Implementing Advances in Pediatric for

Better Child Health

Pre-KONIKA : 6 - 7 Agustus 2017 :: KONIKA : 8 - 11 Agustus 2017

UKK: Respiratory
Category: ePoster Presentation
Code: P - RES - 026

Delayed diagnosis of pulmonary tuberculosis in

severely malnourished children in primary care center
Muhammad Rizki DM(1) , Agniya Ali Fahmi(1) , Tasya Kamila(1) , Pepi Nur Afifah (1) , Jauhari Wasisto (1)

Cianjur District Hospital(1)

Background: Prevalence of tuberculosis (TB) among severely acute malnourished children is higher than
general population and risk is significantly increased with malnutrition. Delayed diagnosis of TB is
associated with more advanced disease and worse treatment outcomes. Early case detection is essential if
childhood TB is to be controlled and eradicated.

Objective: To study the diagnosis and management of TB in severely malnourished children in district
hospital.

Case: A 2-months-old boy was admitted to the Emergency Department with chief complaint of swelling.
Swelling started from his scrotum and spread to his both lower extremities and throughout his whole body
since 1 month before admission. There was history of fever, inadequate breastfeeding, since 6 days before
admission and no histoy of cough. He had two prior admissions to community health center and was
diagnosed with protein enery malnutrition (PEM). The physical examination showed vital signs were
normal. There was miserable expression, apathy, pu y eyelid and face, generalized body swelling, bilateral
pitting edema. The liver was 4 cm below the costal margin. Laboratory investigations revealed anemia,
leucocytosis, low serum total protein and albumin level. The child was admitted to Pediatric Department
with kwarshiokor as highly suspected. Then he was evaluated by paediatrician, and on history taking, his
father was diagnosed with TB on treatment. Mantoux test was performed and showed negative result.
Thorax photo demonstrated perihilar lymphadenopathy with infiltrate. Then the patient was diagnosed
with TB and Kwarshiorkor. He was treated with antituberculosis drug (based on TB score =6) and
intravenous fluid, vitamin A, antibiotics, nasogastric tube feeding for malnutrition. Patient was discharged
in day 12th of hospitalization.

Conclusion: TB in children is o en missed or overlooked due to non-specific symptoms especially in

malnourished children without cough and fever as chief complaint. Systematic screening for TB should be
consider in severe malnourished children.
Keyword : kwarshiorkor, malnutrition, mantoux test, severe malnourished children, tuberculosis