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TYPHOID FEVER
Consultant : Dr. Muhammad Nur, Sp.A
Definition
Typhoid Fever
Acute enteric infectious disease
caused by Salmonella typhi (S.Typhi).
prolonged fever, Relative bradycardia,
Transmision
fecal-oral route
close contact with patients or
carriers
contaminated water and food
Pathogenesis
Bacteria was ingested orally
Stomach barrier (some Eliminated)
enters the small intestine
Penetrate the mucus layer
enter mononuclear phagocytes of ileal
peyer's patches and mesenteric lymph
nodes
proliferate in mononuclear phagocytes
spread to blood. initial bacteremia
(Incubation period).
Pathogenesis
Clinical Manifestation
Prolonged fever (3 weeks) , partly
Laboratory findings
Routine examinations:
decreased.
Leukocytopenia(specially
eosinophilic
leukocytopenia).
Limfositosis relatif
Trombositopenia
Serologis Examination
"O" agglutinin antibody titer
Salmonella Cultur
Blood cultur
Complication
Intraintestinal : intestinal hemorraghe
Ekstraintestinal : typhoid ensefalopati,
TREATMENT
Antibiotic
corticosteroid
Illustration
Patient B, , 10 years old came to AA
hospital at 11 th September 2010 with chief
complain fever since 11 days before admitted
to hospital.
Anamnese was get from his mother.
History
Since 11 days before admitted to hospital,
Past History
Never suffer from diseases like this before
Family History
No family had complaint like the same with
the patient.
Habits History
Patient likes snacks outside
Physical Examination
General appearance : moderate illness
Consciousness : apathetic
Vital sign
BP : 110/70 mmHg
PR
: 88x/i
RR
: 88x/i
T
: 37,9C
Nutritional measurements
Stature
: 128 cm
Body weight
: 21 kg
BW/S NCHS 50th persentil = 84%
Head
: no abnormally
Eye
: ligfht reflex (+/+), isokor, 3/3 mm,
konjungtiva : anemi (+/+), sklera ikterik
(-/-), eyes
not sunken
Ear: normally
Nose
: normally
Mouth
: coated tongue (+), faring mucosal
hiperemic
Neck
: no abnormally
Thorax
I
Abdomen
Inspection
Genitourinary : no abnormally
Extremity
: no abnormally
Laboratory findings
Haematology 31/10/09_Labor) Urin (31/10/09_Labor)
Hb
: 11,5 gr%
Leukocyte : 12.400/mm3
Ht
: 34 vol%
Trombocyte: 455.000/mm3
Color
Bilirubin
Protein
Mikroskopis
: yellow brown
: (-)
: (-)
: erytrosit (-)
leukocyt (-)
epitel (-)
Cylinder (-)
Feces
Macroscopis : brown, hard, mucus (-), blood
( -), leucocyte (-), egg worm (-)
LED : 8/hours
Peripheral blood :
erytrosit : normocrom normocytic,
leucocyt: normal
trombocyt : normal
Diff count : Eos Bas Stab Seg Lym Mon
0
0
3
30 65 2
Malaria : (-)
Point of Anamnesis
fever up and down,
not suddenly.
fever rose during the night and down during the day
Patients always sleeps and often delirious during
their sleep.
pain his stomach and there is no defecation since
11 days
Patients defecation and bath in the Kampar River
Patient likes snacks outside
Point of Laboratory
Hb
: 11,5 gr%
Leukocyte : 12.400/mm3
Ht
: 34 vol%
Trombocyte: 455.000/mm3
Sdt : lym
: 65 (limfositosis)
Working Diagnosis
Typhoid fever
Differential Diagnosis
Acute Tonsilofaringitis
Planning Examination
Widal test : antigen titer O dan H
Ig G dan IgM
Blood cultur and feces cultur
Throat swab
Therapy
Bedrest
IVFD RL 15 tts/i
Paracetamol syrp 3x2 cth
Injection Ceftriaxon 3x500mg
Diet high fiber food with kalori
(1500kkal)
PROGNOSE
Quo ad vitam
: Dubia ad bonam
Quo ad fungsionam : Dubia ad bonam
Day/date
Subjective
Objective
Assesment
Therapi
Sunday
Typhoid fever
Bedrest
12/9/2010
Tuesday
consiusness : apathetic
VS :BP : 110/80, PR: 86x, RR 22x, T : 37,8
Konjungtiva : anemis
Typhoid fever
Pulmo :
Aus : vesikuler, wheezing (-), ronkhi (-)
14/9/2010
wednesday
15/8/2010
Thursday
16/9/2010
No complaint
Typhoid fever
Typhoid fever
continue
Pasien pulang
paracetamol sirup 3x2 cth (K/P),
ambroxol sirup 3x1 cth Cefixim
2x1 cth
Discussion
This diagnostic had been made by anamneses,
and H S. Typhi
Differential diagnostic from this patient is
acute tonsilopharingitis because patient
complained pain of swallowing, from
physical examination had been found
hyperemia pharing, and needed swab of
pharing to exclude this differential
diagnostic.
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