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DDmalaria Hepatitisbacterial enteritisdengue feverrickettsial
infectionsleptospirosisamebic liver abscessesacute HIV
infection1Typhoid fever Dengue feverMalariaHepatitis Epid
in developing nations whose sanitary conditions are poor. warm,
wet areas of the world, tropic and subtropic regionsOutbreaks occur
in the rainy seasonWarm climates:tropics and
subtropicsEtiologySalmonella typhi. virusPlasmodiumHepatitis
virusClassification Plasmodium falciparum---####------
vivax---####------ovale---####------malariaeHepatitis AHepatitis
BHepatitis CSign & sypmtoms
fever, malaise, diffuse abdominal pain, and constipation.High
fever (104 - 105 degrees Fahrenheit), red rash, Headache
(especially behind the eyes), Fatigue, Joint aches, Muscle aches,
Nausea, Swollen lymph nodes, VomitingAnemia, Chills, Coma,
Convulsion,Fever, Headache, Jaundice, Muscle pain, Nausea, stool
bloody, Sweating, VomitingLoss of appetite, Nausea and vomiting,
Diarrhea, Dark-colored urine, pale bowel movements, Stomach pain,
jaundice, yellowing of skin and eyes
2Transmission
Through stool, urin.Hand to mouth transsmissionOral transmission
via sewage-contaminated water or shellfish
spread byAedesaegypti
one human to another by the bite of
infectedAnophelesmosquitoesfrom a mother to her unborn baby
(congenitally)by blood transfusionsHAVEating food prepared by
someone with HV who did not wash their hands after using the
bathroomHaving anal/oral sex with someone with HVNot washing your
hands after changing a diaperDrinking contaminated waterHBVcontact
with an infected person's blood, semen or other body fluid. An
infected woman can give hepatitis B to her baby at birth.HCVcontact
with infected bloodspread through sex with an infected person from
mother to baby during childbirth.
3Exam & TestRoutine examinationBacterial
examinationsSerological test(widal test)Antibody titerfor dengue
virus typesComplete blood count (CBC)Serology studiesto look
forantibodies to dengue viruses
enlarged liveror anenlarged spleenTreatmentvarryThere is no
specific treatment for dengue fever. You will need fluids if there
are signs ofdehydrationAcetaminophen (Tylenol) is used to treat a
high fever. Avoid taking aspirin.1) Drugs non-ACT:Klorokuin
difosfat/sulfat SPKina sulfat Primakuin.2) Combination drugs of
non-ACT:Klorokuin + SPSP+ kinaKlorokuin + Doksisiklin/TetrasiklinSP
+ Doksisiklin/tetrasiklinKina + Doksisiklin/tetrasiklinKina +
klindamisinDrugsVaccine
4Complications
internal bleeding delirium, bowel perforation, and death within
one month of onset .FebrileconvulsionsSevere dehydration
Destruction of blood cells (hemolytic anemia)Liver failure
andkidney failureMeningitisRespiratory failure from fluid in the
lungs (pulmonary edema)Rupture of the spleen leading to massive
internal bleeding (hemorrhage)
cirrhosis, liver failure, and liver cancer.5Typhoid fever
DEFINITIONTyphoid fever is a bacterial disease, caused by
Salmonella typhi. It is transmitted through the ingestion of food
or drink contaminated by the faeces or urine of infected people.
