Articles English Typhoid

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ARTICLES

ENGLISH
typhoid

by:
SilviaDewi
2B NURSING
13.1.111

POLYTECHNIC OF HEALTH HOSPITAL TK II


Dr SOEPRAOEN KESDAM V / BRAWIJAYA
Prodi NURSING
YEAR 2014/2015

DISEASE typhoid
1. Definition of typhoid
Typhoid is an infectious disease caused by acute systemic salmonella infection
thypi. These organisms enter through food and beverages that have been contaminated by
faeces and urine of infected people with salmonella bacteria. (Bruner and Sudart, 1994).
Typhoid is an acute infectious disease of the small intestine caused by the bacteria
salmonella thypi (Arief Maeyer, 1999).
Typhoid is an acute infectious disease of the small intestine caused by salmonella
bacteria and salmonella thypi the thypi A, B, C. synonym of this disease is typhoid and
paratyphoid abdominalis, (Syaifullah Noer, 1996).
Typhoid is an infection of the small intestine disease, typhoid paratyphoid fever
also called, enteric fever, typhoid and typhus abdominalis (.Seoparman, 1996).
Typhoid is a disease of the intestine that cause systemic symptoms caused by
salmonella typhosa, salmonella type ABC transmission occurs pecal, orally through
contaminated food and beverages (Mansoer Orief.M. 1999).
From some sense can be summed up as follows diatasis, Typhoid is an infectious
disease of the small intestine caused by salmonella type A, B and C can be transmitted
through oral, fecal, food and drink contaminated.

2. Clinical Manifestations
Incubation period of 7-14 (average 3-30) days, during incubation found prodromal
(early growth of disease symptoms or symptoms that are not typical):
a. Feeling unwell
b. listless
c. headache
d. dizziness
e. diarrhea
f. anorexia
g. cough
h. Muscle pain (Mansjoer, Arif 1999)
Following the clinical symptoms are:
1. Fever
The fever lasts 3 weeks
Week I: remittent fever, usually decreases in the morning and rising in the
afternoon and evening headache, dizziness, muscle pain, anorexia, nausea,
vomiting, obstipation or diarrhea, uneasy feeling in the belly, coughing and
epistaxis, on physical examination not only obtained an increase in body
temperature
Sunday II: Fever continues, fever, typhoid tongue relative Bradikardikardi (dirty
in the middle, and the red edge tremor), Hepatomegaly, Plenomegali,
meteorismus, Disorders of consciousness as samnolen
Sunday III: Fever began to fall gradually - gradually.
2. In Gastrointestinal Disorders
a. The tongue is covered membrane dirty dirty brownish, reddish tips and edges,
often accompanied by tremors.
b. Enlarged liver and spleen were pain at palpation
c. There is constipation diarrhea
3. Disorders Awareness
a. Awareness is apathy - somnole.
b. Other symptoms "roseola" (reddish spots due to emboli result in skin
capillaries) (Rahmat Sudarsono, 1996).

3. Etiology
Typhus is caused by infection with the bacteria Salmonella typhosa, gram-negative
bacilli, flagella (move with vibrating bristles), anaerobic, and does not produce spores.
The bacteria enter the human body through the human digestive tract and is a major

source of infection are issued when the disease-causing microorganisms are ill or in
recovery. These germs can live very well on the human body and at slightly lower
temperatures, but died at 70 C and by antiseptic.
Typhoid fever is an infectious disease caused by Salmonella typhi or Salmonella
paratyphi (Soedarto, 1996). There are hundreds of types of salmonella, but only 4 types
that can cause typhoid, namely:
a. Salmonella thyposa, gram-negative bacilli that moves with the vibrating bristles,
berspora not have at least three kinds of antigens, namely:
antigen O (somatic, consisting darizat komplekliopolisakarida): is a
polysaccharide that are specific to Salmonella group and are on the surface of
the organism and also the somatic antigens that do not spread.
antigen H: present in flagella and and are thermolabile
antigen V1 (a capsule that covers the body of germs and protects against
b.
c.
d.
e.

phagocytosis O antigen) and hyaline membrane proteins.


Salmonella parathypi A
Salmonella parathypi B
Salmonella parathypi C
Faces and urine of patients thypus (Rahmat Sudarsono, 1996).
Carrier is a person who recover from typhoid fever and still mengekresi salmonella

typhi in feces and urine for more than 1 year.

