TYPHOID FEVER

DEFINISI
Typhoidfever is a systemic disease characterized by fever and
abdominal pain and caused by dissemination of S.typhi or
S.paratyphi.
EPIDEMIOLOGY

Incontrast to other Salmonella serotypes, the etiologic agents of

enteric fever S.typhi and S.paratyphi serotypes A, B, and C have no
known hosts other than humans.
Most commonly, food-borne or waterborne transmission results from
fecal contamination by ill or asymptomatic chronic carriers.
Sexual transmission between male partners has been described.
Healthcare workers occasionally acquire enteric fever after exposure
to infected patients or during processing of clinical specimens and
cultures.
ETIOLOGY
A high incidence of enteric fever correlates with poor sanitation
and lack of access to clean drinking water.
Inendemic regions, enteric fever is more common in urban than
rural areas and among young children and adolescents.
Riskfactors include contaminated water or ice, flooding, food and
drinks purchased from street vendors, raw fruits and vegetables
grown in fields fertilized with sewage, ill household contacts, lack
of hand washing and toilet access, and evidence of prior
Helicobacter pylori infection.
Patofisiologi
MANIFESTASI KLINIK
CLINICAL COURSE
Theincubation period for S.typhi averages 10-14 days but ranges
from 3-21 days, depending on the inoculum size and the hosts
health and immune status.
Themost prominent symptom is prolonged fever (38.8o-40.5oC),
which can continue for up to 4 weeks if untreated.
S.paratyphi
A is thought to cause milder disease than S.typhi, with
predominantly gastrointestinal symptoms.
CLINICAL COURSE
In this series, symptoms reported on iniyial medical evaluation included
headache (80%),
chills (35-45%),
cough (30%),
sweating (20-25%),
myalgias (20%),
malaise (10%), and
arthralgia (2-4%).

Gastrointestinal symptoms included

anorexia (55%),
abdominal pain (30-40%),
nause (18-24%),
vomiting (18%), and
diarrhea (22-28%) more commonly than constipation (13-16%).

Physical findings included coated tongue (51-56%), splenomegaly (5-6%), and abdominal
tenderness (4-5%).
Early physical findings of enteric fever include rash (rose spots 30%),
hepatosplenomegaly (3-6%), epistaxis, and relative bradycardia at the peak of high fever
Diagnosis
In 15-25% of cases, leukopenia and neutropenia are detectable.
Leukocytosis is more common among children, during the first 10
days of illness, and in cases complicated by intestinal perforation
or secondary infection.
Other nonspecific laboratory findings include moderately elevated
liver function tests and muscle enzyme levels.
Hasil Uji Tubex
Skor interpretasi keterangan
<2 Negatif Tidak menunjukan infeksi
typhoid aktif
3 Borderline Pengukuran tidak dapat
disimpulkan. Ulangi
pengujian, apabila masih
meragukan lakukan
pengulangan beebrapa
hari kemudian.
4-5 Positif Menunjukkan infeksi
typhoid aktif
>6 Positif Indikasi kuat infeksi
typhoid.
TREATMEN
T
PREVENTION AND CONTROL
Two typhoid vaccines are commercially available:
1. Ty2la, an oral live attenuated S.typhi vaccine (given on days 1,
3, 5, and 7, with a booster every 5 years) and
2. Vi CPS, a parenteral vaccine consisting of purified Vi
polysaccharide from the bacterial capsule (given in 1 dose, with
a booster every 2 years). The old parenteral whole-cell
typhoid/paratyphoid A and B vaccine is no longer licensed,
largely because of significant side effects.
 Susp. Tifoid

RAWAT

Hentikan antibiotik 1 hari

Kultur darah

Kloramfenikol+Deksametason atau
Kultur Positif Kultur Negatif
Kloramfenikol saja

Relaps Antibiotik uji Sembuh

resistensi Obat di stop

Antibiotik lain Kultur feses

uji Relaps Sembuh
resistensi
Negatif Positif
Pemeriksaan penyakit
sepsis, otoimun,
Antibiotik/ keganasan dll
Kolesistektomi

PENGOBATAN PASIEN TERSANGKA DEMAM TIFOID

 PENGOBATAN
Tujuan : bebas gejala, bebas kuman dan tidak relaps
Pengobatan : perawatan, diet, obat.
Perawatan tirah baring hingga 3hari bebas demam cegah komplikasi
Diet bubur saring diet lunak, tidak merangsang diet biasa
Obat : Antibiotika sesuai hasil uji resistensi
1.Kloramfenikol : 4x500 mg/hr (max 20 gram)
2.Kotrimoksasol : 2x2 tab 14 hari
3.Ampisilin : 3 x 1gram 10 hari
4. Quinolon : Ciprofloxacin 2x 500 7 hari
Levofloxacin 1x 500 mg 7 hari
 KOMPLIKASI

1. Perdarahanusus
-Indonesia:13.715,2%erosiulkusileumdistalminggu-3.
-Tanda:pseudomelena,nadikecildancepat,tekanandarah
turun,keringatdingin,pucatdanpusing.
-Pengobatan:transfusidarah.
antibiotikLevofloksasin1x500mgslama7hari
Sefotaksim3x1grselama7hari
2.Perforasiusus
Terjadipada23%kasus.

Pada ileum distal tidak bisa kentut, perut gembung dan nyeri.
Nadi cepat, suhu meningkat, dinding perut nyeri dan keras pada
perabaan,batasparuhatimenghilangpadaperkusi.
Foto polos abdomen 3 posisi terlihat udara bebas diantara
diafragmadanhati.
Terapipembedahanharussegeradilakukan.
3.Demam tifoid berat
-Kesadaranterganggu/shok
-Tanda:
-Sistolik<90mmHg
-Perfusiperifermenurun
-Urin<20ml/jam
PREVENTION
UMUM : peningkatan higiene & sanitasi
Penyediaan air bersih
Pembuangan dan pengelolaan sampah
Menjaga kebersihan pribadi
Menjaga apa yang masuk mulut (diminum atau
dimakan) tidak tercemar Salmonella typhi
KHUSUS : imunisasi
VAKSIN
VAKSIN YANG
DIBUAT DARI STRAIN SALMONELLA YANG DILEMAHKAN (Ty 21a)
PADA PEMBERIAN ORAL MEMBERIKAN PERLINDUNGAN 87-95 % SELAMA 36
BULAN.
PROGNOSIS
- Pada stadium awal , terapi baik prognosis yang baik.
dgn tandatanda toksik, perdarahan, perforasi prognosis
- Pasien
yang buruk.
THANK YOU