Slide Typhoid Fever

7/18/2019 Slide Typhoid Fever

http://slidepdf.com/reader/full/slide-typhoid-fever 1/27

TYPHOID FEVERPresenters:

ABDUL RAHIM ABDUL RAUF 100 100283

NABILAH SARONI 100100287

S!er"#s$r:

%r& Ne''( R$s%#)n)* S!A+,-



#ntr$%.t#$n&&&

A systemic disease caused by Salmonellatyphi or Salmonella paratyphi

In Indonesia, 91% of people age 3-19years old suffers from typhoid fever

Blood culture positive typhoid fever 1!"per 1 per year



case report...

N)/e: RR

Ae: 1 (e)rs )n% 2 /$nts

Se: /)'e

D)te $4 A%/#ss#$n: 5t2 De.e/6er 2015



Chief complaint: FEVER

History:

P)t#ent )s s44ere% ) # 4e"er 7 %)(s )$ 6e4$re re4erre% t$ HAM

H$s!#t)'& S%%en $nset )n% 4'.t)t#n # 4e"er )n% %$es n$t

re.$"er #t 4e"erre%.#n %rs& S#"ers +-* Se#9res +-&S!$nt)ne$s 6'ee%#n +-&

Bes#%es 4e"er* !)t#ent )'s$ .$/!')#ne% !)#n )t te r#t $4 te

'$er )6%$/en 4$r 1ee& N)se) +;-* "$/#t +;- 4$r 1 ee #t te

4re<en.( $4 35 t#/es ) %)(* )n )/$nt $4 )6$t 10..="$/#t&

V$/#t .$ns#sts $4 !re"#$s'( e)ten 4$$%&

He )'s$ .$/!')#ne% )6$t '$ss $4 )!!et#te 4$r 1 ee& >$ +-*

F' +-* D#)rre) +-&

History of previous illness : Te !)t#ent )s tre)te% #n .'#n#. 6e4$re

te )%/#ss#$n t$ HAM H$s!#t)'&

History of drugs: P)r)/e* Ant)'#n* A/$#.#''#n&

A#A$#SS



History of Pregnancy: Tere #s n$ #st$r( $4 4e"er*(!ertens#$n* %#)6et#. /e''#ts* )n% .$ns/!t#$n $4er6)' /e%#.#ne&

History of Labor: S!$nt)ne$s 6#rt? )tten%e% 6(/#%#"es? B@ 3000 r)/? .()n$t#. +-&

History of Immunization: >$/!'ete nt#' 3 (e)rs $'% Feeding History: Fee%#n #st$r( )s n$t .'e)r

History of ro!th and "evelopment: H#st$r( $4 r$t)n% De"e'$!/ent )s n$t .'e)r&



Generalized status:

B$%( e#t: 30 * B$%( e#t: 15 ./

B@=)e: 3

BH=)e : 8

B@=BH: 78*C

Inter!ret)t#$n : /$%er)te /)'ntr#t#$n

Praesens status:

Le"e' $4 >$ns.#$sness: >$/!$s Ment#s* B'$$% !ressre 100=0

//H* HR: 100 6!/* RR: 25 6!/* 6$%( te/!er)tre: 3C$>* 6$%(

e#t : 30 * 6$%( e#t : 15 ./

Ane/#. +-* I.ter#. +-* >()n$s#s +-* E%e/) +-* D(s!ne) +-&

&'(SI)A*

+A$I#AI#



Localized status

Head : E(e: Is$.$r#. !!#' +3//=3//-* '#t re4'e +;=;-* #n4er#$r

!)'!& .$nn.t#") !)'e +=-* #.ter#. s.'er) +=-

N$se* E)r )n% M$t ere n$r/)'Neck : TV: R 2 ./H2O* L(/! n$%e en')re/ent +-&

Thorax : S(//etr#.)' 4s#4$r/#s* >est retr).t#$n+-* HR : 100 6!/*

re'er* /r/r +-* RR: 25 =#* re')r* r)'es +-&

Abdomen: S$e!e'* N$r/$!er#st)'t#.& L#"er= s!'een n!)'!)6'e& P)#n

)t te r#t #n#n)' +;-&

Extremities: P'se 1006!/* re')r* )%e<)te !ressre )n%

"$'/e* )r/ ).r)'*>RT G 3* B'$$% Pressre 100=0 //H*

Urogenital: M)'e* @#t#n n$r/)' L#/#t)t#$n



Parameters Value Normal Value

Complete Blood Count

Hemoglobin 13.50 g/% 13.2 – 17.3

Leucocyte 7 540 /mm3 4.500 – 11.000

Trombocyte 146.000 /uL 150.000 – 450.000

Hematocrite 33,70 % 43 – 4

!ritrocyte 4.13 mil/mm3 4.20 – 4."7

#$ "1.60 &l "5 '5

#$H 2.10 (g 2" – 32

#$H$ 35.60 g/)l 33 – 35

*+ 12.20 % 11.6 – 14."

