Fewer than 400 cases of typhoid fever are reported in the u.s. Each year. Most cases are brought in from countries where typhid fever is common. A few people can become carriers of the bacteria and continue to release the bacteria in their stools for years.
Fewer than 400 cases of typhoid fever are reported in the u.s. Each year. Most cases are brought in from countries where typhid fever is common. A few people can become carriers of the bacteria and continue to release the bacteria in their stools for years.
Fewer than 400 cases of typhoid fever are reported in the u.s. Each year. Most cases are brought in from countries where typhid fever is common. A few people can become carriers of the bacteria and continue to release the bacteria in their stools for years.
EPIDEMIOLOGY Affected patients' age in Indonesia between 3-19 years to reach 91% of cases. Typhoid fever is common in developing countries, but fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from other countries where typhoid fever is common. ETIOLOGY The bacteria that cause typhoid fever -- S. typhi -- spread through contaminated food, drink, or water. If you eat or drink something that is contaminated, the bacteria enter your body. They travel into your intestines bloodstream lymph nodes, gallbladder, liver, spleen, and other parts of the body. A few people can become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease. Structure of salmonella Gram negative, no spore, anaerob fakultative Have flagel peritrich for movement Endure to frozen water in long period Endure to chemical like sodium deoxycholate, briliant green, saodium tetrathionate. This chemical for inhibit growth of other enteric bacteria Fermentation glucosa (+), manosa (+), no fermentation lactosa and sukrosa TSIA: -/+, H2S (+) Structure antigen 3 major antigen: Ag flagel H: destroy in 60 0 C, alchohol, acid, Ab IgG Ag O: endure to 100 0 C, alcholol, acid. Ab IgM Ag Vi: upper Ag O, as a capsul, prevent fagositosis/ demage of intracellular membran bacteria Destroy 60 0 C within 1 hour
Transmission S typhi has no nonhuman vectors. The following are modes of transmission: Oral transmission via food or beverages handled by an individual who chronically sheds the bacteria through stool or, less commonly, urine Hand-to-mouth transmission after using a contaminated toilet and neglecting hand hygiene Oral transmission via sewage-contaminated water or shellfish (especially in the developing world)
LIFE CYCLE OF S.Typhii Pathophysiology intestine IgA immune response is less well Salmunella breed Food contaminated with Salmonella Penetrate the epithelial cells and proliferate in the lamina propia macrofag DIE Survive Plaque payers KGB mecent erica Tora sikus duct bacteremia Orga n RE Leaving the phagocyt e cells Pathophysiology phagocytes cell Breed in the extracellular organ Bakteriremia II Liver gall bladder Intestinal lumen feces Penetrate more and reactions as previously Macrofag already activated hypera ctive Releasing cytokines Symptoms Reaction hiperplasi plaque peyeri Hyperplasia or necrosis hypersensitivity reactions Erosion of blood vessels The process continues GI bleeding Perforation Penetrate the mucosa and muscle layer Accumulation in inflammatory bowel mononuclear Clinical Manifestation Salmonella thypi infection per oral patients went to the doctor yet Incubation period 10-14 days No symptoms Symptoms begin week 1: prodormal symptoms: fever anorexia nausea, vomiting constipation myalgia
second week and next: relative bradikardi thypoid tongue oeganomegali delirium patient went to the doctor Week 1 second week and next
Symptoms First week of illness Fever, often as high as 103 or 104 F (39.4 or 40 C) Headache Weakness and fatigue Sore throat Abdominal pain Diarrhea or constipation Rash
Second week of illness Continuing high fever Either diarrhea that has the color and consistency of pea soup, or severe constipation Considerable weight loss Extremely distended abdomen
Third week of illness Become delirious Lie motionless and exhausted with your eyes half- closed in what's known as the typhoid state Life-threatening complications often develop at this time. Fourth week of illness Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week to 10 days. But signs and symptoms can return up to two weeks after your fever has subsided. Laboratory Studies Culture Polymerase chain reaction (PCR) Specific serologic tests Assays that identify Salmonella antibodies or antigens support the diagnosis of typhoid fever, but these results should be confirmed with cultures or DNA evidence. Widal test Indirect hemagglutination, indirect fluorescent Vi antibody, and indirect enzyme-linked immunosorbent assay (ELISA) for immunoglobulin M (IgM) and IgG antibodies to S typhi polysaccharide Other nonspecific laboratory studies Serological tests (Widal test): Five types of antigens: somatic antigen (O), flagella (H) antigen, and paratyphoid fever flagella (A,B,C) antigen. Antibody reaction appear during first week 70% positive in 3~4 weeks and can prolong to several months In some cases, antibodies appear slowly, or remain at a low level, some(10~30%) not appear at all. Examination Blood test: Hb Leukocyte trombocyte Leukopenia Mild Thrombocytopenia SGPT/SGOT Liver function: SGOT SGPT THYPHOID Widal Test Culture + Definitive Diagnosis Aglutination Antigen Antibodi Get + 6 months-1 year POST THYPOID BLOOD CULTURE BILE CULTURE TREATMENT Fluids and electrolytes may be given through a vein (intravenously), or you may be asked to drink uncontaminated water with electrolyte packets. Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic.
