DEMAM TIFOID
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Transcript of DEMAM TIFOID
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DEMAM TIFOID
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Pokok Bahasan
Etiologi, epidemiologi, patogenesis, diagnosis.
Diagnosis banding : gejala klinis demam dan
pemeriksaan penunjang (decision making).
Serologi dan bakteriologik : identifikasi dan
interpretasi.
Komplikasi: diagnosis klinis dan pemeriksaan
penunjang serta melakukan rujukan
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Prosedur perawatan (tirah baring, tata laksana
nutrisi).
Terapi medikamentosa (antibiotik lini pertama
dan alternatifnya).
Communication skill.
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Mengatasi penularan : memahami hubungan
antara higiene perorangan, lingkungan dan
terjadinya penyakit.
Memutus rantai penularan : memahami
perjalanan alamiah penyakit demam tifoid.
Vaksinasi demam tifoid: untuk anak dan
dewasa.
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Definisi
Demam tifoid merupakan suatu penyakit sistemik
yang disebabkan oleh bakteri, dengan gejala
(trias tifoid) :
Demam > 5 atau 7 hari
Gangguan pada saluran cerna
Dapat disertai atau tanpa adanya gangguan
kesadaran
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Etiologi
Salmonella typhi (S.typhi)
Sebab lain :
Paratyphi A
S. para-typhii B (Schottmuelleri)
S. paratyphi C (Hirscheldii)
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Salmonella Typhi (group D Salmonella)Basil Gram negatifBerflagel Kapsul (-)Spora (-)Antigen :• Somatik (O)oligosakarida• Flagelar (H)protein• Envelope (K)Polisakarida
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•Antigen O : Ig M •Antigen H : Ig G•Antigen Vi : daya invasif
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EpidemiologiWHO (2003) di dunia : - Angka kejadian : 17 juta - Angka kematian : 600.000 kasus
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Di Indonesia
- Pedesaan 358/100.000 penduduk/tahun
- Perkotaan 760/100.000 penduduk/tahun Indonesia (endemis) : umur 3-19 th (91%) Dinas Kesehatan Kota Semarang
- Th. 2007 : 589 kasus
- Th. 2008 : 7.507 kasus
- Th. 2009 : 7.965 kasus
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PENULARAN
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sanitasi, higiene lingkungan dan pribadi yang buruk
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INKUBASI 3-30 hari (± 7-14 hari)
-Jumlah (load)-Virulensi-Imunitas Pejamu
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Patogenesis Demam Tifoid
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Patofisiologi
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Manifestasi Klinik
Masa inkubasi : 7–14 hari (3–30 hari)
Gejala klinis bervariasi : ringan – berat
Tergantung usia : >> tua >> berat
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Demam
Demam (stap ladder temperature chart)
Demam timbul naik bertahap bertahan tinggi
turun perlahan (minggu ke-4)
Demam lebih tinggi pada sore & malam hari
Gejala sistemik lainnya : nyeri kepala, mual,
muntah, anoreksia, mialgia, nyeri perut, nyeri
tenggorok
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Kasus berat : penderita tampak toksik
Kurang cairan syok hipovolemik
Gangguan saluran cerna
Dapat timbul mual & muntah
Gejala gastro intestinal : diare, obstipasi, atau
obstipasi disusul diare, lidah kotor,
meteorismus , dpt disertai hepatspleenomegali
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Rose spot (ruam makopapuler) pada abdomen,
toraks, ekstremitas & punggung (orang kulit
putih)
Gangguan kesadaran
Saat demam tinggi, dapat disertai gejala sistem
saraf pusat, berupa penuruna kesadaran mulai
apatis sampai koma
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Diagnosa Banding Sepsis
Tuberkulosis
Meningitis
Malaria
Hepatitis anikterik
Mononukleosis infeksiosa
Keganasan (limfoma, leukemia)
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Diagnosis Gejala klinis :
- Demam
- Gangguan gastro intestinal
- Gangguan kesadaran
Dx pasti : isolasi S. Typhi dr darah
( 1 mgg pertama sakit)
Biakan aspirasi sumsum tulang sangat sensitif
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Laboratorium
Pemeriksaan darah tepi
Anemia normokromik normositik
Leukopenia
Trombositopenia
Pada hitung jenis : limfositosis relatif,
aneosinofilia
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Serologi
Serologi widal:
kenaikan titer Salmonella thypii titer O 1:200
atau kenaikan 4 kali titer fase akut ke fase
konvalesens.
