Bronkiolitis akut pada bayi: laporan kasus

Abstract

Introduction: Acute respiratory tract infection (ARI) is the major cause of mortality and morbidity in low – and middle–income countries. Bronchiolitis is the most common respiratory tract infection in <2 years old individuals but is often confused with bronchial asthma. This report aims to describe the difference between those two diseases. Case: Eight–month–old baby girl presented with shortness of breath, abnormal breathing sound, productive cough, fever, nasal discharge, and vomiting for 3 days. She’s got a history of abnormal breathing sound at 4 months old. Parents had no history of allergy or asthma. On examination, she was alert, weighed 6,8 kg, had an axillary temperature of 37°C, heart rate of 128/min, respiratory rate of 56/min with subcostal retraction, rhonchi, and wheezing on both chests. Laboratory findings showed hemoglobin of 11,2 g/dL, hematocrit of 32,3%, leukocyte count of 10.810/mm³, thrombocyte count of 361.000/mm³. Serum electrolytes and blood sugar levels were within normal limits. Chest radiograph showed patchy perihilar infiltrates on both lungs and hyperinflation. She was diagnosed with bronchiolitis and was treated with KAEN3B 700 cc/24 hours, nasal oxygen 2 L/min, 3 x 200 mg ampicillin, 2 x 15 mg gentamicin, 3 x 1 mg dexamethasone, ipratropium bromide and albuterol nebulization 3 times daily, 3 x 70 mg oral paracetamol. Her condition improved, and she was discharged after 7 days of hospitalization. Conclusion: There are fundamental differences in clinical profiles between bronchiolitis and bronchial asthma, which have to be carefully examined to prevent misdiagnosis.   Latar Belakang: Infeksi saluran pernafasan akut (ISPA) merupakan masalah utama penyebab mortalitas dan morbiditas di negara berpenghasilan menengah ke bawah. Bronkiolitis merupakan salah satu infeksi saluran nafas tersering pada anak berusia di bawah 2 tahun yang sering dikira sebagai asma bronkial. Laporan ini bertujuan untuk memberi gambaran perbedaan antara kedua penyakit tersebut. Kasus: Bayi perempuan berusia 8 bulan datang dengan keluhan sesak, suara nafas abnormal, batuk berdahak, demam, pilek, dan muntah selama 3 hari. Pasien memiliki riwayat suara nafas abnormal pada usia 4 bulan. Baik pasien maupun orangtua tidak memiliki riwayat alergi maupun asma bronkial. Pada pemeriksaan fisik, pasien sadar, berat badan 6,8 kg, suhu aksila 37° C, nadi 128 kali/menit, laju pernafasan 56 kali/menit, dan didapatkan retraksi subkostal, ronkhi, serta wheezing pada kedua lapang paru. Hasil laboratorium menunjukkan kadar hemoglobin 11,2 g/dL, leukosit 10.810/mm3, trombosit 361.000/mm3, hematokrit 32,3% dengan kadar elektrolit normal. Pemeriksaan foto toraks menunjukkan gambaran hiperinflasi serta patchy infiltrates pada perihilar kanan dan kiri. Pasien didiagnosis menderita bronkiolitis dan mendapatkan terapi cairan dengan KAEN3B 700 cc/ 24 jam, injeksi ampisilin 3 x 200 mg, injeksi gentamicin 2 x 15 mg, injeksi dexamethasone 3 x 1 mg, nebulisasi ipratropium bromide dan albuterol 3 kali/ hari, serta parasetamol oral 3 x 70 mg. Pada hari ke 7, pasien dipulangkan dalam kondisi sehat. Simpulan: Terdapat perbedaan mendasar pada gejala klinis bronkiolitis dan asma bronkial yang jika tidak dicermati dengan hati – hati akan menyebabkan kesalahan diagnosis.