4. Pathophysiology
Transmission thypi salmonella can be transmitted through a variety of ways, which
is known as 5 F namely Food (food), Fingers (fingers / nails), Fomitus (vomiting), Fly
(flies), and through the feces.
Stool and vomiting in patients with typhoid salmonella bacteria thypi can transmit it
to others. Germs can be spread through the intermediary of flies, which will perch flies in
food that will be consumed by healthy people. If the person is less attention to personal
hygiene such as washing hands and food contaminated with salmonella bacteria thypi
enter the body through the mouth of a healthy person. Then the germs into the stomach,

most bacteria will be destroyed by stomach acid and some into the distal part of the small
intestine and reaches limpoid network. In this limpoid network breed bacteria, and then
enter the bloodstream and reach the reticuloendothelial cells.
At the end of the incubation period (5-9 days) germs back into the blood (secondary
bakteremi) and spread throughout the body, especially the small intestine into the
lymphoid glands, causing ulcers oval above Peyer plaques. The ulcers can lead to
bleeding and bowel perforation. At the time of this bakteremi, bacteria secrete endotoxin
which have a role in helping the local inflammatory process in which the bacteria thrive.
Originally thought to fever and symptoms of toxemia in typhoid caused by endotoxemia.
But based on experimental studies concluded that endotoxemia is not a major cause of
typhoid fever on. Endotoxemia play a role in the pathogenesis of typhoid, because it helps
the local inflammation in the small intestine. Fever is caused due to salmonella thypi and
endotoxin stimulates synthesis and release of pyrogens substances by leukocytes in
inflamed tissue.

5. Complications
a. intestinal complications
1) intestinal bleeding
2) Perporasi intestine
3) Ilius paralytic
b. Extra-intestinal complications
1) cardiovascular complications: circulatory failure (shock sepsis), myocarditis,
thrombosis, tromboplebitis.
2) Complications of blood: hemolytic anemia, trobositopenia, and syndroma
hemolytic uremia.
3) pulmonary complications: pneumonia, empyema, and pleurisy.

4)
5)
6)
7)

complications of the liver and gall bladder: hepatitis, cholecystitis.


Renal Complications: glomerular nephritis, pyelonepritis and perinepritis.
Complications of bone: osteomyolitis, osteoporosis, and rheumatoid spondylitis.
neuropsychiatric complications: delirium, meningiusmus, meningitis, peripheral
polineuritis, Guillain syndrome sidroma bare and catatonia.

6. Investigations
Investigations on the client with typhoid is a laboratory examination, which consists
a. examination of leukocytes
In some literature revealed that there typhoid fever and leukopenia relative
limposistosis but the fact leukopenia is not often encountered. In most cases of
typhoid fever, the number of leukocytes in peripheral blood preparations were in
normal limits even sometimes there leukocytes although no complications or
secondary infection. Therefore examination of the number of leukocytes is not
useful for the diagnosis of typhoid fever.
b. Examination of SGOT and SGPT
SGOT and SGPT in typhoid fever is often increased but can return to normal
after recovery typhoid.
c. blood cultures

If positive blood cultures it indicates typhoid fever, but when negative blood
cultures will possibly happen typhoid fever. This is because the results of blood
cultures depends on several factors:
1) engineering laboratory examination
The results of the examination of the different laboratories with other
laboratories, this is caused by differences in techniques and culture media were
used. Good blood sampling time is the time when the high fever that lasts
bacteremia.
2) When the examination during the course of disease.
Blood cultures positive for salmonella thypi especially in the first week
and decreased in the following weeks.At the time of relapse positive blood
cultures can come back.
3) Vaccination in the past
Vaccination against typhoid fever in the past can lead to antibodies in the
blood of the client, it can suppress the antibody so that blood cultures negative
bacteremia.
4) treatment with anti-microbial drugs
If the client before blood culture already get anti microbial growth of
bacteria in the culture medium inhibited and culture results may be negative.
d. Widal test
Widal test is an agglutination reaction between antigens and antibodies
(agglutinins). Specific agglutinins against salmonella thypi present in the serum client
with typhoid are also present in people who never vaccinated. The antigen used in the
Widal test is a suspension of salmonella that has been turned off and processed in the
laboratory. The purpose of this Widal test is to determine the presence of serum
agglutinins clients suspected of suffering from typhoid. Due to infection by
salmonella thypi, clients make antibodies or agglutinins are:
1) agglutinin O, which made for O antigen stimulation (derived from the body of
germs).
2) agglutinin H, which was made due to the stimulation of antigen H (derived from
bacteria flagellum).
3) Vi agglutinins, which made for Vi antigen stimulation (derived from the hoop
germs)
From the third agglutinin O and H agglutinins only specified titre for the
diagnosis, the greater the higher titre client suffered typhoid.
Factors - factors that affect the Widal test:
a. Factors associated with the client:
1) General condition: poor nutrition can inhibit the formation of antibodies.

