TYPHUS DISEASE PAPER

To fulfill course assignments

coached by Mr. Yulius Irham, S.Pd., M.Pd

Members of Group :
1. Mufida Salsa Billah Rifda M.S (P17220193038)
2. Tufaelatil Makkiyatul Citra (P17220193039)
3. Lusi Arif Rahmawati (P17220193040)
4. Veren Vanessa Titiaji (P17220193041)
5. Nida Niswati Munawaroh (P17220193042)
6. Aniyatul Masfufah (P17220193043)
7. Siti Nur Jannah (P17220193043)

POLITEKNIK KESEHATAN MALANG

JURUSAN KEPERAWATAN
D III KEPERAWATAN LAWANG
Januari 2021
 FORWARD

Assalamu’alaikum wr. wb.

Praise our thanks to Allah SWT who has bestowed His mercy because
only with His permission, guidance and blessing so that we can finish this paper
with the title "typhus or thypus abdominalis" on time.

We realize that there are still many weaknesses and shortcomings in

realizing a good paper in the preparation of this paper, both in content and in
writing. For this reason, we are always looking forward to criticism and
suggestions from all constructive parties for the improvement of this paper in the
future.

We take this opportunity to express our deepest gratitude for all the
assistance of all parties so that this paper can be completed.

Malang, September 2012

Penulis

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 Table of Contents

Forward ..........................................................................................................i

Table of Contents ...........................................................................................ii

Chapter 1 Introduction

1.1 Background........................................................................................1

1.2 Formulation of the Problems.............................................................1

1.3 Purpose of the Problem......................................................................1

Chapter 2 Content
2.1 Definition ..........................................................................................2

2.2 Etiology..............................................................................................3

2.3 Epidomyology ...................................................................................4

2.4 Pathogenesis .....................................................................................4

2.5 Symptoms..........................................................................................5

2.6 Clinical symptoms.............................................................................6

2.7 Relaps ...............................................................................................7

2.8 Complication .....................................................................................7

Chapter 3 Closing...........................................................................................13

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 CHAPTER I
INTRODUCTION

1.1 Background
This disease is still endemic in Indonesia, can be found throughout the
year without a certain sexual potential, and often affects school age groups
and young adults. Any patient with a history of fever for more than 5 days,
and especially in the afternoon, should be suspected of having abdominal
typhus (typhoid fever).
Abdominal typhus or typhoid (typhoid fever, enteric fever) is an acute
infectious disease usually found in the digestive tract (in the small intestine)
and sometimes in the bloodstream, with symptoms of fever that lasts more
than one week, indigestion and impaired consciousness caused by germs.
Salmonella typhi or Salmonella paratyphi A, B and C, apart from this it can
also cause gastroenteritis (food poisoning) and septicemia (does not attack the
intestines).
In society this disease is known as typhus or thypus, but in medicine it is
called TYPHOID FEVER or thypus abdominalis, because it is related to the
intestines in the stomach.

1.2 Formulation of the Problem

1.3 What is meant by abdominal typhus or typhus?
1.4 How does abdominal typhus or typhus occur?
1.5 What symptoms occur in sufferers of abdominal typhus or typhus?
1.6 How is the treatment for abdominal typhus or typhus?

1.3 Purpose of the Problem

2. Knowing the causes and symptoms of abdominal typhus or typhus
3. Knowing the diagnosis and therapy for abdominal typhus or typhus

