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GROUP14
PROBLEM 3GIT 2011
Tuesday, 13 1
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GROUP 14
Tutor dr! "#a$"#aLeader Joyce Gunawan Putri 405090232Se%retary Deviana Putri 405090181S%r#ber Budianto 405090095&re' Ganjar Nugraha 40500023
!a"ri #i$%i 405080041 !a&&y Novi !yah #a&i' 405080115 Dede( Putrawan 4050801)8 !a'ot 4050900)8
*aryn +iranda 405090125 #ui ,ee !ha( 405090229 Nadia -&ena Pa'udji 40509023) *e&een .ei !etiawan 405090239
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PROBLEM 3
/ou receive a caa& $ro' the 'other o$ a reviou&yhea&thy 5yearo&d "oy ive day ago hedeve&oed a te'erature o$ 40 6 * a"do'ina&dico'$ort nauea and contiation $or 2 day7he 'other au'ed he had the a'e y'to'
&i(e hi aunt or 'any other chi&dren in hi daycare center
#owever today he deve&o diarrhea 3 ti'e and
ee' 'ore irrita"&e /ou are a(ing a"out hicurrent hydration tatu the 'other reort thathe vo'it evera& ti'e and a&'ot ta(e ni& "y'outh /ou te&& her to ca&& the a'"u&ance and
then noti$e the &oca& hoita& e'ergency centero$ hi i''inent arriva& 3
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MI() M*
+ E*R$OL) BO
+ )* *GOTEMPER*TURE o-
40 . &
*B)OMI(*L)IS&OM"ORT
(*USE*&O(STIP*TIO(
"OR 2 )*S
/ISTOR /*)S*ME
SMPTOMSLIE /IS*U(T OR
M*( OT/ER&/IL)RE( I(/IS )* &*RE
&E(TERTO)*
)I*RR/E* 3TIMES *()
MOREIRRIT*BLE
T*ES (IL B
MOUT/
))TPOI) "EER,
G*STROE(TERITIS,/EP*TITIS,
P*R*TPOI) "EER,)B)
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LE*R(I(G OBE&TIE
1 Decri"e the a&'one&&oi
2 Decri"e the tyoid and aratyoid
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)
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!cientic c&aication
Do'ain Bacteria
Phy&u' Proteo"acteria
*&aGa''aroteo"acteria
:rder -ntero"acteria&e
a'i&y -ntero"acteriaceae
Genu salmonellasalmonella
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Med#%ay #mportat Samoea Spe%#es
are
a; !a&'one&&a cauing enteric $everery 'a&&
Gra'negative .odhaed?"aci&&i 'oti&e "acteriu'
Nonor'$or'ing
Pro(aryotic ce&& @re&icate Auic(&y;
Noncau&ate ecet !a&'one&&atyhi
Peritrichou Cage&&a acu&tative anaero" =ntigen ?=HD! :ther i''une deciencie and chronic granu&o'atou
dieae
H''unoureive and corticoteroid theray +a&ignancie eecia&&y &eu(e'ia and &y'ho'a #e'o&ytic ane'ia inc&uding ic(&e ce&& dieae
'a&aria and "artone&&oi *o&&agen vacu&ar dieae
HnCa''atory "owe& dieae =ch&orhydria or antacid 'edication ue H'aired intetina& 'oti&ity !chitoo'iai 'a&aria +a&nutrition
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*&inica& +ani$etation
=cute -nteriti7he 'ot co''on c&inica& reentation o$
a&'one&&oi i with acute enteriti
=$ter an incu"ation eriod o$ )L2 hr @'ean 24
hr; there i an a"rut onet o$ naueavo'iting and cra'y a"do'ina& ain ri'ari&yin the eriu'"i&ica& area and right &owerAuadrant $o&&owed "y 'i&d to evere watery
diarrhea and o'eti'e "y diarrhea containing"&ood and 'ucu
= &arge roortion o$ chi&dren are $e"ri&ea&though younger in$ant 'ay ehi"it a nor'a&or u"nor'a& te'erature 22
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*&inica& +ani$etation
=cute -nteriti !y'to' uua&&y u"ide within 2L day in
hea&thy chi&dren and $ata&itie are rare
#owever o'e chi&dren deve&o everedieae with a etice'ia&i(e icture @high$ever headache drowine con$uion'eningi'u ei%ure a"do'ina& ditention;
7he too& tyica&&y contain a 'oderate nu'"ero$ o&y'orhonuc&ear &eu(ocyte and occu&t"&ood +i&d &eu(ocytoi 'ay "e detected
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T b # )# I d d b S
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Tabe!#%a )#seases Idu%ed by Samoeae!
