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Journal : Narra J

A pediatric case and literature review of mucormycosis: Diagnostic and treatment challenges in a resource poor setting Lubis, Inke ND.; Farah, Sara; Pasaribu, Ayodhia P.; Evalina, Rita; Daulay, Rini S.; Wijaya, Hendri
Narra J Vol. 3 No. 3 (2023): December 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i3.426

Abstract

Mucormycosis is an emerging disease that primarily affects immunocompromised patients; however, it has also been reported in immunocompetent individuals. Studies in the pediatric population are limited and reported mostly in case studies or series. The aim of this case report is to present a pediatric mucormycosis originated from Sumatra Island, Indonesia. A 13-year-old boy was referred to a tertiary hospital with facial necrosis involving the nasal, oral, and left maxillary areas, as well as left periorbital edema. No known underlying conditions were documented. The diagnosis was confirmed by histopathological findings of broad, pauci-septate, ribbon-like hyphae branching at 90°. The patient was managed by a multidisciplinary team consisting of the ear, nose, and throat, infectious diseases, dermatology, surgery, microbiology, and pathology departments. Management of the patient included debridement of the necrotic lesion and antibiotics and anti-fungal (fluconazole). Due to unavailability, the patient was not treated with amphotericin B. The patient died after 30 days of admission. This case highlights the importance of maintaining a high suspicion of invasive mucormycosis, even in immunocompetent children, when symptoms and signs are present, especially in resource-limited settings.
Norwegian scabies in human immunodeficiency virus and tuberculosis-infected child: A case report Wijaya, Hendri; Kollins, Fini; Lubis, Inke ND.; Pasaribu, Ayodhia P.; Evalina, Rita; Nababan, Kristo A.; Paramita, Deryne A.
Narra J Vol. 4 No. 1 (2024): April 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i1.661

Abstract

Norwegian scabies is a rare scabies with the manifestation of thick crusts of the extremities of the skin that contain eggs and mites. Several conditions in which scabies infection is easily transmitted include immunocompromised, home nursing, and severe neurological disorder. The aim of this case report was to present a thorough analysis of a comprehensive resource for the management of Norwegian scabies patients, with a specific focus on individuals who also have HIV or other immunocompromising diseases.  A 1-year-and-7-month-old boy was presented to the hospital with a chief complaint of a thick crust that he had experienced for four months. It began as a red papule in the lower extremity, then crusted and spread to the whole body. The patient kept scratching due to itching, had a recurrent fever and diarrhea for three months, and cough for one month. The patient was diagnosed with human immunodeficiency virus (HIV) and pulmonary tuberculosis at three months, suspected to get the infection from the parents. Sarcoptes scabiei was found from microscopy examination of skin scraping. The patient received holistic treatment, including antiretroviral drugs, antituberculosis medication, scabies treatment, and malnutrition treatment. Appropriate scabies treatment aimed at peeling crusted skin, relieving itching, and increasing the patient ability to use the extremities. Comorbidity conditions caused by HIV and pulmonary tuberculosis should also be treated to optimize the outcome. The patient was discharged in good condition with sanitation education and regular follow-up at the outpatient clinic. This case highlights that Sarcoptes scabiei infestation may be a clue to an immunocompromised condition. Holistic therapy aiming to cure underlying infection, infestation and underlying nutrition and psychosocial problems must be addressed to fully cure this high-burden case.