Defenition

Typhoid fever is a systemic bacterial

disease contracted by consuming
food or water that has been
contaminated with the bacterium
SalmonellaTyphi.
 Epidemiology
Worldwide, however, there were an estimated
22 million cases of enteric fever, with 200,000
deaths, in 2002.
The incidence is highest (>100 cases per
100,000 population per year) in south-central
and Southeast Asia;
Medium (10100 cases per 100,000) in the rest
of Asia, Africa, Latin America, and Oceania
(excluding Australia and New Zealand);
And low in other parts of the world.
Fig. 1. The typhoid fever surveillance study sites
Fig. 2. Incidence of typhoid fever and mean age
of patients
Etiology
Table. Clinical Diseases Induced by Salmonellae.

Enteric Fevers Septicemias Enterocolitis

Incubation period 720 days Variable 848 hours
Onset Insidious Abrupt Abrupt
Fever Gradual, then Rapid rise, then Usually low
high plateau, with spiking "septic"
"typhoidal" state temperature
Duration of Several weeks Variable 25 days
disease
Gastrointestinal Often early Often none Nausea, vomiting,
symptoms constipation; diarrhea at onset
later, bloody
diarrhea
Blood cultures Positive in first to Positive during Negative
second weeks of high fever
disease
Stool cultures Positive from 2nd Infrequently Positive soon
week on; positive after onset
negative earlier in
disease
Enterobactericeae
Diagnostic Laboratory Tests
 Specimens
Blood for culture must be taken repeatedly. In enteric
fevers and septicemias, blood cultures are often
positive in the first week of the disease.
Bone marrow cultures may be useful.
Urine cultures may be positive after the second week.
Stool specimens also must be taken repeatedly. In
enteric fevers, the stools yield positive results from the
second or third week on; in enterocolitis, during the
first week.
A positive culture of duodenal drainage establishes the
presence of salmonellae in the biliary tract in carriers.
 Bacteriologic Methods for Isolation
of Salmonellae
1. Differential Medium Cultures
2. Selective Medium Cultures
3. Enrichment Cultures
4. Final Identification
5. Serologic Methods
6. Agglutination Test
7. Tube Dilution Agglutination Test (Widal Test)
The Widal test to detect these antibodies
against the O and H antigens carried out in
week two to four fever.
 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 (eg, carmine) used in drugs, foods, and cosmetics.

Household Pets
Turtles, dogs, cats, etc.
 Prevention & Control
Sanitary measures must be taken to prevent contamination of
food and water by rodents or other animals that excrete
salmonellae.
Infected poultry, meats, and eggs must be thoroughly cooked.
Carriers must not be allowed to work as food handlers and
should observe strict hygienic precautions.
Two injections of acetone-killed bacterial suspensions of
Salmonella Typhi, followed by
Booster injection ,some months later, give partial resistance to
small infectious inocula of typhoid bacilli but not to large ones.
Oral administration of a live avirulent mutant strain of Salmonella
Typhi has given significant protection in areas of high endemicity.
Vaccines against other salmonellae give less protection and are not
recommended.
 REFERENCE
Jawetz, Melnick, & Adelberg's
Medical Microbiology, 24th
Edition
 Sign and Symptom
Prolonged fever Gastrointestinal
(38.840.5C; 101.8 symptoms included
104.9F)
anorexia (55%)
Initial medical
abdominal pain (30
evaluation included
40%)
headache (80%)
chills (3545%)
nausea (1824%)
cough (30%) vomiting (18%)
sweating (2025%) diarrhea (2228%)
myalgias (20%) more commonly
malaise (10%) than constipation
arthralgia (24%). (1316%).
 Sign and Symptom
Physical findings Early physical
included findings of enteric
coated tongue (51
fever include
56%)
rash ("rose spots")
splenomegaly (5
hepatosplenomegal
6%)
y (36%)
abdominal
Epistaxis
tenderness (45%).
relative bradycardia
at the peak of high
fever.
Sign and Symptom
Pathogenesis
Algoritma Endotoksin

Salmonella tifi
Panas

Makanan
Mulut Usus halus
Minuman

Aliran darah Pembuluh

(Transien bakteriemia) limfe

Organ tubuh Aliran darah

(hati,limpa) (Bakteriemia sekunder)

Kel limfoid Tukak Perforasi

usus halus Plaque Peyeri
Perdarahan

Empedu Carrier Peritonitis

Theraphy