Slide 1
Management and diagnostics approach to detect infectious disease M.SABIRDEPT.OF MICROBIOLOGYFAC.OF MEDICINE AND HEALTH SCIENCETahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurTYPHOID FEVER
SEROTYPE : D GROUP SALMONELLAGRAM-NEGATIVERODNON-SPOREFLAGELLACULTURE CHARACTERISTICSTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurANTIGENS : LOCATED IN THE CELL CAPSULEH (FLAGELLAR ANTIGEN)O (SOMATIC OR CELL WALL ANTIGENVi (POLYSACCHARIDE VIRULENCE
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurEndotoxin A variety of plasmidsResistance: Live 2-3 weeks in water. 1-2 months in stool. Die out quickly in summer Resistance to drying and coolingTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurEpidemiology
continues to be a global health problem areas with a high incidence include Asia, Africa and Latin America
affects about 6000000 people with more than 600000 deaths a year. 80% in Asia .
sporadic occur usually, sometimes have epidemic outbreaks.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur6Source of infection
Cases and chronic carriersCases discharge from incubation, more in 2~4 weeks after onset, a few (about 2~5%) last longer than 3 months chronic carrier Typhoid Mary
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur7
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurTransmission fecal-oral route close contact with patients or carriers contaminated water and food flies and cockroaches.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur9Susceptibility and immunityall people equally susceptible to infectionacquired immunity can keep longer, reinfection are rareimmunity is not associated with antibody level of H, Oand VI.No cross immunity between typhoid and paratyphoid.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur10Susceptibility and immunityAll seasons, usually in summer and autumn.Most cases in school-age children and young adults.both sexes equally susceptible.
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur11Pathogenesisgastrointestinal tract host-pathogen interactionsThe amount of bacilli infection (>105baeteria).
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur12ingested orally Stomach barrier (some Eliminated) enters the small intestinePenetrate the mucus layer enter mononuclear phagocytes of ileal peyer's patches and mesenteric lymph nodes proliferate in mononuclear phagocytes spread to blood. initial bacteremia (Incubation period).PathogenesisTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurPathogenesis enter spleen, liver and bone marrow (reticulo-endothelial system) further proliferation occurs A lot of bacteria enter blood again. (second bacteremia). RecoveryTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur
S.Typhi.
stomachLower ileumpeyer's patches &mesenteric lymph nodesthoracic duct 1st bacteremia(Incubation stage)10-14d(mononuclear phagocytes )2nd bacteremialiverspleengallBM ,ectearly stage&acme stage(1-3WLN Proliferate,swell necrosis defervescence stage3-4wBac. In gallBac. In fecesS.Typhi eliminatedconvalvescence stage(4-5w)Enterorrhagia, intestinal perforation Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurLaboratory findingsRoutine examinations: white blood cell count is normal or decreased. Leukocytopenia(specially eosinophilic leukocytopenia). recovery with improvement of diseases decreased in relapseTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur16Bacteriological examinations: Blood culture: the most common use80~90% positive during the first 2 weeks of illness 50% in 3rd week not easy in 4th weekre-positive when relapse and recrudesce attention to the use of antibioticsTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur17The bone marrow culture the most sensitive testspecially in patients pretreated with antibiotics.Urine and stool culturesincrease the diagnostic yieldpositive less frequentlystool culture better in 3~4 weeks The duodenal string test to culture bile useful for the diagnosis of carriers.Rose spots: Not use routinelyTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur18Serological tests(Vidal test): five types of antigens:somatic antigen(O),flagella(H) antigen, and paratyphoid fever flagella(A,B,C) antigen.Antibody reaction appear during first week70% positive in 3~4 weeks and can prolong to several monthsin some cases, antibodies appear slowly, or remain at a low level, some(10~30%) not appear at all.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur19"O" agglutinin antibody titer 1:80 and "H" 1:160 or "O" 4 times higher supports a diagnosis of typhoid fever"O" rises alone, not "H", early of the disease.Only "H" positive, but "O" negative, often nonspecifically elevated by immunization or previous infections or anamnestic reaction.Antibody level maybe lower when have used antibiotics early.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurSome cross reaction between group D and A.False positive in some infectious diseases.Some positive in blood culture ,but negative in vidal test.'Vi" often useful for carrier (1:40)
molecular biological tests: DNA probe or polymerase chain reaction (PCR)
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur21ComplicationsIntestinal hemorrhageCommonly appear during the second-third week of illnessdifference between mild and greater bleedingoften caused by unsuitable food, diarrhea et al serious bleeding in about 2~8%a sudden drop in temperature rise in pulseand signs of shock followed by dark or fresh blood in the stool.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur22Intestinal perforation: The more serious .Incidence,1-4%Commonly appear during 2-3 weeks. Take place at the lower end of ileum.Before perforation,abdominal pain or diarrhea,intestinal bleeding . When perforation, abdominal pain, sweating, drop in temperature, and increase in pulse rate, then, rebound tenderness when press abdomen, abdomen muscle entasia, reduce or disappear in the sonant extent of liver, leukocytosis . Temperature rise .peritonitis appear.celiac free air under x-ray. Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur23Toxic hepatitis: common,1-3 weeks hepatomegaly, ALT elevated get better with improvement of diseases in 2~3 weeksToxic myocarditis. seen in 2-3 weeks, usually severe toxemia. Bronchitis, bronchopneumonia. seen in early stageTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurOther complications:toxic encephalopathy. Hemolytic uremic syndrome. acute cholecystitismeningitisnephritis et al.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur25Diagnosis Epidemiology data
Typical symptoms and signs
Laboratory findings.
