PROBLEM 3 -VARLA.pptx

8/12/2019 PROBLEM 3 -VARLA.pptx

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PROBLEM 3

By: Varla Septrinidya Gharatri - 405090215


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TYPHOID FEVER


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DEFINITION

Acute enteric infectious disease

Caused by Salmonel la typhi (S.Typhi ) and

S.parathypi (a,b), S.chloreaesuis

Prolonged fever, relative bradycardia, apathetic facial

expressions, roseola, splenomegaly, hepatomegaly,

leukopenia.

intestinal perforation, intestinal hemorrhage


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EPIDEMIOLOGY

Affected patients' age in Indonesia between3-19 years to reach 91% of cases .Typhoid fever is common in developingcountries, but fewer than 400 cases arereported in the U.S. each year.Most cases in the U.S. are brought in from

other countries where typhoid fever iscommon.


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ETIOLOGY

The bacteria that cause typhoid fever -- S.typhi -- spread through contaminated food,drink, or water .

If you eat or drink something that iscontaminated, the bacteria enter your body.They travel into your intestines bloodstream

lymph nodes, gallbladder, liver, spleen, and

other parts of the body. A few people can become carriers of S.typhi and continue to release the bacteria intheir stools for years, spreading the disease.


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Structure of salmonella

Gram negative, no spore, anaerobfakultative

Have flagel peritrich for movement Endure to frozen water in long period Endure to chemical like sodium

deoxycholate, briliant green, saodium

tetrathionate . This chemical for inhibit growthof other enteric bacteria

Fermentation glucosa (+), manosa (+), nofermentation lactosa and sukrosa

- + +


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Structure antigen

3 major antigen: Ag flagel H :

destroy in 60 0C, alchohol, acid, Ab IgG

Ag O : endure to 100 0C, alcholol, acid. Ab IgM

Ag Vi : upper Ag O, as a capsul, prevent fagositosis/ demage of intracellular

membran bacteria Destroy 60 0C within 1 hour


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Transmission

S typhi has no nonhuman vectors . Thefollowing are modes of transmission:

Oral transmission via food or beverages handled by

an individual who chronically sheds the bacteriathrough stool or, less commonly, urineHand-to-mouth transmission after using acontaminated toilet and neglecting hand hygiene

Oral transmission via sewage-contaminated wateror shellfish (especially in the developing world)


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LIFE CYCLE OF S.Typhii


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Pathophysiologyintestine

IgA immuneresponse is less well

Salmunella breed

Food

contaminated withSalmonella

Penetrate theepithelial cells and

proliferate in the

lamina propia

macrofagDIE

SurvivePlaquepayers

KGBmecent

erica

Torasikusduct

bacteremia

Organ RE

Leavingthe

phagocyt

e cells


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Pathophysiology

phagocytescell

Breed in theextracellular

organ

BakteriremiaII

Livergall

bladder

Intestinal

lumen

feces

Penetrate moreand reactions as

previously

Macrofagalready

activated

hyperactive

Releasing cytokines Symptoms

Reaction hiperplasi plaque peyeri Hyperplasia or

necrosis

hypersensitivity

reactions

Erosion of blood vessels

The process continues

GI bleeding

Perforation Penetrate the mucosa and

muscle layer

Accumulation ininflammatory bowelmononuclear


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Clinical Manifestation

Salmonellathypi

infectionper oral

patients went to the doctor yet

Incubation period 10-14 days

Nosymptoms

Symptomsbegin

week 1:prodormal symptoms:

feveranorexianausea, vomiting

constipationmyalgia

second week and

next:relative bradikardithypoid tongueoeganomegali

delirium

patient went to the doctor

Week 1 second weekand next


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Symptoms

First week of illness

Fever, often as high as 103 or 104 F (39.4 or 40 C)

Headache

Weakness and fatigue

Sore throat

Abdominal painDiarrhea or constipation

Rash


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Third week of illness

Become delirious

Lie motionless and exhausted with your eyes half-

closed in what's known as the typhoid state

Life-threatening complications often develop at thistime.


