Typhoid Fever in Special Case

7/23/2019 Typhoid Fever in Special Case

1/27

Curriculum VitaeCurriculum Vitae

NamaNama :: Dr. Ronald Irwanto, SpPD, KPTIDr. Ronald Irwanto, SpPD, KPTI

Pendidikan :Pendidikan :

SMA CaniiuSMA Caniiu, !akarta, "##$, !akarta, "##$

Dokter %mumDokter %mum, &K TRISAKTI, '((", &K TRISAKTI, '(("

Speiali Pen)akit Dalam *Internit+Speiali Pen)akit Dalam *Internit+, &K%I, '((#, &K%I, '((#

Konultan Su- Speiali Pen)akit Tropik dan InekiKonultan Su- Speiali Pen)akit Tropik dan Ineki, Di/ii Pen)akit, Di/ii Pen)akitTropik 0 Ineki, Departemen Ilmu Pen)akit Dalam, &K%I 1 RSCM,Tropik 0 Ineki, Departemen Ilmu Pen)akit Dalam, &K%I 1 RSCM,'("2'("2


2/27

Mana3in3 T)p4oid &e/er in Special Cae :Mana3in3 T)p4oid &e/er in Special Cae :

Pre3nanc) andPre3nanc) andMDR1Salmonella t)p4i *MDR1ST+ InectionMDR1Salmonella t)p4i *MDR1ST+ Inection

Ronald IrwantoRonald Irwanto

Di/iion o Tropical Medicine and Inectiou DieaeDi/iion o Tropical Medicine and Inectiou DieaeDepartment o Internal MedicineDepartment o Internal Medicine

&acult) o Medicine %ni/erit) o Indoneia&acult) o Medicine %ni/erit) o Indoneia


3/27

A56NDAA56NDA

Typhoid fever : The Epidemiology andTyphoid fever : The Epidemiology and

Microorganism CharacteristicMicroorganism Characteristic

Clinical Appearance and Diagnostic ofClinical Appearance and Diagnostic ofTyphoid FeverTyphoid Fever

Treatment of Typhoid Fever : General andTreatment of Typhoid Fever : General and

in Pregnancyin Pregnancy

Treatment of MDR-TTreatment of MDR-T

Concl!sionConcl!sion


4/27

Typhoid fever : The EpidemiologyTyphoid fever : The Epidemiologyand Microorganism Characteristicand Microorganism Characteristic


5/27

T)p4oid &e/erT)p4oid &e/er

T)p4oid e/er i an acute )temicT)p4oid e/er i an acute )temic

inection caued -) Salmonellainection caued -) Salmonella

enterica erot)pe t)p4i or parat)p4ienterica erot)pe t)p4i or parat)p4i

w4ic4 i alo known a Salmonellaw4ic4 i alo known a Salmonella

t)p4it)p4i


6/27

Among "#"$ s!%&ects 'ith fever(Among "#"$ s!%&ects 'ith fever( Salmonella typhiSalmonella typhi 'as'asidentified in )) *$+, andidentified in )) *$+, and Salmonella paratyphiSalmonella paratyphiA in . */+,A in . */+,patientspatients

Paratyphoid feverParatyphoid fever'as independently associated 'ith:'as independently associated 'ith:

0 cons!mption of food from street vendorscons!mption of food from street vendors0 andand and flooding1and flooding1

Typhoid feverTyphoid fever!sing the comm!nity control gro!p 'ere mostly!sing the comm!nity control gro!p 'ere mostlyrelated to the ho!sehold( ie( to recent typhoid fever in therelated to the ho!sehold( ie( to recent typhoid fever in theho!sehold:ho!sehold:

0 no !se of soap for hand'ashing2no !se of soap for hand'ashing2

0 sharing food from the same plate(sharing food from the same plate(0 and no toilet in the ho!sehold1and no toilet in the ho!sehold1

0 also( typhoid fever 'as associated 'ith yo!ng age in years1also( typhoid fever 'as associated 'ith yo!ng age in years1

Rik actor or T)p4oid 0 Parat)p4oid &e/erRik actor or T)p4oid 0 Parat)p4oid &e/er

in !akartain !akarta

3ollaard( AM1( 4AMA1 ##52$"*",:.#6-."7


7/27

&actor t4at Inluence Inecti/it)&actor t4at Inluence Inecti/it)

