Typhoid Fever

Morning Report by Squad 3

Patient’s identity
• Name : Mr. Eko
• Birthday/Age : 15 – March – 1990 / 28 y.o
• Gender : male
• No RM : 00.09.13.61
• Entry date : 22-01-2018
• Diagnosis : Typhoid Fever
• GCS : E4M5V6
• DPJP : dr. Sahala , Sp.PD
S/ a male patient came to IGD RS UKI Hospital with complaints
of fever since 3 days ago. fever is felt the patient gets heavier in
the afternoon until evening. shivering (+). today the patient has
twice defecate with consistency of liquid, the contents of dregs,
not bleeding. other than that the patient also admitted nausea
accompanied by vomiting. no history of food allergy, DM, HT,
asthma. Family history is denied.

O/ awareness : composmentis
• GCS : E4 M6 V5
• BP : 130/80 mmHg
• Pulsation : 96x/min
• RR : 22x/ min
• Temperature : 37,5˚ C
• Food & medicine allergy : (-)
• Cranial : • Abdominal :
Normocephali, sklera ikterik
-/-, conjunctiva anemic -/-
• Ins : appeared flattened
• Neck : lymph gland’s normal • Aus : intestinal sounds
• Chest : (+), 5x/menit
• Ins : symmetrical respiratory movement • Per : timpanic sound,
• Pal : symmetrical vocal fremitus percussion pain (-)
• Per : sonor sounds all over lung
platforms • Pal : supple, pressure
• Aus : lung sounds vesicular, Rhonki -/-, pain (-), release pain (-),
wheezing -/-
• heart sound 1&2 : regular, murmur
defense muscular (-)
(-), gallop (-) • Extremities : CTR < 2”,
warm extermities,
oedeme (-)
Assesment
• Thypoid fever
Laboratorium
H2TL • Imunologi (widal)
• Hb : 13.6 g/dl • S typose H : negatif
• Leu : 8.4 ribu/ uL • S paratyph A H : + (1/320)
• Hematokrit : 40.6 % • S paratyph B H : negatif
• Trombosit : 123 ribu/uL • S paratyph C H : negatif
• S typose O : + (1/320)
• S paratyphi A H : + (1/320)
• S paratyphi B H : negatif
• S paratyphi C H : + (1/320)
Planning & Therapy
• Pro-hospitalized
• Soft food diet
• Diet steamed rice
• IVFD:
• RL 500 No.III/24 hours
• Levofloxacin 1x750 mg
• Omeprazole 3x20 mg
• Sanmol 3x500 mg
Literature review
Definition Typhoid Fever
• Enteric (typhoid) fever is a systemic disease characterized by
fever and abdominal pain and caused by dissemination of S.
typhi or S. paratyphi.
Clinical manifestation
Buds period about 10-14 days. the symptoms that arise vary:
• In the first week, there are signs of acute infection such as
fever, headache, dizziness, auto pain, anorexia, nausea,
vomiting, obstipation or diarrhea, abdominal discomfort,
cough, and epistaxis. fever that occurs patterned like a step
with a higher temperature day by day, lower in the morning
and high in the afternoon.

• In the second week the symptoms become more pronounced

with fever, relative bradycardia, typhoid (dirty amid, red edges
and edges, with tremors), hepatomegaly, splenomegaly,
meteorismus, conscious disorders, and more rarely, roseolae.
Supporting examination
• Peripheral blood tests: leukopenia / normal / leukocytosis, mild
anemia, thrombocytopenia, increased sedimentary blood rate,
increased SGOT / SGPT.

• Widal test: detection of antibody titer against S.typh, S.paratyphi

ie O agglutinin (from germ body) and aglutinin H (flagella germ).
Aglutinin O persists 4-6 months while agglutinin H persists 9-12
months. antibody titers O> 1: 320 or H 1: 640 antibodies
corroborate the diagnosis of a typical clinical picture.

• TUBEX test : colometric semiquantitative test for antibody

detection of S.typhi O9. positive results indicate salmonellae
serogroup D infection and not specific S.typhi. S.paratyphi
infection showed negative results. 75-90% specificity and 75-80%
sensitivity.
TUBEX
Supporting examination
• Typhidot test: IgM and IgG detection of S. typhi outer
membrane proteins. Positive results are obtained 2-3 days
after infection and specifically identify IgM and IgG against
S.typhi. 98% sensitivity, specificity 76.6%.

• Dipstick IgM test : Specific IgM specific detection of s.typhi on

serum or blood specimens using strips containing S.typhi and
anti IgM lipopolysaccharide antigens as controls. 65-77%
sensitivity and 95-100% specificity. Accuracy is obtained when
the examination is done 1 week after the onset of symptoms.
• Blood culture: positive results confirm tifoid fever but negative
results do not get rid of.
 Management
• rest and treatment to prevent
complications. • fluoroquinolone group:
• norfloxacin 2 x 400mg / day for 14 days
• soft diet and supportive • ciprofloxation 2 x 500mg / day for 6 days
therapy (antipyretics, • ofloxacin 2 x 400mg / day for 7 days
antiemetics, adequate fluids). • a combination of antibiotics is
• antibiotics, with other delivery given to toxic typhoid, peritonitis
options: or perforation, septic shock.
• chloramphenicol 4 x 500 mg / • in pregnancy: ampicillin,
day orally / IV to 7 days free of amoxicillin, ceftriaxone.
fever
• tiamfenicol 4 x 500 mg
• cotrimoxazole 2 x 960 mg for 2
weeks
• ampicillin and amoxicillin 50-150
mg / KgBB for 2 weeks
• ceftriaxone 3-4 grams in 100cc
dextrose for half an hour per
infusion once daily, for 3-5 days