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    Febris Typhoid

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    cahyo setiawan
    This document discusses typhoid fever (enteric fever). It notes that there are an estimated 21.7 million cases of typhoid fever worldwide each year, resulting in 217,000 deaths. In Indonesia, there are approximately 100,000 cases per year. The gold standard for diagnosis is blood or bone marrow culture, but these methods are not widely available in Indonesia. Alternative diagnostic methods like the Widal test and PCR have limitations in sensitivity and specificity. The document discusses the Tubex TF test as a rapid diagnostic test for typhoid fever with high sensitivity and specificity. It provides interpretations of Tubex test results and guidelines for antibiotic therapy based on drug susceptibility.

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    Febris Typhoid

    Uploaded by

    cahyo setiawan
    90 views20 pages
    This document discusses typhoid fever (enteric fever). It notes that there are an estimated 21.7 million cases of typhoid fever worldwide each year, resulting in 217,000 deaths. In Indonesia, there are approximately 100,000 cases per year. The gold standard for diagnosis is blood or bone marrow culture, but these methods are not widely available in Indonesia. Alternative diagnostic methods like the Widal test and PCR have limitations in sensitivity and specificity. The document discusses the Tubex TF test as a rapid diagnostic test for typhoid fever with high sensitivity and specificity. It provides interpretations of Tubex test results and guidelines for antibiotic therapy based on drug susceptibility.

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    This document discusses typhoid fever (enteric fever). It notes that there are an estimated 21.7 million cases of typhoid fever worldwide each year, resulting in 217,000 deaths. In Indonesia, there are approximately 100,000 cases per year. The gold standard for diagnosis is blood or bone marrow culture, but these methods are not widely available in Indonesia. Alternative diagnostic methods like the Widal test and PCR have limitations in sensitivity and specificity. The document discusses the Tubex TF test as a rapid diagnostic test for typhoid fever with high sensitivity and specificity. It provides interpretations of Tubex test results and guidelines for antibiotic therapy based on drug susceptibility.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    90 views20 pages

    Febris Typhoid

    Uploaded by

    cahyo setiawan
    This document discusses typhoid fever (enteric fever). It notes that there are an estimated 21.7 million cases of typhoid fever worldwide each year, resulting in 217,000 deaths. In Indonesia, there are approximately 100,000 cases per year. The gold standard for diagnosis is blood or bone marrow culture, but these methods are not widely available in Indonesia. Alternative diagnostic methods like the Widal test and PCR have limitations in sensitivity and specificity. The document discusses the Tubex TF test as a rapid diagnostic test for typhoid fever with high sensitivity and specificity. It provides interpretations of Tubex test results and guidelines for antibiotic therapy based on drug susceptibility.

    Copyright:

    © All Rights Reserved
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    of 20

    FEBRIS TYPHOID

    BUDI RAHARDJO SARDJOENI


    RSUD TEMANGGUNG
    7AGUSTUS 2019
    Typoid- Paratyphoid fever ( Enteric
    Fever)

     Insiden
    didunia febris typhoid 21,7 juta ,217. 000
    mengalami kematian.
     Febris
    paratyphoid th 2000 populasinya 5,7 juta dan tidak
    ada kematian
     Di Indonesia insidens / kasus , kira2 100.000 kasus/tahun
    DIAGNOSIS OF TYPHOID FEVER

     CLINICAL MANIFESTATION IS DIFFICULT OR NON SPESIFIC AND MOST


    ATYPICAL.
     GOLD STANDARD STANDARD NOW : BLOOD CULTUR OR CULTUR
    FROM BONE MARROW PUNCTION.
     BUT CULTURE METHODS ARE NOT WIDELY AVAILABLE IN INDONESIA.
     BLOOD CULTURE SENSITIVE IS ABOUT 50 – 60 %. BONE MARROW
    CULTUR IS MORE SENSITIVE AT ABOUT 80 – 90 %
     THE OTHER FOR DIAGNOSIS GOLD STANDARS IS PCR
    HOW ABOUT WIDAL FOR DIAGNOSIS
    OF FEBRIS TYPHOID?

