Pemeriksaan Antigen NS1 dan IgM Anti Salmonella typhi, sebagai Pengganti Uji Widal untuk Diagnosis Dengue dan Tifoid (Mendahulukan Dengue dari Demam Tifoid)

Abstract: Dengue was the most important arthropod-borne viral disease of public health significance. Compared to nine reporting countries in the 1950s, today the geographic distribution includes more than 112 countries worldwide. The World Health Organization (WHO) estimates that more than 2.5 billion people are at risk of dengue infection. Most will have asymptomatic infections. A high number of cases was reported, mentioning that in 2005 there were 50,196 dengue cases in Indonesia. Some regions of Indonesia i.e. some areas of Sumatera and West Java areas were parts of a significant cluster of dengue mortality. The average number of dengue fever (DF)/dengue hemorrhagic fever (DHF) cases reported to WHO per year has risen. The real figure is estimated to be closer to 50 million cases a year causing 24,000 deaths. Of an estimated 500,000 cases of DHF/DSS requiring hospitalisation each year, roughly 5% die according to WHO statistics. Half the world’s population lives in countries endemic area, underscoring the urgency to find solutions for dengue control. The consequence of severe illness was high mortality rates. In 20-30% of DHF cases, the patient develops shock. Worldwide, children younger than 15 years comprise 90% of DHF subjects. Different from dengue, typhoid fever in most cases is not fatal. Antibiotics, such as ampicillin, amoxicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin and cefepime, have been commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%.  Classical disease duration is 4 weeks and most of the complications of typhoid fever develops in the third and fourth weeks of the infection in untreated patients. Although almost all systems may be involved, intestinal hemorrhage and perforation, toxic myocarditis, bronchitis and toxic confusion are the most common complications. Perforation rate was higher in patients with typhoid fever before chloramphenicol. This article describes the urgency of doctors to take a priority when diagnose dengue firstly rather than typhoid fever. Concerning with the acutely course of dengue disease that may be followed by severe complications and the high risk of mortality, the diagnosis of dengue disease has to be confirmed as soon as possible in order to achieve the proper management.
Keywords: dengue-antigen NS1, fatality-mortality, typhoid fever, Widal- IgM anti Salmonella typhi

Penulis: MTS Darmawan

Published on : JKKI Volume 2, Nomor 6 Juli 2010