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Case Morbili
Case Morbili
PATIENT IDENTITY
Name
: Shaafiyah
Birth Date : December 12th 2013
Age
: 2 years old
Gender : Female
Address
: Ketapang, Munjul
Nationality : Indonesia
Religion
: Islam
Admission : December 21th 2015
Examination : December 21th 2015
PARENTS IDENTITY
Father
Mother
Name
Mr.Agus
Mrs. Aini
Age
30 years old
26 years old
Job
Entrepreneur
Housewife
Nationality
Javanese
Javanese
Religion
Islam
Islam
Education
Earning/mo
Approximately
nth
Address
Rp.2.000.000,Ketapang,Munjul.
(graduated)s
-
School
HISTORY TAKING
Taken on December 21th 2015
by Alloanamnesis (from patients
mother)
Chief
Chiefcomplain
complain: :
Shortness of breath 8 hours before admission to hospital
Additional
Additional
complain
complain: :
High fever, productive cough, runny nose, hoarseness, red
patches all over the body, loss appetite
HISTORY OF PRESENT
ILLNESS
S
O
H
E
R
O
F
BE
S
S
I
M
D
A
L
A
T
I
P
5 DAYS
HOSPITAL
December 21th 2015
ION
8 HOURS
1 DAYS
Shortness of breath,
Rash spreading to thrunk
and chest
Bacillary
Dysentry
Amoeba Dysentry
Pneumonia
Diarrhea
Morbilli
Thypoid
Pertussis
Worms
Varicella
Surgery
Diphteria
Brain Concussion
Malaria
Fracture
Polio
Drug Reaction
Enteritis
Prenatal History
Antenatal care
Antenatal check ups performed at
the doctor in the hospital. There was
no problems during pregnancy.
No maternal illness during pregnancy
Drugs consumption:
Vitamins every antenatal care
Birth History
Labor
: Hospital
Birth attendants
: doctor
Mode of delivery : pervaginam
Gestation
: 38 weeks
Infant state
: healthy
Birth weight
: 3400 grams
Body length
: 50 cm
According to the mother, the baby started
to cry and the baby's skin is red, no
congenital defects were reported
Development History
History of Eating
Breast Milk
Exclusively 6 month..
Formula milk
Biscuits milna
Baby biscuits
Fruit and vegetables
Banana, Papaya
History of Immunization
Immunization
Frequency
Time
BCG
1 time
1 month old
Hepatitis B
3 times
0, 1, 6 months old
DPT
3 times
2, 4, 6 months old
Polio
4 times
0, 2, 4, 6 months old
Hib
3 times
2, 4, 6 months old
Measles
Family History
Patients both parents were married
when they were 26 years old and 24
years old, and this is their first
marriage.
There are not any significant
illnesses or chronic illnesses in the
family declared.
History of sibling
Childbirth
Spontan
pervaginam,
gestation aterm
Gender
Age Died
Sumption Died
Age
girl
2 years
old
Physical Examination
(December 21 2015)
General Status
Antropometry Status
Weight
height
: 10,5 kilogram
: 80 cm
Head
Eyes
Ears
Nose
Mouth
Lips
Teeth
Mucous
Tongue
Tonsils
Pharynx
Neck
Dry
No caries
Dry
Not dirty
T1/T1, no hyperemia
Hyperemia
Lymph node enlargement (-), scrofuloderma (-)
Thorax
Inspection:
Palpation:
Percussion:
Auscultation
Cor :
Pulmo:
Abdomen
:
Inspection :
Palpation
Percussion:
Auscultation:
Vertebra
Scoliosis (-) kyphosis (-) lordosis(-), any mass along the line
of vertebra (-)
Ekstremities
Skin
Laboratory Investigation
Hematology (December 21th 2015)
Hematology
Results
Normal Value
Haemoglobin
11.8 g/dL
13-16 g/dL
Leukocytes
6.400/L
5,000 10,000/L
Hematocrits
36 %
40 48 %
Trombocytes
164.000/ L
150,000
400,000/L
Erythrocytes
Working Diagnosis
Bronchopneumonia
Morbili
Management
PROGNOSIS
dubia ad
bonam
dubia ad
bonam
Quo ad
Quo ad vitam
functionam
dubia ad
bonam
Quo ad
Sanationam
A
P
MACROSCO
PIC
RESULT
S
NORMAL
COLOR
YELOW
CLEARNESS
Slightly
Cloudy
Clear
8.0
5-8.5
DENSITY
1.070
1.000-1.030
PROTEIN
NEGATIVE
BILIRUBIN
GLUCOSE
PH
MICROSCO
PIC
RESULT
S
NORMAL
LEUCOCYTE
SEDIMENTATI
ON
NEGATIVE
Leucocyte
1-2
0-5/LPB
Erythrocyte
0-2
1-3/LPB
Epitel Cell
NEGATIVE
Cylinder Cell
NEGATIVE
