Demam Tifoid Dr-Ida
Demam Tifoid Dr-Ida
2000
2001
2002
2003
2004
2000
2001
2002
2003
2004
Hostbarriers
Local:pH,GITmotility,intestinalfloraGeneral : humoralandsellularimmunity
Organism
Numberofmicrobes Virulence (serotype)
Antibioticresistance
Intestinal Epithel Lamina propria Multiplication Plaque Payeri Thoracic Duct Primary bakteremia circulation
Target Organ RES (Liver, spleen, bone marrow) Secundary bakteremia Other organs (metastatic)
Incubation period
Asimptomatic
Invasive period
Intermittent fever Headache Malaise Abdominal pain Constipation Diarrhea
Typhoid phase
Persistent fever Bradicardia Hepatomegaly Splenomegaly Constipation Diarrhea Rose spot
Convalescence
Carrier Relapse
Day -15
Day 0
Day 7
Day 21
Fever
Delirium,decreasingconsciousness Adolescent~adult
Toxicappearance,dehidrated, Typhoidtongue hepatomegaly,splenomegaly
Fever Chilling Abdominalpain Nausea Vomiting Diarrhea Obstipation Raving Unconsciousness Typhoidtongue Epigastricpain Hepatomegaly Splenomegaly
10 25 50 75 100
Bloodcounts
leucopenia,aneosinophilia, relativelymphocytosis thrombocytopenia
Bhutta ZA.Currentconceptsinthediagnosisandtreatmentoftyphoidfever.BMJ2006;333:7882.
Widaltest,since1896
Oantibody,establishedearlierbutforshorttimeonly(4 6months), Hantibody,laterandstaylonger(9months 2years), Viantibody,late(persistincarriers)
InterpretationofWidaltestshouldbetakencarefully,dependon:
Diseasestadium Laboratorymethods Endemicityofdisease Immunisationhistory
Nsutebu EF, Ndumbe PM, Koulla S. Trans R Soc Trop Med Hyg. 2002 Jan-Feb;96(1):64-7.
AdvantagesofWidaltest
Olopoenia LA, King, AL. Widal agglutination test - 100 years later: still plagued by controversy. Postgrad Med J 2000;76:80-84.
GROUP
ANTIGEN O 1, 2, 12 1, 4, 5, 12 1, 4, 5, 12 6, 7 6, 7 9, 12, Vi 1, 9, 12
A B C D
Jaffery G, Hussain W, Saeed, Anwer M and Maqbool S. Annual Pathology Conference, 2003, Pakistan and 3rd Scientific Conference of Paediatric Association of SAARC Countries 2004, Lahore
TubexTFdibandingkandenganUjiWidalpada pasiendenganbiakandarahdan/atauPCR
RSCM,RSPersahabatan,RSTangerang,Mei Oktober2006 Diperiksa52kasus,27laki2dan25wanitadenganusiatertua 20 30tahun(53.8%) SemuapasientelahmemenuhiSkortifoidNelwan>=8dan klinismemenuhisyaratdemamtifoid. TubexTFdibandingujiWidalterhadapskoritumenghasilkan
Sensitifitas100%dan53.1% Spesifitas90%dan65% Nilaiprediksipositif94.1%dan70.8%,prediksinegatif100%dan46.4% Ratiolikelihood(+)10dan1.51,Ratiolikelihood()0dan0.72 AUCROCTubex5.91danWidal0.591,sangatberbedabermakna
Surya H, Setiawan B, Shatri H, Sudoyo A dan Loho T. Diunduh dari http:/pacbiotekindo.co.id/tubextf.html, 29.11.2009
Intraintestinaltract
Outsideintestinaltract
Onethirdof102casesdevelopcomplications
Anicterichepatitis,bonemarrowsupression,paralyticileus, myocarditis,psychosis,cholesystitis,osteomyelitis,peritonitis, pneumonia,hemolysis,andSIADH Ifhepatitisisexcluded,therateofcomplicationsis11%.
Supportive:
Fluidtherapy,dietetic Electrolyte Acidbase
Causal:
Medicamentous (antibiotics,steroid) Surgery (complicationtherapy)
Fluid
Maintenance,D5:NaCl0.9%(3:1) Additional 12.5%foreach10 Cincrement
Dietetic
Solidfoodscouldbegivenassoonaspossible,insteadof conventionalstrainedfood Lessfibersandstimulatingfood Nottostrict
Acidbasecorrections Electrolytecorrections
Bhutta ZA.Currentconceptsinthediagnosisandtreatmentoftyphoidfever.BMJ2006;333:7882.
Antibiotics Ampicillin Amoxycillin Nalidixic acid Chloramphenicol Cefixime Azithromycine Cotrimoxazole Ciprofloxacin
Sensitive 34 28 64 46 80 78 64 84
Interme diate 10 6 12 40 14 22 0 1
Resistant 54 66 24 24 6 0 36 15
E Hartoyo, A Yunanto, L Budiarti. 3rd Congress of Pediatric Infectious Diseases. Cebu City, Philippines, March 2006
Chloramphenicol
100mg/kgBW/day oral, max 2gram,10days Notrecommendedforcaseswithleucocytecount <2000/Ul
Cotrimoxazole
6mg/kgBW/day,10days
Amoxicillin
100mg/kgBW/day,10days
Ceftriaxone (cephalosporin3rdgen) 50 80mg/kgBW/day ,5days Cefixime (cephalosporin3rdgen) 10 20mg/kgBW/day ,10days Oral Azithromycin 20mg/kg/day Fluoroquinolone Notrecommendedfor <14yearsold
Asitromisin
Pada 149kasus anak dan remaja,yangmenderita demam tifoid klinis diberikan asitromisin oral (20mg/kg/hari) atau seftriakson iv(75mg/kg/hari) selama 5hari. Ternyata 30(94%) kelompok asitromisin serta 35(97%) dari kelompok seftriakson sembuh dan tidak berbeda bermakna. Enam kasus dengan seftriakson mengalami relaps dan tidak ada relaps pada kelompok asitromisin.Pengobatan 5hari dengan asitromisin dinyatakan cukup efektif untuk mengobati demam tifoid tanpa komplikasi pada anak dan remaja.
Frenck RW, Mansour A, Nakhla I, Sultan Y, Putnam S, Wiezerba T et al. Clin Infect Dis. 2004;38(7):951-7.
Feverdefervescence(days)
Ampicilin/Amoxicilin Cotrimoxazole Chloramphenicol Ceftriaxone Cefixime 5,2 3,2 6,5 1,3 4,2 1,1 5,4 1,5 5,7 2,1
Hadinegoro SR. Naskah lengkap PKB Ilmu Kesehatan Anak XLIV. Jakarta: FKUI 2001 :105-16.
Encephalopaty
Dexametason13mg/BW/day, 35days Fluidrestrictionto4/5 Acidbaseandelectrolytecorrection
Peritonitis,intestinalhemorrhage
Fasting,parenteral nutrition,bloodtransfusion (if indicated) parenteralantibiotic
RSCMJakarta,RSHSBandung,RSWSMakasar, RSKSemarang,RSMHPalembang,19911996