DD

malaria
Hepatitis
bacterial enteritis
dengue fever
rickettsial infections
leptospirosis
amebic liver abscesses
acute HIV infection

Typhoid fever

Dengue fever

Malaria

Epid

in developing
nations whose
sanitary conditions
are poor.

warm, wet
areas of the
world, tropic
and subtropic
regions
Outbreaks
occur in the
rainy season

Warm climates:
tropics and
subtropics

Etiology

Salmonella typhi.

virus

Plasmodium

Hepatitis virus

Plasmodium
falciparum
---####-----vivax
---####-----ovale
---####-----malariae

Hepatitis A
Hepatitis B
Hepatitis C

Anemia, Chills,
Coma,
Convulsion,Fev
er, Headache,
Jaundice,
Muscle pain,
Nausea, stool
bloody,

Loss of
appetite,
Nausea and
vomiting,
Diarrhea, Darkcolored urine,
pale bowel
movements,

Classificatio
n

Sign &
sypmtoms

fever, malaise,
diffuse abdominal
pain, and
constipation.

High fever (104

- 105 degrees
Fahrenheit), red
rash, Headache
(especially
behind the
eyes), Fatigue,
Joint aches,

Hepatitis

Transmission

Through stool,
urin.
Hand to mouth
transsmission
Oral
transmission via
sewagecontaminated
water or shellfish

spread
by
Aedes
aegypti

1) one human HAV

to another
Eating food
by the bite
prepared by
of
someone with HV
infectedAn
who did not wash
ophelesmo
their hands after
squitoes
using the bathroom
2) from a
Having anal/oral
mother to
sex with someone
her unborn
with HV
baby
Not washing your
(congenitall
hands after
y)
changing a diaper
3) by blood
Drinking
transfusion
contaminated water
s
HBV
contact with an
infected person's
blood, semen or
other body fluid. An
infected woman can
give hepatitis B to
her baby at birth.
HCV
contact with
infected blood
spread through sex
with an infected

Exam &
Test

Routine
examinatio
n
Bacterial
examinatio
ns
Serological
test(widal
test)

Antibody titerfor
dengue virus types
Complete blood count
(CBC)
Serology studiesto
look forantibodies to
dengue viruses

enlarged liveror
anenlarged
spleen

Treatment

varry

1) There is no specific
treatment for
dengue fever. You
will need fluids if
there are signs
ofdehydration
2) Acetaminophen
(Tylenol) is used to
treat a high fever.
Avoid taking aspirin.

1) Drugs non-ACT:
Klorokuin
difosfat/sulfat
SP
Kina sulfat
Primakuin.
2) Combination
drugs of non-ACT:
Klorokuin + SP
SP+ kina
Klorokuin +
Doksisiklin/Tetrasi
klin
SP +
Doksisiklin/tetrasi
klin
Kina +
Doksisiklin/tetrasi
klin

Drugs
Vaccine

Complication
s

internal
bleeding
delirium,
bowel
perforation,
and death
within one
month of onset
.

Febrileconvulsi
ons
Severe
dehydration

Destruction of
blood cells
(hemolytic
anemia)
Liver failure
andkidney failure
Meningitis
Respiratory failure
from fluid in the
lungs (pulmonary
edema)
Rupture of the
spleen leading to
massive internal
bleeding
(hemorrhage)

cirrhosis,
liver failure,
and liver
cancer.

