Upload
monazzt-asshagab
View
223
Download
0
Embed Size (px)
Citation preview
8/18/2019 4. Tropis 4 2012 (Salmonella)
1/42
Mochammad Hatta@2013Mochammad Hatta@2013
SALMONELLA TYPHI
Prof. Dr. Mochammad Hatta, Ph.D, SpMK (K)
Dept Microbiology, Fac.Medicine,
Hasanuddin ni!ersity,
Ma"asssar
8/18/2019 4. Tropis 4 2012 (Salmonella)
2/42
Electron micrograph of a metal-shadowed whole cell ofSalmonella typhi, showing agella and shorter straightmbriae (magnied 7,800 times)
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
3/42
Mochammad Hatta@2013Mochammad Hatta@2013
• Disease : Demam #ifoid (#yphoid Fe!er)
Gastrointestinal infection -- endemik in Indonesia--developing
countries -- environmental/sanitation/hygiene relationship
(Hattta M et al! "rans! #oyal "rop! Med! Hyg $ond %&&'
• )amily : *ntero+acteriaceae -- Gram negative -- non-sporing +acillus -- %-, -- motile -- long peritrichous flagella -- aero+e/
facultative anaero+e -- temperature .o- ,.o 0 optimum '1o 2
• 2olonies on Mac2onkey3s medium 0 44 agar
• 5iochemical reactions: Glucose 0 mannitol: fermentation (6 0
gas (6 -- lactose 0 sucrose : fermentation (-
8/18/2019 4. Tropis 4 2012 (Salmonella)
4/42
Mochammad Hatta@2013Mochammad Hatta@2013
• $iability : death point : 7o 2
• In soil survival for 7 8eeks
• Pathogenesis : infection +y ingestion --- small intestinal via
lymphatics --- mesenteric glands -- multiplication --- +lood via
thoracic duct --- +acteriaemic phase ( . - .& days : infection
liver gall +ladder spleen kidney 0 +one marro8!
Gall +ladder --- invasion lymphoid tissue -- 9eyer3s patches
0 lymphoid follicles -- acute inflammatory reactions --- ulcer
haemorrhage -- perforation 0 necrosis
8/18/2019 4. Tropis 4 2012 (Salmonella)
5/42
CLINICAL PICTURE
Symptoms begin with sudden onset of high-
grade feer! heada"he # dry "ough$
%eer is swinging or may show step &adder
pattern # patient initia&&y fee& we&& # mobi&e$
Abdomina& pain # to'i"ity fo&&ow soon # by
the end of (st wee) sp&een is pa&pab&e # pin)!
dis"rete! s)in rash appears oer the trun)$
Constipation is more "ommon than diarrhea
whi"h is usua&&y greenish in "o&or *pea soup+$
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
6/42
CLINICAL PICTURE,
Abdomina& tenderness # hepatomega&y o""ur
in ./0 of patients$
The pu&se is re&atie&y s&ow in re&ation to feer
*Paget sign+$
The tongue is "oated with free margins #ha&itosis may be present$
The sweat of some patients sme&& &i)e yeast$
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
7/42
CLINICAL PICTURE,1
The 1rd wee) of i&&ness is the usua& time for
"omp&i"ations in the untreated patients$
Lo"a& gut as we&& as systemi""omp&i"ations may o""ur$
Serious infe"tions may progress rapid&y to
drowsiness # "oma whi"h is usua&&y fata&*"oma igi&+$
2orta&ity is un&i)e&y after the 3th wee) #
patients may be"ome "arrier if not treated$Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
8/42
Enteric fe!er" #ose spotsEnteric fe!er" #ose spots
Paratyphoid feverTyphoid fever
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
9/42
Intestina& hemorrhage
Para&yti" i&eus
Intestina& perforation
L4CAL C42PLICATI4NS
5en)er degeneration of abdomina& mus"&es
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
10/42
Endo"arditis
Arteritis # arteria& embo&i
Cho&e"ystitis
S6STE2IC C42PLICATI4NS
4steomye&itis # septi" arthritis
7epati" # sp&eni" abs"esses
Pneumonia or empyema
2eningitis
