THE CORRELATION BETWEEN TYPHOID FEVER AND PERITONITIS ON CHILDREN BELOW 10 IN WEST JAKARTA IN 2009

Written by: Fani Safitri 030.08.097

The Faculty of Medicine Trisakti University

PREFACE

First of all, I would say million thanks to ALLAH SWT who always watches over me in every time I breath. Then, hopefully the peace is always upon Mohammad, the Prophet who leads us to the truth. I also thanks to Dra. Tanti Malike, MPd as my English lecturer, who teaches me how to make paper throughout his assignment. For my parents and everyone who help me to finish my paper of English, I beg many thanks. This paper about The Correlation Between Typhoid Fever and Peritonitis on Children below 10 in West Jakarta In 2009, was prepared to fulfill the assignment in connection with English II, as subject in 2nd semester at the Faculty of Medicine Trisakti University. If there are many mistakes that I had, I really sorry. Nevertheless, I have tried my best to finish this paper and I hope that this paper could be useful for others.

Jakarta, July 1st 2009

Fani Safitri

CONTENTS

PREFACE

CONTENTS

CHAPTER I INTRODUCTION

1.1 1.2 1.4 1.6

Background Problems Objectives Frame of writing

1.3. Limitation of problems 1.5. Method of writing

CHAPTER II TYPHOID FEVER

2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8

Definition Etiology Epidemiology Symptomatology Diagnosis Therapy and treatment Prognosis Prevention

CHAPTER III PERITONITIS

3.1. Definition

3.2 3.3 3.4 3.5 3.6 3.7 3.8

Etiology Epidemiology Symptomatology Diagnosis Therapy and Treatment Prognosis Prevention

CHAPTER IV PERITONITIS

THE CORRELATION BETWEEN TYPHOID FEVER AND

CHAPTER V CONCLUSION

BIBLIOGRAPHY

Chapter I Introduction
1.1 BACKGROUND Typhoid fever is an acute illness with fever caused by infection with the Salmonella typhi bacteria contracted from contaminated water and food. The disease has an insidious onset characterized by fever, headache, constipation, malaise, chills, and myalgia (muscle pain). Diarrhea is uncommon, and vomiting is not usually severe. Confusion, delirium, intestinal perforation, and death may occur in severe cases. Without therapy, the illness may last for 3 to 4 weeks and death rates range between 12% and 30%. The disease is transmitted through contaminated drinking water or food. Large epidemics are most often related to fecal contamination of water supplies or street vended foods. A chronic carrier state -- excretion of the organism for more than 1 year -- occurs in approximately 5% of cases. Typhoid Mary was a chronic carrier. About 16 million cases of typhoid fever and 600,000 deaths occur yearly worldwide. There are about 400 cases a year in the US, mostly among travelers. For people traveling to high risk areas, vaccines are recommended. One needs to complete the vaccination at least a week before travel so that the vaccine has time to take effect. The risk of typhoid is greatest for travelers to the Indian subcontinent and to developing countries in Asia, Africa, and Central and South America where there is prolonged exposure to potentially contaminated food and drink. Vaccination is particularly recommended for anyone traveling to smaller cities, villages, and rural areas off the usual tourist itineraries. Typhoid vaccination is not 100% effective and is not a substitute for careful selection of food and drink. According to the World Health Organization (WHO), as of May 30, 2003, 200 cases of typhoid fever, including 40 deaths, had occurred in remote villages of the Grand Bois Area of Haiti. Three of the cases were laboratory confirmed. The residents of the affected villages lack access to health care facilities and safe water.

All water points in the area showed E.coli bacterial contamination. Deaths occurred primarily among people who did not receive medical attention. Treatment is with antibiotics but taking antibiotics does not prevent typhoid fever There is still 1-2% mortality (risk of death). Peritonitis is inflammation of the peritoneum (The peritoneum is the tissue layer of cells lining the inner wall of the abdomen and pelvis). Peritonitis can result from infection (such as bacteria or parasites), injury and bleeding, or diseases (such as systemic lupus erythematosus).

1.2 PROBLEMS Typhoid Fever is a disease that is caused by infection with the Salmonella typhi bacteria contracted from contaminated water and food. More than 139 cases of typhoid fever have been reported in West Jakarta in 2009 especially for children under 10 years old and the case fatality is 14%. In this paper, I want to discuss about the correlation between Typhoid Fever and Peritonitis. The discussion about the definition until the treatments of the disease. Especially, this discussion will talk about Typhoid Fever on children below 10 in West Jakarta (Indonesia) in 2009. 1.3 LIMITATION OF PROBLEMS The topics that I will discuss in this paper are : What is Typhoid Fever? What is Peritonitis? Who is at risk of getting Typhoid Fever? Why Typhoid Fever can influence the risk of getting Peritonitis? How do we prevent Typhoid Fever?

1.4

OBJECTIVES After reading this paper, the writer hopefully is successful on giving greater information regarding to the correlation between Typhoid Fever and Peritonitis. From this paper, we can get more information about Typhoid Fever and Peritonitis. Because this paper tells us about the definition, etiology, signs and symptoms, diagnosis, treatments, and prevention. It also discuss the correlation between Typhoid Fever and Peritonitis, especially on children below 10 years old.