-nteric ever !etice'ia -nteroco&iti
Hncu"ation
eriod
L20 day >aria"&e 8L48 hour
:net Hnidiou ="rut ="rut
ever Gradua& thenhigh &ateauwith tyhoida&
tate
.aid rie theni(ing eticte'erature
Fua&&y &ow
Duration o$dieae
!evera& wee( >aria"&e 2L5 day
Gatrointetina&y'to'
:$ten ear&ycontiationI
&ater "&oodydiarrhea
:$ten none Naueavo'iting
diarrhea atonet
B&ood cu&ture Poitive in rtto econd wee(o$ dieae
Poitive duringhigh $ever
Negative
!too& cu&ture Poitive $ro' Hn$reAuent&y Poitive oon24
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7 h id
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Humans are the only hosts Disease results from ingestion of contaminated food & water
Prolonged fever after incubation period of 3-2 days
!on specific symptoms" chills# headache# sweating# cough# malaise# arthralgias
$% symptoms" anoreia# nausea# vomiting# diarrhea# constipation# abdo'pain
Physical findings" rose spots# hepatosplenomegaly# epistais# relative bradycardia'
(omplications" intestinal perforation# $% hemorrhage due to ulceration & necrosis of infiltratedPeyer)s patches
(arier" -*+ patients associated w, disease in the bladder# biliary# or $%
7yhoid ever L:verview
#arri2)
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-PHD-+H:,:G/
7yhoid $ever occur wor&dwide ri'ari&y indeve&oing nation whoe anitary conditionare oor
7yhoid $ever i ende'ic in =ia =$rica ,atin
='erica the *ari""ean and :ceania "ut 80o$ cae co'e $ro' Bang&adeh *hina HndiaHndoneia ,ao Nea& Pa(itan or >ietna'
ithin thoe countrie tyhoid $ever i 'ot
co''on in underdeve&oed area 7yhoid $ever in$ect rough&y 21) 'i&&ion eo&e
@incidence o$ 3) er 1000 ou&ation; and (i&&an eti'ated 200000 eo&e every year
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Incubation Week 1 Week 2 Week 3 Week 4 Post
Systemic Recovery phase
or death (15% o
untreated cases!
1"%#2"%
re$apse 3%#
4% chronic
carriers
$onterm
neuro$o&ic
se'ue$ae
(etreme$y
rare!&a$$b$adder
cancer
(RR)1*+
carriers!
Step$adder
ever pattern or
insidious onset
ever
,ery commona ,ery common
-cute hi&h ever ,ery rareb
.hi$$s -$most a$$c
Ri&ors /ncommon-noreia -$most a$$
0iaphoresis ,ery common
euro$o&ic
a$aise -$most a$$ -$most a$$ yphoid state
(common!Insomnia ,ery common
.onusionde$irium
.ommond
,ery common
Psychosis ,ery rare .ommon
.atatonia ,ery rare
eadache
(usua$$y mi$d!