Urinary tra"t infe"tionMochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
11/42
Mochammad Hatta@2013Mochammad Hatta@2013
P4SITI8E CULTURE AN9 Ig2 ANTI:496 RESP4NS IN T6P74I9P4SITI8E CULTURE AN9 Ig2 ANTI:496 RESP4NS IN T6P74I9
%E8ER%E8ER
8/18/2019 4. Tropis 4 2012 (Salmonella)
12/42
$yphoid fe!er $yphoid fe!er%aboratory diagnosis%aboratory diagnosis
• Polymerase Chain Reaction (PCR)Polymerase Chain Reaction (PCR)
• Culture of blood or bone marroCulture of blood or bone marro& !0" durin# first ee$!0" durin# first ee$
• Culture of urine or stoolCulture of urine or stool& in %resence of characteristic clinical %icturein %resence of characteristic clinical %icture
• &erolo#y test&erolo#y test& antibody test a#ainst somatic (') orantibody test a#ainst somatic (') or
fla#ellar (H) anti#enfla#ellar (H) anti#en
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
13/42
Mochammad Hatta@2013Mochammad Hatta@2013
Prinsip tehni" Polymerase %hain &eaction (P%&)
D:; yang akan ' *
diamplifikasi * +++++++++++++++++++++++++ '
Denaturasi 6 primer
8/18/2019 4. Tropis 4 2012 (Salmonella)
14/42
Mochammad Hatta@2013Mochammad Hatta@2013
Deteksi Salmonella typhi dengan :ested 92#
8/18/2019 4. Tropis 4 2012 (Salmonella)
15/42
Mochammad Hatta@2013Mochammad Hatta@2013
Typhoid feer Typhoid feer
*nested+*nested+
ST( ; .
8/18/2019 4. Tropis 4 2012 (Salmonella)
16/42
Mochammad Hatta@2013Mochammad Hatta@2013
Hasil nested 92# S.typhi dari penderitademam tifoid
8/18/2019 4. Tropis 4 2012 (Salmonella)
17/42
Mochammad Hatta@2013Mochammad Hatta@2013
MD& P%& product S.typhi $ietnam and /ndonesian isolated
>ietnam Indonesia
8/18/2019 4. Tropis 4 2012 (Salmonella)
18/42
Mochammad Hatta@2013Mochammad Hatta@2013
MD# 92# product 4!typhi >ietnam isolated
012 bp
320
4*0
*25
8/18/2019 4. Tropis 4 2012 (Salmonella)
19/42
Mochammad Hatta@2013Mochammad Hatta@2013
P%& for the detection of S. typhi specific D67 in blood, stool and urine
samples from patients 8ith suspected typhoid fe!er.
6o (9) of patients 8ith the follo8ing result
Patient group :lood Faeces rine 6eg Pos 6eg Pos 6eg Pos
2ulture positive . (. 1. (?? .7 (71 @ ('' %% ('@ '7 (7%
2ulture negative %. (,/ %7 (// 1 (,. .& (/? .. (%@ %@ (1%
:on-typhoid patients .% (.&& & (& % (.&& & (& .& (.&& & (&
(/6%;D% 55>)
8/18/2019 4. Tropis 4 2012 (Salmonella)
20/42
Mochammad Hatta@2013Mochammad Hatta@2013
CONSTRAINTS OF PCRCONSTRAINTS OF PCRTECHNIQUETECHNIQUE
11 uite e*%ensi+euite e*%ensi+e
2 ,eed s%ecial e-ui%ment2 ,eed s%ecial e-ui%ment
3 ,eed hi#h s$ill and laboratory3 ,eed hi#h s$ill and laboratory
. &o%histicated. &o%histicated
8/18/2019 4. Tropis 4 2012 (Salmonella)
21/42
Mochammad Hatta@2013Mochammad Hatta@2013
SalmonellaSalmonella
bateria onbateria on
!aCon"ey!aCon"ey
a#ara#ar
$ato%e&$ato%e&
po%itivepo%itive
bateria %ho'bateria %ho'
pin" olonie%pin" olonie%()pper left*()pper left*
$ato%e&$ato%e&
ne#ativene#ative
bateria havebateria haveolorle%%olorle%%
olonie% (lo'erolonie% (lo'er
ri#ht*ri#ht*
8/18/2019 4. Tropis 4 2012 (Salmonella)
22/42
Mochammad Hatta@2013Mochammad Hatta@2013
+iohemial reation% for identi,ation+iohemial reation% for identi,ation
of of S. typhiS. typhi by theby the API -.E proed)reAPI -.E proed)re
8/18/2019 4. Tropis 4 2012 (Salmonella)
23/42
Mochammad Hatta@2013Mochammad Hatta@2013
+la"+la"olonie% of olonie% of Salmonell Salmonell
a typhia typhi
afterafter#ro'th on#ro'th on
bi%m)thbi%m)th
%)l,te%)l,te
a#ara#ar
8/18/2019 4. Tropis 4 2012 (Salmonella)
