DEMAM TIFOID

Dr. SUHAEMI,
SpPD,FINASIM
DEMAM TIFOID
Merupakan penyakit sistemik akut yg
disebabkan oleh infeksi kuman Salmonella
typhi atau Salmonella paratyphi.

DIAGNOSIS:

Anamnesis: Demam naik secara bertangga pd

minggu pertama lalu demam menetap pada
minggu kedua.
Demam terutama sore hari/malam hari
SALMONELLA TYPHI
Human reservoir
Carrier state common
Contaminated food
Water supply
Poor sanitary conditions
DISEASES: SALMONELLOSIS
Salmonellae produce three main types of disease in
humans, but mixed forms are frequent
 TYPHOID: PATHOGENESIS
Septicemia
- occurs 10-14 days
- lasts 7 days

Gall bladder
shedding, weeks

Acute phase, gastroenteritis

Gastroenteritis
 Sakit kepala, nyeri otot, anoreksia , mual,
muntah, obstipasi atau diare.

PEMERIKSAAN FISIS:

Demam, Kesadaran berkabut, Bradikardia

relatif, lidah yang berselaput
,Hepatomegali,splenomegali, nyeri abdomen
LABORATORIUM
Lekopeni,lekosiotosis, lekosit normal

LED meningkat
TrombositopeniaAnemi ringan
Gangguan fungsi hati
Kultur Darah Positif
Peningkatan Titer uji Widal > 4x
Uji Widal dgn titer antibodi O 1/320 atau H
1/640
ANTIGENIC STRUCTURES
O antigen
Lipopolysacchride
H antigen
Flagella
K antigen
Capsule
Vi antigen
In Salmonella Typhi,
the capsular antigen is
called Vi antigen
PATHOGENESIS
The organisms enter via the oral route
With contaminated food or drink
The mean infective dose to produce clinical
infection in humans is 105108 salmonellae
butperhaps as few as 103 Salmonella Typhi
organisms

Host factors of resistance to salmonella

infection
Gastricacidity
Normal intestinal microbial flora
TIFOID KARIER
Ditemukan kuman Salmonella typhi dlm
biakan feses atau urin pd seseorang tanpa
tanda klinis, atau pd seseorang setelah 1 thn
pasca demam tifoid
TYPHOID MARY
Mary Mallon, the cook who
became known as Typhoid Mary,
due to her alarming tendency to
spread typhoid fever via the
kitchens of 1904 New York City.
When she was first suspected to be
the cause of the outbreak, she
disappeared, becoming the subject
of an intense pursuit. Once caught,
she escaped, thus beginning the
chase anew
DIAGNOSIS BANDING
Infeksi Virus
Malaria

PATOGENESIS

Kuman masuk tubuh manusia melalui makan

dan air yg tercemar, sebagian kuman
dimusnahkan oleh asam lambung, dan
sebagian lagi masuk ke usus halus dan
mencapai jaringan limfoid plak Pyeri di Ileum
terminalis yg hipertropi
 S.Typhi. liver spleen gall
BM ,ect
2nd bacteremia early stage&acme stage
(1-3W

stomach

(monon Bac. In gall

uclear
phagoc
ytes )
Bac. In
Lower feces
ileum

peyer's patches & S.Typhi eliminated

mesenteric lymph nodes convalvescence stage
(4-5w)
LN Proliferate,swell 1st bacteremia
necrosis
defervescence stage thoracic
(Incubation stage)
Enterorrhagia,i
3-4w duct 10-14d
ntestinal
perforation


(PEYERSPATC
HES)

(TYPHOI
D
NODUL
E)
 MAJOR FINDINGS IN LOWER ILEUM
Hyperplasia stage(1st week):
swelling lymphoid tissue and
proliferation of macrophages.
Necrosis stage(2nd week):

necrosis of swelling lymph

nodes or solitary follicles.
MAJOR FINDINGS IN LOWER
ILEUM
Ulceration stage(3rd week):
shedding of necrosis tissue and
formation of ulcer ----- intestinal
hemorrhage, perforation .
Stage of healing (from 4th week):
healing of ulcer, no cicatrices and
no contraction

LAB DIAGNOSIS
Specimens
Blood, bone marrow
Urine, stool
Duodenal drainage
Isolations, Cultures, and Differentiations
Selective,
differential media
Biochemical reactions
Serological tests
Agglutination test
Widal test Tube dilution agglutination test
WIDAL TEST
A test of blood serum that uses an agglutination reaction to
diagnose typhoid fever
After Fernand Widal (18621929), French physician
WIDAL TEST
Methods
At least two serum specimens, obtained at intervals of 710 days,
are needed to prove a rise in antibody titer
Serial (twofold) dilutions of unknown serum are tested against
antigens from representative salmonellae
Results
Serum agglutinins rise sharply during the second and third weeks
High or rising titer of O ( 1:160) suggests that active infection is
present
High titer of H ( 1:160) suggests past immunization or past
infection
High titer of antibody to the Vi antigen occurs in some carriers
Results of serologic tests must be interpreted cautiously
The possible presence of cross-reactive antibodies limits the use of
serology in the diagnosis of salmonella infections
SEROLOGICAL TEST FOR EARLY
DETECTION OF TYPHOID FEVER
Serologic techniques are used to identify
unknown cultures with known sera and may
also be used to determine antibody titers in
patients with unknown illness

IgM

Widal test
SPECIMENS FOR LAB DIAGNOSIS
Blood for culture must be taken repeatedly
In
enteric fevers and septicemias, blood cultures
are often positive in the 1st week of the disease
Bone marrow cultures may be useful
Urine cultures may be positive after the 2nd week
Stool specimens also must be taken repeatedly
In enteric fevers, the stools yield positive results
from the 2nd or 3rd week on
In enterocolitis, during the first week
A positive culture of duodenal drainage
suggests the presence of salmonellae in the
biliary tract in carriers
TERAPI
NON FARMAKOLOGIS
Tirah baring
Makanan lunak rendah serat
Vitamin dan Mineral
FARMAKOLOGIS
SIMTOMATIS
ANTIMIKROBA

Kloramfenikol 4x500 sampai 7 hari bebas

demam
Tiamfenikol 4x500 mg
Kotrimoksazol 2x2 selama 2 minggu
Ciprofloksasin 2x500 mg
Pefloksasin 400 mg
TIFOD TOKSIK
Demam tifoid yg disertai gangguan kesdaran
dgn gangguan neurologis atau tanpa ggn
neurologis:

Kloramfenikol 4x500
Ampisilin 4x1 gr
Deksametason 3x5 mg
KOMPLIKASI

PERDARAHAN INTESTINAL
PERFORASI USUS
ILEUS PARALITIK
PANKREATITIS
PROGNOSIS

Bila penyakit berat, pengobatan terlambat/

tidak adekuat atau komplikasi berat,
prognosis buruk
IMMUNITY
Infections with Salmonella Typhi or
Salmonella Paratyphi usually confer a
certain degree of immunity
Reinfection may occur but is often milder
than the first infection
Circulating antibodies to O and Vi are
related to resistance to infection and
disease
CARRIER CONTROL
In most carriers, the organisms persist in the
gallbladder (particularly if gallstones are
present) and in the biliary tract
Some chronic carriers have been cured by
ampicillin alone, but in most cases
cholecystectomy must be combined with
drug treatment