Pemeriksaan IgM Salmonella (Tubex Test)
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Kultur darah
Biakan darah terutama pada minggu 1-2 dari
perjalanan penyakit
Biakan sumsum tulang, masih positif sampai
minggu ke-4
Dx Salmonella thypii pd biakan empedu
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Radiologi
Foto torak komplikasi pneumonia
Foto abdomen komplikasi intraintestinal
perforasi usus (distribusi udara tidak merata,
air fluid level, bayangan radiolusen didaerah
hepar, udara bebas di abdomen) atau
perdarahan saluran cerna.
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Komplikasi
1. Gastro intestinal
Perdarahan usus (1-10%)
Perforasi usus (0.5-3%) biasanya terjadi
minggu ke-3 sakit
Peritonitis
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2. Ekstra gastro intestinal
Gangguan neuropsikiatri
disorientasi, delirium, stupor.
Gangguan neurologi
afasia, ataksia serebral akut, thrombosis
serebral, tuli, mielitis transversal, neuritis perifer,
meningitis, ensefalopati, ensefalomielitis,
guillain-barre syndrome.
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Gangguan kardiovaskuler
miokarditis (aritmia, perubahan ST-T pada EKG,
syok kardiogenik, nekrosis jantung)
Paru
pneumonia, efusi pleura
Hepar
hepatitis tifosa asimtomatik (serum transaminase
meningkat tidak tinggi), ikterik, kolesistitis akut.
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Saluran kencing
sistitis, pielonefritis, glomerulonefritis, gagal
ginjal maupun sindroma nefrotik.
System hematopoetik
DIC, HUS (Hemolytic Uremic Syndrome)
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Pengobatan suportif Cairan
– rumatan, larutan D5 : NaCl 0.9% (3:1)– tambah 12.5% setiap kenaikan suhu 1º
Diet– makan lunak– kurangi serat, zat yang merangsang– tidak terlalu ketat
Koreksi asam basa Koreksi elektrolit
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Pengobatan kausal (1) Kloramfenikol
Dosis : 100 mg/kg BB/ hari iv/peroral tiap 6 jam (Maks. 1500 mg) Hati-hati terhadap anemia dan lekopeni. Lama pengobatan : 10 hari
Seftriakson (sefalosporin generasi III)– 80 mg/kgBB/hari – intravena, intramuskular, per-infus– lama pengobatan 5 hari
Ampisilin / Amoksisilin Dosis : 100 mg/ kg BB/ hari
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Pengobatan Kausal (2)
Sefiksim (sefalosporin generasi III)– 10-15 mg/kgBB/hari dlm 2 dosis– per-oral, – lama pengobatan 10 hari (lanjutkan Seftriaxon)
Kuinolon – tidak direkomendasikan <14 tahun (binatang
percobaan: artropati tulang rawan), FDA 1997
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Evaluasi Pengobatan
37,5
Suhu 0CAntibiotik1st line
Demam menetap
0 1 2 3 4 5 6 7 8
Hari rawat
Evaluasi klinisKesadaran
Deteksi komplikasiAmati gejala lain
KomplikasiFokal infeksi lainAb resistenDosis suboptimalSalah diagnosisDrug fever
LeukositTransaminaseFoto toraksLP, CT-scan,
dll
Pengobatan disesuaikan?
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Prognosis
Prognosis pada umumnya baik pada demam
tifoid tanpa komplikasi
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Pencegahan
Higiene sanitasi
Kebersihan perseorangan
Sanitasi Lingkungan
Pengobatan karier dan vaksinasi
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Vaksinasi Tipoid Tiga macam vaksin :
Kuman yang dimatikanKuman hidupKomponen Vi
TAB Vaccine :Berisi Salmonella typhi, S. Paratyphi A,
S. Paratyphi B yg dimatikanDiberikan secara subkutanDaya kekebalan terbatasEfek samping lokal sering terjadi
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Ty-21a (Vivovit)
Berisi Salmonella typhi hidup yang dilemahkan
Diberikan secara Oral, 3 kali dg interval 1 hari
Daya perlindungan 6 tahun
Diberikan anak > 2 tahun Capsular Vi polysaccharide (Typhim Vi)
Diberikan secara IM, diberikan anak > 2 tahun
Daya perlindungan 60-70% selama 3 tahun
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Terima kasih
please wash your hands…..