4. Tropis 4 2012 (Salmonella)

8/18/2019 4. Tropis 4 2012 (Salmonella)

1/42

Mochammad Hatta@2013Mochammad Hatta@2013

SALMONELLA TYPHI

Prof. Dr. Mochammad Hatta, Ph.D, SpMK (K)

Dept Microbiology, Fac.Medicine,

Hasanuddin ni!ersity,

Ma"asssar


2/42

Electron micrograph of a metal-shadowed whole cell ofSalmonella typhi, showing agella and shorter straightmbriae (magnied 7,800 times)



3/42


• Disease : Demam #ifoid (#yphoid Fe!er)

Gastrointestinal infection -- endemik in Indonesia--developing

countries -- environmental/sanitation/hygiene relationship

(Hattta M et al! "rans! #oyal "rop! Med! Hyg $ond %&&'

• )amily : *ntero+acteriaceae -- Gram negative -- non-sporing +acillus -- %-, -- motile -- long peritrichous flagella -- aero+e/

facultative anaero+e -- temperature .o- ,.o 0 optimum '1o 2

• 2olonies on Mac2onkey3s medium 0 44 agar

• 5iochemical reactions: Glucose 0 mannitol: fermentation (6 0

gas (6 -- lactose 0 sucrose : fermentation (-


4/42


• $iability : death point : 7o 2

• In soil survival for 7 8eeks

• Pathogenesis : infection +y ingestion --- small intestinal via

lymphatics --- mesenteric glands -- multiplication --- +lood via

thoracic duct --- +acteriaemic phase ( . - .& days : infection

liver gall +ladder spleen kidney 0 +one marro8!

Gall +ladder --- invasion lymphoid tissue -- 9eyer3s patches

0 lymphoid follicles -- acute inflammatory reactions --- ulcer

haemorrhage -- perforation 0 necrosis


5/42

CLINICAL PICTURE

Symptoms begin with sudden onset of high-

grade feer! heada"he # dry "ough$

%eer is swinging or may show step &adder

pattern # patient initia&&y fee& we&& # mobi&e$

Abdomina& pain # to'i"ity fo&&ow soon # by

the end of (st wee) sp&een is pa&pab&e # pin)!

dis"rete! s)in rash appears oer the trun)$

Constipation is more "ommon than diarrhea

whi"h is usua&&y greenish in "o&or *pea soup+$



6/42

CLINICAL PICTURE,

Abdomina& tenderness # hepatomega&y o""ur

in ./0 of patients$

The pu&se is re&atie&y s&ow in re&ation to feer

*Paget sign+$

The tongue is "oated with free margins #ha&itosis may be present$

The sweat of some patients sme&& &i)e yeast$



7/42

CLINICAL PICTURE,1

The 1rd wee) of i&&ness is the usua& time for

"omp&i"ations in the untreated patients$

Lo"a& gut as we&& as systemi""omp&i"ations may o""ur$

Serious infe"tions may progress rapid&y to

drowsiness # "oma whi"h is usua&&y fata&*"oma igi&+$

2orta&ity is un&i)e&y after the 3th wee) #

patients may be"ome "arrier if not treated$Mochammad Hatta@2013Mochammad Hatta@2013


8/42

Enteric fe!er" #ose spotsEnteric fe!er" #ose spots

Paratyphoid feverTyphoid fever



9/42

Intestina& hemorrhage

Para&yti" i&eus

Intestina& perforation

L4CAL C42PLICATI4NS

5en)er degeneration of abdomina& mus"&es



10/42

Endo"arditis

Arteritis # arteria& embo&i

Cho&e"ystitis

S6STE2IC C42PLICATI4NS

4steomye&itis # septi" arthritis

7epati" # sp&eni" abs"esses

Pneumonia or empyema

2eningitis

Urinary tra"t infe"tionMochammad Hatta@2013Mochammad Hatta@2013


11/42


P4SITI8E CULTURE AN9 Ig2 ANTI:496 RESP4NS IN T6P74I9P4SITI8E CULTURE AN9 Ig2 ANTI:496 RESP4NS IN T6P74I9

%E8ER%E8ER


12/42

$yphoid fe!er $yphoid fe!er%aboratory diagnosis%aboratory diagnosis

• Polymerase Chain Reaction (PCR)Polymerase Chain Reaction (PCR)

• Culture of blood or bone marroCulture of blood or bone marro& !0" durin# first ee$!0" durin# first ee$

• Culture of urine or stoolCulture of urine or stool& in %resence of characteristic clinical %icturein %resence of characteristic clinical %icture

• &erolo#y test&erolo#y test& antibody test a#ainst somatic (') orantibody test a#ainst somatic (') or

fla#ellar (H) anti#enfla#ellar (H) anti#en



13/42


Prinsip tehni" Polymerase %hain &eaction (P%&)

D:; yang akan ' *

diamplifikasi * +++++++++++++++++++++++++ '

Denaturasi 6 primer


14/42


Deteksi Salmonella typhi dengan :ested 92#


15/42


Typhoid feer Typhoid feer

*nested+*nested+

ST( ; .