24/42
Mochammad Hatta@2013Mochammad Hatta@2013
'ipstic for $yphoid e!er'ipstic for $yphoid e!er
*roced+re*roced+re& dd .l ser+m to /0.l detection reagentdd .l ser+m to /0.l detection reagent& nc+bate dipstic for 1 ho+rsnc+bate dipstic for 1 ho+rs
& #inse with tap water#inse with tap water& #ead by !is+al inspection#ead by !is+al inspection
#es+lt#es+lt
(2ochammad 3atta, et al merican 4(2ochammad 3atta, et al merican 4 $ropical $ropical
2edicine 5 3ygiene, /00/)2edicine 5 3ygiene, /00/)
8/18/2019 4. Tropis 4 2012 (Salmonella)
25/42
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
26/42
Mochammad Hatta@2013Mochammad Hatta@2013
'ipstic for $yphoid e!er'ipstic for $yphoid e!er
*roced+re*roced+re& dd .l ser+m to /0.l detection reagentdd .l ser+m to /0.l detection reagent& nc+bate dipstic for 1 ho+rsnc+bate dipstic for 1 ho+rs& #inse with tap water#inse with tap water
& #ead by !is+al inspection#ead by !is+al inspection
#es+lt#es+lt 9atients 8ithclinical
suspicion of
typhoid feverfrom Makassar
Indonesia
2ontrol
"est
$ h id 'i ti $yphoid e!er 'ipstic
8/18/2019 4. Tropis 4 2012 (Salmonella)
27/42
Mochammad Hatta@2013Mochammad Hatta@2013
$yphoid e!er 'ipstic $yphoid e!er 'ipstic6$', 3o 6hi 2inh 6ity, iet am6$', 3o 6hi 2inh 6ity, iet am
6omparison of tests6omparison of tests
$est Sensiti!ity (9) Specicity (9)
g2 E%S ≥:";00g< E%S ≥:":=00g E%S ≥:"/00
7=8/
>;>/>
?idal @ ≥:";00?idal 3 ≥:"/00 ;7=0 >1>8
'ipstic 77 >
8/18/2019 4. Tropis 4 2012 (Salmonella)
28/42
Mochammad Hatta@2013Mochammad Hatta@2013
$yphoid e!er 'ipstic $yphoid e!er 'ipsticSemarang, ndonesiaSemarang, ndonesia
Patient #ro)p/ )lt)re re%)lt
N)mber po%itive (0 * 1 total
2r3 4ariadi Ho%pital(bone marrow c+lt+re) S. typhi po%itive S. typhi ne#ative
5 di%trit ho%pital%
(blood c+lt+re)
S. typhi po%itive S. typhi ne#ative
56 (7.38* 1 98. (.* 1 -
5- (6:39* 1 57- (737* 1 -:
8/18/2019 4. Tropis 4 2012 (Salmonella)
29/42
Mochammad Hatta@2013Mochammad Hatta@2013
$yphoid e!er 'ipstic $yphoid e!er 'ipstic
2aassar, ndonesia2aassar, ndonesia
Patient #ro)p No3 po%itive (0 * 1total
S)%pet%
Clinial dia#no%i%; typhoid S. typhi )lt)re po%itive S. paratyphi )lt)re po%itive C)lt)re ne#ative
Clinial dia#no%i%; other C)lt)re ne#ative
Ho%pital ontrol%Shool hildren
69 (8739* 1
8/18/2019 4. Tropis 4 2012 (Salmonella)
30/42
Mochammad Hatta@2013Mochammad Hatta@2013
$yphoid e!er 'ipstic $yphoid e!er 'ipstic
2aassar, ndonesia2aassar, ndonesiaollow-+pollow-+p
Sample 2PO No3 po%itive (0 * 1Total
S. typhi )lt)re po%itive irst Second $hird
S.typhi )lt)re ne#ative irst Second $hird
6
8/18/2019 4. Tropis 4 2012 (Salmonella)
31/42
Mochammad Hatta@2013Mochammad Hatta@2013
$yphoid fe!er $yphoid fe!er
6+lt+re and 'ipstic6+lt+re and 'ipstic
A%%ay
C)lt)re
2ip%ti"
Sen%itivity
:93=0
87390
Spei,ity
780
:90
'ipstic" nger pric blood, same day res+lt
8/18/2019 4. Tropis 4 2012 (Salmonella)
32/42
Mochammad Hatta@2013Mochammad Hatta@2013
#apid test for typhoid fe!er#apid test for typhoid fe!er
A 809 sensiti!ity compared with blood809 sensiti!ity compared with bloodc+lt+rec+lt+re
A ** (>/9) and * (=;9) somewhat** (>/9) and * (=;9) somewhatlower than that of c+lt+relower than that of c+lt+re
A Same day res+ltSame day res+lt
A Easy to performEasy to performA 3igh stability of components3igh stability of components
8/18/2019 4. Tropis 4 2012 (Salmonella)
33/42
Mochammad Hatta@2013Mochammad Hatta@2013
2IPSTIC4 FOR 2ETECT I?!2IPSTIC4 FOR 2ETECT I?!