Antibiotic Therapy For Enteric Fever in Adults Indication Agent Dosage (Route) Duration , Days Empirical Treatment Ceftriaxone Azithromycin 1-2 g/d (IV) 1 g/d (PO) 7-14 5 Fully Susceptible Ciprofloxacin(1 st line)
Amoxicilin (2 nd line)
Chloramphenicol
Trimethoprim- Sulfamethoxazole 500mg bid (PO) or 400mg q12h(IV) 1g tid (PO) or 2 g q6h (IV) 25mg/kg tid (PO/IV)
160/800mg bid (PO) 5-7
14
14-21
14 Source : Harrison Indication Agent Dosage (Route) Duration, Days Multidrug- Resistant Ciprofloxacin
10-14 Source : Harrison Management Non pharmacology Bed rest and treatment to prevent complication and make healing faster Bed rest , having meal, drink, take a bath, stools Once in the care need ,should taking care of cleanliness of the bed, clothes, and equipment in use Diet and supporting therapy Some researchers show that solved food (rice with side dish low cellulose) is safe for patient Surgical Care Surgery is usually indicated in intestinal perforation cases. Most surgeons prefer simple closure of the perforation with drainage of the peritoneum. Small-bowel resection is indicated for patients with multiple perforations.
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.
PREVENTION Vaccines are recommended for travel outside of the U.S., Canada, northern Europe, Australia, and New Zealand, and during epidemic outbreaks. If you are traveling to an area where there is typhoid fever, ask your health care provider if you should bring electrolyte packets in case you get sick. Immunization is not always completely effective and at-risk travelers should drink only boiled or bottled water and eat well-cooked food. Studies of an oral live attenuated typhoid vaccine are now under way and appear promising. Water treatment, waste disposal, and protecting the food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.
DYSENTRY BACILLI DEFINITION A condition characterized by diarrhea, with the consistency of stool is usually soft, accompanied by inflammatory exudate containing polymorphonuclear leukocytes and blood. Acute infection terminal ileum and colon caused by bacteria of the genus Shigella EPIDEMIOLOGI Shigella infection easily occur in densely populated, poor sanitation, lack of water, and low levels of personal hygiene. Shigella infection in endemic area is 10-15% cause of diarrhea in children. Number of bacteria to cause disease are relatively few, it ranged between 10-100 germs. Therefore it is very easy transmission is fecal-oral route, either by direct contact or due to contaminated food and drink MICROBIOLOGY Shigella including enterobacteriaceae group, which is gram negative, facultative anaerobes and very similar to eschericia coli. Several properties that distinguish the bacteria with E. coli are bacteria do not stir it active, do not produce gas in glucose media and in general negative lactose. Known 4 shigella species with different serotypes namely: S. dysenteriae (12 serotypes), S. flexneri (14 serotypes), S. boydii (15 serotypes), and S. sonnei (1 serotypes)
PATHOPHISIOLOGY After passing through the stomach and small intestine the bacteria invade the colonic mucosal epithelial cells and proliferate in it. Expansion of the invasion of bacteria into the surrounding cells through a mechanism of cell-to- cell transfer Although the initial lession occurs in the epithelial layer but the local inflammatory response that accompanies severe enough, involving PMN leukocytes and macrophages. It causes edema, mikroabses, loss of goblet cells, damage to tissue architecture and mucosal ulceration.