TYPHOID FEVER

DEFINITION
Typhoid fever is a bacterial disease,
caused by Salmonella typhi. It is
transmitted through the ingestion of
food or drink contaminated by the
faeces or urine of infected people.
(WHO)
Typhoid fever is a life-threatening
illness caused by the bacterium
Salmonella Typhi. (CDC)

EPHIDEMIOLOGY
Typhoid fever as an endemic disease
in Indonesia
In 1990 9,2 per 10,000 citizen
In 1994 became 15,4 per 10,000
citizen
1981-1986 improved 35,8% :
19.596 26.606cases

EPHIDEMIOLOGY
Fig. 1. The typhoid fever
surveillance study sites

Incidence of typhoid fever

Strongly endemic
Endemic
Sporadic cases
http://www.who.int/bulletin/volumes/86/4/06-039818/en/

Fig. 2. Incidence of typhoid

fever and mean age of patients

ETIOLOGY
Salmonella typhi
Structure :
Basil like shaped
Gram negative
Facultative anaerob
Equipped with capsul to prevent
phagocytosis and flagel for movement

Salmonella typhi
Antigen
Antigen H
Antigen of the flagel
Resistance against heat (up to 60 C) and acid (up to 1,5)
IgG will be produced to fight against it

Antigen somatic (O)

Antigen of the outer membrane
Resistance against heat (up to 100 C) and acid (up to
1,5)
IgM will be produced to fight against it

Antigen Vi
Located above antigen O (capsule)
Act as capsule to prevent phagocytosis and intracellular
damage

etiology
The bacteria that
cause typhoid fever -S. typhi -- spread
through contaminated
food, drink, or water.
A few people can
become carriers of S.
typhi and continue to
release the bacteria in
their stools for years,
spreading the disease.

Sources of Infection
Water
Contamination with feces often results in explosive epidemics.
Milk and Other Dairy Products (Ice Cream, Cheese, Custard)
Contamination with feces and inadequate pasteurization or improper handling. Some outbreaks
are traceable to the source of supply.
Shellfish
From contaminated water.
Dried or Frozen Eggs
From infected fowl or contaminated during processing.
Meats and Meat Products
From infected animals (poultry) or contamination with feces by rodents or humans.
"Recreational" Drugs
Marijuana and other drugs.
Animal Dyes
Dyes (e.g, carmine) used in drugs, foods, and cosmetics.
Household Pets
Turtles, dogs, cats, etc.

Virulence Factors
1.
2.
3.
4.

Damage to host cells

The ability to invade cells
Form a coat lipopolisacharide
Can remove toxins

Modes of Transmission
Person to person transmition
Rarely (bactery 10 - 10 6)
Contamination of food products
Salmonella live in the chicken
intestine
Contamination of food processing
contamination of process
equipment food presentation

Risk Factors
Worldwide, children are at greatest risk of getting the
disease, although they generally have milder
symptoms than adults do.
If you live in a country where typhoid fever is rare,
you're at increased risk if you:
- Work in or travel to areas where typhoid fever is
endemic
- Work as a clinical microbiologist handling Salmonella
typhi bacteria
- Have close contact with someone who is infected or
has recently been infected with typhoid fever
- Have an immune system weakened by medications
such as corticosteroids or diseases such as HIV/AIDS

Pathofisiology

The 1st week

Fever, which will gradually rise and
then settle at around 3940C
Abdominal pain -Constipation or
Diarrhoea-Vomiting,
Dry cough

Dull headache -Delirium

Skin rash
Sign &
symptoms

The 2nd week

If you don't receive treatment for typhoid

fever, you may enter a second stage during
which you become very ill and experience
Continuing high fever
Either diarrhea or severe
constipation
Considerable weight loss
Extremely distended abdomen
Sign &
symptoms

The 3rd week ( typhoid stage

)
Become Delirious
Lie motionless and
exhausted with eyes
half-closed in what's
known as the typhoid
state
Life-threatening
complications often
develop at this time.

