Mira Mariana Ulfah,Khotimatun Hasanah,MS Anam ,Dwi Wastoro Dadiyanto,Magdalena Sidhartani
Diponegoro University Dr Kariadi Hospital
Background : Indonesia is the second highest of tuberculosis burden countries according to WHO Global Tuberculosis Report 2016. One segment of the Indonesian population that is vulnerable to tuberculosis exposure is the students in suburb boarding schools due to their crowded conditions and poor hygiene. The risk of tuberculosis transmission among adolescents is higher because it is usually a multibacillary disease and they have high social interactions. We report three cases of tuberculosis in adolescents living in suburb boarding schools.
Case Presentation Summary : In March 2018 at Dr. Kariadi Hospital we found three cases of tuberculosis in male adolescents 14-16 years old who lived in suburb boarding schools in three different cities for 3-5 years, where 25 m2 room was inhabited by 15-20 students. Two patients were diagnosed as meningoencephalitis and also miliary tuberculosis, one patient as lymphadenitis tuberculosis. The main clinical features included weight loss and prolonged fever, and decreased of conciousness in patient with meningoencephalitis. All patients had positive Acid-Fast Bacilli (AFB) from sputum and the Xpert MTB/RIF results were MTB (Mycobacterium Tuberculosis) detected, Rifampicin resistance was not detected. Patient with lymphadenitis tuberculosis had positive AFB from Fine Needle Aspiration Biopsy (FNAB). Patients received tuberculosis treatment for 6 months and 12 months for meningoencephalitis. Antibiotics and corticosteroids were added to patient with meningoencephalitis and miliary tuberculosis. Two patients improved after two months, AFB staining were negative, body weight and chest x-ray were improved. They continued treatment at the nearest health centre. One patient with severe meningoencephalitis died on second day of hospitalization. Contact tracing were attempted but with negative result.
Learning Points/Discussion : The nearest health centre were encouraged to ensure the treatment compliance of the patients, and to make active case finding and further contact tracing.
Keywords: tuberculosis adolescent suburb boarding school
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