(WHO)Typhoid fever is a life-threatening illness caused by the
bacterium Salmonella Typhi. (CDC)8EPHIDEMIOLOGYTyphoid fever as an
endemic disease in IndonesiaIn 1990 9,2 per 10,000 citizenIn 1994
became 15,4 per 10,000 citizen1981-1986 improved 35,8% : 19.596
26.606cases9EPHIDEMIOLOGY
Fig. 1. The typhoid fever surveillance study
siteshttp://www.who.int/bulletin/volumes/86/4/06-039818/en/
Incidence of typhoid feverStrongly endemicEndemicSporadic
cases10Fig. 2. Incidence of typhoid fever and mean age of
patients
ETIOLOGYSalmonella typhiStructure :Basil like shaped Gram
negativeFacultative anaerobEquipped with capsul to prevent
phagocytosis and flagel for movementSalmonella typhiAntigenAntigen
HAntigen of the flagelResistance against heat (up to 60 C) and acid
(up to 1,5)IgG will be produced to fight against itAntigen somatic
(O)Antigen of the outer membraneResistance against heat (up to 100
C) and acid (up to 1,5)IgM will be produced to fight against
itAntigen ViLocated above antigen O (capsule)Act as capsule to
prevent phagocytosis and intracellular damage
etiologyThe bacteria that cause typhoid fever -- S. typhi --
spread through contaminated food, drink, or water.
A few people can become carriers of S. typhi and continue to
release the bacteria in their stools for years, spreading the
disease.
Sources of InfectionWaterContamination with feces often results
in explosive epidemics.
Milk and Other Dairy Products (Ice Cream, Cheese,
Custard)Contamination with feces and inadequate pasteurization or
improper handling. Some outbreaks are traceable to the source of
supply.
ShellfishFrom contaminated water.
Dried or Frozen EggsFrom infected fowl or contaminated during
processing.
Meats and Meat ProductsFrom infected animals (poultry) or
contamination with feces by rodents or humans.
"Recreational" DrugsMarijuana and other drugs.
Animal DyesDyes (e.g, carmine) used in drugs, foods, and
cosmetics.
Household PetsTurtles, dogs, cats, etc.
Virulence FactorsDamage to host cellsThe ability to invade
cellsForm a coat lipopolisacharideCan remove toxins
18Modes of Transmission Person to person transmition Rarely
(bactery 10 - 10 6)Contamination of food products Salmonella live
in the chicken intestineContamination of food processing
contamination of process equipment food presentation19Risk
FactorsWorldwide, children are at greatest risk of getting the
disease, although they generally have milder symptoms than adults
do. If you live in a country where typhoid fever is rare, you're at
increased risk if you: - Work in or travel to areas where typhoid
fever is endemic- Work as a clinical microbiologist handling
Salmonella typhi bacteria- Have close contact with someone who is
infected or has recently been infected with typhoid fever- Have an
immune system weakened by medications such as corticosteroids or
diseases such as HIV/AIDS- Drink water contaminated by sewage that
contains S. typhi
Pathofisiology
The 1st week Sign & symptomswhich will gradually rise and
then settle at around 3940C (103104F), * abdominal painskin rash
made up of pink spots 14cm wide (usually the rash is made up of
fewer than five spots), and23The 2nd weekIf you don't receive
treatment for typhoid fever, you may enter a second stage during
which you become very ill and experienceSign & symptomsThe 3rd
week ( typhoid stage )
Sign & symptomsbouts of foul-smelling, yellow-green, watery
25The 4th week (Improvement )If a person survives until the fourth
week, their symptoms will gradually improve
Though weight loss and physical exhaustion can continue for
several months.