CLINICAL SYMPTOMS The shoots ranged from 7 hours to 7 days. 7-day average duration symptoms in adults, but can take up to 4 weeks. In the early phase of patients complained of lower abdominal pain, rectal burning sensation, diarrhea accompanied by fever which can reach 40 C. Further reduced but the stool was diarrhea containing blood and mucus, tenesmus, and decreased apetite. In children may get a high fever with or without convulsions, delirium, headache, stiff neck, and lethargy. DIAGNOSE Microscopic examination of feces showed eritrocytes and PMN leukocytes. To confirm the diagnosis made from the material culture of fresh feces or anal swab. Sigmoidoscopy can confirm the diagnosis of colitis, but the examination generally not necessary, because it causes the patient to feel very uncomfortable. In the acute phase of shigella infection, serology test are not useful.
DIFFERENTIAL DIAGNOSE Salmonellosis Enterotoxin diarrhea syndrome due to E. coli Cholera Colitis ulserosa COMPLICATIONS Intestinal Toxic megacolon Intestinal perforation Dehydration Hypovolemic shock Malnutrition Extraintestinal Coughs Colds Pneumonia Meningismus Seizures Peripheral neuropathy Hemolytic uremic syndrome Thrombocytopenia Leukemoid reaction Arthritis TREATMENT Address the balance of fluid and electrolyte disturbances The majority of patients with dysentery can be treated with oral rehydration. In patients with severe diarrhea with dehydration and patients with excessive vomiting that cannot be performed by oral rehydration, intravenous rehydration should be done. Antibiotics Making use of antibiotics based on severity of the disease entirely, in which patients with moderate to severe symptoms of dysentery with persistent diarrhea. Some types of antibiotics that are recommended are: Ampicilin 500 mg 4 times per day Cotrimoxazole 2 times 2 tablets per day Tetracycline 500 mg 4 times per day for 5 days Narcotic drugs and derivates Avoid drugs that can inhibit intestinal motility such as narcotics and its derivates, because it can reduce the elimination of bacteria, and provoke toxic megacolon. Symptomatic treatment Are given to according to the patient analgesic- antipiretic and anticonvulsant
CHOLERA DEFINITION Cholera is an infection of the small intestine that causes a large amount of watery diarrhea. CAUSES, INCIDENCE, RISK FACTORS Cholera is caused by the bacterium Vibrio cholerae. The bacteria releases a toxin that causes increased release of water in the intestines, which produces severe diarrhea. Cholera occurs in places with poor sanitation, crowding, war, and famine. Common locations for cholera include: Africa Asia India Mexico South and Central America People get the infection by eating or drinking contaminated food or water. A type of vibrio bacteria also has been associated with shellfish, especially raw oysters. Risk factors include: Exposure to contaminated or untreated drinking water Living in or traveling to areas where there is cholera
SYMPTOMS Abdominal cramps Dry mucus membranes or mouth Dry skin Excessive thirst Glassy or sunken eyes Lack of tears Lethargy Low urine output Nausea Rapid dehydration Rapid pulse (heart rate) Sunken "soft spots" (fontanelles) in infants Unusual sleepiness or tiredness Vomiting Watery diarrhea that starts suddenly and has a "fishy" odor Note: Symptoms can vary from mild to severe.
SIGNS AND TESTS Tests that may be done include: Blood culture Stool culture
TREATMENT The objective of treatment is to replace fluid and electrolytes lost through diarrhea. Depending on your condition, you may be given fluids by mouth or through a vein (intravenous). Antibiotics may shorten the time you feel ill. The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical intravenous fluid. This solution of sugar and electrolytes is now being used internationally.
PROGNOSIS Severe dehydration can cause death. Given adequate fluids, most people will make a full recovery. COMPLICATIONS Severe dehydration Death
PREVENTION The U.S. Centers for Disease Control and Prevention does not recommend cholera vaccines for most travelers. (Such a vaccine is not available in the United States.) Travelers should always take precautions with food and drinking water, even if vaccinated. When outbreaks of cholera occur, efforts should be directed toward establishing clean water, food, and sanitation, because vaccination is not very effective in managing outbreaks.
