PEMICU 3 GIT

Alexandra Adeline
405090036
 Typhoid Fever
Endemic disease in Indonesia
Acute systemic infection (GIT)
Epidemiology Typhoid Fever
Case fatality rate typhoid fever in
Indonesia on 1996 = 1,08%
Typhoid fever not included on 10
illness with high mortality
 Etilogy
Salmonella typhii
Salmonella paratyphii
 Signs & Symptoms
First week fever, headache,
dizziness, nausea, vomit, abdominal
discomfort, cough, epistaksis
Temperature rise slowly especially in
the afternoon until night
Second week fever, relatif
bradikardi, hepatomegaly,
spleenomegaly, somnolen, delirium,
coma
Salmonella typhii Endotoksin
Pathogenesis

fever
Contaminated food
and drink Oral fecal Small intestine

(Transien bakteriemia)
Pembuluh limfe

Liver and Spleen

Incubation
Secondary bacteremia

Kel limfoid Perforation

Small intestine Tukak
Plaque Peyeri
hemoragic

Carrier
BILE Peritonitis
 Diagnosis Typhoid Carrier
Found S. Typhii in feces culture or
urine without any clinical infection or
1 year after infection
Typhoid Carrier negative there is
no S.Typhii in 6x randomly feces
culture
 Examination
Bacteria Identification
ELISA
Widal Test
Tubex Test
Typhidot Test
IgM Dipstick Test
Culture
Gaal Culture
Molecular
PCR (Polymerase Chain Reaction)
 Treatment
Rest
Supportive care and symptomatic
Diet
Antimicroba
 Other Treatment
Corticisteroid
Only indicated for toxic typhoid or typhoid fever
with septic shock
3 x 5 mg
Combination Antimicroba
Only for typhoid toxic, peritonitis/perforation, septic
shock, 2 type of microorganism in blood culture
Typhoid Fever in pregnancy
Ampisilin, amoksisilin, seftriakson
Contraindication Kloroamfenikol, Tiamfenikol,
Klorokuinolon, Klotrimoksazol
 DD
Fever > 5-7 days
Paratyphoid Fever : serologic test, culture
TBC Millier: LF, LED, Mt tes
Malaria : blood swab
UTI : urine sedimen, culture
Pneumonia : thorax foto
DHF : serologic test, trombosit, hematokrit
Sepsis : blood culture
 Complication
Intra Intestinal
Intestinal hemoragic
Intestinal perforation
Ileus paralitic
Pankreatitis
Extra Intestinal
Cardiovascular tromboflebitis, miocarditis, perifer circulation
failure
Hemato anemia hemolitic, trombositopenia, thrombosis
Lung pneumonia, empiema, pleuritis
Hepatobilier hepatitis, kolesistitis
Kidney glomerulonefritis, pielonefritis, perinefritis
Bone osteomielitis, periostitis, spondilitis, arthritis
Neuropsikiatrik/typhoid toxic
 Prevention
Identification and eradication S.
Typhii in typhoid patient,
asymptomatic, carrier and acute
Prevent direct contact from acute
patient or carrier S. Typhii
Protection for high risk infected
person
 DHF
Infectious caused illness by dengue
virus
 Etiology
Genus : Flavivirus
Famili : Flaviviridae
Vector : Aedes aegypti, Aedes
Albopictus
4 virus serotype
DEN 1
DEN 2
DEN 3 mostly in Indonesia
DEN 4
 Diagnosis
Serologic dengue test positive
DHF acute fever 2-7 days with 2 or
more from this clinical manifestation
Headache
Retro orbital pain
Mialgia/atralgia
Skin rash
Hemoragic manifestation
Leukopenia
 Diagnosis DHF based WHO 1997
Fever or acute fever, 2-7 days
At least one sign from this hemoragic manifestation :
Uji bendung positive
Petechie, ekismosis, or purpura
Mucosa hemoragic
Hematemesis or melena
Trombocytopenia (<100.000/l)
At least one sign from plasma leakage symptoms :
Hematokrit raise > 20% from normal standard
Hematokrit down >20% after fluid therapy, based from the
last hematokrit result
Plasma leakage pleura efusion, asites, or hipoproteinemia
 Treatment
Supportive care
oral fluid prevent dehidration and
hemoconcentration
 Examination
Laboratorium
Hemoglobin
Hematokrit
Trombosit
Blood swab
Radiologic
Thorax photo pleura effusion
Right lateral decubitus
Cell culture virus antigen detection
RT-PCR
Serologic test for total antibody IgM and IgG
 DD DHF
Leptospirosis
Typhid fever
Campak
Influenza
Chikungunya
 Disentri / Shigellosis
An acute infection in colon caused by
shigella
Shigella 43 serotype
Non motile basil
Gram negative
Enterobactericeae family
4 species of Shigella
S. dysentriae
S.flexneri
S. bondii
S. sonnei single serotype
 Signs & Symptoms
Abdomen cramp
Diarrhea
Mucous and bloody feces
Tenesmus
 Diagnosis
amoeba or cyst in feces and rectal
swab
PCR
Immunoassay toxin in feces
For severe case sigmoidoskopi
(cytology examination)
 Treatment
Enough rest
Rehidration
Fluid and electrolite