     WIDAL AGGLUTINATION TEST DEVELOVED BY F WIDAL IN 1896


     OVER 100 YEARS SINCE THIS INTRODUCTION AS TEST FOR DETECTING FOR
    FEBRIS TYPHOID
     WIDAL NOW IS TO BE PLAGUED WITH CONTROVERSION INVOLVING THE
    QUALTY OF THE ANTIGEN USED AND THE INTERPRETATION OF THE
    RESULT,PARTICULARLY IN ENDEMIC AREA . Alternating of diagnosiic
    must done.
     WIDAL IS SO DETECTING IN CROWDED AREA OR ENDEMIC AREA
     WIDAL TEST MUST BE CHECK IN TWISE IN THE OTHER DAY BUT IT IS NOT
    PRACTICAL
    CONCLUTION OF WIDAL TEST

     THE DIAGNOSIS OF ENTERIC FEVER DEPENDS


    UPON TECHNIQUES, BLOOD CULTURE AND PCR
    WHICH ARE NOT AVAILABLE IN THE VERY AREA
    WERE THE DISEASES IS MOST COMMONT
     THE WIDAL TEST AND THE OTHER SEROLOGICAL
    DIAGNOSIS TOOLS HAVE LIMITATION BECAUSE
    OF THEIR LOW SENSITIVITY OR SPECIVITY

     WAIN J AND HOSOGLUU S , 2010


    HOW THE TUBEX TF TEST

     THE TEST IS INVITRO SEMI QUANTITATIVE TEST. INHIBITION ELISA USING A


    METHODE OF MAGNETING BINDING INHIBITION IMMUNOASSAY.
     MEASURE THE ABILITY OF ANTIBODY IN SERUM TO INHIBIT REACTION BETWEEN
    ANTIGEN ( MAGNETIC LATEX PARTICLE ) AND MONOCLONAL ANTIBODY OF
    SAMONELLA TYPHI.
     THIS IS A SIMPLE TEST AND RAPID DIAGNOSTIC TEST ( RESULT IN 10 MINUTES )
     THE TEST IS DETECT SPECIFIC ANTIBODY . IF IgM ANTIBODY S- TYPHY LPS 09
    MEANS ACUTE PHASE
     SENSITIVITY AND SPECIVITY > 90 %.
     CROSS REACTION IS VERY RARE, USUALLY FOR SALMONELLA ENTERIDIS
    INTERPRETATION OF THE TUBEX TEST
    INTERPRETASI TUBEX TEST

    Skor Nilai Interpretasi

    <2 Negatif Tidak menunjukkan infeksi tifoid aktif


    3 Borderline Pengukuran tidak dapat disimpulkan. Ulangi
    pengujian, apabila masih meragukan lakukan
    pengulangan beberapa hari kemudian

    4-5 Positif Menunjukkan infeksi tifoid aktif


    >6 Positif Indikasi kuat infeksi tifoid
    Interpretasi Tubex Test
    COMMON CLINICAL FEATURE OF TF IN
    CHILDHOOD IN HOSPITAL AND
    COMMUNITY SETTING IN KARACHI
    ( Butto,ZA BMJ,2006 )
    No. Name hospitalized comunity
    (n 1158) (n 340)
    1. High grade fever 1044(95) 338( 99)
    2. Anorexia 811(70) 811(70)
    3. Vomiting 811(70) 11(3)
    4. Hepatomegaly 471(40) 68(20)
    5. Diarhae 409(35) 26(8)
    6. Toxicity 377(33) 1(0,3)
    7. Abdominal Pain 320(28) 65(19)
    8. Splenomegaly 226(20) 17(5)
    9. Constipation 127(11) 1(0,3)
    10. Jaudice 138(12) 26(8)
    11. Jaundice 23(2) 0
    12. Obtudantion 23(2) 1(0,3)
    13. Lieus 12(1) 1(0,3)
    14. Int-perforation 58(0,5) 1(0,3)
    15. Myalgia 174(15) 15(4,4)
    Culture confirmed TF in community
    health in Demak district, central Java(
    SM Abduh,Husen G,Suharyono et al )
     May-November 2005, a fever study incommunity of
    Karangawen and Mranggen Demak district 150 out patient
    with acut fever were included on this study. Blood collected to
    Bactec culture method
     Blood culture positive in 37 ( 24, 7 % ) of 150 patient.Samonella
    typhi was detected in 10 ( 27 %) patients ( mean age 10,3 year,
    range 11-14)
     The presenting symptoms were acute fever >/ 3 days,
    headache, myalgia, constipation, cough etc
     Most of subjects were initially diagnosed as having upper
    repiratory tract infection
    Laboratory parameters at presentation for enteric
    fever attending the Sihanouk Hospital centre 0f
    Hope in Pnom Penh ( Kuljpers LMF, etal, 2017)
    ,cambodia