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurDifferential diagnosisViral infections: such as upper respiratory tract infection. abrupt onset with fever, headache, leucopenia, sore throat, cough, coryza. no rose spots, no enlargement of liver & spleen. The course of illness no more than 2 wks. differential diagnosis depends on typical manifestations and blood culture.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur27Malariahistory of exposure to malaria.Paroxysms(often periodic) of sequential chill,high fever and sweating.Headache, anorexia, splenomegaly, anemia, leukopeniaCharacteristic parasites in erythrocytes,identified in thick or thin blood smears.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur28LeptospirosisEndemic area,contacted with urine of mice.Abrupt fever,chills,severe headache,and myalgias, especially of the calf muscles.Leptospires can be isolated from blood,cerebrospinal fluid.Special agglutination titers develop after 7 days and may persist at high levels for many years.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur29Epidemic Louse-Borne typhusprodromal of malaise and headache followed by abrupt chills and fever.headaches,prostration,persisting high fever.Maculopapular rash appears on the forth to seventh days on the trunk and in the axillas, spreading to the rest of the body but sparing the face,palms,and soles.Laboratory confirmation by proteins OX19 agglutination and specific serologic tests. Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur30Tuberculosiscontinuous high or low fever,fatigue,weight loss,night sweats.Mild coughpulmonary infiltration on chest radiographpositive tuberculin skin test reaction(most cases)acid-fast bacilli on smear of sputumsputum culture positive for mycobacterium tuberculosis.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur31Septicemia of Gram-negative bacilliabrupt onset,high fever,symptom of toxemia.Chill,sweats.Shock.Positive of gram-negative bacilli from blood culture.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur32Prognosis:Case fatality 0.51%. but high in old agesinfantand serious complicationsHave immunity for ever after diseasesAbout 3% of patients become fecal carriers .
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurTREATMENTGeneral treatmentisolation and restgood nursing care and supportive treatment close observation T,P,R,BP,abdominal condition and stool . suitable diet include easy digested food or half-liquid food.drink more water intravenous injection to maintain water and acid-base and electrolyte balanceTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurSymptomatic treatment: for high fever:physical measures firstlyantipyretic drugs such as aspirin should be administrated with cautiondelirium,coma or shock,2-4mg dexamethasone in addition to antibiotics reduces mortality.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur35Etiologic and special treatment1.Quinolones: first choice its highly against S.typhi penetrate well into macrophages,and achieve high concentrations in the bowel and bile lumens Norfloxacin (0.10.2 tidqid/1014 days).Ofloxacin (0.2 tid 1014days). ciprofloxacin (0.25 tid)caution: not in children and pregnant Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur2.Chloramphenicol: For cases without multiresistant S.typhi. Children in dose of 5060mg/kg/per day. adult 1.52g/day. tid. Unable to take oral medication, the same dosage given introvenously after defervescence reduced to a half. complete a 1014 day course.But ,drug resistance, a high relapse rate,bone marrow toxicity. Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur373.Cephalosporines: Only third generation effective Cefoperazone and Ceftazidime. 24g/day .10~14 days.4.Treatment of complication.Intestinal bleeding: bed rest, stop diet,close observation T,P,R,BP. intravenous saline and blood transfusion,and attention to acid-base balances. sometimes,operative. Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur38Perforation: early diagnosis. stop diet. decrease down the stomach pressure. intravenous injection to maintain electrolyte and acid-base balances. use of antibiotics. sometimes operative. Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur39Toxic myocarditis: bed rest, cardiac muscle protection drugs, dexamethasone, digoxin.5.Chronic carrier: Ofloxacin 0.2 bid or ciprofloxacin 0.5 bid, 46 weeks.Ampicillin 36g/day tid plus probenecid 11.5g/day. 46 weeks.TMP+SMZ2 tabs. Bid. 13 months.Cholecystitis may require cholecystectomy.Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur40Prophylaxis1.control source of infection Isolation and treatment of patients stool culture one time per 5 days. if negative continued two times ,without isolation. Control of carriers. observation of 25 days(15 days in paratyphoid) when close contactTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur412. Cut of course of transmission key way avoid drinking untreated water and food. 3.Vaccination side-effect more, less useTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurFutureRisk Factors for typhoid, Malaria,TB and Dengue FeverClinical Nutrition for Infectious diseasesSocial interaction of the host,agent and environmentEpidemiology study for diseasesCarriers of typhoid control and preventionTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia TimurNow, What we should do?Finished your study with one of them???Or do something else..Or ..Or ..
Thank you very muchTahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur
Tahun 2030,PSPD FKIK Unggul dalam pengabdian melalui peneltian infeksi tropis dan traumatologi di Kawasan Indonesia Timur