Crystal
KETONE
NEGATIVE
Etc
BLOOD/HB
NEGATIVE
NITRIT
NEGATIVE
0.1
0.1-1.0 IU
UROBILINOG
EN
A
P
PARAMETE
R
PH
RESUL NORMAL
TS
VALUE
7.47
7.35-7.45
PCO2
26
35-45
mmHg
PO2
114
85-95
mmHg
O2
SATURATIO
N
100
85-95
HCO3
19
21-25
Mmol/L
BE
-3
-2.5 to
+2.5
Mmol/L
SBC
22
22-26
Mmol/L
TOTAL CO2
20
21-27
Mmol/L
-4
-2.4 to
+2.3
Mmol/L
alkalosis respiratorik
IBE
A
P
RESULTS
MICROSCOPIS
RESULTS
COLOR
Brown
LEUCOCYTE
1-2 /LPB
CONSISTENCY
Solid,
smooth
ERYTHROCYTE
0-1 / LPB
MUCUS
NEGATIVE
HELMINTH EGG :
BLOOD
NEGATIVE
ASCARIS SP
NEGATIVE
ANCHILOSTOMA
SP
NEGATIVE
TRICHIURIS SP
NEGATIVE
OXYURIS SP
NEGATIVE
Bronchopneumonia
Morbili
Patient can go home
IVFD RL, micro drip 14 dpm 1000cc/24 hrs
Cefotaxim injection 2x 500 mg, IV
Ambroxol syrup 3x1 cth, oral
Vit A 100.000 IV
TERATURE
ITERATUREREVIEW
REVIEWAND
AND
DISCUSSION
DISCUSSION
CHARACTERISTIC OF MORBILI
Known as : Measles, Rubeola
It is an acute highly contagious viral disease
It has 3 stages of progression; catarrhal, eruption
and convalescence
The latest stage characterized by maculopapular
rash erupting succesively over the neck, face,
trunk, arms and legs.
EPIDEMIOLOGY OF MORBILI
(WHO, 2015)
Leading cause of death in children worldwide
Globally there are 30 million people suffering from
measles.
In Indonesia it is estimated 30.000 children die every
year due to its complications.
Most often in :
ETIOLOGY OF MORBILI
Measles virus
RNA virus
From Paramyxoviridea of
genus Morbilivirus
PATHOPHYSIOLOGY OF MORBILI
ERUPTION
CONVALESCENCE
CATARRHAL
(PRODORMAL)
Kopliks Spots
Conjunctivitis
Kopliks Spots
ERUPTION
CONVALESCENCE
DIAGNOSTIC INVESTIGATION
ONLY IF COMPLICATIONS
SUSPECTED
Chest
If bacterial bronchopneumonia
Chest
is suspected
Radiography
Radiography
Complete
CompleteStool
Stool If bacterial enteritis is
Test
Test
suspected
Lumbar
Lumbar
If encephalitis is suspected
Puncture
Puncture
CSF examination reveals : ioncreased protein, normal
glucose, mild pleocytosis with a predominance of
lymphocytes
COMPLICATIONS OF MORBILI
CROUP
Acute
Laryngitis
Bronchopneumonia
Otitis Media
Enteritis
Myocarditis
Tuberculosis
Encephalitis
TREATMENT
SUPPORTIVE
SUPPORTIVE
CARE
CARE
Vitamin
VitaminAA
ANTIVIRAL
ANTIVIRAL
THERAPY
THERAPY
ANTIBIOTIC
ANTIBIOTIC
THERAPY
THERAPY
PREVENTION
Measles vaccine to increase
active immunity
The vaccine contains life
attenuated measles viral
Usually given in combination with
mumps and German measles ( MMR )
first dose : age 12-15 months of age
second dose : age 4-6 years
Vaccine Effectiveness
1-dose: ~93%
2-dose: ~97%
PROGNOSIS
Case Fatality rate higher among
patients :
Younger than 5 y.o.
Malnutrition
Vitamin A Defficiency
Immunodeficiency disease
Inadequate vaccination or
unvaccinated
Low socio-economic
REFERENCES
Chen S. Measles. Available online at :
http://emedicine.medscape.com/article/966220-overview#a6. (Last
update on March 30, 2015).
WHO. Measles. Available online at :
http://www.who.int/immunization/diseases/measles/en. (Last update
on Augustus 13 2015).
Centers for Disease Control and Prevention. Measles (Rubeola).
Available online at : http://www.cdc.gov/measles/about/history.html.
(Last update on November 3, 2014).
Measles Y. Maldonado . In : US Wahab ( editor ) . Nelson Health
Sciences Children , edition to -15 . Jakarta : EGC , 2000. 1608-71.
Jawetz , Melnick JL , Adellberg 's EA . Measles Virus Infection . In :
Brooks GF , Ornston LN , Irawati ( editors ) . Medical Microbiology ,
20th edition Jakarta : EGC , 1996. 542-47
Soegijanto Pediatrics S. Tropical and Infectious diseases . Jakarta :
Agency IDAI Publishers , 2000. 125-40
Tumbelaka AR , et al . Standards of Medical Care Child Health .
Jakarta : Agency IDAI publishers , 2004. 95-98