Page 282 - Abstract Book KONIKA 18

Infection & Tropical Disease

P-ITD-053
Adequate Infection and Nutritional Management
in a Severely Immunocompromised Child with Noma

1
Lanny Christine Gultom , Debbie Latupeirissa , Valensia Vivian The 2
1
l
Department of Child Health, Fatmawati Hospita and Primaya Evasari Hospital , Jakarta, Indonesia
2
Abstract
Background Management of children with human immunodeficiency virus (HIV) is often complicated by
severe malnutrition, which significantly increases the risk of opportunistic infections. One of which is noma,
a rapidly progressive necrotic ulcer of the orofacial area. Late treatment might lead to death due to septic
shock. Good outcome might be achieved with appropriate nutritional and antimicrobial management along
with careful monitoring of complications. Objective To report a case of adequate infection and nutritional
management in severely immunocompromised child with nomal. Case A 2-year-10-month-old girl was
referred to Fatmawati hospital with prolonged fever, chronic recurrent cough, severe malnutrition, oral
thrush, and perioral lesion causing feeding difficulty. Her mother died a year before admission due to HIV
infection. The patient was diagnosed with HIV infection, noma, severe malnutrition, milliary tuberculosis,
and oral candidiasis. She received antituberculosis regimen in addition to intravenous antibiotic and antifungal
treatment. The perioral lesion was also treated with saline wet dressing and topical antibiotic. Enteral nutrition
was initiated using oral nutrition supplement (ONS). Despite careful initiation of antiretroviral (ARV)
therapy, the patient developed immune reconstitution inflammatory syndrome (IRIS), which was managed
successfully with corticosteroid. The patient also experienced episodes of anemia which was managed with
blood transfusion and modification of ARV regimen. The patient was discharged with normal nutritional
status and significant improvement of noma after 7 weeks of treatment. Conclusion Infection management,
nutritional support and close monitoring of complication are important for successful management of
immunocompromised patients with severe opportunistic infection.
Keywords: HIV; severe malnutrition; noma

P-ITD-054
Clinical Profiles of Pediatric Covid-19
at Covid-19 Emergency Hospital Kemayoran:
Following the Second Wave of Pandemic in Indonesia

Fitria Mahrunnisa, Tiona Romauli, NPA Natasha Anjasmara, Safitri Nenik, Nia Fitriyani
Covid-19 Emergency Hospital, Kemayoran, Jakarta, Indonesia

Abstract
Background The Delta variant of Coronavirus was labeled by WHO as a variant of concern (VOC) on May
2021 and it had been recorded that 76% of the variant had dominated Indonesia. The Ministry of Health
found that it tended to infect children aged 18 years and younger although data regarding its symptoms
in children is very limited especially in Indonesia. Objective To identify clinical profile during second
wave of cases in RSDCWAK. Methods Descriptive study from reported patients during June-July 2021.
Results There were 610 reported patients confirmed Covid-19 with most common age group were adolescent
group age 10-18 years old (38%) and 18.5% cases were asymptomatic. Of mild symptomatic cases (81.5%),
it was found that 83% of cases presented as multiple symptoms with multi-organ symptoms, both two or
three organ systems combination, became the most cases of all (46%). Whereas respiratory symptoms
were the most cases of single-organ, multiple symptoms and the least was gastrointestinal symptoms (2%).
The same pattern happened as in one symptom which was the most cases as respiratory symptoms (74%).
During hospitalization, 2 cases become severe cases which were both cases presented as multiple symptoms
in group age less than 5 years old. Conclusion Second wave of Covid-19 cases presented more as multiple
symptoms in Covid-19 Emergency Hospital Kemayoran (RSDCWAK). Multiple symptoms presented with
younger age may become a clinical concerned for pediatrician for becoming severe cases. Further studies
are needed for better understanding about pediatric Covid-19 in new variants.
Keywords: clinical profile; pediatric; covid-19; delta variant

234 KONIKA XVIII Abstract Book