8ngestion of8ngestion of

0 "#"#77organism ca!se clinical disease in 7+organism ca!se clinical disease in 7+

0 "#"#66

organisms ca!sed disease in 7#+organisms ca!sed disease in 7#+0 "#"#$$organisms ca!sed disease in $7+organisms ca!sed disease in $7+

trains that do not have 93i antigen are lesstrains that do not have 93i antigen are less

infective and less vir!lentinfective and less vir!lent


8/27

6pidemiolo3) o T)p4oid &e/er6pidemiolo3) o T)p4oid &e/er

5lo-al 4ealt4 pro-lem and 4i34l) endemic in5lo-al 4ealt4 pro-lem and 4i34l) endemic inIndoneiaIndoneia

5lo-al annual incidence 22 million cae and5lo-al annual incidence 22 million cae and

"7 million deat4."7 million deat4.Incidence in Indoneia etimated 27(18"(Incidence in Indoneia etimated 27(18"(cae"((.((( population per )earcae"((.((( population per )ear

Cae atalit) rate '.81"9Cae atalit) rate '.81"9

2 o all mortalit) *7(.((( deat4)ear+2 o all mortalit) *7(.((( deat4)ear+

Seowandojo E, 1998


9/27

". 5ram1ne3ati/e, la3ellated and

acultati/e anaero-ic -acteria

'. T4e cell en/elope contain a comple;

lipopol)acc4aride *


10/27


11/27

Some e;ample o commonl)

=ccurin3 Salmonella erot)pe and 3roup

Gro!p erotype

A 1 paratyphi A

; 1 paratyphi ;

1 stanley

1 saintpa!l 1 agona

1 typhim!ri!m

C 1 paratyphi C

1 choleraes!is

1 vircho' 1 thompson

D 1 typhi

1 enteritidis

1 d!%lin

1 gallinari!m


12/27

Clinical Appearance and Dia3notic oClinical Appearance and Dia3notic o

T)p4oid &e/erT)p4oid &e/er


13/27

Clinical Preentation o T)p4oid &e/erClinical Preentation o T)p4oid &e/er


14/27

Dia3notic criteriaDia3notic criteria

Deinite :Deinite :

Poiti/e 3all culture or PCR Salmonella t)p4iPoiti/e 3all culture or PCR Salmonella t)p4i

?idal erolo3) a33lutinin = titer?idal erolo3) a33lutinin = titer @@ "9$("9$(

or titeror titer @@""'8(""'8(

Increaed o = titer twice or moreIncreaed o = titer twice or more

Pro-a-le :Pro-a-le :

?idal erolo3) a33lutinin = titer "2'(?idal erolo3) a33lutinin = titer "2'(

or titer "9$(.or titer "9$(.


15/27

Blood culture and PCR reult inBlood culture and PCR reult in

dia3noi o T)p4oid &e/erdia3noi o T)p4oid &e/er


16/27

Treatment o T)p4oid &e/er : 5eneralTreatment o T)p4oid &e/er : 5eneral

and in Pre3nanc)and in Pre3nanc)


17/27

5eneral Treatment in T)p4oid &e/er5eneral Treatment in T)p4oid &e/er

=on Pharmacologic : ;ed rest( =!trition=on Pharmacologic : ;ed rest( =!trition

PharmacologicPharmacologic

ymptomaticymptomatic

Anti%iotic :Anti%iotic :

Ampicillin@Amo>icillinAmpicillin@Amo>icillin Chloramphenicol 5>7##mgChloramphenicol 5>7##mg

Cephalosporin : Ceftria>one /-5 g@daysCephalosporin : Ceftria>one /-5 g@days

Fl!oro!inolones : Ciproflo>a>in >7## mgFl!oro!inolones : Ciproflo>a>in >7## mg

Bflo>acin >5## mgBflo>acin >5## mg

Peflo>acin ">5## mgPeflo>acin ">5## mg

Flero>acin ">7## mgFlero>acin ">7## mg

evoflo>acin ">7##mgevoflo>acin ">7##mg


18/27

Anti%iotics d!ring pregnancy and lactationAnti%iotics d!ring pregnancy and lactation*",*",

A3entA3ent6m-r)ionic6m-r)ionic

periodperiod

PotPot6m-r)onic6m-r)onicperiodperiod

PeripartalPeripartalperiodperiod

aole *+*+ *+*+ 11 11 Teratogenic in animalTeratogenic in animale>periments( ernicter!se>periments( ernicter!s