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 CHAPTER II
CONTENT
2.1 Definition
Abdominal typhus is an acute infectious disease that usually affects
the digestive tract with symptoms of fever for more than 7 days,
gastrointestinal disorders, impaired consciousness, and is more common in
children aged 12-13 years (70% - 80%), at the age of 30 - 40 years (10%
-20%) and over the age of children 12-13 years (5% -10%). (Mansjoer,
Arif 1999).
Abdominal typhus is an acute infectious disease that usually affects
the digestive tract with symptoms of fever for more than 1 week,
indigestion and impaired consciousness. The paratips - a milder type of
typhoid - may experience occasional passing stools. When observed, the
tongue appears milky white membrane, the edges are bright red. The lips
are dry, and the physical condition looks weak, and is noticeably sick. If it
is advanced, jaundice may appear, because in typhus the liver can swell
like symptoms of hepatitis. In typhus the spleen also swells.
Typhoid germs are ingested through contaminated food or drink. It
could be the source of the germ carrier without typhus himself. Germs
lodged in the intestine, and the walls of the intestine. The intestine is
injured, and at times a typhoid ulcer can burst, and the intestine becomes
perforated. This is the most dreaded complication of typhoid. Typhoid
complications generally appear in the second week of fever.
That is, if the temperature suddenly drops and it is thought that the
pain has healed, but the pulse is high, the stomach churns, and the patient
looks very sick. This condition requires emergency help, because intestinal
contents that spill into the abdominal cavity must be cleaned as soon as
possible. To know if you have typhus, you should check your blood. After
the first week of fever positive signs of typhus appear in the blood (Widal
test).

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 These germ carriers are dangerous if the profession is a waiter or
someone who prepares food and drink snacks (food handler). Now typhus
can be prevented by typhoid immunity. Typhus in Indonesia is still a lot.
Those who have the risk of contracting it, there is nothing wrong with
participating in vaccinations.
Typhus or in medical language known as Typhus Abdominalis
(typhoid) is caused by a type of germ called Typhoid Bacillus. These
germs attack lymph tissues. This disease often attacks children over 2
years of age. Even though it is not actually considered a dangerous
disease, it often makes parents worry because of the symptoms that follow
typhoid, which can usually result in dehydration and inflammation of the
brain if not treated properly.
Typhoid bacteria are found in the stool and urine of sufferers.The
spread of bacteria into food or drinks can occur due to washing hands that
are not clean after defecating or after urinating. Flies can spread bacteria
directly from feces to food. The bacteria enter the digestive tract and can
enter the bloodstream. This will be followed by inflammation of the small
intestine and large intestine. In severe cases, which can be fatal, the
affected tissue can experience bleeding and perforation (perforation).
Approximately 3% of patients infected with Salmonella typhi /
typosa and have not received treatment, this bacteria will be found in the
feces for more than 1 year. Some of these carriers show no symptoms of
typhoid fever. Typhoid is an acute small intestine infection caused by
salmonella thypi and salmonella para thypi A, B, C. synonyms of this
disease are Typhoid and abdominal paratyphoid, (Syaifullah Noer, 1998).

2.2 Etiology
Salmonella thyposa, gram-negative bacilli that moves with shaking
hair, does not have a spore and has at least three kinds of antigens,
namely:- antigen 0 (somatik, terdiri dari zat kompleks liopolisakarida)
- H antigen (flagella), and

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 - V1 antigen and hyaline membrane protein Salmonella parathypi A
In the patient's serum, there are anti-substances (agglutinins) against these
three types of antigens.

2.3 Epidomyology
In Indonesia it is in an endemic state. Children who are found are usually
over one year old. Most of the patients (80%) treated at the Pediatrics
Department of the Faculty of Medicine - RSCM Jakarta are over 5 years old

2.4 Pathogenesis
The infection occurs in the digestive tract. Basil is absorbed in the small
intestine through the small lymph vessels into the bloodstream to the organs,
especially the liver and spleen. Basil that is not destroyed multiply in the liver
and spleen so that these organs will enlarge along with pain on the touch.
Then the bacilli enter the blood again (bacteremia) and spread throughout the
body, especially into the lymphoid glands of the small intestine, causing an
oval-shaped ulcer in the mucosa above the Peyeri plaque. These ulcers can
result in bleeding and perforation of the intestines. Symptoms of fever are
caused by endocytoxins while symptoms in the digestive tract are caused by
abnormalities in the intestine.
Salmonella typi transmission can be transmitted in various ways, known as
5 F, namely Food (food), Fingers (fingers / nails), Fomitus (vomiting), Fly
(flies), and through feces.
Feces and vomiting in typhoid sufferers can transmit the salmonella thypi
bacteria to other people. These germs can be transmitted through fly
intermediaries, where the flies will land on food that will be consumed by
healthy people. If the person does not pay attention to personal hygiene, such
as washing hands and food contaminated with salmonella typi germs, enter
the body of a healthy person through the mouth. Then the germs enter the
stomach, some of the germs will be destroyed by stomach acid and some will
enter the distal small intestine and reach the lymphoid tissue. In this lymphoid