#- 10.30 &l 7.0 – 10.2

-+ 11." &l

-$T 0.15%

LABORATORESULT 5TH DE

2015



Leucocytes Count :

eutro(il 4.50% 37 – "0

Lym(ocyte 43.20% 20 – 40

#onocyte 6.50% 2 ' "

!oino(il 0.10% 1 – 6

ao(il 0.700% 0 – 1 eutro(il abolute 3.73 103/L 2.7 – 6.5

Lym(ocyte abolute 3.26 103/L 1.5 – 3.7

#onocyte abolute 0.4 103/L 0.2 – 0.4

!oino(il abolute 0.01 103/L 0 – 0.10

ao(il abolute 0.05 103/ L 0'0.1

Chemical Chemistry:

+ at ran)om 103.60 mg/)l <200

Electrolyte:

$a 7. mg/)L .2'11.0

a 12" m!/L 135'155

3.0 m!/L 3.6'5.5

$l 4 m!/L .6'106



"ifferential "iagnosis:

T(!$#% 4e"er

M)')r#)

Dene 4e"er

Ur$en#t)' #n4e.t#$n

#or$ing "iagnosis:

T(!$#% 4e"er ; E'e.tr$'(te #/6)')n.e



%anagement:

IVFD D N)>' 0&5 J 30tt=# /)r$

In& >e4tr#)$n 70/=12 $rs IV

P)r).et)/$' 300/ +#4 ne.ess)r(-

D#et %)#'( /en 1800 .)' ; 0 r)/ !r$te#n



"iagnostic Planning:

>$rre.t#$n 4$r H(!$n)tre/#):

+13128- 0& 30 J 12 /E<

M)#nten)n.e: 25 /E<=BB J 0120 /E< K 100/E<

T$t)': 12 ; 100 J 22 /E<

D N)>' 0&C 22=15 1000.. J 157 .. 4#n#se% #n 25 $rs +0tt=# /#r$ $r

20tt=# /)r$-

A..$r%#n t$ /)#nten)n.e J 30tt=# /)r$

>$rre.t#$n 4$r H(!$.)'.e/#): 0&..=BB J 0& 30 J 1 .. >) '$n)se ; 1.. D10 4#n#se% #n 1 $r J

30..=$r

Chec$ &rinalysis' Feces (outine' )ube* )est' Ig% and Ig anti dengu+lectrolyte&



, Fever -/

0 Sens: A'ert* B$%( Te/!er)tre: 38* 0 0> &

Head E(e: Is$.$r#. !!#' +3//=3//-* '#t re4'e +;=;-* #n4er#$r

!)'!e6r) .$nn.t#") !)'e +=-* #.ter#. s.'er) +=-&

N$se* E)r )n% M$t ere #t#n n$r/)' '#/#t&

1ec$ VP: R;2 ./H2O* L(/! n$%e en')re/ent +-&)hora* S(//etr#.)' 4s#4$r/#s* >est retr).t#$n +-* HR :1006!/* re')r* /r/r

+-* RR: 25 =#* re')r* r)'es +-&

2bdomen S$e!e'& N$r/$!er#st)'t#.& '#"er* s!'een )n% ren)' n!)'!)6'e& P)#n )t te

r#t #n#n)' re#$n +;-&

+*tremities B'$$% !ressre: 100=0//H* P'se 100 6!/* re')r* )%e<)te !ressre

)n% "$'/e* )r/ ).r)'*>RT G 3&

enital M)'e* #t#n n$r/)' '#/#t

2 ' T(!$#% 4e"er' M)')r#)

' Dene 4e"er

' Ur$en#t)' #n4e.t#$n

P ' IVFD D N)>' 0&5 K 30tt=# /)r$

' I >e4tr#)$ne 70/=12$r IV -H3 /

' P)r).et)/$' 300/ +#4 ne.ess)r(-

' D#et %)#'( /en 1800 .)' ; 0 r !r$te#n

.