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Fourth week of illness

Improvement may come slowly during the fourth

week. Your fever is likely to decrease gradually until

your temperature returns to normal in another week

to 10 days. But signs and symptoms can return up to

two weeks after your fever has subsided.


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Serological tests (Widal test):

Five types of antigens :

somatic antigen (O), flagella (H) antigen, and paratyphoid

fever flagella (A,B,C) antigen.

Antibody reaction appear during first week

70% positive in 3~4 weeks and can prolong to several

months

In some cases, antibodies appear slowly, or remain at a lowlevel,

some(10~30%) not appear at all.


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Examination

Blood test:

HbLeukocytetrombocyte

LeukopeniaMild ThrombocytopeniaSGPT/SGOT

Liver

function:SGOTSGPT

THYPHOID

Widal Test

Culture +

Definitive Diagnosis

Aglutination Antigen Antibodi

Get + 6 months-1 year

POST THYPOID

BLOODCULTURE

BILECULTURE


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TREATMENT

Fluids and electrolytes may be given througha vein (intravenously), or you may be asked todrink uncontaminated water with electrolyte

packets. Appropriate antibiotics are given to kill thebacteria. There are increasing rates ofantibiotic resistance throughout the world, soyour health care provider will check currentrecommendations before choosing anantibiotic.


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Antibiotic Therapy For Enteric Fever in Adults

Indication Agent Dosage (Route) Duration, Days

EmpiricalTreatment

CeftriaxoneAzithromycin

1-2 g/d (IV)1 g/d (PO)

7-145

Fully Susceptible

Ciprofloxacin(1 st line)

Amoxicilin (2 nd line)

Chloramphenicol

Trimethoprim-Sulfamethoxazole

500mg bid (PO) or400mg q12h(IV)1g tid (PO) or 2 g q6h(IV)25mg/kg tid (PO/IV)

160/800mg bid (PO)

5-7

14

14-21

14

Source : Harrison


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Indication Agent Dosage (Route) Duration, Days

Multidrug-Resistant

Ciprofloxacin

Ceftriaxone

Azithromycin

500 mg bid (PO) or400 mg q12h (IV)2-3 g/d (IV)

1 g/d (PO)

5-7

7-14

5

Nalidixic Acid-Resitant

Ceftriaxone

Azithromycin

High-doseciprofloxacin

1-2 g/d (IV)

1 g/d (PO)

750 mg bid (PO) or400mg q8h (IV)

7-14

5

10-14

Source : Harrison


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Management

Non pharmacology

Bed rest and treatment to prevent complication and make healing faster

Bed rest , having meal, drink, take a bath, stools

Once in the care need ,should taking care of cleanliness of the bed, clothes,

and equipment in useDiet and supporting therapy

Some researchers show that solved food (rice with side dish low cellulose) is

safe for patient

Surgical Care

Surgery is usually indicated in intestinal perforation cases.

Most surgeons prefer simple closure of the perforation with drainage of the

peritoneum.

Small-bowel resection is indicated for patients with multiple perforations.


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PROGNOSIS

Symptoms usually improve in 2 to 4 weekswith treatment.The outcome is likely to be good with earlytreatment , but becomes poor if complicationsdevelop.Symptoms may return if the treatment has not

completely cured the infection.


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Complication IntestinalIntestine bleeding

Perforation small intestineIlleus paralitic

Complication Extraintestinal Hematology thrombocytopenia, hypofibrinogenemia,

increase prothrombin time, increase partial

thromboplastin time, increase fibrin degradationproducts, DIC Hepatitis typhosa Myocarditis

Neuropsychiatric parkinson rigidity


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PREVENTION

Vaccines are recommended for travel outside of theU.S., Canada, northern Europe, Australia, and NewZealand, and during epidemic outbreaks.If you are traveling to an area where there is typhoidfever, ask your health care provider if you should bringelectrolyte packets in case you get sick.Immunization is not always completely effective andat-risk travelers should drink only boiled or bottledwater and eat well-cooked food . Studies of an orallive attenuated typhoid vaccine are now under wayand appear promising.Water treatment, waste disposal, and protectingthe food supply from contamination are importantpublic health measures. Carriers of typhoid must not

be allowed to work as food handlers.