1 Contraindicated ornot recommended

*+ onl) i clearl)indicated

ae or ue w4en indicated

A to -e precri-edonl) in e;ceptional cae

6m-r)onic period *"tto "'t4wk. o pre3nanc)+ Potem-r)onic period *"2t4to 2#t4wk. opre3nanc)+ Peripartal period *$(t4wk. o pre3nanc) till deli/er) +


19/27

Antibiotics during pregnancy andlactation(2)

A3entA3ent6m-r)ionic6m-r)ionicperiod period

PotPot6m-r)onic6m-r)onic

period period

PeripartalPeripartalperiod period

periments

MetronidaoleMetronidaole AA AA AA AA Teratogenic in animalTeratogenic in animale>perimentse>periments

AmphotericinAmphotericin;;

11 A*+A*+ A*+A*+ A%ortion and foetalA%ortion and foetalretardation reportedretardation reported

6m-r)onic period *"tto "'t4

wk. o pre3nanc)+

Potem-r)onic period *"2t4to 2#t4

wk. o pre3nanc)+

Peripartal period *$(t4wk. o

pre3nanc) till deli/er) +

1 Contraindicatedor

notrecommended

*+onl) i clearl)

indicated

ae or ue w4en indicated

A to -e precri-ed

onl) in e;ceptionalcae


20/27

Comm!nica%le Disease Control and provincial a%oratory ervices( 'a!l! =atal

Dept1 of


21/27

Treatment of MDR-TTreatment of MDR-T


22/27

?4at i MDR1STE?4at i MDR1STE

MDR-T is almonella typhi 'hich has aMDR-T is almonella typhi 'hich has a

m!tagen *Gyr-A or TEM-", that canm!tagen *Gyr-A or TEM-", that can

resistant to fl!or!inolens or partially toresistant to fl!or!inolens or partially to

%eta-lactam *not all,%eta-lactam *not all,


23/27

The possi%ility of MDR-T sho'ed %yThe possi%ility of MDR-T sho'ed %y

clinical impressionclinical impressionin 'hich theres no goodin 'hich theres no good

response after empirical ade!ate therapyresponse after empirical ade!ate therapy

;y :;y :

- Penicillin- Penicillin : Amo>ycillin( Ampicillin: Amo>ycillin( Ampicillin

- Fl!or!inolones- Fl!or!inolones :: Ciproflo>acinCiproflo>acin

evoflo>acinevoflo>acin- Cephalosporines- Cephalosporines : Ceftria>one: Ceftria>one

MDR Salmonella T)p4i*MDR1ST+

Cae Poi-ilit)

Hoon


24/27

A M!lti-Dr!g Resistant almonella typhiA M!lti-Dr!g Resistant almonella typhi

*MDRT, 'as appeared %y the present of*MDRT, 'as appeared %y the present of

gyrA and TEM-" gene1gyrA and TEM-" gene1

MDRT

5)r A

5ene

T6M1"5ene

&luorFuinolone

Reitance

BetalactamaeBut not 6SBhi%ited s!periorse>hi%ited s!periors

antimicro%ial activity compared to other anti%iotics(antimicro%ial activity compared to other anti%iotics(

incl!dingincl!ding ceftaidimeceftaidime'ith M8C$#+ #()!g @ ml *M8C'ith M8C$#+ #()!g @ ml *M8C#(#7 to "(7. !g @ ml,#(#7 to "(7. !g @ ml,

Hoon


26/27

ConcluionConcluion

"1"1 Typhoid fever : ac!te systemic illness d!e to almonellaTyphoid fever : ac!te systemic illness d!e to almonellatyphi and paratyphityphi and paratyphi

1 Treatment : !pportive and symptomatic1 Treatment : !pportive and symptomatic

Antimicro%ial : Ampicillin( ChloramphenicolAntimicro%ial : Ampicillin( Chloramphenicol Fl!or!inolonesFl!or!inolones

//rdrdGen CephalosporineGen Cephalosporine

/1 Treatment choices in pregnancy : Penicillin and/1 Treatment choices in pregnancy : Penicillin and

CephalosporinesCephalosporines51 Treatment option for MDR-T : AteronamICar%apenem51 Treatment option for MDR-T : AteronamICar%apenem


27/27

Documents

Typhoid Fever in Special Case