Page 279 - Abstract Book KONIKA 18

Infection & Tropical Disease

P-ITD-047
MIS-C in Long-COVID-19 : A Case Report

Elviri Ngedihu, Jeffri Simatupang, Susanto Isman, Ivan Riyanto Widjaja
Koja General Hospital, Jakarta, Indonesia

Abstract
Background Covid-19 has become a global pandemic that caused disasters all around the world. MIS-C
(Multisystem Inflammatory Syndrome in Children) causes inflammation in many organs such as digestive
tract, heart and kidneys. MIS-C has been widely reported in patients aged under 21 years. Recent reports in
Europe and America said that there is a correlation between hyperinflammation in children with Covid-19.
Objective To evaluate the manifestation of MIS-C in Positive Long-Covid. Case A 13-year-old boy is
brought to Koja General Hospital with short of breath, fever and cough since 3 days ago. He had been self-
isolation from covid for 14 days before with only fever and didn’t confirmed negative swab after isolation.
He had normal nutrition status with tachypnea and high temperature, chest retraction, rhonchi in both lung.
Laboratory finding thrombocytopenia with normal CT-Thorax and negative antigen test. After 3 days, the
symptoms worsen with hypotension, another CT-Thorax and nasopharyngeal swab with result of Bilateral
Subpleural Consolidation and positive result. Thrombocytopenia dropped and elevated liver enzymes,
Troponin, CRP, D-dimer and IL-6. The patient diagnosed MIS-C with Long-Covid and was treated with
high oxygenation, steroid, meropenem, amikacin, remdesivir, enoxaparine 1mg/kg/dose and IVIG 1g/kg.
The symptom reduced in 24hours, CT-thorax and laboratory back to normal within 3days. The patient then
discharged after 10days of hospitalization. Conclusion Symptom of covid is not always shown in the first
few days, in our case the boy came with symptoms after 2weeks of self-isolation with sign of MIS-C and
recovered with steroid, antivirus, IVIG and anticoagulant.
Keywords: Covid-19; MIS-C; respiratory distress; long Covid; IVIG

P-ITD-048
Cryptosporidium Infection in Immunocompromised Patient: A Case Report

Yudis Jayaprabhowo , Fabiola Vania , Edi Hartoyo , Budiyanto , Munawaroh Pasaribu 2
1
1
1
1
2
Department of Child Health and Department of Microbiology , Ulin General Hospital,
1
Banjarmasin, South Borneo, Indonesia
Abstract
Background Cryptosporidium infection or cryptosporidiosis is an illness caused by protozoan parasite
Cryptosporidium spp. that primarily infected the distal small intestine and colon. Patient with advanced
immunosuppression, typically CD4 T lymphocyte (CD4) cell counts <100/mm3, had the highest risk
of infection. Cryptosporidiosis cases can present with no symptom or transient disease, to relapsing
chronic diarrhea or cholera-like diarrhea, which can lead to life-threatening wasting and malabsorption.
Therefore, understanding the diagnosis and treatment cryptosporidiosis remains a challenge.
Objective To demonstrate the first finding of Cryptosporidium infection in stool sample using modified
Ziehl-Neelsen stain procedure.Case A 7-year-old boy, weighed 9 kg, was hospitalized in our hospital
with chronic diarrhea in immunocompromised condition. Diarrhea was slightly improved with probiotic,
zinc, oral rehydration solution, and antibiotic azithromycin. Patient was evaluated comprehensively. CD4
level was 9 cells/μL and oocyst of Cryptosporidium spp was found in stool examination by modified
Ziehl-Neelsen stain procedure. This oocyst finding was the first and would make the diagnosis and
treatment more thoroughly if the recommended treatment (paromomycin, nitazoxanide) was available in
our region. In immunocompromised children, chronic severe diarrhea can result in malnutrition, failure
to thrive, and substantial intestinal fluid and electrolytes losses, resulting in severe dehydration and even
death. These were both challenges and chances for better management of cryptosporidiosis in children.
Conclusion Cryptosporidiosis could become a threat especially in immunocompromised patient. The diagnosis
could be a challenge, as well as the management in limited resources area.
Keywords: cryptosporidiosis; immunocompromised; chronic diarrhea; ziehl-Neelsen

KONIKA XVIII Abstract Book 231