SALMONELLA

epidemiologyThe encounter of humans to S. typhi is made via fecal-oral route from infected individuals to healthy ones. Poor hygiene of patients shedding the organism can lead to secondary infection, as well as consumption of shellfish from polluted bodies of water. The most common source of infection, however, is drinking water tainted by urine and feces of infected individuals.

Typhoid Fever

Typhoid FeverAcute illness associated with fever that is most often caused by theSalmonella typhibacteria. It can also be caused bySalmonella paratyphi, a related bacterium that usually leads to a less severe illness

Typhoid fever is contracted by the ingestion of the bacteria in contaminated food or water. Patients with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria

evidemiologyWith an estimated 1633 million cases of annually resulting in 216,000 deaths in endemic areas, the World Health Organization identifies typhoid as a serious public health problem. Its incidence is highest in children and young adults between 5 and 19 years old.

PathophysiologySalmonella invasion thyphosa absorbed in the intestine and invades the epithelial cells in the lamina propia lived experience and phagocytosis in mononuclear cells of lymphoid follicles intestines / Peyer node into lymph vessels and the ductus torasikus bloodstream (bacteremia 1st) enter the liver and spleenback into the bloodstream (bacteremia 2nd) spread throughout the body of the spleen, intestine and gall bladder germs released from the gallbladder to the intestine reinfection

PATOFISIOLOGI

*Bakterimia GITFesesRHCl

Spending out Endotoxin by Salmonella thyphosa :Stimulate macrophages release mediators IL1 increase hypothalamic set point (fever); TNF tissue necrosis and release of NO (hypotension and septic shock); IL 1 + TNF acute reaction system, bone marrow depression (relative pancytopenia) Activation of Factor XII DIC

Symptompoor appetite;abdominal pain;headaches;generalized aches and pains;fever, often up to 104 F (39 C-40 C).lethargy (usually only if untreated);intestinal bleeding or perforation (after two to three weeks of the disease);diarrheaorconstipation.

Clinical ManifestationFirst week (hyperplasia) - Incubation time 4-14 days Fever about interminten / remittances. Dirty tongue, dry mouth, nausea, vomiting. Upper respiratory tract symptoms. Severe headache, seem apathetic, tired. Discomfort in the abdomen and may kontipation/ diarrhea, found splenomegaly / hepatomegaly. Raseola may be found.

Second week (necrosis) Continuous fever Relative bradycardia The person's condition declined, apathy, confusion Membrane covered with a thick tongue and loss of appetite Pain, abdominal distension, meteorismus

Third week (ulceration) Disorientation, confusion, insomnia, listless and dispirited The face is toxic: the eyeshiny and mayredness, eyelidgaunt, pale and flushing in cheek area Breathing fast and shallow Appear more distended abdomen From time to time may arise bleeding and perforation Pea soap diarrhea

Laboratory FindingsBlood tests: leukopenia, leukocytosis relatively acute phase, there may be anemia and thrombocytopenia, SGOT and SGPT increased

Widal serological test: titer O, H (to express one's positive titer is dependent thyfoid from endemic areas and institutional agreements)

Isolation / culture of bacteria (blood, feces, urine or bile)

TreatmentTyphoid fever is treated with antibiotics that kill theSalmonellabacteriaChloramphenicol - the original drug of choice for many years. Because of rare serious side effects, chloramphenicol has been replaced by other effective antibioticsCiprofloxacin- is the most frequently used drug in the U.S. for nonpregnant patients

Ceftriaxone - an intramuscular injection medication, is an alternative for pregnant patientsAmpicillinand Trimethoprim-sulfamethoxazoleare frequently prescribed antibiotics although resistance

ComplicationComplications in the small intestine:Intestinal bleedingIntestinal perforationPeritonitis

Complications outside the intestine:Pulmonary manifestations upper respiratory disorders, bronchitisHaematological manifestations pancytopeniaNeuropsychiatric manifestations headache, meningitis, typhoid encephalopathy, comaCardiovascular manifestations relative bradycardia - myocarditisManifestations Hepatobilier hepatobilier asymptomatic hepatitis ( SGOT and SGPT), and acute kolesistisisand icterus Urogenital manifestations glomerulonephritis

PreventionThere are two forms of the vaccine available an oral and an injectable form. The vaccination needs to be completed at least one week prior to travel and, depending on the type of vaccine, only protects from two to five years. The oral vaccine is contraindicated in patients with depressed immune systems

Hiegene and environmental sanitationHiegene of food and beveragesVaccination; Acetone inactivated vaccinePrevention in patients with the form, Bed rest "absolute".Precaution: urine, feces, and vomit material sufferers.

Diferential DiagnosisShigella DysentryOnset in sudden, shiver, high feverAbdominal painDiarrhea:stool mixed with blood, mucus & pusTenesmus ,continence

Laboratory FindingsBlood picture: total WBC count increase, neutrophils increaseStool examination:Direct microscopic exam.: WBC, RBC, pus cellsBacteria culture:Sigmoidoscope: shallow ulcer,scar, polyps

DHFEarly symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. These symptoms are followed by a shock -like state.

Bleeding may appear as tiny spots of blood on the skin (petechiae) and larger patches of blood under the skin (ecchymoses). Minor injuries may cause bleeding.Shock may cause death. If the patient survives, recovery begins after a one-day crisis period.

Early symptoms include:Decreased appetiteFeverHeadacheJoint achesMalaiseMuscle achesVomiting

A physical examination may reveal:

Enlarged liver (hepatomegaly)Low blood pressureRashRed eyesRed throatSwollen glandsWeak, rapid pulse

Tests may include:

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

Treatment

Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the only treatment is to treat the symptoms.

A transfusion of fresh blood or platelets can correct bleeding problems

Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances

Oxygen therapy may be needed to treat abnormally low blood oxygen

Rehydration with intravenous (IV) fluids is often necessary to treat dehydration

Supportive care in an intensive care unit/environment

Complication:

EncephalopathyLiver damageResidual brain damageSeizuresShock

prevention

There is no vaccine available to prevent dengue fever. Use personal protection such as full-coverage clothing, netting, mosquito repellent containing DEET, and if possible, travel during periods of minimal mosquito activity. Mosquito abatement programs can also reduce the risk of infection.

dysentry

Infection:

Entry by mouthThey can through gaster acid barrier

Signs and simptoms:

Less in defecationAbdominal discomfort feels like colicVomitHeadacheRed currant jellys feces

Endoscopy look:

Hemoragic mucose loss and elcerationSometimes close by eksudat

Complication:

Arthritis (sometimes come in healing phase)Haemoroid dan bisul

Differential diagnosis:

Colon inflamationChrons colitis

Treatment:

SiprofloksasinMakrolide azitromisineTinktura beladona

Leptospirosis

Epidemiology:

Inside of mouses body, leptosvira will stay and make a colony then grow up inside in epitel of kidney tubulus then flow in urine filtrat.

Infection:

Infection can happen if theres erotion on skin.

patogenesis:

Leptosvira come into body by skinThrough blood flow then developThen systemic infectionImunology resvons

Clinical look:

There is 2 vhase:1) leptospiraemia phase2) imun phase

Leptospiraemia phaseLeptospira in blood and cerebrospinal fluidHeadache in frontalMyalgiaFever for first week

Imun phaseFeverpain on neck, abdomen, and leg muscleEpistaksispurpurapetechiae

Diagnosis:

FeverHeadache on frontalMyalgiaphotofobiaNausea and vomitBradikardiHepatomegaliUreum and creatinin increase

treatmentpenisilin