Antibiotic for severe case

 Examination
Endoscopi hemoragic mucosa and
ulceration
Sometimes covered with exudat
Mostly on distal colon and
progressively better in proximal colon
 Complication
HUS
Arthritis
Stenosis ulcer circullar or intestinal
obstruction
Toxic mega colon
Rectal prolaps
Perforation
 Leptospirosis
Leptospirosis is a zoonosis disease
caused by microorganism Leptospira
interogans
Also known by mud fever, slime
fever, cane cutter fever
People can get infected by contact
with Leptospira
 Epidemiology
Leptospira is spread all over the
world execpt Antartika
But, mostly Leptospira at tropical
country
 Etiology
Genus : Leptospira
Famili : treponemataceae
Microorganism : spirocheta
Leptospira interogans 5-15m,
with a really soft spiral with width
0,1-0,2m
Leptospira needs weeks and special
condition and media to grow
Medium Fletchers obligat aerob
 Type of Leptospira
Leptospira Interrogans patogen
L. icterohemorrhagica rat as reservoir
L. canicola dog as reservoir
L. pomona pig and cow as reservoir

Leptospira Biflexa non

patogen/saprofit
 Infection
Water, mud, and soil that
contaminated with urine of
Leptospira infected animal (scar)
Bite from contaminated animal
Contact with Leptospira culture on
laboratorium
Long exposure of contaminated
water on normal skin
 Pathogenesis
Skin / mucous membrane blood
stream jaringan tubuh
Immunologic response cellular or
hormonal specific antibody
 Examination
Isolation of Leptospira from body
fluid or serologic
Blood culture
Serologic
PCR
Silver staon
Florscent antibody stain
 Treatment
Supportive care
Observation for dehidration, hipotensi, hemoragic, kidney failure
Some patients need temporary hemodialisis
Antibiotic
4 days after onset time
Mild
Doksisiklin 2 x 100mg
Ampisilin 4 x 500-750mg
Amoxicicilin 4 x 500mg
Modere
Penisilin G 1,5bil unit/6hour IV
Ampisilin 1g/6hour IV
Amoxicicilin 1g/6hour IV
Severe
Doksisiklin 200mg/week
 Prognosis
If there is no icterus not fatal
With icterus
death rate 5% for age > 30 yo
Death rate for geriatric patients 30-40%
 Prevention
Doksisiklin 200mg/week for high risk
patient
 Malaria
Parasite infection disease caused by
plasmodium and invade erythrocyte
and found asexual form in blood
 Etiology
Famili : Plasmodiae
Genus : Plasmodium
Asexual reproduction liver,
eritrocyt
Sexual reproduction in mosquito
body (female Anopheles)
 Classification
Plasmodium vivax malaria
tertiana(benign malaria)
Plasmodium falciparum malaria
tropicana (malignan malaria)
Plasmodium malariae
Plasmodium ovale