Thypoid FeverThypoid Fever

Tehar Karo KaroTehar Karo Karo

Smf penyakit Dalam RS AM/ FK Smf penyakit Dalam RS AM/ FK UNILAUNILA

TYPHOID FEVERTYPHOID FEVER

AcuteAcute SystemicSystemic ProlongedProlonged DebilitatingDebilitating

Endemic : developing countries Endemic : developing countries poor hygiene & sanitationpoor hygiene & sanitation

Remains a major problemRemains a major problem

TYPHOI D FEVER:I NCI DENCE

Worldwide : 16.6 million cases Worldwide : 16.6 million cases annually annually (Pang T et al, 1998)(Pang T et al, 1998)

Asia : 2 million cases annuallyAsia : 2 million cases annually

West J ava (2000):West J ava (2000):

outpatient 18,949 outpatient 18,949

inpatient 19,719inpatient 19,719

(West J ava Provincial Health Offi ce) (West J ava Provincial Health Offi ce)

Outpatient New Cases in West Java Provincial Hospital (2000)

DiarrhoeaDiarrhoea 80,16980,169 Pulmonary TBPulmonary TB 34,49734,497 TyphodTyphod feverfever 18,94918,949 PneumoniaPneumonia 16,14816,148 Pulmonary TB (AFB+)Pulmonary TB (AFB+) 15,44615,446 MeaslesMeasles 3,8493,849 HepatitisHepatitis 3,2223,222

(West J ava (West J ava ProvProv Health Offi ce 2000)Health Offi ce 2000)

I npatient in West J ava Provincial Hospital (2000) DiarrhoeaDiarrhoea 43,16043,160

Typhoid feverTyphoid fever 19.71919.719

PneumoniaPneumonia 15,35115,351

Pulmonary TBPulmonary TB 6,9896,989

Pulmonary TB (AFB+)Pulmonary TB (AFB+) 3,7553,755

DHFDHF 3,5523,552

MeaslesMeasles 2,0742,074

TYPHOI D FEVER : ETI OLOGY

Salmonella Salmonella enterica enterica

serovar Typhiserovar Typhi

serovar Paratyphi serovar Paratyphi AA

serovar Paratyphi serovar Paratyphi BB

serovar Paratyphi serovar Paratyphi CC

TYPHOID FEVER:INCUBATION PERIOD

Depend on bacterial count and Depend on bacterial count and virulencevirulence

1 1 –– 3 weeks (3 weeks (FalenFalen, 1951), 1951) 10 10 –– 14 days (Christie 1980, Manson14 days (Christie 1980, Manson--

Bahr 1987)Bahr 1987)

3 3 –– 5 days5 days ((Adams, 1984Adams, 1984))

TYPHOI D FEVER:I NCUBATI ON PERI OD Dose of microorganismDose of microorganism

10103 3 remain healthyremain healthy

10105 5 25 % ill25 % ill

10107 7 50 % ill50 % ill

10109 9 90 % ill90 % ill

among healthy volunteersamong healthy volunteers

(Hook, 1984; Hoff man, 1991)(Hook, 1984; Hoff man, 1991)

TYPHOI D FEVER:DI AGNOSI S

AnamnesisAnamnesis

Physical fi ndingsPhysical fi ndings

Laboratory : routineLaboratory : routine

serologyserology

culture : culture : blood, BM, blood, BM, stool, urine, stool, urine, rose spotrose spot

TYPHOI D FEVER:CLI NI CAL MANI FESTATI ONS

Cardinal Signs (MansonCardinal Signs (Manson--Bahr)Bahr)

FeverFever

Relative Relative bradicardiabradicardia

ToxaemiaToxaemia

Rose spotRose spot

SlenomegaliSlenomegali

Penyulit thypoid fever :

TYPHOI D FEVER:TREATMENT BedrestBedrest DieteticDietetic MedicamentousMedicamentous::

ChloramphenicolChloramphenicolAmpicillinAmpicillin & & amoxycillinamoxycillinCotrimoxazoleCotrimoxazoleQuinoloneQuinoloneCephalosporinCephalosporinAzithromycinAzithromycin

Management

Antibiotik :Antibiotik :

ChloramphenicolChloramphenicol Ampicillin & amoxycillinAmpicillin & amoxycillin CotrimoxazoleCotrimoxazole QuinoloneQuinolone CephalosporinCephalosporin AzithromycinAzithromycin

TYPHOI D FEVER : PREVENTI ONTYPHOI D FEVER : PREVENTI ON

•Sanitation improvement

•Vaccination :

•Heat killed phenolyzed vaccine

•2 x 0.5 ml “whole cell” vaccine, 4-6 weeks apart

•70 %

•Booster 3 years

•Vi capsular polysaccharide antigen vaccine

•Single parenteral dose

•64-75 %

•Booster 3 years

•Live attenuated oral vaccine

•S. typhi Ty 21a, 3 doses alternate days

•67 % (I ndonesia 42 %)

•Booster 3 years