TYPHOID FEVER

Oleh : DANDY PRIDINARYANA P WISNU BASKORO 042010101025 052010101040

AYUDIA D.A
DEVVY MEGAWATI LILYANA T. K. S

052010101037
022010101048 03700232 Dokter Pembimbing :

Dr. H. Agus Yudho Santoso, Sp.PD, Akp. FinaSim

Lab/SMF Ilmu Penyakit Dalam RSUD Balung Jember

Fakultas Kedokteran
Universitas Jember 2010

Typhoid fever is a systemic infection caused by Salmonella enterica serotype Typhi (S. typhi). The disease remains an important public health problem in developing countries.

PATHOGENESIS

CLINICAL MANIFESTATION

The incubation : averages 10-20 (range 3-56) days The duration of illness in an untreated individual is usually 4 weeks. Patients often remain asymptomatic during the incubation period, which usually lasts 7-14 days but can be as short as 3 days and as long as 60 days, depending on the number of organisms ingested.

In the first week, features are nonspecific, with headache, malaise, and a rising remittent fever as high as 103-104F (39-40C). headache (80%), chills (3545%), cough (30%), sweating (2025%), myalgias (20%), malaise (10%), and arthralgia (24%). Gastrointestinal symptoms included anorexia (55%), abdominal pain (3040%), nausea (1824%), vomiting (18%), and diarrhea (22 28%) more commonly than constipation (1316%).

PHISICAL EXAMINATION
Crops of 2-4 mm diameter pink papules (rose spots) that fade with pressure develop on the upper abdomen and lower chest between the seventh and twelfth days. Relative bradycardia and a dicrotic pulse During the second week :

the patient seems apathetic with sustained pyrexia. The abdomen is distended slightly, and splenomegaly is common.

In the third week:

weight loss Pyrexia persists, and a delirious state (typhoid state) emerges. Pronounced abdominal distension develops, and liquid, foul, green-yellow diarrhea (pea soup diarrhea) The patient is weak with thready pulse and tachypnea, and crackles may develop over the lung bases. Death may occur at this stage from overwhelming toxemia, myocarditis, intestinal hemorrhage, or perforation.

In patients surviving into the fourth week:

the fever, mental state, and abdominal distension slowly improve over a few days, but intestinal complications may still occur. Convalescence is prolonged, and most relapses occur at this stage.

COMPLICATION

DIAGNOSIS
The definitive diagnosis of enteric fever requires the isolation of S. Typhi or S. Paratyphi from blood, bone marrow, other sterile sites, rose spots, stool, or intestinal secretions. bone marrow culture remains highly (90%) sensitive Several serologic tests, including the classic Widal test for "febrile agglutinins," are available

THERAPY

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