Formulating Diet for Transitional Feeding in Tuberculous Meningitis Patient during Hospital Care and through to Period of Home Healthcare

抄録

Tuberculosis (TB) affects one-third of the world’s population and is the leading cause of human mortality and morbidity. Tuberculous meningitis (TBM) is the most severe type of extrapulmonary diasease. Medical treatment and nutritional management is the most efficient and cost-effective of all health interventions. In case: A 25-y-woman presented with loss of appetite, fluctuating fever for two weeks, and loss of consciousness for 9 d. There was no history of headache, nausea, vomiting and neck pain. Physical examination shows signs of meningeal irritation, anemia, dermatitis in neck, armpit and back, decubitus and limb paralysis. Laboratory examinations showed normocytic normochromic anemia, immune depletion, hypoalbuminemia, hyponatremia, hyperlipidemia and elevated liver transaminase. Nutritional therapy was given by enteral nutrition, contained of high protein and choline ONS (oral nutritional supplement), blenderized diet. Vitamin A, B complex, C, D, zinc, and cork fish extract as the source of albumin, immunonutrient such as fish oil was given as supplementation. After 35-d of treatment, there were increased of albumin plasma and lymphocyte level, accelerated wound healing, dermatitis, and functional capacity. Home healthcare visit and physiotherapy was conducted for about 1-month to support oral feeding from liquid to blenderized diet to porridge and improve cognitive and functional capacity. This report is intended to describe how nutritional support with transitional feeding to enhance adequate intake can accelerate wound healing, decrease morbidity and mortality rate in TBM patient.