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TYPHOID FEVER

DEPARTMENT OF PEDIATRIC
FACULTY OF MEDICINE YARSI UNIVERSITY
RADEN SAID SUKANTO POLICE CENTER HOSPITAL
02 JULY 2018 – 08 SEPTEMBER 2018

Supervisor:
dr. Pulung M Silalahi, Sp.A

By:
Bening Irhamna 1102013057
DEFINITION

✢ Typhoid fever is a bacterial infection of the


intestinal tract.
✢ The acute illness is characterized by
prolonged fever, headache, nausea,
loss of appetite, and constipation or
sometimes diarrhea.
EPIDEMIOLOGY

✢ The World Health Organization (WHO)


data of 2003 estimates there are about 17
million cases of typhoid fever worldwide
with an incidence of 600,000 cases of
death each year.
✢ In developing countries, cases of typhoid
fever are reported as endemic diseases
where 95% is an outpatient case so the
actual incidence is 15-25 times greater
ETIOLOGY
✢ Typhoid fever is caused by Salmonella
typhi.
✢ Gram negative, rod shaped, non spore
forming, predominantly motile bacteria
with peritrichous flagella.
✢ Are facultative anaerob.
Antigenic Structure
Salmonella typhi possesses 3 main antigenic
factors:
✢ the O, or somatic antigen

✢ the H, or flagellar antigen

✢ the Vi (K), or encapsulation antigen


PATHOGENESIS

✢ Human are the only reservoir of Salmonella


typhi.
✢ Mode of transmission: fecal-oral route (most
common).
✢ Transplasental transmission of a pregnant
mother may also occur in bacteremia to her
baby.
✢ Infectious dose: 105-109 organisms.
CLINICAL FEATURES

✢ Onset is insidious and varies from a


mild illness with low-grade fever,
malaise and slight, dry cough to severe
clinical picture with abdominal
discomfort and multiple complications.
✢ Presentation of typhoid may be more
dramatic in children younger than 5
years of age, with comparatively higher
rates of complications and
hospitalization.
FEATURES OF 1ST WEEK
ILLNESS
✢ Rising step ladder type of fever
✢ Coated tongue
✢ Vomiting
✢ Constipation or diarrhea
✢ Occasionally minimal, non-productive
cough
FEATURES OF 2ND WEEK OF
ILLNESS
✢ Continuous high grade fever and
remittent (39-41oC)
✢ Rose spots
✢ Abdominal pain and tenderness
✢ Soft tender splenomegaly
✢ Soft tender hepatomegaly
Rose spots
✢ Faint salmon colored
macules on the trunk and
abdomen
✢ Appear in crop 10-15
✢ First seen after 7-10
days of illness
✢ Last for up to 2-3 days
✢ Fades on pressure
FEATURES OF 3RD WEEK OF
ILLNESS
✢ Hepatosplenomegaly
✢ Intestinal bleeding or perforation
✢ Features of peritonitis
✢ Septic shock
DIAGNOSIS
✢ Bacteriological diagnosis of typhoid
fever consists of:
1. Isolation of the bacilli from patient
(culture)
2. Demonstration of antibodies in
serum (serological)
3. Demonstration of typhoid antigen in
serum or urine (serological)
1. Isolation of the bacilli from
patient – Blood Culture
✢ Bacteremia occurs early in the disease
✢ Blood culture is positive in about
90% cases in 1st week
75% cases in 2nd week
60% cases in 3rd week
✢ Blood cultures rapidly becomes
negative on treatment with antibiotics
Other samples which can be
cultures
✢ Feces
✢ Urine
✢ Bone marrow
✢ Bile
✢ Sputum
✢ Rose spots
2. Demonstration of antibodies in
serum – Widal Test
✢ This is a test for the measurement of H
and O agglutinins for typhoid in the
patients sera.
✢ First there will be an increase in
antibody titers O. Antibodies H arise
more slowly, but will remain long to
several years, while antibody O more
quickly disappear.
2. Demonstration of antibodies in
serum – Widal Test
✢ If titer O agglutinins once check ≥ 1/80
or on titer occurs increase 4 times then
diagnosis of typhoid fever can be
enforced.
✢ Agglutinins H is mostly associated with
post-immunization or past infections.
✢ A false negative result is obtained if the
patient has previously taken antibiotics.
✢ A false-positive results are obtained
when cross-reactions with other
Other test to detect circulating
antibodies
✢ TUBEX Test (detect IgM antibodies
against antigen S.typhi O9
lipopolysaccharide)
✢ Typhidot (detect IgM antibodies against
outer membrane protein of S.typhi)
3. Demonstration of antigen in
serum/urine
✢ PCR
DIFFERENTIAL DIAGNOSIS
Malaria  History of previous attacks
 More rapid onset
 Shivering and sweating
 High early pyrexia
 Relative infrequent
abdominal symptoms and
signs
 Positive blood smear
Influenza  More rapid onset
 High temperature,
 Severe sore throat and cough
 Absence of a palpable spleen and
rose spots.
DIFFERENTIAL DIAGNOSIS
Tu b e r c u l o s i s  The pyrexia and vague symptoms
(Ab do mi n al /Pu lmo nary) and signs may be very similar.
 A chest X-ray, or laboratory
confirmation of typhoid, may be
the only sure method of
diagnosis.
Brucellosis  Onset tends to be more insidious.
 Painful joint is frequently present.
MANAGEMENT – NON MEDICAL
✢ Bed rest
✢ Nutrition
✢ Fluid
MANAGEMENT – MEDICAL
✢ Symptomatic
✢ Antibiotic
○ Chloramphenicol
○ Cotrimoxazole
○ Ampicilin and Amoxicillin
○ Cephalosporin 3rd generation
(Ceftriaxone, Cefotaxime, Cefixime)
COMPLICATIONS
✢ Small intestine: bleeding, perforated,
peritonitis
✢ Non small intestine: meningitis,
myocarditis, chronic carrier, urinary
tract infection
PREVENTION
“Simple
hand
hygiene and
washing can
reduce
several
cases of
Typhoid”

Best prevention Scrub them off your hands


PREVENTION
PREVENTION
VACCINATION
✢ Live oral attenuated vaccine
✢ Whole cell inactivated typhoid (TAB
vaccine)
✢ Vi-capsular polysaccharide (Vi-PS)
vaccine
PROGNOSIS
✢ The prognosis of typhoid fever depends
on the accuracy of therapy, age,
previous health condition, and
presence of complications.
Thank You