacterial pneumonia is greater than 3.185 to diagnose pulmonary tuberculosis,
with a sensitivity of 53% and specificity of 75%. Conclusion Patients with pulmonary tuberculosis have higher
NLR compared to bacterial pneumonia. The NLR with cut-off > 3.185 to diagnose pulmonary tuberculosis
(sensitivity 53% and specificity 75%).
Keywords: neutrophils lymphocyte ratio; pneumonia; tuberculosis

P-ITD-046
Dengue Shock Syndrome in Infants with Confirmed COVID-19:
Case Report

Arvin Leonard Sumadi Jap, Patton, Alok Adipurnama
Immanuel General Hospital, Bandung, West Java, Indonesia

Abstract
Background Dengue virus infection is a major cause of acute febrile illness in tropical countries, especially
in Indonesia. Coronavirus disease (COVID-19), caused by SARS-CoV-2 has spread globally. Dengue
and COVID-19 may have similar clinical and laboratory features. Coinfection of COVID-19 and dengue
should be considered in children with acute fever living in endemic tropical region of dengue. Objective To
report a case of dengue shock syndrome (DSS) in infant with confirmed COVID-19. Case A 8-month-old
boy was admitted with history of fever for 3 days. No history of cough/cold, shortness of breath, vomiting,
diarrhea, and bleeding manifestation. Both parents denied contact history with confirmed case of COVID-19.
On admission, the patient was alert, with temperature of 38.1OC. No abnormalities were found on physical
examination. On complete blood count test, no abnormalities were found, but the non-structural-1 (NS-
1) dengue and SARS-CoV-2 antigen test were positive. Chest X-ray showed right bronchopneumonia.
SARS-CoV-2 RT-PCR was positive on the next day. On day 3 hospitalization, he looked drowsy with
tachypnea, decreased oxygen saturation, liver enlargement, cold extremities, and prolonged capillary refill
time, there were no chest indrawing and crackles. The platelet count dropped to 18.000/mm3, concurrent
with hemoconcentration. His condition was improved after fluid resuscitation and oxygenation were given.
He was discharged after 6 days of hospitalization, with final diagnoses of DSS and mild COVID-19.
Conclusion We should consider dengue infection especially if thrombocytopenia with shock is found in
patients with COVID-19 living in endemic tropical region of dengue.
Keywords: dengue shock syndrome; COVID-19; SARS-CoV-2; infant

230 KONIKA XVIII Abstract Book