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 tissue, germs multiply, then enter the bloodstream and reach the
reticuloendothelial cells.
These reticuloendothelial cells then release germs into the blood
circulation and cause bacteremia, the germs then enter the spleen, small
intestine and gallbladder.
Initially it was thought that the fever and symptoms of toxemia in typhoid
were caused by endotoxemia. But based on experimental research, it is
concluded that endotoxemia is not the main cause of fever in typhoid.
Endotoxemia plays a role in typhoid pathogenesis, because it helps local
inflammatory processes in the small intestine. Fever is caused by salmonella
thypi and its endotoxin stimulates synthesis and the release of pyrogenic
substances by leukocytes in inflamed tissues.

2.5 Symptoms
Usually the symptoms begin to appear gradually within 8-14 days after
infection. Symptoms can include fever, headache, joint pain, sore throat,
constipation, decreased appetite and abdominal pain. Sometimes the sufferer
feels pain when urinating and coughing and bleeding from the nose occur.
If treatment is not started, the body temperature will slowly increase
within 2-3 days, reaching 39-40? Celsius for 10-14 days. The heat begins to
gradually fall at the end of the third week and returns to normal by the fourth
week. Fever is often accompanied by a slow heart rate and extreme fatigue. In
severe cases there may be delirium, stupor or coma. In about 10% of
sufferers, a cluster of small pink spots appears on the chest and abdomen in
the second week and lasts 2-5 days.
Body heat is getting higher day by day, especially in the afternoon and at
night. Occurs for 7-10 days, then the heat becomes constant and continuous.
In general, in the morning you feel better, but when it's late at night the
condition starts to decline again. In the early stages, symptoms of weakness,
headache, throat infection, abdominal discomfort, constipation or sometimes

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 difficulty passing stools occur, and diarrhea. In severe situations, the sufferer
gets sicker and the consciousness begins to decline.
A fever develops slowly - starting from feeling unwell and decreasing
appetite for several days. After 5 - 7 days, a high fever appears which can
even reach 40 degrees Celsius. There are complaints of difficulty defecating
because what is attacked is the digestive tract. In certain cases, the patient
cannot defecate for up to a week, the heart rate slows down, a rash may occur
on the skin surface.

2.6 Clinical symptoms

The clinical symptoms of typhoid fever in children are usually milder than in
adults. The average sprouting period of 10 - 20 days, the shortest is 4 days if
infection occurs through food, while the longest is up to 30 days if infection
is through drinking. During the incubation period, prodrome symptoms may
be found, namely feeling unwell, lethargic headache, dizziness and lack of
excitement. Then following the usual clinical symptoms, namely:
a) Fever
In typical cases, fever persists within 3 weeks. It is febrile in nature and
the temperature is not too high. During the first week, the body
temperature gradually increases each day, usually decreasing in the
morning and increasing again in the afternoon and evening. In the second
week, the patient continues to be in a state of fever. In the third week the
body temperature gradually drops and returns to normal at the end of the
third week.
b) Disorders of the digestive tract
In the mouth there is breath that smells bad. Dry and cracked lips
(ragaden). The tongue is covered with a dirty white membrane (coated
tongue), the edges and edges are reddish, rarely accompanied by tremors.
On the abdomen may be found flatulence (meteorismus). Enlarged liver
and spleen accompanied by pain on the touch.
c) Impaired consciousness

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 Generally, the patient's consciousness decreases although not to much,
namely apathy to somnolence. Sopor, coma or restlessness is rare. In
addition to these commonly found symptoms, other symptoms may also
be found. On the back and limbs can be found roseola, which is reddish
spots due to embolism of bacilli in the capillaries of the skin. Usually
found in the first week of fever. Sometimes bradycardia is found in older
children and there may be epistaxis.