GASTROENTERITIS DEFINITION Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract). An infection may be caused by bacteria or parasites in spoiled food or unclean water. The severity of infectious gastroenteritis depends on your immune systems ability to resist the infection. Electrolytes (these include essential elements of sodium and potassium) may be lost as you vomit and experience diarrhea. CAUSES Viruses and bacteria are the most common. Viruses and bacteria are very contagious and can spread through contaminated food or water. Gastroenteritis caused by viruses may last 1-2 days. On the other hand, bacterial cases can last a week or more. Bacteria: Escherichia coli - Travelers diarrhea, food poisoning, dysentery, colitis, or uremic syndrome Salmonella - Typhoid fever; handling poultry or reptiles such as turtles that carry the germs Campylobacter - Undercooked meat, unpasteurized milk Shigella - Dysentery
Viruses: Viral outbreaks (30-40% of cases in children) can spread rapidly through close contact among children in day care and schools. Poor handwashing habits can spread viruses. Common viral causes include the following: Adenoviruses Rotaviruses Caliciviruses Astroviruses Norovirus (formerly called Norwalk-like virus or NLV) and Norwalk virus Parasites and protozoans: These tiny organisms are less frequently responsible for intestinal irritation. You may pick up one of these by drinking contaminated water. Swimming pools are common places to come in contact with these parasites. Common parasites include these: Giardia - The most frequent cause of waterborne diarrhea causing giardiasis Cryptosporidium - Affects mostly people with weakened immune systems, causes watery diarrhea
Giardia Lamblia Other common causes: Chemical toxins most often found in seafood, food allergies, heavy metals, antibiotics, and other medications also may be responsible for bouts of gastroenteritis that are not infectious to others. Medications Aspirin Nonsteroidal anti-inflammatory medicines (such as Motrin or Advil) Antibiotics Caffeine Steroids - Excessive use or a sudden change in frequency or dosage Laxatives Inability to tolerate the sugar lactose in milk and milk products such as cheese and ice cream Exposure to heavy metals sometimes present in drinking water Arsenic Lead Mercury SYMPTOMS Gastroenteritis may affect both the stomach and the intestines, resulting in one or more of the following symptoms: Common symptoms: Low grade fever (99F) Nausea with or without vomiting Mild-to-moderate diarrhea: May range from 2-4 loose stools per day for adolescents and adults to stools that run out of the diaper in infants. Crampy painful bloating Vomiting: May or may not accompany diarrhea. More serious symptoms Blood in vomit or stool Vomiting more than 48 hours Fever higher than 101F Swollen abdomen or abdominal pain coming from the right lower side Dehydration - Little to no urination, extreme thirst, lack of tears, and dry mouth (dry diapers in infants)
EXAMS AND TESTS Anamnese Checking electrolytes, blood, and stool.
Normal stain of stool sample looking for ova, parasites, and leukocytes. Image courtesy of Alexis Carter, MD, Department of Pathology and Laboratory Medicine, East Carolina University. SELF CARE AT HOME Dehydration in children: Children should be given oral rehydration solutions such as Pedialyte, Rehydrate, Resol, and Rice-Lyte. Cola, tea, fruit juice, and sports drinks will not correctly replace fluid or electrolytes lost from diarrhea or vomiting. After each loose stool, children younger than 2 years should be given 1-3 ounces of any of the rehydration solutions. Older children should be asked to drink 3-8 ounces. Adults should drink as much as possible. In underdeveloped nations or regions without available commercial pediatric drinks, the World Health Organization has established a field recipe for fluid rehydration: Mix 2 tablespoons of sugar (or honey) with teaspoon of table salt and teaspoon of baking soda. (Baking soda may be substituted with teaspoon of table salt.) Mix in 1 liter (1 qt) of clean or previously boiled water. You will need solid foods eventually to help end the diarrhea. After 24 hours, begin to offer bland foods with the BRAT dietbananas, rice, applesauce without sugar, toast, pasta, or potatoes.