De.e/



' H6: 12&10 * Ht: 32&10* Tr$/6$.(te: 15&000 //3* Le.$.(te: 150 //3

' Ur#n)'(s#s:

o >$'$r Ye''$

o '.$se Ne)t#"e

o B#'#r6#n Ne)t#"e

o ,et$n Ne)t#"e

o !H &

o Pr$te#n Ne)t#"eo Ur$6#'#n$en Ne)t#"e

o N#tr)te Ne)t#"e

o B'$$% Ne)t#"e

o S!e.#4#. r)"#t( 1&010

' Ur#ne se%#/ent

o Er(tr$.(te 01

o Le.$.(te 01

o E!#te' 01

o >)st ne)t#"e

o >r(st)'s ne)t#"e

' E'e.tr$'(te: N): 130 /E<=L* ,: 3&0 /E<=L* >': C8 /E<=L

' I//n$ser$'$(:

' anti "HF Ig%: negative'

' anti "HF Ig: negative'

' )ube* )F: 4 -positive/

LABORRESULT T

2015

b



"ecember 5th67th 8934

, F'.t)t#n Fe"er +;-

0 Sens: A'ert* B$%( Te/!er)tre: 37*37*0>&


!)'!e6r) .$nn.t#") !)'e +=-* #.ter#. s.'er) +=-&


1ec$ VP: R;2 ./H2O* L(/! n$%e en')re/ent +-&

)hora* S(//etr#.)' 4s#4$r/#s* >est retr).t#$n+-* HR :C81006!/*

re'er* /r/r +-* RR: 25 =#* re')r* r)'es +-&

2bdomen S$e!e'& N$r/$!er#st)'t#.& '#"er* s!'een )n% ren)' n!)'!)6'e&

+*tremitie

s

B'$$% !ressre: 100=0//H* P'se C8100 6!/* re')r*

)%e<)te !ressre )n% "$'/e* )r/ ).r)'*>RT G 3&enital M)'e* #t#n n$r/)' '#/#t

2 T(!$#% Fe"er

P ' IVFD D N)>' 0&5 J 30tt=# /)r$

' I >e4tr#)$ne 70/=12 $rs IV -H86H/

' P)r).et)/$' 300/ +#4 ne.ess)r(-

'

D#et %)#'( /en 1800 .)' ; 0r !r$te#n



' Fe.es r$t#ne

o >$'$r 6r$n

o >$ns#sten.( s$4t

o B'$$% ne)t#"e

oM.s ne)t#"e

o@$r/ es ne)t#"e

o A/$e6) ne)t#"e

o Er(tr$.(te 01o Le.$.(te 01

LABORATORY

RESULT TH DE>EMBER2015

"ecember ;th 8934



"ecember ; 8934

, F'.t)t#n 4e"er +;-

0 Sens: A'ert* B$%( Te/!er)tre: 37*0> &


!)'!e6r) .$nn.t#") !)'e +=-* #.ter#. s.'er) +=-&



)hora* S(//etr#.)' 4s#4$r/#s* >est retr).t#$n +-* HR :1006!/*

re'er* /r/r +-* RR: 25 =#* re')r* r)'es +-&

2bdome

n

S$e!e'& N$r/$!er#st)'t#.& '#"er* s!'een )n% ren)' n!)'!)6'e&

+*tremit

ies

B'$$% !ressre: 110=70//H* P'se 100 6!/* re')r* )%e<)te

!ressre )n% "$'/e* )r/ ).r)'*>RT G 3&


2 T(!$#% 4e"er

P ' IVFD D N)>' 0&5 J 30tt=# /)r$

' I >e4tr#)$ne 70/=12 $rs IV -H4/

' P)r).et)/$' 300/ +#4 ne.ess)r(-

' D#et %)#'( /en 1800 .)' ; 0r !r$te#n



' >$ns't)t#$n 4r$/ M$%'e In4e.t#$n )n%

Tr$!#.)' D#se)se:

o A: T(!$#% 4e"ero P: I& >e4tr#)$ne 80100/=BB=)r#

L$ 4#6er %#et

B .$/! 21 t)6

"ecember <th639th 8934



"ecember < 39 8934

, F'.t)t#n 4e"er +;-

0 Sens: A'ert* B$%( Te/!er)tre : 37*38*00> &

Head E(e: Is$.$r#. !!#' +3//=3//-* '#t re4'e +;=;-* #n4er#$r !)'!e6r)

.$nn.t#") !)'e +=-* #.ter#. s.'er) +=-&


1ec$ VP: R;2 ./H2O* L(/! n$%e en')re/ent +-&)hora* S(//etr#.)' 4s#4$r/#s* >est retr).t#$n+-* HR :C81006!/* re'er*