2) When the examination during the course of the disease: new agglutinins
found in the blood after 1 week ill clients and peaked at week 5 or 6th.
3) Disease - specific disease: there are some diseases that can accompany
typhoid fever that would not result in antibodies as agamaglobulinemia,
leukemia and advanced carcinoma.
4) Early treatment with antibiotics: Early treatment with anti-microbial
drugs can inhibit the formation of antibodies.
5) Immunosuppressive drugs or corticosteroids: these drugs can inhibit the
formation of antibodies due to suppression of the reticuloendothelial
system.

6) Vaccination with kotipa or TIPA: someone who is vaccinated with kotipa


or TIPA, O and H agglutinin titer can be increased. Agglutinin O usually
disappear after 6 months to 1 year, while the H agglutinin titer decreased
slowly for 1 or 2 years. Therefore H agglutinin titers in people who have
never been vaccinated less diagnostic value.
7) Infection clients with clinical / subclinical by salmonella before: this
situation can support the Widal test results were positive, although with a
low titer results.
8) Reaction anamnesis: the circumstances in which an increase in titer of
agglutinins against salmonella thypi because infection with typhoid fever
is not someone who ever contracted salmonella in the past.

7. How to Treat Diseases typhoid


The disease is not too severe, but it can greatly disrupt our activities. That is
needed is a complete bed rest for a few weeks or even months. For people who are very
active, it was miserable. You can not feel anything (at least this is what I feel when
suffering from this disease).
Noteworthy post exposed to typhoid is eating right. For example should be soft, so
soft to apply ate specified limits doctor, then the food is greasy, spicy, sour, spicy avoid.
Reduce activities that are too strenuous. Then to maintain stamina could be given
Capsules Tread (in accordance with the doctor) Liman 3 x 2 Kaps / hr, Kaps leaves spoon
3 x 2 Kaps.hr, and Patikan Kebo 3x1 Kaps / hr. (to help accelerate wound healing in
intestines due typus).
Treatment of these patients includes bed rest, low-fiber diet - high in calories and
proteins, drugs such as antibiotics (described in the next paragraph), as well as the
treatment of the complications that may arise.
Cure for the disease is antibiotic classes Types Chloramphenikol, Thiamphenikol,
Ciprofloxacin etc. given for 7-10 days. The duration of antibiotic treatment should be
enough to give the doctor who prescribed. Do not be discontinued if a fever or other
symptoms have subsided for 3-4 days taking medication. Drug should be taken until the
end (7-10 days). If not, then the typhoid bacteria that exist in the patient's body has not
been dead all and will eventually relapse

8. Prevention of typhoid disease


Primary prevention in the spread of this disease is to improve food hygiene and
environmental sanitation as familiarize wash your hands thoroughly after defecating and
before eating.

Vaccination with TAB vaccine (containing the typhoid bacillus and parathypoid
Adan B are turned off) are given subcutaneous administration of 2 or 3 times at intervals
of 10 days is practical measures to prevent the transmission of typhoid fever. The number
of cases of the disease in Indonesia is quite high, around 358-810 cases per 100,000
population per year. Typhoid immunization injections may be performed every two years
when the oral vaccine is taken every five years. However, vaccination does not provide
protection guarantee 100 per cent.
Drinking water that has been cooked. Cook water for at least five full minutes
(when water is ripe, let him for five minutes longer). Create a stone water using the water
cooked. Had're traveling, use bottled water or carbonated fizz drinks without ice. You let
more careful with water ice or rock mixed nuts that use water destroyed, particularly in
the present circumstances. Eat freshly cooked food. If forced to eat in the shop, make sure
the food is ordered typical and are in a state of `smoky 'as the newly appointed from the
kitchen. Hood all the food and drinks that are not exposed to flies. Put food in high
places.
Use tweezers, spoon, or fork cleaner to pick up the food. Fruits let peeled and rinsed
before eating. Wash hands with soap and clean water before menyedia or eating food,
throwing leavings, holding a raw material or after a bowel movement. You will find the
incidence of typhoid berkurangan with this practice are fitting into the daily obligations day and not just the epidemic season. Choose a place that is clean and the food handler. In
the present circumstances, it is better if it were the crowded evasive than buying food or
drinks especially street vendors that sell cold drinks. Clean the breeding of flies - flies.
Use the perfect place. Immediately see a doctor if you experience signs of typhoid
plagued.

