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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