Typhoid fever
One of the acute systemic infectious diseases that are often found in various parts of the world today is typhoid fever caused by the gram-negative bacterium Salmonella typhi. In Indonesia, typhoid fever is better known by the public with the term "typhoid disease".
In the last four decades, typhoid fever has become a global health problem for the world community. It is estimated that the incidence of this disease reaches 13-17 million cases worldwide with a death rate of 600.000 people per year. Typhoid fever endemic areas are spread across various continents, from Asia, Africa, South America, the Caribbean, to Oceania. Most cases (80%) are found in developing countries, such as Bangladesh, Laos, Nepal, Pakistan, India, Vietnam, and including Indonesia. Indonesia is one of the endemic areas for typhoid fever with the majority of cases occurring in the age group 3-19 years (91% of cases).1,3,4
The incubation period for Salmonella typhi is between 3-21 days, depending on the patient's health and immune status. In the early phase of the disease, typhoid fever sufferers always suffer from fever and many report that the fever feels higher in the evening or at night than in the morning. There are also those who call the characteristics of fever in this disease the term "step ladder temperature chart", which is characterized by a fever that rises gradually every day, reaches its highest point at the end of the first week then remains high, and then will decrease slowly in the fourth week if there is no fever. focus of infection.1,4
On peripheral blood examination, decreased hemoglobin levels, thrombocytopenia, increased ESR, aneosinophilia, lymphopenia, leukopenia, normal leukocytes, and leukocytosis can be found.5
Management
Until now, chloramphenicol is still the drug of choice for the treatment of typhoid fever in Indonesia. The dose given to adult patients is 4 x 500 mg for up to 7 days free of fever. Other alternatives besides chloramphenicol, namely: thiamphenicol (4 x 500 mg), co-trimoxazole (2 x 2 tablets for 2 weeks), ampicillin or amoxicillin (50-150 mg/kg BW for 2 weeks), third generation cephalosporin group (example: ceftriaxone 3 -4 grams in 100 cc dextrose for ½ hour per infusion once a day for 3-5 days), and the fluoroquinolone group (for example: ciprofloxcacin 2 x 500 mg/day for 6 days).5
One of the complications of typhoid fever that can occur in patients who do not receive adequate treatment is perforation and bleeding of the small intestine. This complication often occurs in the third week which is characterized by a sudden drop in body temperature, signs of shock and intestinal perforation such as abdominal pain, muscular defence, liver dimming disappears. Other complications that can occur are pneumonia, myocarditis, and meningitis.2,4
Prevention of Salmonella typhi infection can be done by adopting a clean and healthy lifestyle. Everyone can get used to various simple but effective things from an early age to maintain personal and environmental hygiene, such as getting used to washing hands with soap before eating or touching cutlery/drinking utensils, consuming nutritious food and drinks that have been thoroughly cooked, storing food properly so that not infested with flies or exposed to dust, choosing a place to eat that is clean and has adequate water facilities, getting used to defecating in the bathroom, and managing waste disposal so as not to pollute the environment.
- Cammie F. Lesser, Samuel I. Miller, 2005. Salmonellosis. Harrison's Principles of Internal Medicine (16th ed), 897-900.
- Chambers, HF, 2006. Infectious Disease: Bacterial and Chlamydial. Current Medical Diagnosis and Treatment (45th ed.), 1425-1426.
- Brusch, JL, 2010, Typhoid Fever. http://emedicine.medscape.com/article/231135-overview.
- Indonesian Pediatricians Association, 2008, Textbook of Tropical Infection and Pediatrics (2nd ed), IDAI Publishing Agency, Jakarta.
- Association of Indonesian Internal Medicine Specialists, 2006, Medical Service Standards, PB PABDI, Jakarta.
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Medical Faculty Educative Staff Universitas Islam Indonesia