Sign &
symptoms

The 4th week

(Improvement )
If a person survives
until the fourth week,
their symptoms will
gradually improve
Though weight loss and
physical exhaustion can
continue for several
months.
Sign &
symptoms

Diagnose

Diagnose
LAB diagnose
Rutine check

-SGOT and SGPT increase

-leukositosis (aneusinofilia and limfopenia)
- LED increase

WIDAL TEST

Aglutination reaction between S. Typhii (antigen) with

antibody (aglutinin)

TUBEX test

Detect antibody anti S.Typhi 09 in the serum of

patient

Typhidot
TEST

Antibody IGM and IG G in the outer membran of

salmonela typhi

IGM dipstick
test

Antibody IGM specific S.Typhii in the whole blood

serum

Blood culture

Positive if typhoid fever but can be negative too

Laboratory Test
Serology
Widal test :
Test the titer of antigen O and H (during the 2 nd to 4th
week of fever)
(+) titer > 4x normal titer

Microbiology
DNA Probe
IgG protein
Immunoblotting
PCR
Culture

Culture of S.Tyhpi
Selected media : EMB , McConkey ,
SS (salmonella-shigella) , XLD and
TSIA (triple sugar iron agar)
Result :
Colorless colony in McConkey
TSIA, result : -/+ (H2S without gas)

McConkey
(left)

SS

XLD

TSIA

Treatment
Bed Rest and treatment
Diet and supportive therapy
Giving antimicrobial
- Chloramphenicol (first line)
- Tiamfenikol
- Cotrimoxazole
- Ampycilin
- Amoxicillin

Treatment of typhoid fever in pregnant women:

ampycilin, amoxicillin, and ceftriaxone

Complication Intestinal
Intestine bleeding
Perforation small intestine
Illeus paralitic

Complication Extraintestinal
Hematology

thrombocytopenia,
hypofibrinogenemia, increase prothrombin time,
increase partial thromboplastin time, increase
fibrin degradation products, DIC
Hepatitis typhosa
Myocarditis
Neuropsychiatric parkinson rigidity

Prevention
Avoid risky foods and drinks.
Get vaccinated against typhoid fever.
Vacci
ne
Name

How
Given

Number
Time
Time
Minumu
of Doses Betwee Immunizatio m age for
Necessa n Doses n should be vaccinati
ry
completed
on
by (before
possible
exposure)

Booster
Every

Ty21a

1
Capsul
e oral

2 days

1 week

6 Years

5 Years

ViCPS

Injectio
n

2 weeks

2 Years

2 Years

Typhoid fever vaccine

Injection: capsular Vi polysaccharide
for intramuscular use, is a sterile
solution containing the cell surface Vi
polysaccharide extracted from
Salmonella enterica
for age > 2 years old
booster every 3years

 Oral: Ty-21 a vaccine

for age > 6 years
Ty21a is an orally taken, live,
weakened vaccination
consisting of a set of 4
capsules (each one to be
taken on alternate days)

Prognosis
Symptoms usually improve in 2 to 4
weeks with treatment. The outcome
is likely to be good with early
treatment, but becomes poor if
complications develop.
Symptoms may return if the
treatment has not completely cured
the infection

SALMONELLOSIS

Disea se -a ssoc ia te d fa ct s

Salmonellosis: Any of several bacterial infections

caused by species of Salmonella, ranging from mild
to serious infections.

Two main kinds in humans: enteric fever (typhoid

and paratyphoid) and gastroenteritis (non-typhoidal).

Principal habitats in different types of Salmonella

Their principal habitat is the intestinal tracts and
bloodstream of humans, and in the intestinal tracts of
a wide variety of animals.
The WHO groups Salmonella into 3 types:

- Typhoidal (enteric) Salmonella

(example: S. typhi)

causes typhoid and paratyphoid fever

restricted to growth in human hosts

principal habitat is in intestinal tracts

and the bloodstream

- Nontyphoidal Salmonella (example: S. enteritidis, S.

typhimurium)
prevalent in gastrointestinal tracts of a broad range of
animals, including mammals, reptiles, birds and insects.
cause a whole range of diseases in animals and humans,
mainly gastroenteritis.
usually transferred animal-to-person, through certain
food products: fresh meat, eggs and milk
- fruits, vegetables, seafood
house and exotic pets, contamination through contact
with their feces

- Salmonella mostly restricted to certain animals, such

as cattle and pigs; infrequently in humans; if these
strains do cause disease in humans, it is often
invasive and life-threatening.

Etiolog
y

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