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DYSENTRY BACILLI


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DEFINITION

A condition characterized by diarrhea, with theconsistency of stool is usually soft,accompanied by inflammatory exudate

containing polymorphonuclear leukocytes andblood.

Acute infection terminal ileum and coloncaused by bacteria of the genus Shigella


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EPIDEMIOLOGI

Shigella infection easily occur in denselypopulated, poor sanitation, lack of water,and low levels of personal hygiene.

Shigella infection in endemic area is 10-15%cause of diarrhea in children.Number of bacteria to cause disease are

relatively few, it ranged between 10-100germs.Therefore it is very easy transmission isfecal-oral route , either by direct contact ordue to contaminated food and drink


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MICROBIOLOGY

Shigella including enterobacteriaceae group,which is gram negative , facultative anaerobesand very similar to eschericia coli.

Several properties that distinguish the bacteriawith E. coli are bacteria do not stir it active , donot produce gas in glucose media and ingeneral negative lactose .

Known 4 shigella species with differentserotypes namely: S. dysenteriae (12 serotypes),S. flexneri (14 serotypes), S. boydii (15serotypes), and S. sonnei (1 serotypes)


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PATHOPHISIOLOGY

After passing through the stomach and smallintestine the bacteria invade the colonicmucosal epithelial cells and proliferate in it.Expansion of the invasion of bacteria into thesurrounding cells through a mechanism of cell-to-cell transfer

Although the initial lession occurs in the epitheliallayer but the local inflammatory response thataccompanies severe enough, involving PMNleukocytes and macrophages.It causes edema, mikroabses, loss of goblet cells,damage to tissue architecture and mucosalulceration.


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CLINICAL SYMPTOMS

The shoots ranged from 7 hours to 7 days.7-day average duration symptoms in adults, butcan take up to 4 weeks.

In the early phase of patients complained oflower abdominal pain, rectal burningsensation, diarrhea accompanied by feverwhich can reach 40 C. Further reduced but the stool was diarrheacontaining blood and mucus , tenesmus, anddecreased apetite.

In children may get a high fever with or withoutconvulsions delirium headache stiff neck


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DIAGNOSE

Microscopic examination of feces showederitrocytes and PMN leukocytes.To confirm the diagnosis made from the

material culture of fresh feces or analswab.Sigmoidoscopy can confirm the diagnosis of

colitis, but the examination generally notnecessary, because it causes the patient tofeel very uncomfortable.In the acute phase of shigella infection,serology test are not useful.


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DIFFERENTIAL DIAGNOSE

SalmonellosisEnterotoxin diarrhea syndrome due to E. coliCholeraColitis ulserosa


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COMPLICATIONS

IntestinalToxic megacolonIntestinal perforation

DehydrationHypovolemic shockMalnutrition

ExtraintestinalCoughsColds

PneumoniaMeningismusSeizures

Peripheral neuropathyHemolytic uremicsyndromeThrombocytopeniaLeukemoid reaction

Arthritis


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TREATMENT

Address the balance of fluid and electrolytedisturbances

The majority of patients with dysentery can be treated withoral rehydration .In patients with severe diarrhea with dehydration and

patients with excessive vomiting that cannot be performedby oral rehydration, intravenous rehydration should bedone.