     Typhoid fever, Paratyphoid fever:


     lekositosis : 2- 10 %
     leukopenia : 6 – 9 %
     Trombocytopenia : 16 – 21
    Laboratory finding of 504 typhoid
    fever patient ( culture confirm )
    Complicated TF Complicated TF TF non complicated
     Onadmision During hospitalization N = 336
    N= 28 n= 80
    Hemoglobin(g/dl) 10,3 ± 1,6 11,2 ± 2,0 11,8 ± 1,7
    Leucocyte x 10³ /mm 4,3 ± 1,6 5,1 ± 2,5 4,8 ± 1,7
    % lympocytes 23,6 ± 7,4 25,0 ± 8,7 27,1 ± 2,7
    Trombocytopenia S 10 (37%) 15 (19%) 27(8%)

    S: <100 x 10³/ml
    Clinical data from Dr
    Kariadi Hospital
    Laboratory support for diagnosis
    typhoid Fever
    Diagnostic test Faskes I Faskes II

    Complete blood count available available

    RDT Ig M and Not available Available(or NA)


    antisalmonella typhi

    BLOOD CULTURE NA NA
    When the time for test Laboratory

    Complete blood count on


    admission repeat minimum every
    2 days
    Recuest RTD after 4 day of onset
    fever ( Tubex or other )
    Blood culture on first week of
    illness( Bactec )
    ANTI MYCROBIAL THERAPY FOR TYPHOID FEVER

    Optimal Therapy Alternative effective drugs


    Susceptibility Antibiotic Daily Days Antibiotic Daily Days
    dose dose
    mg/kg mg/k
    g
    Fully sensitive Fluoroquinolone 15 5-7 Chloramphenicol 50-70 14
    Faskes 1&2 Ciprofloxacin or 2x500 Amoxicilin 100 14
    Levofloxacin 1x500 TMP/SMK 8/40 14
    Multidrug Fluoroquinolone 15 5-7 Azitromycin # 8-10 14
    resistance or Cefixime 15-20 7-14
    Quinolon Ceftriaxone or 75 10 Cefixime 15-20 7-14
    Resistance ¶ Azithromycin # 8-10 7
    # For adult or periatric cases with MDR or with reduced susceptibility to quinolones.
    ¶ The optimum therapy for quinolone-resistant TF has not been determined. Azithromycin, the 3rd
    generation Cephalosporins, or 10-14 day course of high-dose Fluoroquinolon is effective.
    Culture-confirmed typhoid fever in community
    health centers (puskesmas / faskes 1)of
    Demak district, Central Java
    During a fever study in community health centers of Karangawen and
    Mranggen, Demak district, Central Java (May-November 2005), 150
    out patients with acute fever were included in the study, blood
    samples were collected from all patients and cultured by BACTEC
    method.
    Blood cultures were positive in 37 (24,7%) of 150 partients. Of those with
    positive blood culture, Salmonella enterica servovar Typhi was
    detected in 10 (27%) patients (mean age: 10,3 yr; range 11-14yr).
    The presenting symptoms were acute fever ≥ 3 days, headache,
    myalgia, constipation, cough etc.
    Most of subjects were initially diagnosed as having upper respiratory
    Fluoroquinolones in thypoid fever
    Advantages
     Ciprofloxacin & other FQ’s have added values, more than their anti-
    infective activity:
    1)Immunomodulatory activities
    2)Higher capacity in the elimination of Salmonella from bone-marrow
    3)Low fecal carrier and low relapse rates
    Disadvantages
     Widespread use of FQ’s may cause a decrease susceptibility of
    Salmonella strains to FQ’s
     Increases NARST related infection
     It could be associated with poor clinical outcomes of TF
    RESEARCH A comparison of Fluoroquinolones versus other
    antibiotics for treating enteric fever: meta-
    analysis
    Durrane Thavet, research medical officer.1 Anta K M Zaidi, professor.1Julia Crrchley. Senior lecturer in
    epidemiology.2 Asma Azmatullah research medical officer.1 Syed Ali Madri. Reseach medical
    officer.1 Zulfiqar A Bhutta, professor and chair1

    Conclusions :
    In typhoid/paratyphoid fever, fluoroquinolones
    are better than:
     Chloramphenicol for reducing clinical relapse
     Cefixime for reducing clinical failure & relapse
     Ceftriaxone for reducing clinical failure

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