16/42


Hasil nested 92# S.typhi dari penderitademam tifoid


17/42


MD& P%& product S.typhi $ietnam and /ndonesian isolated

>ietnam Indonesia


18/42


MD# 92# product 4!typhi >ietnam isolated

012 bp

320

4*0

*25


19/42


P%& for the detection of S. typhi specific D67 in blood, stool and urine

samples from patients 8ith suspected typhoid fe!er.

6o (9) of patients 8ith the follo8ing result

Patient group :lood Faeces rine 6eg Pos 6eg Pos 6eg Pos

2ulture positive . (. 1. (?? .7 (71 @ ('' %% ('@ '7 (7%

2ulture negative %. (,/ %7 (// 1 (,. .& (/? .. (%@ %@ (1%

:on-typhoid patients .% (.&& & (& % (.&& & (& .& (.&& & (&

(/6%;D% 55>)


20/42


CONSTRAINTS OF PCRCONSTRAINTS OF PCRTECHNIQUETECHNIQUE

11 uite e*%ensi+euite e*%ensi+e

2 ,eed s%ecial e-ui%ment2 ,eed s%ecial e-ui%ment

3 ,eed hi#h s$ill and laboratory3 ,eed hi#h s$ill and laboratory

. &o%histicated. &o%histicated


21/42


SalmonellaSalmonella

bateria onbateria on

!aCon"ey!aCon"ey

a#ara#ar

$ato%e&$ato%e&

po%itivepo%itive

bateria %ho'bateria %ho'

pin" olonie%pin" olonie%()pper left*()pper left*

$ato%e&$ato%e&

ne#ativene#ative

bateria havebateria haveolorle%%olorle%%

olonie% (lo'erolonie% (lo'er

ri#ht*ri#ht*


22/42


+iohemial reation% for identi,ation+iohemial reation% for identi,ation

of of S. typhiS. typhi by theby the API -.E proed)reAPI -.E proed)re


23/42


+la"+la"olonie% of olonie% of Salmonell Salmonell

a typhia typhi

afterafter#ro'th on#ro'th on

bi%m)thbi%m)th

%)l,te%)l,te

a#ara#ar


24/42


'ipstic for $yphoid e!er'ipstic for $yphoid e!er

*roced+re*roced+re& dd .l ser+m to /0.l detection reagentdd .l ser+m to /0.l detection reagent& nc+bate dipstic for 1 ho+rsnc+bate dipstic for 1 ho+rs

& #inse with tap water#inse with tap water& #ead by !is+al inspection#ead by !is+al inspection

#es+lt#es+lt

(2ochammad 3atta, et al merican 4(2ochammad 3atta, et al merican 4 $ropical $ropical

2edicine 5 3ygiene, /00/)2edicine 5 3ygiene, /00/)


25/42



26/42


'ipstic for $yphoid e!er'ipstic for $yphoid e!er

*roced+re*roced+re& dd .l ser+m to /0.l detection reagentdd .l ser+m to /0.l detection reagent& nc+bate dipstic for 1 ho+rsnc+bate dipstic for 1 ho+rs& #inse with tap water#inse with tap water

& #ead by !is+al inspection#ead by !is+al inspection

#es+lt#es+lt 9atients 8ithclinical

suspicion of

typhoid feverfrom Makassar

Indonesia

2ontrol

"est

$ h id 'i ti $yphoid e!er 'ipstic


27/42


$yphoid e!er 'ipstic $yphoid e!er 'ipstic6$', 3o 6hi 2inh 6ity, iet am6$', 3o 6hi 2inh 6ity, iet am

6omparison of tests6omparison of tests

$est Sensiti!ity (9) Specicity (9)

g2 E%S ≥:";00g< E%S ≥:":=00g E%S ≥:"/00

7=8/

>;>/>

?idal @ ≥:";00?idal 3 ≥:"/00 ;7=0 >1>8

'ipstic 77 >


28/42


$yphoid e!er 'ipstic $yphoid e!er 'ipsticSemarang, ndonesiaSemarang, ndonesia

Patient #ro)p/ )lt)re re%)lt

N)mber po%itive (0 * 1 total

2r3 4ariadi Ho%pital(bone marrow c+lt+re) S. typhi po%itive S. typhi ne#ative

5 di%trit ho%pital%

(blood c+lt+re)