AntibioticsMaking use of antibiotics based on severity of the diseaseentirely , in which patients with moderate to severesymptoms of dysentery with persistent diarrhea.Some types of antibiotics that are recommended are:

Ampicilin 500 mg 4 times per dayCotrimoxazole 2 times 2 tablets per day

Tetracycline 500 mg 4 times per day for 5 days


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Narcotic drugs and derivates Avoid drugs that can inhibit intestinal motility suchas narcotics and its derivates , because it can

reduce the elimination of bacteria, and provoketoxic megacolon.

Symptomatic treatment Are given to according to the patient analgesic-antipiretic and anticonvulsant


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DEFINITION

Cholera is an infection of the small intestinethat causes a large amount of watery diarrhea.

CAUSES INCIDENCE RISK


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CAUSES, INCIDENCE, RISKFACTORS

Cholera is caused by the bacterium Vibr io cho lerae . The bacteria releases a toxin that causes increased release of water in theintestines, which produces severe diarrhea.Cholera occurs in places with poor sanitation, crowding, war, andfamine .Common locations for cholera include :

Africa AsiaIndiaMexicoSouth and Central America

People get the infection by eating or drinking contaminated food orwater .

A type of vibrio bacteria also has been associated with shellfish, especiallyraw oysters.Risk factors include:

Exposure to contaminated or untreated drinking waterLiving in or traveling to areas where there is cholera


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SYMPTOMS

Abdominal crampsDry mucus membranes or mouthDry skinExcessive thirstGlassy or sunken eyes

Lack of tearsLethargyLow urine outputNauseaRapid dehydration

Rapid pulse (heart rate)Sunken "soft spots" (fontanelles) in infantsUnusual sleepiness or tirednessVomitingWatery diarrhea that starts suddenly and has a "fishy" odorNote: Symptoms can vary from mild to severe.


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SIGNS AND TESTS

Tests that may be done include:Blood cultureStool culture


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TREATMENT

The objective of treatment is to replace fluidand electrolytes lost through diarrhea .Depending on your condition, you may be

given fluids by mouth or through a vein(intravenous).Antibiotics may shorten the time you feel ill.The World Health Organization (WHO) has

developed an oral rehydration solution thatis cheaper and easier to use than thetypical intravenous fluid .This solution of sugar and electrolytes isnow being used internationally.


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PROGNOSIS

Severe dehydration can cause death.Given adequate fluids, most people will makea full recovery.


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COMPLICATIONS

Severe dehydrationDeath


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PREVENTION

The U.S. Centers for Disease Control andPrevention does not recommend choleravaccines for most travelers. (Such a vaccine

is not available in the United States.)Travelers should always take precautionswith food and drinking water, even ifvaccinated .When outbreaks of cholera occur, effortsshould be directed toward establishing cleanwater, food, and sanitation , because

vaccination is not very effective in managing


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GASTROENTERITIS


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DEFINITION

Gastroenteritis is a condition that causesirritation and inflammation of the stomachand intestines (the gastrointestinal tract).

An infection may be caused by bacteria orparasites in spoiled food or unclean water .The severity of infectious gastroenteritisdepends on your immune systems ability toresist the infection.Electrolytes (these include essential elementsof sodium and potassium) may be lost as youvomit and experience diarrhea.


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CAUSES

Viruses and bacteria are the most common.Viruses and bacteria are very contagious and canspread through contaminated food or water.Gastroenteritis caused by viruses may last 1-2 days .On the other hand, bacterial cases can last a weekor more .Bacteria:

Escherichia coli - Travelers diarrhea, food poisoning,

dysentery, colitis, or uremic syndromeSalmonella - Typhoid fever; handling poultry orreptiles such as turtles that carry the germsCampylobacter - Undercooked meat, unpasteurizedmilkShi ella - D senter


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Viruses :Viral outbreaks (30-40% of cases in children) canspread rapidly through close contact amongchildren in day care and schools.Poor handwashing habits can spread viruses.Common viral causes include the following:

AdenovirusesRotavirusesCaliciviruses

AstrovirusesNorovirus (formerly called Norwalk-like virus orNLV) and Norwalk virus