ANTI+O2IESANTI+O2IES
1 &im%le and ra%id1 &im%le and ra%id
2 Re-uired no e-ui%ment2 Re-uired no e-ui%ment
3 Hi#hly stable rea#ents3 Hi#hly stable rea#ents
. /o cost. /o cost
asy to a%%lied in field asy to a%%lied in field
!ohammad Hatta, 2arga '
8/18/2019 4. Tropis 4 2012 (Salmonella)
34/42
$B*3@' %ateral low $B*3@' %ateral low*rinciple*rinciple
Immuno"hromatographi" strip assay
2est Control
&am%le %ad Con4u#ate 5etection stri% &in$blood cell %ad
se%aration filter
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
35/42
$B*3@' %ateral low $B*3@' %ateral low2ethod2ethod
• 6dd 6dd µµl seruml serum
• 6dd 130 6dd 130µµl sam%le fluidl sam%le fluid
• 7ait 10 minutes7ait 10 minutes
• Read resultRead result
4ample 8ell
2ontrol line
"est line
Mochammad Hatta@2013Mochammad Hatta@2013
!ohammad Hatta, $heresia 3 bdoel, 3en% Smits Simple, rapid and aCordable point-of-care test for the serodiagnosis of typhoid fe!er
J. Diagnostic Microbiology and InfectiousDisease ol =: (/) " :/>-:1;, eb (-..6*3
8/18/2019 4. Tropis 4 2012 (Salmonella)
36/42
Mochammad Hatta@2013Mochammad Hatta@2013
Typhoid %eer Late' Agg&utinationTyphoid %eer Late' Agg&utination
seconds . seconds
, seconds A 7& seconds
$heresia 3 bdoel, #ob *astoor, 3en % Smits,!ohammad Hatta/ %aboratory e!al+ation of a simple andrapid lateD aggl+tination assay for the serodiagnosis oftyphoid fe!er. Transactions of the Royal Society ofTropical Medicine and Hygiene. !ol :0: (:0), :01/-:018(-..7*3
8/18/2019 4. Tropis 4 2012 (Salmonella)
37/42
TREAT2ENT
2edi"a& "are in"&ude rehydration! antipyreti"s #antibioti"s$
9rugs of "hoi"e are Ceftria'one # "iprof&o'a"in
but Cotrimo'a?o&e # Ch&orampheni"o& are sti&&used in dee&oping "ountries$ Ampi"i&&in )i&&s
ba"i&&i hiding in the bi&e # hen"e preents or
redu"e the "arrier state$
Chroni" resistant "arrier state may ne"essitate
"ho&e"yste"tomy$ Surgi"a& "are may a&so be
needed in patients with intestina& "omp&i"ations$Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
38/42
NURSIN= CARE
Iso&ation # barrier nursing is indi"ated
Tra"e sour"e of infe"tion$
"ontinue breastfeeding infants # young "hi&dren
and gie 4RS # &ight diet for other patients in the
first 3@ hours$
Notifi"ation of the "ase to the infe"tion "ontro&
nurse in the hospita&$
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
39/42
PRE8ENTI4N
Edu"ation on hygiene pra"ti"es &i)e hand
washing after toi&et use # aoidan"e of eating in
non hygieni" restaurants$
Antibioti" prophy&a'is is not needed for
house-ho&d "onta"ts$
Proper hand&ing # refrigeration of food een
after "oo)ing$
Sa&mone&&a TA: a""ine is aai&ab&e butaffe"tiity is &ow *./0 "&aimed prote"tion+$
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
40/42
PR4=N4SIS
ith ear&y diagnosis and prompt treatmentmost patients with typhoid feer wi&& re"oer in
due time$
%eer # to'i"ity subsides within B hours ofantibioti" treatment$