/r/r +-* RR: 252 =#* re')r* r)'es +-&

2bdomen S$e!e'& N$r/$!er#st)'t#.& '#"er* s!'een )n% ren)' n!)'!)6'e&

+*tremities B'$$% !ressre: 110=70//H* P'se C8100 6!/* re')r* )%e<)te

!ressre )n% "$'/e* )r/ ).r)'*>RT G 3&

enital M)'e* #t#n n$r/)' '#/#t2 T(!$#% 4e"er

P ' IVFD D N)>' 0&5 J 30tt=# /)r$

' I >e4tr#)$ne 1r=12 $rs IV +H=6H5/

' P)r).et)/$' 300/ +#4 ne.ess)r(-

' D#et %)#'( /en 1800 .)' ; 0r !r$te#n

' B .$/! 21 t)6



' H6: 12&0*

' Ht: 32&80*

' Tr$/6$.(te: 33&00 //3*

' Le.$.(tes: C0 //3

LABORATORY RESULT CTH DE>EMBER

2015

"ecember 33th 8934



"ecember 33 8934

, Fe"er +- +D)( 1-



!)'!e6r) .$nn.t#") !)'e +=-* #.ter#. s.'er) +=-&



)hora* S(//etr#.)' 4s#4$r/#s* >est retr).t#$n+-* HR :C26!/* re'er*

/r/r +-* RR: 25 =#* re')r* r)'es +-&

2bdom

en


+*trem

ities

B'$$% !ressre: 110=70//H* P'se C2 6!/* re')r* )%e<)te

!ressre )n% "$'/e* )r/ ).r)'*>RT G 3&


2 T(!$#% 4e"er

P ' IVFD D N)>' 0&5 J 30tt=# /)r$

' I >e4tr#)$ne 1r=12 $rs IV -H7/

' D#et %)#'( /en 1800 .)' ; 0r !r$te#n

' B .$/! 21 t)6

"ecember 38th 8934



"ecember 38 8934

, Fe"er +- +D)( 2-



!)'!e6r) .$nn.t#") !)'e +=-* #.ter#. s.'er) +=-&



)hora* S(//etr#.)' 4s#4$r/#s* >est retr).t#$n+-* HR :C26!/*

re'er* /r/r +-* RR: 20 =#* re')r* r)'es +-&

2bdom

en


+*trem

ities

B'$$% !ressre: 110=70//H* P'se C2 6!/* re')r* )%e<)te

!ressre )n% "$'/e* )r/ ).r)'*>RT G 3&


2 T(!$#% 4e"er

P ' I >e4tr#)$ne 1r=12 $rs IV K )44

' B .$/! 21 t)6

' PB

THEORY FINDINGS



ANAMNESES Te /$st !r$/#nent s(/!t$/ $4 t#ss(ste/#. #n4e.t#$n #s !r$'$ne% 4e"er&A !r$%r$/e $4 n$ns!e.#4#. s(/!t$/s$4ten !re.e%es 4e"er )n% #n.'%es.#''s* e)%).e* )n$re#)* .$*e)ness* s$re tr$)t* %#99#ness* )n%

/s.'e !)#ns& )str$#ntest#n)'s(/!t$/s )re <#te ")r#)6'e&P)t#ents .)n !resent #t e#ter%#)rre) $r .$nst#!)t#$n&On'( 20 t$50 $4 !)t#ents !resent #t)6%$/#n)' !)#n* )'t$ te/)$r#t( )"e )6%$/#n)' ten%erness$"er te .$rse $4 te %#se)se&

Fe)tres $4 t#s %#se)se4e"er )n%)6%$/#n)' !)#n)re ")r#)6'e& @#'e4e"er #s %$./ente% )t !resent)t#$n#n /$re t)n 7 $4 .)ses* )6%$/#n)'!)#n #s re!$rte% #n $n'( 20 t$ 50&

Te !)t#ent )% 6eene!er#en.#n s%%en$nset $4 # 4e"er 4$r 7%)(s* )n% %$es n$tre.$"er #t 4e"erre%.#n %rs& Te

!)t#ent )'s$ .$/!')#ne%!)#n )t te r#t $4 '$er)6%$/en 4$r $ne ee*)n% n)se) )n% "$/#ts#t te 4re<en.( $4 35t#/es ) %)( t)t 'e)%s t$'$ss $4 )!!et#te



THEORY FINDINGS

PHYSICAL

EXAMINATIO

N

T(!$#% 4e"er )s ) !resent)t#$n $4r)s +r$se s!$ts-*e!)t$s!'en$/e)'(* e!#st)#s* )n%re')t#"e 6r)%(.)r%#)& R$se s!$ts