Sign & symptoms
Diagnose Diagnose LAB diagnoseRutine check-SGOT and SGPT
increase-leukositosis (aneusinofilia and limfopenia)- LED
increaseWIDAL TESTAglutination reaction between S. Typhii (antigen)
with antibody (aglutinin)TUBEX test Detect antibody anti S.Typhi 09
in the serum of patientTyphidot TESTAntibody IGM and IG G in the
outer membran of salmonela typhiIGM dipstick testAntibody IGM
specific S.Typhii in the whole blood serumBlood culture Positive if
typhoid fever but can be negative too28Laboratory TestSerologyWidal
test :Test the titer of antigen O and H (during the 2nd to 4th week
of fever)(+) titer > 4x normal titerMicrobiologyDNA ProbeIgG
proteinImmunoblottingPCRCulture29Culture of S.TyhpiSelected media :
EMB , McConkey , SS (salmonella-shigella) , XLD and TSIA (triple
sugar iron agar)Result :Colorless colony in McConkeyTSIA, result :
-/+ (H2S without gas)30
McConkey (left)
XLD
SS
TSIA31TreatmentBed Rest and treatmentDiet and supportive
therapyGiving antimicrobial- Chloramphenicol (first line)-
Tiamfenikol- Cotrimoxazole- Ampycilin- Amoxicillin
Treatment of typhoid fever in pregnant women: ampycilin,
amoxicillin, and ceftriaxoneTerjadi trombositopeni jika terjadi
komplikasiDiet diberi yg rendah serat , lunak
Kloramfenikol adalah DOC tapi daapt menyebabkan anemia aplastik
sehingga pranng dengan leukosit 2500 jangan kloramfenikol, tidak
diberi pada bayi bikin gray syndrome32Complication Intestinal
Intestine bleedingPerforation small intestineIlleus
paraliticComplication Extraintestinal Hematology thrombocytopenia,
hypofibrinogenemia, increase prothrombin time, increase partial
thromboplastin time, increase fibrin degradation products,
DICHepatitis typhosaMyocarditisNeuropsychiatric parkinson
rigidity
33PreventionAvoid risky foods and drinks.Get vaccinated against
typhoid fever.
Vaccine NameHow GivenNumber of Doses NecessaryTime Between
DosesTime Immunization should be completed by (before possible
exposure)Minumum age for vaccinationBooster Every Ty21a1 Capsule
oral42 days1 week6 Years5 YearsViCPSInjection1-2 weeks2 Years2
Yearswww.cdc.gov
34Typhoid fever vaccineInjection: capsular Vi polysaccharidefor
intramuscular use, is a sterile solution containing the cell
surface Vi polysaccharide extracted from Salmonella enterica
for age > 2 years oldbooster every 3years
Oral: Ty-21 a vaccinefor age > 6 years
Ty21a is an orally taken, live, weakened vaccination consisting
of a set of 4 capsules (each one to be taken on alternate days)
PrognosisSymptoms usually improve in 2 to 4 weeks with treatment.
The outcome is likely to be good with early treatment, but becomes
poor if complications develop.Symptoms may return if the treatment
has not completely cured the infection
Mediline plus www.nlm.nih.gov
37Salmonellosis
Disease-associated factsSalmonellosis: Any of several bacterial
infections caused by species of Salmonella, ranging from mild to
serious infections. Two main kinds in humans: enteric fever
(typhoid and paratyphoid) and gastroenteritis (non-typhoidal).
Principal habitats in different types of SalmonellaTheir
principal habitat is the intestinal tracts and bloodstream of
humans, and in the intestinal tracts of a wide variety of
animals.
The WHO groups Salmonella into 3 types: - Typhoidal (enteric)
Salmonella (example: S. typhi) causes typhoid and paratyphoid fever
restricted to growth in human hosts principal habitat is in
intestinal tracts and the bloodstream - Nontyphoidal Salmonella
(example: S. enteritidis, S. typhimurium) prevalent in
gastrointestinal tracts of a broad range of animals, including
mammals, reptiles, birds and insects. cause a whole range of
diseases in animals and humans, mainly gastroenteritis. usually
transferred animal-to-person, through certain food products: fresh
meat, eggs and milk - fruits, vegetables, seafood house and exotic
pets, contamination through contact with their feces - Salmonella
mostly restricted to certain animals, such as cattle and pigs;
infrequently in humans; if these strains do cause disease in
humans, it is often invasive and life-threatening.
Etiology Kesimpulan dan SaranBerdasarkan gejala, Kemungkinan
anak ini menderita demam typoid Ganti cairan elektrolit
(rehidrasi)Dilakukan pemeriksaan lanjutanMenjaga kebersihan
lingkungan dan makanan