Disease Research Center of the United States provides two methods to protect
yourself from typhoid fever:
a. Boiled, cooked, peeled
Avoid foods and drinks that are at risk (street snacks). It may surprise you but
look at what you eat and drink, especially when the trip is important for health .With
avoid risk foods are also able to protect yourself from diseases such as cholera /
epidemic, dysentery and hepatitis A.
b. Get S.thypi vaccine

If you live or the way to the usual state attacked fever outbreak, you need to
consider vaccination fever. See your doctor if you want to know more about your
vaccine choices.
In men more exposed to S. typhi bacteria than women because of activities
outside the home more. All age groups can be infected with typhoid disease, but that
many are adult age group. The incidence of typhoid fever is not influenced by the
season, but in the area - an area endemic typhoid fever occur, the incidence
increased in the month - a particular month. In Indonesia, the incidence of typhoid
fever increased in the long dry season or the beginning of the rainy season.

20 QUESTION AND 20 ANSWER


1. What is the cause of typhoid?
Typhoid fever is caused by Salmonella and Salmonella parathypi thypi. Salmonella is
a rod-shaped gram-negative bacterium that belongs to the family Enterobacteriaceae.
Salmonella has the characteristics of fermenting glucose and mannose without
producing gas, but does not ferment lactose or sucrose.
2. How many antigens in Salmonella?
Salmonella has three kinds of antigens are antigens O (heat-resistant, consisting of
lipopolysaccharide), Vi antigen (can not stand the heat, polysaccharides), and antigen
H (can be denatured by heat and alcohol).

3. Used to any antigen in Salmonella?


These antigens can be used for diagnosis enforcement inspection.
4. How can the spread of germs in typhoid?
Typhoid transmission can occur through a variety of ways, which is known as 5 F
namely Food (eat,), Fingers (fingers or fingernails), Fomitus (vomiting), Fly (flies),
and Feces.
5. How long is the incubation period of typhoid fever?
The average incubation period of 7-14 days. Clinical manifestations in children are
generally lighter and more varied.
6. Where areas of high incidence of typhoid fever?
tropic regions
7. The source of transmission of the disease typhoid?
Patients with active, patients in the convalescent period and chronic career
8. How many presentations at the age of typhoid patients?
a. 12-29 years 70-80%
b. 30-39 years 10-20%
c. > 40 years of 5-10%
9. What are the complications of typhoid disease?
a. intestinal bleeding
b. Perporasi intestine
c. Ilius paralytic
10. What is the Prevention of typhoid?
Primary prevention in the spread of this disease is to improve food hygiene and
environmental sanitation as familiarize wash your hands thoroughly after defecating
and before eating.
11. What are the signs symptoms of typhoid?
Presenting symptoms include fever, often filmed or merely sleeping, headache,
nausea, vomiting, decreased appetite, abdominal pain, diarrhea or even constipation
(difficult bowel movements) for a few days.
12. What are the treatment thypid?
The disease is not too severe, but it can greatly disrupt our activities. That is needed is
a complete bed rest for a few weeks or even months. For people who are very active,
it was miserable. Usually the doctor member medicine: klorampenikol, tiampenikol,
kontrimoxazol, amoxilin and ampicillin.
13. What maksd of Ilius paralytic in typhoid?
Paralytic ileus is a paralysis of the intestine, inhibits the movement of food through
the intestines.
14. What is the diet for patients affected by typhoid?
Appropriate diet sufficient in calories and high in protein. The first diet provided is
mush strain, then rough and eventually rice porridge in accordance with a cure rate of
patients
15. Why do patients need bed rest for 7 days without fever?

Since the aim to prevent the complications of intestinal bleeding


16. In case of indigestion what characteristics:
Breath smells, dry lips and chapped (ragaden), the tongue is covered with dirty white
membrane (coated tongue, tongue typhoid), tip and red edges, often accompanied by
tremors.
17. Could the typhoid patients can be cured?
Can not be completely cured if low antibiotic will recur again
18. What food should not be consumed by people with typhoid?
Fats, oils for frying, animal fats, coconut and coconut milk, drinks, coffee, and tea
thick, beverages containing soda and alkohol.Bumbu, chilli and pepper.
19. Who can typhoid disease?
Everyone can typhoid disease depends on the person can keep clean and maintain
healthy or not.
20. Why typhoid disease is most prevalent in young children?
Because small children do not understand how to keep clean and can not distinguish
the good and the food is not good for consumption,

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