2.7 Relaps
That is the recurrence of the symptoms of abdominal typhus, but it is
lighter and shorter. Occurs in the second week after normal body temperature
returns. The occurrence is difficult to explain, as is the state of natural
immunity, which is never to become sick even though a fairly severe
infection.
In theory, relapses occur because of the presence of bacilli in organs that
neither drugs nor anti-agents can destroy. It is also possible that during the
healing of the ulcer, bacilli invasion occurs along with the formation of
fibroblast tissues.

2.8 Complications
Most sufferers experience complete healing, but complications can occur,
especially in patients who are not treated or if treatment is too late:
- about 2% have heavy bleeding. Usually bleeding occurs in the third week.
- Intestinal perforation occurs in 1-2% of patients and causes severe
abdominal pain because intestinal contents infect the stomach ronga
(peritonitis).
- Pneumonia can occur in the second or third week and usually results from
pneumococcal infection (although typhoid bacteria can also cause
pneumonia).
- Bladder and liver infections.
- Blood infection (bacteremia) sometimes causes bone infection

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 (osteomyelitis), heart valve infection (endocarditis), lining of the brain
(meningitis), kidney infection (glomerulitis) or urinary-genital tract
infection.
- In about 10% of untreated cases, symptoms of the initial infection return
within 2 weeks after the fever has subsided.
Can happen to:
1. Small intestine
Generally rare, but often fatal, namely:
a. Intestinal bleeding. If a little is found only if the stool is examined with
benzidine. If the bleeding occurs a lot of melena and if it is heavy there
can be a feeling of abdominal pain with signs of shock.
b. Intestinal perforation. Occurs usually in the third week or after that and
occurs in the distal ileum. Perforations that are not accompanied by
peritonitis can only be found when there is air in the peritoneal cavity,
ie the liver disappears and there is air between the liver and the
diaphragm on an upright abdominal X-ray.
c. Peritonitis. Usually accompanies perforation but may occur without
bowel perforation. Acute abdominal symptoms were found, namely
severe abdominal pain, tension in the abdominal wall (muscular
defense) and pain in pressure.
2. Complications outside the intestine
Occurs due to the location of inflammation due to sepsis (bacteremia),
namely meningitis, cholecystitis, encephalopathy and others. Occurs due
to secondary infection, namely bronchopneumonia. Dehydration and
acidisation can occur due to insufficient food intake and perspiration due
to high body temperature.
3 Occupational diagnosis
From the history and physical examination a diagnosis can be made
"Observation of abdominal typhus". To confirm the diagnosis, it is necessary
to do the following laboratory tests:
1. Examinations that are useful to support the diagnosis

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 i. Peripheral blood examination.
There are features of leukopenia, relative lymphocytosis and
aneosinosinophilia at the onset of illness. There may be anemia and
mild thrombocytopenia. This peripheral blood test is simple, easy
to do in a simple laboratory, easy to do in a simple laboratory but
useful to help with a quick diagnosis.
ii. Bone marrow examination
Can be used to support a diagnosis. This examination does not
include simple routine checks. There is an image of bone marrow
in the form of hyperactivity of the RES in the presence of
macrophage cells, while the erythropoesis system, granulopoesis
and thrombopoesis are reduced.
2. Laboratory tests to make a diagnosis.
Bile culture to find salmonella typhosa and widal examination are tests
that can be used to make a definitive diagnosis of abdominal typhus.
Both checks need to be done at admission and each following week.
a. Bile culture
Basil samonella typhosa can be found in the patient's blood usually
within the first week of illness. Furthermore it is more frequently
found in urine and feces and may remain positive for a long time.
Therefore a positive examination of blood samples is used to
confirm the diagnosis, while negative tests of urine and feces
samples 2 consecutive times are used to determine that the sufferer
has completely recovered and is not a carrier of germs (carriers).
b. Widal check
The basis of the examination is the agglutination reaction that
occurs when the patient's serum is mixed with the salmonella
typhosa antigen suspension. A positive test is if there is an
agglutination reaction. By diluting the serum, the levels of anti-
substances can be determined, namely the highest dilution that still
causes agglutination reactions. To make a diagnosis, it is

