Typhoid Fever

INTRODUCTION

Typhoid fever or typhus abdominalis is an acute infection that occurs in the small intestine caused by the bacteria Salmonella typhi. Typhoid fever patients in Indonesia is pretty much expected 800 / 100,000 population per year and spread everywhere. Found almost throughout the year, but especially in the summer. Typhoid fever can be found at all ages, but most often in older children, aged 5-9 years and men more than women with a ratio of 2-3: 1.

Transmission can occur anywhere, anytime, from age one starts to consume food from outside, if food or beverages consumed less clear. Usually only considered when there is a typhoid fever continuously for more than 1 week can not come down with fever medication and strengthened by the impression of a child lying passive, appear pale, abdominal pain, no bowel movements or diarrhea a few days.

The faster the typhoid fever can be diagnosed the better. Treatment in early stage would be very profitable given the mechanism of the immune system is still quite good and the bacteria are still localized only in few places.

Mode of transmission Typhoid Fever Disease
Typhoid fever can strike when the bacteria enter through food or water, resulting in infection of the digestive tract is the small intestine. And through the bloodstream, the bacteria reach the organs especially the liver and spleen. He then proliferate in the liver and spleen that causes pain when touched.

Signs and Symptoms of Typhoid Fever
After infection will appear one or more of the following symptoms:

    * High fever of 39 ° to 40 ° C (103 ° to 104 ° F), which increased slowly
    * Shivering
    * Weak heart rate (bradycardia)
    * Weakness (weakness)
    * Headache
    * Muscle pain myalgia
    * Loss of appetite
    * Constipation
    * Abdominal pain
    * In certain cases the spread of the spots appear pink ("rose spots")

This disease can strike when the bacteria enter through food or water, resulting in infection of the digestive tract is the small intestine. Then follow the bloodstream, the bacteria reach the liver and spleen that proliferate there that causes pain when diraba.Gejala clinical typhoid fever in children usually give a mild clinical picture even without symptoms (asymptomatic).

CLINICAL PICTURE

The average incubation period of 7-14 days. Clinical manifestations in children are generally lighter and more varied. Fever is the most constant symptom of all the clinical appearance.

In the first week, complaints and symptoms resembling an acute infectious disease in general, such as fever, headache, nausea, vomiting, decreased appetite, abdominal pain, diarrhea or constipation a few days, whereas physical examination found only the body temperature rises and settled. Temperature increases mainly afternoon and evening.

After the second week it becomes more obvious symptoms of high fever is continuous, malodorous breath, dry skin, dry hair, dry lips chapped / peeling, the tongue is covered with dirty white membrane, the tip and edges red and tremors, an enlarged liver and spleen and the resulting pain when touched, abdominal bloating. The child appears ill, with a mild disturbance of consciousness where the bed passive, indifferent (apathetic) to severe (delier, coma).

Severe typhoid fever gave bleeding complications, leakage of the intestine (perforation), infection of the lining of the intestines (peritonitis), seizure, bronkopnemoni and abnormalities in the brain (encephalopathy, meningitis).

So there are three main components of the symptoms of typhoid fever are:
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Prolonged fever (more than 7 days),
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Gastrointestinal disorders
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CNS disorders / awareness

Care and Treatment of Typhoid Fever Disease
Care and treatment of patients with typhoid fever disease aims to stop the invasion of bacteria, shortening the course of the disease, prevent complications, and did not prevent recurrence. Treatment of typhoid was done by isolating the patient and conduct disinfection of clothing, faeces and urine to prevent transmission. The patient must lie in bed for three days until the heat down, and then be sitting, standing and walking.
Treatment of Typhoid Fever patients in the Hospital consists of supportive treatment melipu + ti rest and diet, Medical, complications of therapy (depending on the complications that occur). Rest aims to prevent complications and promote healing. Patients should be absolute bed rest until fever-free minimum of 7 days or more for 14 days kurag. Mobilization done gradually, in accordance with the recovery power of the patient.
Complications of Typhoid Fever Disease
A common complication in patients with typhoid fever is intestinal bleeding due to perforation, infection of the gallbladder (cholecystitis), and hepatitis. Disorders of the brain (encephalopathy) are occasionally found also in children.
Complications of typhoid fever can be divided in:
A. Intestinal complications (intestinal)
A. Intestinal bleeding
2. Intestinal perforation
3. Paralytic ileus
2. Complications ekstraintetstinal
A. Cardiovascular complications: peripheral circulatory failure (shock / sepsis), myocarditis, thrombosis and thrombophlebitis.
2. Blood complications: hemolytic anemia, and thrombocytopenia or disseminated intravascular coagulation syndrome and uremia hemoltilik.
3. Pulmonary complications: penuomonia, empyema and peluritis.
4. Liver and bladder complications: hepatitis and kolelitiasis.
5. Renal complications: glomerulonephritis, pyelonephritis and perinefritis.
6. Bone complications: osteomyelitis, periostitis, spondylitis and arthritis.
7. Neuropsychiatric complication: delirium, mengingismus, meningitis, peripheral polineuritis, sindrim Guillain-Barre syndrome, psychosis and catatonia.
In young anaka with paratyphoid fever, complications are rare. Complications are more common in a state of severe toxemia and general weakness, when patient care is less than perfect.
Prevention
Prevention of typhoid fever pursued through a variety of ways: general and specific / immunization. Including common ways include improved hygiene and sanitation because of improved hygiene and sanitation alone can reduce the incidence of typhoid fever. (Provision of clean water, sewage and waste management). Maintain personal hygiene and keeping what goes mouth (drink or eat) is not contaminated Salmonella typhi. Termination of the transmission chain is also important that the supervision of the seller (the circumference) drinks / food.
There are two vaccines to prevent typhoid fever. The first is an inactivated vaccine (dead bacteria) are given by injection. The second is an inactivated vaccine (attenuated) is administered orally. Typhoid vaccine is not routinely recommended, hanta typhoid vaccine is recommended for travelers visiting the places where typhoid fever is often the case, people who had contact with typhoid patients and laboratory workers career.


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