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Djoko Widodo
Seowandojo E, 1998
Epidemiologic Distribution of Typhoid Fever
♦ Strongly endemic
♦ Endemic
♦ Sporadic cases
Group Serotype
A S. paratyphi A
B S. paratyphi B
S. stanley
S. saintpaul
S. agona
S. typhimurium
C S. paratyphi C
S. choleraesuis
S. virchow
S. thompson
D S. typhi
S. enteritidis
S. dublin
S. gallinarium
Method of Transmission:
Developed Countries:
• Good sewage and water supply system
• Most cases are sporadic or imported or can be
traced to contact with chronic carriers
Developing World:
• Chronic carriers are less important in transmission
• Peak in hot dry months or rainy season
• The incidence of typhoid fever is 2- 3 times that of
paratyphoid fever
Risk factors for Typhoid & Paratyphoid Fever
in Jakarta
Leucopenia
High fever Mild thrombocytopenia
Headache Relative neutrofilia
Abdominal discomfort Aneosinofilia
Diarrhea or constipation
Relative bradicardia
0 5 7 14
Fever pattern : typhoid fever
Typhus Inversus Pattern
Lowest early in the morning
Highest about 5.30 to 6.30 pm
Can be found in typhoid fever
tuberculosis
Pulse Temperature dissosiation
In normal temperature 37oC (99oF) pulse 80 beats/min
Increased 9 beats/min every 1o C
Relative bradicardia can be found in
enteric/typhoid fever
mycoplasma, malaria falciparum
Devervescence : 3-7 days after treatment
usually on 2nd or 3rd weeks
Laboratory Examination
Makassar (2007) :
resistant of S.typhi
infection 6,8%.
Severe Manifestations
Poor intake
Toxic typhoid
Perforation symptoms
Conclusions
Typhoid fever : acute systemic illness due to
Salmonella typhi and paratyphi
Transmission : fecal oral : food – water
Clinical manifestation :
Fever, GI symptoms, systemic symptoms
Treatment : Supportive and symptomatic
Antimicrobial : FQ : Ciprofloxacin, etc
3rdG Cephalosporine :ceftriaxone
Prevention : hand washing, avoiding non hygiene
food, vaccination and detection carrier
Thank you