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Parasites and protozoans :These tiny organisms are less frequentlyresponsible for intestinal irritation.You may pick up one of these by drinkingcontaminated water.Swimming pools are common places to come incontact with these parasites.Common parasites include these:

Giardia - The most frequent cause of waterbornediarrhea causing giardiasisCryptosporidium - Affects mostly people withweakened immune systems, causes watery

diarrhea


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Giardia Lamblia


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Other common causes :Chemical toxins most often found in seafood, food allergies, heavymetals, antibiotics, and other medications also may be responsible forbouts of gastroenteritis that are not infectious to others.Medications

AspirinNonsteroidal anti-inflammatory medicines (such as Motrin or Advil)

AntibioticsCaffeineSteroids - Excessive use or a sudden change in frequency or dosageLaxatives

Inability to tolerate the sugar lactose in milk and milkproducts such as cheese and ice creamExposure to heavy metals sometimes present in drinkingwater

ArsenicLeadMercury


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SYMPTOMS

Gastroenteritis may affect both the stomach and theintestines, resulting in one or more of the followingsymptoms:

Common symptoms:Low grade fever (99F)

Nausea with or without vomitingMild-to-moderate diarrhea: May range from 2-4 loose stools per dayfor adolescents and adults to stools that run out of the diaper ininfants.Crampy painful bloatingVomiting: May or may not accompany diarrhea.

More serious symptomsBlood in vomit or stoolVomiting more than 48 hoursFever higher than 101FSwollen abdomen or abdominal pain coming from the right lower sideDehydration - Little to no urination, extreme thirst, lack of tears,

and dry mouth (dry diapers in infants)


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EXAMS AND TESTS

AnamneseChecking electrolytes, blood, and stool.


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Normal stain of stool sample looking for ova, parasites, and


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SELF CARE AT HOME

Dehydration in children :Children should be given oral rehydration solutions suchas Pedialyte, Rehydrate, Resol, and Rice-Lyte.

Cola, tea, fruit juice, and sports drinks will not correctly replacefluid or electrolytes lost from diarrhea or vomiting.

After each loose stool, children younger than 2 years shouldbe given 1-3 ounces of any of the rehydration solutions. Olderchildren should be asked to drink 3-8 ounces. Adults shoulddrink as much as possible.In underdeveloped nations or regions without availablecommercial pediatric drinks, the World Health Organization

has established a field recipe for fluid rehydration : Mix 2tablespoons of sugar (or honey) with teaspoon of table saltand teaspoon of baking soda. (Baking soda may besubstituted with teaspoon of table salt.) Mix in 1 liter (1 qt) ofclean or previously boiled water.You will need solid foods eventually to help end the diarrhea.

After 24 hours, begin to offer bland foods with the BRATdiet bananas, rice, applesauce without sugar, toast, pasta, or


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Dehydration in adults : Although adults and adolescents have a largerelectrolyte reserve than children, electrolyte

imbalance and dehydration may still occur as fluidis lost through vomiting and diarrhea.Initially, adults should eat ice chips and clear,noncaffeinated, nondairy liquids such as

Gatorade, ginger ale, fruit juices, and Kool-Aid orother commercial drink mixes. After 24 hours of fluid diet without vomiting, begina soft-bland solid diet such as the BRAT diet .


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MEDICAL TREATMENT

RehydrationAntibiotics may be given for certain bacteria,specifically Campylobacter, Shigella ,

and Vibrio cholerae Antiemetics for adultsAvoid antidiarrheal medications for all age

groups if they suspect the infection is causedby a toxin


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PREVENTION

With most infectious germs, the key is to blockthe spread of the organism.