Dehydration in adults: Although adults and adolescents have a larger electrolyte reserve than children, electrolyte imbalance and dehydration may still occur as fluid is lost through vomiting and diarrhea. Initially, adults should eat ice chips and clear, noncaffeinated, nondairy liquids such as Gatorade, ginger ale, fruit juices, and Kool-Aid or other commercial drink mixes. After 24 hours of fluid diet without vomiting, begin a soft-bland solid diet such as the BRAT diet.
MEDICAL TREATMENT Rehydration Antibiotics may be given for certain bacteria, specifically Campylobacter, Shigella, and Vibrio cholerae Antiemetics for adults Avoid antidiarrheal medications for all age groups if they suspect the infection is caused by a toxin PREVENTION With most infectious germs, the key is to block the spread of the organism. Always wash your hands. Eat properly prepared and stored food. Bleach soiled laundry. Vaccinations for Salmonella typhi, Vibrio cholerae, and rotavirus have been developed. For lactose intolerance, supplementary enzymes are available over-the-counter for adolescents and adults to aid digestion of milk sugars. Soy formulas and other lactose-free products are available from most grocery stores for formula-feeding infants.
DENGUE HEMORRHAGIC FEVER DEFINITION Dengue hemorrhagic fever is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti). CAUSE, INCIDENCE, RISK FACTORS Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person catches a different type dengue virus after being infected by another one sometime before. Prior immunity to a different dengue virus type plays an important role in this severe disease. Worldwide, more than 100 million cases of dengue fever occur every year. A small number of these develop into dengue hemorrhagic fever. Most infections in the United States are brought in from other countries. It is possible, but uncommon, for a traveler who has returned to the United States to pass the infection to someone who has not traveled. Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection and being younger than 12, female, or Caucasian.
SYMPTOMS Early symptoms include: Decreased appetite Fever Headache Joint aches Malaise Muscle aches Vomiting Acute phase symptoms include: Restlessness followed by: Ecchymosis Generalized rash Petechiae Worsening of earlier symptoms Shock-like state Cold, clammy extremities Sweatiness (diaphoretic)
SIGNS AND TESTS A physical examination may reveal: Enlarged liver (hepatomegaly) Low blood pressure Rash Red eyes Red throat Swollen glands Weak, rapid pulse Tests may include: Arterial blood gases Coagulation studies Electrolytes Hematocrit Liver enzymes Platelet count Serologic studies (demonstrate antibodies to Dengue viruses) Serum studies from samples taken during acute illness and convalescence (increase in titer to Dengue antigen) Tourniquet test (causes petechiae to form below the tourniquet) X-ray of the chest (may demonstrate pleural effusion)
TREATMENT Because Dengue hemorrhagic fever is caused by a virus for which there is no known cure or vaccine, the only treatment is to treat the symptoms. A transfusion of fresh blood or platelets can correct bleeding problems Intravenous (IV) fluids and electrolytes are also used to correct electrolyte imbalances Oxygen therapy may be needed to treat abnormally low blood oxygen Rehydration with intravenous (IV) fluids is often necessary to treat dehydration Supportive care in an intensive care unit/environment
PROGNOSIS With early and aggressive care, most patients recover from dengue hemorrhagic fever. However, half of untreated patients who go into shock do not survive. COMPLICATIONS Encephalopathy Liver damage Residual brain damage Seizures Shock
PREVENTION There is no vaccine available to prevent dengue fever. Use personal protection such as full-coverage clothing, netting, mosquito repellent containing DEET, and if possible, travel during periods of minimal mosquito activity. Mosquito abatement programs can also reduce the risk of infection. Viral infection Such as upper respiratory tract infection. Abrupt onset with fever, headache, leucopenia, sore throat, cough, coryza. No rose spots, no enlargement of liver & spleen. The course of illness no more than 2 weeks. Differential diagnosis depends on typical manifestations and blood culture.
Malaria History of exposure to malaria. Paroxysms(often periodic) of sequential chill,high fever and sweating. Headache, anorexia, splenomegaly, anemia, leukopenia Characteristic parasites in erythrocytes,identified in thick or thin blood smears.
Dengue Fever Sudden high fever day 1-3 (above 38,5 o C), in day 3 or day 4-5 increase but not very high (below 38,5 o C)