/)e ! ) 4)#nt* s)'/$n.$'$re%*6')n.#n* /).'$!)!')r r)s'$.)te% !r#/)r#'( $n te trn )n%.est& Te r)s #s e"#%ent #n 30 $4!)t#ents )t te en% $4 te 4#rst ee)n% res$'"es )4ter 2 t$ %)(s#t$t 'e)"#n ) tr).e& P)t#ents .)n)"e t$ $r tree .r$!s $4 'es#$ns*

)n% Salmonella .)n 6e .'tre% 4r$/!n. 6#$!s#es $4 tese 'es#$ns& Te4)#ntness $4 te r)s /)es #t%#44#.'t t$ %ete.t #n %)rs#nne%!)t#ents&

Within normal

limitation

)H+0(> FI1"I1,



DIANOSIS Te %#)n$st#. $'% st)n%)r% #s ) .'tre !$s#t#"e4$r S. typhi $r S. paratyphi& Te (#e'% $4 6'$$%.'tres #s <#te ")r#)6'e: #t .)n 6e )s # )s C0%r#n te 4#rst ee $4 #n4e.t#$n )n% %e.re)se t$0 6( te t#r% ee& A '$ (#e'% #s re')te% t$ '$n/6ers $4 Salmonella +1 $r)n#s/s !er /#''#'#ter-

#n #n4e.te% !)t#ents )n%=$r t$ re.ent )nt#6#$t#.tre)t/ent& Un'#e 6'$$% .'tres* 6$ne /)rr$.'tres re/)#n #'( +C0- sens#t#"e %es!#te %)(s $4 )nt#6#$t#. ter)!(& >'tre $4 #ntest#n)'se.ret#$ns +6est $6t)#ne% 6( ) n$n#n")s#"e%$%en)' str#n test- .)n 6e !$s#t#"e %es!#te )ne)t#"e 6$ne /)rr$ .'tre& I4 6'$$%* 6$ne/)rr$* )n% #ntest#n)' se.ret#$ns )re )'' .'tre%*

te (#e'% $4 ) !$s#t#"e .'tre #s C0& St$$'.'tres* #'e ne)t#"e #n 0 t$ 70 $4 .)ses%r#n te 4#rst ee* .)n 6e.$/e !$s#t#"e %r#nte t#r% ee $4 #n4e.t#$n #n ntre)te% !)t#ents&A't$ te /)$r#t( $4 !)t#ents +C0- .'e)r6).ter#) 4r$/ te st$$' 6( te e#t ee* ) s/)''!er.ent)e 6e.$/e .r$n#. .)rr#ers )n% .$nt#net$ )"e !$s#t#"e st$$' .'tres 4$r )t 'e)st 1 (e)r&

n$r/)' r#ne )n% 4e.'tre 6t #t ) !+5- T6e test&

)H+0(> FI1"I1,



TREATMENT >'$r)/!en#.$' #s st#'' te 4#rst .$#.e #n tetre)t/ent $4 t(!$#% 4e"er #t te )%/#n#stere%%$se $4 100/== %)( %#"#%e% #n 5 t#/es 4$r 101%)(s $r 7 %)(s )4ter 4e"er )s $ne&A/!#.#''#nres!$n% 'ess en .$/!)re% #t>'$r)/!en#.$'& Te re.$//en%e% %$se #s 200

/ = = %)( %#"#%e% #n 5 t#/es te #ntr)"en$s)%/#n#str)t#$n& Te %$s)e $4 A/$#.#''#n #t 100/ = = %)( %#"#%e% #n 5 t#/es te $r)')%/#n#str)t#$n #"es s#/#')r res'ts t$>'$r)/!en#.$' %es!#te '$ner re%.t#$n $4 4e"er&>$/6#n)t#$n $4 Tr#/et$!r#/ S'4)/et$)9$'e+TMPSM- #"es !$$r res'ts en .$/!)re% #t.'$r)/!en#.$'& Te re.$//en%e% %$se #s 10 /

TMP = = %)( $r SM 0/ = = %)( #n 2 %#"#%e%%$ses& Pr$"#s#$n $4 t#r%ener)t#$n >e!)'$s!$r#nss. )s >e4tr#)$ne 100 / = = %)( #n 1 $r 2%#"#%e% %$ses +! t$ 5 = %)(- 4$r 7 %)(s $r>e4$t)#/e 10200 / = = %)( %#"#%e% #n 35%$ses #s e44e.t#"e&

In& >e4tr#)$n 80100/==%)(&



Date post:	14-Jan-2016
Category:	Documents
Upload:	khamisah-ghazali
View:	56 times
Download:	0 times

Slide Typhoid Fever

Documents