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 necessary to have a titer of the anti-O antigen. A titre of 1/200 or
more and or which shows a progressive increase is used to make
the diagnosis.
The titer reaches its peak along with the patient's healing. Titer
against H antigen is not necessary for diagnosis, because it can
remain high after receiving immunization or if the patient has long
recovered. Widal's examination is not always positive even though
the patient does suffer from abdominal typhus as evidenced by the
autopsy after the patient dies. It is better if the titer can be positive
because of the following circumstances:
1) O and H titers are high due to the presence of normal
agglutinins, due to infection with pathogenic coli bacilli in the
intestine.
2) In neonates, the anti-substance is obtained from the mother
through the umbilical cord
3) Presence of cross infection with Rickettsia (Weil Felix)
4) As a result of natural immunization due to the entry of oral
bacilli or in a state of subclinical infection.
4 Differential diagnosis
If there is a fever that lasts more than 1 week and the disease that can explain
the cause of the fever is not clear, it is necessary to also consider abdominal
pain, the following diseases: paratyphoid A, B, and C, influenza, malaria,
tuberculosis, dengue, lobar pneumonia and others.
5 Prevention
To prevent someone from getting this disease, it is now there :
- Typhus or Typhoid vaccines that are injected or by taking medicine and can
protect a person within 3 years.
- Typhus vaccine by mouth (swallowed) provides protection by 70%.
This vaccine is only given to people who have been exposed to Salmonella
typhi bacteria and people who are at high risk (including laboratory workers
and travelers).

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 Travelers should avoid eating raw vegetables and other foods that are served
or stored at room temperature. They should choose foods that are still hot or
frozen foods, canned drinks and peeled fruit. Or you can:

 Environmental efforts:
 Provision of adequate drinking water
 Hygienic disposal of human waste (urination / defecation)
 Eradication of flies.
 Supervision of houses and food vendors.
 Efforts against humans.
 Immunization
 Health education in the community: personal hygiene sanitation hygiene
6 Treatment
Patients who are treated with an observation diagnosis of abdominal typhus
should be considered and needed immediately as a patient with abdominal
1. Isolate the patient and disinfect clothing and excreta.
2. Good care to avoid complications, given the long illness, weakness and
anorexia and others.
3. Rest for up to 2 weeks of fever to return to normal, namely absolute
rest, lie still in bed. A week later you can sit and then you can stand and
walk.
4. Diet. Food must contain enough fluids, calories and high in protein.
Food ingredients should not contain a lot of fiber, not stimulate and not
cause a lot of gas. Milk 2 times one glass a day needs to be given.
Types of food for sufferers with decreased awareness are liquid food
that can be given through a gastric tube. If the child is conscious and
has a good appetite, soft food can be given.
5. The drug of choice is chloramphenicol, unless the patient is not
compatible with other drugs such as ampicillin, cotrimoxazole and
others. High doses of chloramphenicol are recommended, namely

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 100mg / kgbb / day, given 4 times a day orally or intramuscularly or
intravenously if needed
The administration of high doses of chloramphenicol provided benefits,
namely that the treatment time was shortened and relapses did not
occur. However, perhaps the formation of anti-deficient substances,
because the bacilli is destroyed too quickly. Discharged patients need to
be given an injection of the Tipa vaccine.
6. If there are complications, appropriate therapy should be given. For
example, giving intravenous fluids for patients with dehydration and
acidosis. If there is bronchopneumonia, penicillin and others should be
added.
7 Prognosis
In general, the prognosis for abdominal typhus in children is good as long
as the sufferer goes toepay for treatment. The mortality in treated patients
was 6%. The prognosis is poor or bad if there are severe clinical symptoms
such as:
1. High heat (hyperpyrexia) or continuous febrile.
2. Consciousness is very low, namely sopor, coma or delirium.
3. There are serious complications such as dehydration and acidosis,
peritonitis, bronchopneumonia and others.
4. The condition of the patient's malnutrition (protein energy
malnutrition).

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 CHAPTER III

CLOSING

Conclusion

From the discussion in this paper, the conclusions of the authors are
as follows. Typhus or typhus or typhoid fever is a disease caused by
infection with the bacteria Salmonella typhii. Typhus can be transmitted
quickly, generally through consumption of food or drinks that have been
contaminated with feces that contain Salmonella typhii bacteria.

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