Typhoid disease (Typhoid Fever) is still a
global problem today. Not only in Indonesia, worldwide Tifes disease is still a
community problem. The problems that arise are in terms of how to make the
diagnosis, how to handle, and how to prevent it.
To make a diagnosis for example, doctors
sometimes have difficulty remembering symptoms often resemble other infectious
diseases, such as: Dengue Fever, Leptospirosis, Malaria, Urinary Tract
Infection, or Breathing Infections.
To ensure Diagnosispun, not all hospitals are
able to perform blood culture examination. As a result, only with clinical
symptoms and a simple investigation (Widal's test) is diagnosed.
The selected drug (first choice) for Tifes
treatment is Chloramphenicol. Most doctors still use the drug. Now begin to
emerge a new problem that is: the recurrence. Not a few patients who get tifes
treatment is easy to relapse.
Furthermore the problem of drug resistance.
Germs that cause Tifes, Salmonella typhi, some have resistance to
chloramphenicol drugs. That is, if given the drug, then the germs are immune to
natural mechanisms.
Symptoms and
signs
Incubation period (inclusion of germs until
symptoms develop) about 10-14 days (5-23 days). Symptoms include: acute fever
(sudden), fever chills, headaches and disturbances around the stomach (nausea,
vomiting, discomfort in the uluhati) and decreased appetite.
Signs of Typhoid
disease:
Fever rises gradually, sometimes up to 41 °
C. This temperature rise can take place continuously, or up and down. Generally
body temperature will increase in the afternoon. There is a relative
bradycardia, ie the increase in pulse rate is not proportional to the rise in
body temperature.
There is a tifes tongue in the form of:
reddish tongue with white tongue edge. Some patients have meteorismus: a
bulging abdomen due to weak bowel movement, so air is retained in the intestine
and difficult to remove. Sometimes patients experience enlarged liver and
spleen (hepatosplenomegaly).
Diagnosis
To establish a diagnosis of Tifes, can still
use the Typhoid Fever Clinic Score. This score gives the value of one and two
of each symptoms and signs experienced by the patient. A single score is given
for symptoms: fever less than a week, headache, body "nglungrah" (not
powerful), nausea, abdominal pain and decreased appetite. One score is also
given for signs: vomiting and decreased bowel movements.
While the two scores are given for:
difficulty sleeping, enlarged liver and spleen, and fever that is more than one
week.
When added, the clinical score of Tifes can
be up to 20. However, if the clinical score reaches 13 or more it can be stated
that Clinical Typhoid Fever.
In order to help establish the diagnosis of
Tifes, laboratory investigation is required. Among other blood routine
occasionally found leukopeni (decreased leukocyte count).
Widal laboratory tests can still be used, but
should be more careful in providing interpretations of Widal. In some patients
Widal positive results will last for months, some even up to one year after the
attacks Tifes still positive. But that does not mean it is now attacked by Tifes.
A subsequent examination that is helpful in
establishing the diagnosis of Tifes is IgM Salmonella (Tubex TF). This check
produces positive results in the heat of the fourth or fifth day. And some will
Survive to remain positive for up to 35 days or there are up to two months
still positive.
Therefore, do not protest to the doctor if it
is healed from tifes kok results IgM Salmonelanya still positive. This is our
immune to the germs of tifes. Not that we're tifes, or relapse tifesnya, as
long as there is no fever, although IgM Salmonelanya positive.
So, we should use the results of laboratory
tests as a support for the diagnosis. Do not treat laboratory results if there
are no symptoms and signs that lead to typhoid fever (Tifes).
Recent
Handling
Handling Tifes is not enough with
antibiotics. Need general care and not always hospitalized. Indications are
hospitalized if the patient vomits repeatedly, high fever that does not come
down with the medicine down the heat, and the body is not weakened.
Antibiotics are the main choice until now is
still chloramphenicol group. However, the weakness of this drug should be given
for 14 days and a day three to four times drinking. Though some patients are
often the seventh day is not fever and the drug will soon be stopped by itself.
As a result the treatment becomes ineffective and allows for relapse again. In
addition it will facilitate the resistance of germs (immune) to the antibotics
given.
The next antibiotic is the Fluoroquinolone
group Ciprofloxacin and Levofloxacin. Ciprofloxocin is a good antibiotic for
Tifes. This drug is able to pursue the germs that cause tifes to the bone
marrow (where hiding Salmonella Typhi in our bodies). Only this drug is given
within seven days with a dose twice a day.
Recent antibiotics that have been studied in
several cities in Indonesia (Jakarta, Bandung, Semarang, Malang, Denpasar,
Makassar) are Levofloxacin. The advantage of this drug, able to reduce heat
earlier than ciprofloxacin. In addition, the side effects (nausea, vomiting,
abdominal discomfort, impaired liver function) are lighter than ciprofloxacin.
And given for seven days but with a sufficient dose once a day. For patients it
would be more convenient if only taking medication once Day (compare with
chloramphenicol 3-4 times, ciprofloxacin 2x daily).
Levofloxacine antibiotics are known for
respiratory tract infections, lung infections (pneumonia) and urinary tract
infections. With the research was able to overcome the germ Salmonella Typhi
with good results.
Now, many researchers have shown that early
dense feeding of rice with low-cellulose side dishes (abstinence vegetables
with coarse fiber) can be safely administered to early Tifes patients. And it
turns out, because some Tifes patients do not like porridge, so given the
opportunity to eat rice directly increased appetite. As a result, improving the
patient's recovery process and his tipes quickly heals.
If the tifes patient prefers to eat rice
instead of porridge, so go ahead. Do not be afraid his intestines to leak just
because of eating rice. Because until now there are still many patients who
ask: "tifes sick really told to eat rice tho dock? If it's like this when
is it healed? "
As we know, whatever our food is, it will
soften in our stomach. So as to get to the small intestine and the large
intestine is in a state of gentle. Automatically does not affect our gut right?
So it is not possible bowel leak because of eating rice! ***
Dr.
Muchlis AU Sofro: SpPD-KPTI, FINASIM, Section / SMF Internal Medicine RSUP Dr
Kariadi / FK UNDIP
