Dr. H. Harun Hudari, SpPD, FINASIM.

DIVISION OF TROPICAL INFECTIOUS DISEASESDEPARTMENT OF INTERNAL MEDICINESCHOOL OF MEDICINE, SRIWIJAYA UNIVERSITYMOH. HOESIN HOSPITALPALEMBANG

Acute Intestinal Disease

ETIOLOGY

S. TYPHIS. PARATYPHI, AS. PARATYPHI, BS. PARATYPHI, C

Etiology Serotype: D group of Salmonella Gram-negative rod non-spore flagella Culture characteristics

Antigens: located in the cell capsule H (flagellar antigen). O (Somatic or cell wall antigen). Vi (polysaccharide virulence) widel test

A schematic diagram of a single Salmonella typhi cell showing the locations of the H (flagellar), 0 (somatic), and Vi (K envelope) antigens.

Endotoxin A variety of plasmidsResistance: Live 2-3 weeks in water. 1-2 months in stool. Die out quickly in summer Resistance to drying and cooling

EPIDEMIOLOGY

In Indonesia ; Endemic

Occurs WorldwideIn particular, the developing countriesTropical areas

Found all year long in Indonesia

continues to be a global health problem areas with a high incidence include Asia, Africa and Latin America affects about 6.000.000 people with more than 600.000 deaths a year. 80% in Asia . sporadic occur usually, sometimes have epidemic outbreaks.

INCIDENT

=

ages :12-30 yrs = 70-80%30-40 yrs = 10-20%> 40 yrs = 5-10%

Oral routeContaminated food

PATHOLOGY in small Intestines

Week I : Peyer's patches hyperplasia Week II : Peyer's patches necrosis Week III : Peyer's patches ulceration Week IV : ulcer healing

CLINICAL COURSE

Incubation period : 10-14 days

Week I Fever HeadacheDizzinessMuscle painsAnorexic Nause, Vomitting ConstipationDiarrhea

Week IIFeverRelative Bradycardia Spesific toungeHepatomegalySplenomegalyMeteorismusMental disordersRoseola

ROUTINE LABORATORY FINDINGS

Text book : leucopenia relative lymphocytosis

Fact : normal leucocytes (mostly)

WIDAL test

Affecting factors:

Patient related factorsTechnical factors

Patient related factors

General conditionOn site examinationEarly antibiotic treatmentSpecific diseasesImmunosuppressive agents or steroidal agentsVaccinationClinical or sub clinical infection of prior SalmonellaAnamnesis reaction

Technical factors

Cross agglutination Antigen suspension concentration Salmonella Strain

TREATMENT CareDietDrugs

CARE

7 days fever free bed resting

DIET

(grinded porridge-porridge-diet) BS BB NBResearch studysolid food (cooked rice + side dish, low cellulose) safe

DRUGS

ChloramphenicolThiamphenicol CotrimoxazoleAmpicilline & AmoxicilineQuinoloneChephalosporin

COMPLICATION

1. INTESTINAL

Intestinal bleeding Intestinal perforationParalytic illeus

2. EXTRA INTESTINALCardiovascular Blood Lungs Liver Kidneys Bone Neuropsychiatry

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