,ery common
enin&ea$ si&ns Raree
RareParkinsonism ,ery rare
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I%ubat#o
:ee; 1 :ee; 2 :ee; 3 :ee; 4 Post
Ear, ose, ad t
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Incubation Week 1 Week 2 Week 3 Week 4 Post
Sharp ri&ht
$o6er
'uadrant
pain
Rare
7astrointesti
na$
hemorrha&e
,ery rare
usua$$y trace
,ery common
intestina$peroration
Rare
epatosp$en
ome&a$y
.ommon
8aundice .ommon
7a$$b$adder
pain
,ery rare
/ro&enita$
/rinary
retention
.ommon
ematuria Rare
Rena$ pain Rare 31
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Incubation Week 1 Week 2 Week 3 Week 4 Post
uscu$oske$eta$
ya$&ias ,ery rare
-rthra$&ias ,ery rare
Rheumato$o&ic
-rthritis
($ar&e 9oint!
:treme$y rare
0ermato$o&ic
Rose spots Rare
isce$$aneous
-bscess
(any6here!
:treme$y
rare
:treme$y
rare
:treme$y
rare
aery %ommo Symptoms o%%ur # 'e o=er #matey 6+7$+78!bery rare Symptoms o%%ur # ess t
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M*(I"EST*SI LI(IM*(I"EST*SI LI(I
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Ink Week I Week 2 Week 3 Week 4
;$ood
cu$ture
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B&ood cu&ture in 7yhoid$ever
Hn =du&t 5 10 '& o$ B&ood i co&&ected"y veneuncture inocu&ated into 50 L
100 '& o$ Bi&e "roth @ 05 ; !evera& other 'edia are avai&a"&e ued
a er the avai&a"i&ity o$ 'ediu' to uittheir &a"oratory condition
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Bood &utures # Typ
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Idet#C%at#o o-Samoea
!u" cu&ture are done a$ter overnightincu"ation at 30cand u"cu&ture
are done on +ac *on(eyO agar !u"cu&ture are reeated uto 10
day a$ter $uther incu"ation
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!a&'one&&a on +ac *on(eyOagar
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!a&'one&&a on ,D agar
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Id #- # E #
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Idet#-y#9 Eter#%Or9a#sms
Ho&ate which are Non &actoe $er'enting
+oti&e Hndo&e oitive
Freae negative
er'ent G&ucoe+annito&+a&toe Donot $er'ent ,actoe !ucroe
7yhoid "aci&&i are anaerogenic
!o'e o$ the Paratyhoid $or' acid and ga
urther identication done "y &ide agg&utinationtet
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S#de a99ut#at#o
tests Hn &ide agg&utination
tet a (nown eru'and un(nown cu&ture
io&ate i 'iedc&u'ing occurwithin $ew 'inute
*o''ercia& era are
avai&a"&e $ordetection o$ =B*1*2D and -
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&ot %uture
*&ot cu&ture are 'ore roductive inyie&ding "etter reu&t in io&ation
= "&ood a$ter c&otting the c&ot i &yedwith !treto(inae "ut eenive toer$or' in deve&oing countrie
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Ba%te; ad Rad#ometr#% basedmet
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-'erging +ethod inDiagnoi o$ -nteric $ever
Detection o$ circu&atingantigen "y &o$a99ut#at#o 'ethodwith ue o$ *owan
train !tahy&ococcucoated with anti"odie
P*. T
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)#a9os#s o- &arr#ers
Fe$u& in u"&ic hea&th uroe
Fe$u& in creening $ood hand&ercoo( to detect carrier tate
7yhoid "aci&&i can "e io&ated $ro'$ece or $ro' "i&e airate
Detection o$ >i agg&utinin in theB&ood can "e deter'inant o$ carriertate
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:#da Test
Hn 189) ida& = ro$eor o$ atho&ogyand interna& 'edicine at the Fniverityo$ Pari @1911L29; he deve&oed arocedure $or diagnoing tyhoid $ever"aed on the $act that anti"odiein the"&ood o$ an in$ected individua& caue
the "acteria to "ind together intoc&u' @the ida& reaction;