S. typhi po%itive S. typhi ne#ative

56 (7.38* 1 98. (.* 1 -

5- (6:39* 1 57- (737* 1 -:


29/42


$yphoid e!er 'ipstic $yphoid e!er 'ipstic

2aassar, ndonesia2aassar, ndonesia

Patient #ro)p No3 po%itive (0 * 1total

S)%pet%

Clinial dia#no%i%; typhoid S. typhi )lt)re po%itive S. paratyphi )lt)re po%itive C)lt)re ne#ative

Clinial dia#no%i%; other C)lt)re ne#ative

Ho%pital ontrol%Shool hildren

69 (8739* 1


30/42


$yphoid e!er 'ipstic $yphoid e!er 'ipstic

2aassar, ndonesia2aassar, ndonesiaollow-+pollow-+p

Sample 2PO No3 po%itive (0 * 1Total

S. typhi )lt)re po%itive irst Second $hird

S.typhi )lt)re ne#ative irst Second $hird

6


31/42


$yphoid fe!er $yphoid fe!er

6+lt+re and 'ipstic6+lt+re and 'ipstic

A%%ay

C)lt)re

2ip%ti"

Sen%itivity

:93=0

87390

Spei,ity

780

:90

'ipstic" nger pric blood, same day res+lt


32/42


#apid test for typhoid fe!er#apid test for typhoid fe!er

A 809 sensiti!ity compared with blood809 sensiti!ity compared with bloodc+lt+rec+lt+re

A ** (>/9) and * (=;9) somewhat** (>/9) and * (=;9) somewhatlower than that of c+lt+relower than that of c+lt+re

A Same day res+ltSame day res+lt

A Easy to performEasy to performA 3igh stability of components3igh stability of components


33/42


2IPSTIC4 FOR 2ETECT I?!2IPSTIC4 FOR 2ETECT I?!

ANTI+O2IESANTI+O2IES

1 &im%le and ra%id1 &im%le and ra%id

2 Re-uired no e-ui%ment2 Re-uired no e-ui%ment

3 Hi#hly stable rea#ents3 Hi#hly stable rea#ents

. /o cost. /o cost

asy to a%%lied in field asy to a%%lied in field

!ohammad Hatta, 2arga '


34/42

$B*3@' %ateral low $B*3@' %ateral low*rinciple*rinciple

Immuno"hromatographi" strip assay

2est Control

&am%le %ad Con4u#ate 5etection stri% &in$blood cell %ad

se%aration filter



35/42

$B*3@' %ateral low $B*3@' %ateral low2ethod2ethod

• 6dd 6dd µµl seruml serum

• 6dd 130 6dd 130µµl sam%le fluidl sam%le fluid

• 7ait 10 minutes7ait 10 minutes

• Read resultRead result

4ample 8ell

2ontrol line

"est line


!ohammad Hatta, $heresia 3 bdoel, 3en% Smits Simple, rapid and aCordable point-of-care test for the serodiagnosis of typhoid fe!er

J. Diagnostic Microbiology and InfectiousDisease ol =: (/) " :/>-:1;, eb (-..6*3


36/42


Typhoid %eer Late' Agg&utinationTyphoid %eer Late' Agg&utination

seconds . seconds

, seconds A 7& seconds

$heresia 3 bdoel, #ob *astoor, 3en % Smits,!ohammad Hatta/ %aboratory e!al+ation of a simple andrapid lateD aggl+tination assay for the serodiagnosis oftyphoid fe!er. Transactions of the Royal Society ofTropical Medicine and Hygiene. !ol :0: (:0), :01/-:018(-..7*3


37/42

TREAT2ENT

2edi"a& "are in"&ude rehydration! antipyreti"s #antibioti"s$

9rugs of "hoi"e are Ceftria'one # "iprof&o'a"in

but Cotrimo'a?o&e # Ch&orampheni"o& are sti&&used in dee&oping "ountries$ Ampi"i&&in )i&&s

ba"i&&i hiding in the bi&e # hen"e preents or

redu"e the "arrier state$

Chroni" resistant "arrier state may ne"essitate

"ho&e"yste"tomy$ Surgi"a& "are may a&so be

needed in patients with intestina& "omp&i"ations$Mochammad Hatta@2013Mochammad Hatta@2013