Always wash your hands.Eat properly prepared and stored food.Bleach soiled laundry.Vaccinations for Salmonella typhi, Vibrio cholerae ,and rotavirus have been developed.For lactose intolerance, supplementary enzymes are

available over-the-counter for adolescents and adultsto aid digestion of milk sugars.Soy formulas and other lactose-free products areavailable from most grocery stores for formula-feedinginfants.


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DENGUE HEMORRHAGICFEVER


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DEFINITION

Dengue hemorrhagic fever is a severe,potentially deadly infection spread by certainspecies of mosquitoes ( Aedes aegypti ).

CAUSE INCIDENCE RISK


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CAUSE, INCIDENCE, RISKFACTORS

Four different dengue viruses are known to cause denguehemorrhagic fever.Dengue hemorrhagic fever occurs when a person catches adifferent type dengue virus after being infected by another onesometime before.Prior immunity to a different dengue virus type plays an importantrole in this severe disease.Worldwide, more than 100 million cases of dengue fever occurevery year.

A small number of these develop into dengue hemorrhagic fever.Most infections in the United States are brought in from other

countries.It is possible, but uncommon, for a traveler who has returned to theUnited States to pass the infection to someone who has nottraveled.Risk factors for dengue hemorrhagic fever include havingantibodies to dengue virus from prior infection and being youngerthan 12, female, or Caucasian.


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SYMPTOMS

Early symptoms include:Decreased appetiteFeverHeadacheJoint aches

MalaiseMuscle achesVomiting

Acute phase symptoms include:Restlessness followed by:

EcchymosisGeneralized rashPetechiaeWorsening of earlier symptoms

Shock-like stateCold, clammy extremities

Sweatiness (diaphoretic)


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SIGNS AND TESTS

A physical examination may reveal:Enlarged liver (hepatomegaly)Low blood pressureRashRed eyesRed throatSwollen glandsWeak, rapid pulse

Tests may include: Arterial blood gasesCoagulation studiesElectrolytesHematocrit

Liver enzymesPlatelet countSerologic studies (demonstrate antibodies to Dengue viruses)Serum studies from samples taken during acute illness and convalescence (increasein titer to Dengue antigen)Tourniquet test (causes petechiae to form below the tourniquet)X-ray of the chest (may demonstrate pleural effusion)


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TREATMENT

Because Dengue hemorrhagic fever is caused bya virus for which there is no known cure orvaccine, the only treatment is to treat thesymptoms.

A transfusion of fresh blood or platelets cancorrect bleeding problemsIntravenous (IV) fluids and electrolytes are alsoused to correct electrolyte imbalancesOxygen therapy may be needed to treatabnormally low blood oxygenRehydration with intravenous (IV) fluids isoften necessary to treat dehydrationSupportive care in an intensive careunit/environment


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PROGNOSIS

With early and aggressive care, most patientsrecover from dengue hemorrhagic fever.However, half of untreated patients who go

into shock do not survive.


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COMPLICATIONS

EncephalopathyLiver damageResidual brain damageSeizuresShock


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PREVENTION

There is no vaccine available to preventdengue fever.Use personal protection such as full-coverage

clothing, netting, mosquito repellent containingDEET, and if possible, travel during periods ofminimal mosquito activity.Mosquito abatement programs can alsoreduce the risk of infection.

Such as upper respiratory tract infection. Abrupt onset

with fever, headache, leucopenia, sore throat, cough,


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Viral infection

, , p , , g ,

coryza.

No rose spots, no enlargement of liver & spleen.

The course of illness no more than 2 weeks.

Differential diagnosis depends on typical manifestationsand blood culture.

Malaria

History of exposure to malaria.

Paroxysms(often periodic) of sequential chill,high fever

and sweating.

Headache, anorexia, splenomegaly, anemia,

leukopenia

Characteristic parasites in erythrocytes,identified in

thick or thin blood smears.

Dengue Fever

Sudden high fever day 1-3 (above 38,5 o C), in day 3 orday 4-5 increase but not very high (below 38,5 o C)


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PROBLEM 3 -VARLA.pptx