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http://www.britannica.com/EBchecked/topic/643157/Fernand-Isidore-Widalhttp://www.britannica.com/EBchecked/topic/643157/Fernand-Isidore-Widal -
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)#a9os#s o- Eter#% "e=erWidal test
!eru' agg&utinin raie a"rut&y during the 2ndor3rdwee(
7he wida& tet detect anti"odie againt : and #antigen
T'o serum spe%#mes obta#ed at #ter=aso- D 10 days to read t
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S#9#C%at T#ters
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Widal test Still a populartest
7he ida& tet @ida& agg&utination reaction; iroutine&y ractied $or the erodiagnoi o$ tyhoid$ever "y 'ot o$ the &a"oratorie !evera& wor(er haveereed dou"t regarding the re&ia"i&ity o$ the tet
!evera& $actor have contri"uted to thi uncertainty7hee inc&ude oor&y tandardied antigen theharing o$ antigenic deter'inant with other!a&'one&&ae and the eEect o$ i''uniation with 7=Bvaccine =nother 'ajor ro"&e' re&ate to the diQcu&ty
o$ interreting ida& tet reu&t in area where!a&'one&&a tyhi i ende'ic and where the anti"odytitre o$ the nor'a& ou&ation are o$ten not (nown
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L#m#tat#os o- :#da test
*&aica&&y a $our$o&d rie o$ anti"ody in airedera ida& tet i conidered diagnotic o$tyhoid $ever #owever aired era are o$ten
diQcu&t to o"tain and ecic che'otheray hato "e intituted on the "ai o$ a ing&e ida&tet urther'ore in area where $ever due toin$ectiou caue i a co''on occurrence the
oi"i&ity eit that $a&e oitive reaction'ay occur a a reu&t o$ nontyhoid
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DH-.-N7H=, DH=GN:!H!
Paratyphoids A, B & CR 7he &a"oratory iuua&&y reAuired a the na& authority 7hearatyhoid tend to run a 'i&der coure withro$ue roe ot
Salmonella inection and gastroenteritisR !a&'one&&ae the dyentery grou and
tahy&ococci 'ay occaiona&&y caue aninvaive i&&ne ree'"&ing tyhoid $ever with
"actere'ia Fua&&y however thegatrointetina& y'to' are 'ore acutethan the genera& 'ani$etation and theyreia 'uch &ower and o$ horter duration
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DH-.-N7H=, DH=GN:!H!
!ther diseases in di"erential diagnosisa!Maar#aR 7hi 'ay "e 'ita(en $or tyhoid in
countrie where "oth are ende'ic = hitory o$reviou attac( the 'ore raid onet in 'a&ariathe hivering and weating the high ear&yyreia the re&ative in$reAuency o$ a"do'ina&y'to' and ign and a oitive "&ood &idea&& oint to a diagnoi o$ 'a&aria
b! IueHaR HnCuen%a 'ay a&o "e con$uedwith tyhoid "ut i uua&&y o$ 'uch 'ore raidonet with high te'erature evere ore throatcough and the a"ence o$ a a&a"&e &een androe ot
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DH-.-N7H=, DH=GN:!H!
%! Ba%#ary dyseteryR 7hi dieae e&do' caue 'uchdiQcu&ty in diagnoi 7he onet i uua&&y acute with evere"&ood diarrhoea a&though in 'i&d cae the "&ood 'ay "ea"ent Diarrhoea with "&ood i rare in ear&y tyhoid 7he ignand y'to' in dyentery are uua&&y a"do'ina& and re'aino the 'enta& tate and chet "eing c&ear
d! Typ
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Dengue ever
Dengue $ever i viru L "aeddieae read "y 'oAuitoe
+ot co''on&y the 'oAuito =ede=egyti
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!HGN =ND !/+P7:+P
ever
#eadache
+uc&e and joint ain Nauea ? vo'iting
.ah
#e'orrhagic 'ani$etation
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*riteria uect o$ dengue
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4 necceary criteria=**HN-!
.outine tyhoid vaccination i indicated $oraccine are not aroved $or ue chi&drenyounger than 2 year
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*o'&ication
Itest#a %omp#%at#os
Hntetina& "&eeding
Hntetina& er$oration
Para&ytic i&eu
&omp#%at#ose;stra#test#a
*ardiovacu&ar