38/42

NURSIN= CARE

Iso&ation # barrier nursing is indi"ated

Tra"e sour"e of infe"tion$

"ontinue breastfeeding infants # young "hi&dren

and gie 4RS # &ight diet for other patients in the

first 3@ hours$

Notifi"ation of the "ase to the infe"tion "ontro&

nurse in the hospita&$



39/42

PRE8ENTI4N

Edu"ation on hygiene pra"ti"es &i)e hand

washing after toi&et use # aoidan"e of eating in

non hygieni" restaurants$

Antibioti" prophy&a'is is not needed for

house-ho&d "onta"ts$

Proper hand&ing # refrigeration of food een

after "oo)ing$

Sa&mone&&a TA: a""ine is aai&ab&e butaffe"tiity is &ow *./0 "&aimed prote"tion+$



40/42

PR4=N4SIS

ith ear&y diagnosis and prompt treatmentmost patients with typhoid feer wi&& re"oer in

due time$

%eer # to'i"ity subsides within B hours ofantibioti" treatment$

2orta&ity is ./0 in untreated seere typhoid

feer parti"u&ar&y in "hi&dren # e&der&y$

Re"rudes"en"e is rare but "hroni" "arrier

state is reported in (/0 of patients$Mochammad Hatta@2013Mochammad Hatta@2013


41/42

Infe"tion fo&&ows ingestion of "ontaminated

food or water$ 2eat! pou&try! eggs # diary

produ"ts are freDuent sour"es$

TRANS2ISSI4N

Pets! domesti" anima&s and infe"ted human

are potentia& reseroirs$ Person to person #

anima& to human transmission is re"ogni?ed$

In hea&thy humans a dose of about one mi&&ion

ba"teria is ne"essary to produ"e symptoms$



42/42

#eferences#eferences

A !ohammad!ohammad HattaHatta, 2iram Faer, Stella !an Feer, $heresia 3 bdoel, 3en % Smits #is, 2iram Faer, Stella !an Feer, $heresia 3 bdoel, 3en % Smits #isfactors for clnical typhoid fe!er in !illages in #+ral So+th S+lawesi, ndonesiafactors for clnical typhoid fe!er in !illages in #+ral So+th S+lawesi, ndonesia InternationalInternational Journal of Tropical Medicine Journal of Tropical Medicine ol ; (1)" >:->>, ol ; (1)" >:->>, (-..=*(-..=*

A !ohammad!ohammad HattaHatta andand #atnawati Enteric fe!er in endemic areas of ndonesia" an#atnawati Enteric fe!er in endemic areas of ndonesia" anincreasing problem of resistanceincreasing problem of resistance. J. Infection Developing ountries. J. Infection Developing ountries (( JID JID*3*3 ol /(;)G />8-ol /(;)G />8-

10:10: (-..6*(-..6*

A #ob *astoor,#ob *astoor, !ohammad!ohammad HattaHatta, $heresia 3 bdoel, 3en % Smits, $heresia 3 bdoel, 3en % Smits Simple, rapid andSimple, rapid andaCordable point-of-care test for the serodiagnosis of typhoid fe!eraCordable point-of-care test for the serodiagnosis of typhoid fe!er J. Diagnostic J. Diagnostic

Microbiology and Infectious DiseaseMicrobiology and Infectious Disease ol =:"(/)G:/>-:1;, eb ol =:"(/)G:/>-:1;, eb (-..6*3(-..6*3A !ohammad!ohammad HattaHatta and 3en % Smits 'etection ofand 3en % Smits 'etection of Salmonella typhiSalmonella typhi by nested *olymeraseby nested *olymerase

6hain #eaction in blood, +rine and stool samples6hain #eaction in blood, +rine and stool samples American J. Tropical Medicine American J. Tropical Medicine

Hygiene.Hygiene.!ol " 7=G:1>-:;1!ol " 7=G:1>-:;1 (-..7*(-..7*

A $heresia 3 bdoel, #ob *astoor, 3en % Smits, $heresia 3 bdoel, #ob *astoor, 3en % Smits, !ohammad!ohammad HattaHatta// %aboratory e!al+ation%aboratory e!al+ationof a simple and rapid lateD aggl+tination assay for the serodiagnosis of typhoid fe!erof a simple and rapid lateD aggl+tination assay for the serodiagnosis of typhoid fe!er ..

Transactions of the Royal Society of Tropical Medicine and HygieneTransactions of the Royal Society of Tropical Medicine and Hygiene !ol :0: (:0)G !ol :0: (:0)G

:01/-:018:01/-:018 (-..7(-..7**

A !ohammad!ohammad HattaHatta, 2arga '

4. Tropis 4 2012 (Salmonella)

Documents

Transcript of 4. Tropis 4 2012 (Salmonella)