2orta&ity is ./0 in untreated seere typhoid
feer parti"u&ar&y in "hi&dren # e&der&y$
Re"rudes"en"e is rare but "hroni" "arrier
state is reported in (/0 of patients$Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
41/42
Infe"tion fo&&ows ingestion of "ontaminated
food or water$ 2eat! pou&try! eggs # diary
produ"ts are freDuent sour"es$
TRANS2ISSI4N
Pets! domesti" anima&s and infe"ted human
are potentia& reseroirs$ Person to person #
anima& to human transmission is re"ogni?ed$
In hea&thy humans a dose of about one mi&&ion
ba"teria is ne"essary to produ"e symptoms$
Mochammad Hatta@2013Mochammad Hatta@2013
8/18/2019 4. Tropis 4 2012 (Salmonella)
42/42
#eferences#eferences
A !ohammad!ohammad HattaHatta, 2iram Faer, Stella !an Feer, $heresia 3 bdoel, 3en % Smits #is, 2iram Faer, Stella !an Feer, $heresia 3 bdoel, 3en % Smits #isfactors for clnical typhoid fe!er in !illages in #+ral So+th S+lawesi, ndonesiafactors for clnical typhoid fe!er in !illages in #+ral So+th S+lawesi, ndonesia InternationalInternational Journal of Tropical Medicine Journal of Tropical Medicine ol ; (1)" >:->>, ol ; (1)" >:->>, (-..=*(-..=*
A !ohammad!ohammad HattaHatta andand #atnawati Enteric fe!er in endemic areas of ndonesia" an#atnawati Enteric fe!er in endemic areas of ndonesia" anincreasing problem of resistanceincreasing problem of resistance. J. Infection Developing ountries. J. Infection Developing ountries (( JID JID*3*3 ol /(;)G />8-ol /(;)G />8-
10:10: (-..6*(-..6*
A #ob *astoor,#ob *astoor, !ohammad!ohammad HattaHatta, $heresia 3 bdoel, 3en % Smits, $heresia 3 bdoel, 3en % Smits Simple, rapid andSimple, rapid andaCordable point-of-care test for the serodiagnosis of typhoid fe!eraCordable point-of-care test for the serodiagnosis of typhoid fe!er J. Diagnostic J. Diagnostic
Microbiology and Infectious DiseaseMicrobiology and Infectious Disease ol =:"(/)G:/>-:1;, eb ol =:"(/)G:/>-:1;, eb (-..6*3(-..6*3A !ohammad!ohammad HattaHatta and 3en % Smits 'etection ofand 3en % Smits 'etection of Salmonella typhiSalmonella typhi by nested *olymeraseby nested *olymerase
6hain #eaction in blood, +rine and stool samples6hain #eaction in blood, +rine and stool samples American J. Tropical Medicine American J. Tropical Medicine
Hygiene.Hygiene.!ol " 7=G:1>-:;1!ol " 7=G:1>-:;1 (-..7*(-..7*
A $heresia 3 bdoel, #ob *astoor, 3en % Smits, $heresia 3 bdoel, #ob *astoor, 3en % Smits, !ohammad!ohammad HattaHatta// %aboratory e!al+ation%aboratory e!al+ationof a simple and rapid lateD aggl+tination assay for the serodiagnosis of typhoid fe!erof a simple and rapid lateD aggl+tination assay for the serodiagnosis of typhoid fe!er ..
Transactions of the Royal Society of Tropical Medicine and HygieneTransactions of the Royal Society of Tropical Medicine and Hygiene !ol :0: (:0)G !ol :0: (:0)G
:01/-:018:01/-:018 (-..7(-..7**
A !ohammad!ohammad HattaHatta, 2arga '