1.5 METHOD OF WRITING I look up these materials of Typhoid Fever and Peritonitis in many textbooks in the library. I also collect many information and journals by using internet on-line. 1.6 FRAME OF WRITING PREFACE CONTENT CHAPTER I: INTRODUCTION 1.1. Background 1.2. Problems 1.3. Limitation of Problems 1.4. Objectives 1.5. Methods of Writing 1.6. Frame of Writing CHAPTER II: TYPHOID FEVER 2.1 Definition 2.2 Etiology 2.3 Epidemiology 2.4 Symptomatology 2.5 Diagnosis 2.6 Therapy and Treatment 2.7 Risk Factors

2.8 Prevention CHAPTER III: PERITONITIS 3.1.Definition 3.2 Etiology 3.3 Epidemiology 3.4 Symptomatology 3.5 Diagnosis 3.6 Therapy and Treatment 3.7 Risk Factors 3.8 Prevention CHAPTER IV: THE CORRELATION BETWEEN TYPHOID FEVER AND PERITONITIS ON CHILDREN BELOW 10 IN WEST JAKARTA IN 2009 CHAPTER V: CONCLUSION BIBLIOGRAPHY

Chapter II TYPHOID FEVER

2.1 DEFINITION Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized countries. However, it remains a serious health threat in the developing world. Typhoid fever spreads through contaminated food and water or through close contact with someone who's infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea. When treated with antibiotics, most people with typhoid fever feel better within a few days, although a small percentage may die of complications. Vaccines against typhoid fever are available, but they're only partially effective. Vaccines are usually reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common. 2.2 ETIOLOGY Typhoid fever is caused by a virulent bacterium called Salmonella typhi. Although they're related, this isn't the same as the bacteria responsible for salmonellosis, another serious intestinal infection. Fecal-oral route The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, where typhoid is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up

the typhoid bacteria while traveling and spread it to others through the fecal-oral route. This means that S. typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn't washed carefully after using the bathroom. You can also become infected by drinking water contaminated with the bacteria. Typhoid carriers Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tract or gallbladder, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves. 2.3 EPIDEMIOLOGY Typhoid fever remains a serious threat in the developing world, where it affects more than 12 million people annually. The disease is endemic in India, Southeast Asia, Africa, South America and in many other areas. 2.4 SYMPTOMATOLOGY Although children with typhoid fever sometimes become sick suddenly, signs and symptoms are more likely to develop gradually, often appearing one to three weeks after exposure to the disease. In some cases you may not become sick for as long as two months after exposure. First stage Once signs and symptoms do appear, you're likely to experience: Fever, often as high as 103 or 104 F (39 or 40 C)

Headache Weakness and fatigue A sore throat Abdominal pain Diarrhea or constipation Rash

Children are more likely to have diarrhea, whereas adults may become severely constipated. During the second week, you may develop a rash of small, flat, rosecolored spots on your lower chest or upper abdomen. The rash is temporary, usually disappearing in two to five days. Second stage If you don't receive treatment for typhoid fever, you may enter a second stage during which you become very ill and experience: Continuing high fever Either diarrhea that has the color and consistency of pea soup or severe constipation Considerable weight loss Extremely distended abdomen

The typhoid state By the third week, you may:

Become delirious Lie motionless and exhausted with your eyes half-closed in what's known as the typhoid state

Life-threatening complications often develop at this time. Improvement Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week to 10 days. But signs and symptoms can return up to two weeks after your fever has subsided. 2.5 DIAGNOSIS Medical and travel history Your doctor is likely to suspect typhoid fever based on your symptoms and your medical and travel history. But the diagnosis is usually confirmed by identifying S. typhi in a culture of your blood or other body fluid or tissue. Blood or body fluid or tissue culture For the culture, a small sample of your blood, stool, urine or bone marrow is placed on a special medium that encourages the growth of bacteria. In 48 to 72 hours, the culture is checked under a microscope for the presence of typhoid bacteria. A bone marrow culture often is the most sensitive test for S. typhi. Antibody and antigen testing Your doctor may recommend other tests to help diagnose typhoid fever, such as:

Enzyme-linked immunosorbent assay (ELISA). This blood test looks for an antigen that's specific to typhoid bacteria. An antigen is any substance, such as a virus, bacterium, toxin or foreign protein, that triggers an immune system response in your body. An ELISA test can identify if you carry the disease, but not whether you have an active infection.

Fluorescent antibody test. This test checks for antibodies to S. typhi. Antibodies are proteins produced by your immune system in response to harmful substances (antigens). Each antibody is unique and defends your body against a single antigen.

2.6

THERAPY AND TREATMENT Commonly prescribed antibiotics In the United States, most doctors prescribe ciprofloxacin for nonpregnant adults. Women who are pregnant and children most often receive ceftriaxone (Rocephin) injections, because ciprofloxacin has been associated with problems in these groups. All of these drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria. Problems with antibiotic resistance In the past, the drug of choice was chloramphenicol. Doctors no longer commonly use it, however, because of severe side effects, a high relapse rate and widespread bacterial resistance. In fact, the existence of antibiotic-resistant bacteria is a growing problem in the treatment of typhoid, especially in the developing world. In recent years, S. typhi also has proved resistant to trimethoprim-sulfamethoxazole and ampicillin. Supportive therapy

Other treatment steps aimed at managing symptoms include:

Drinking fluids. This helps prevent the dehydration that results from a prolonged

fever and diarrhea. If you're severely dehydrated, you may need to receive fluids through a vein in your arm (intravenously).

Eating a healthy diet. Nonbulky, high-calorie meals can help replace the nutrients

you lose when you're sick.

2.7

RISK FACTORS Work in or travel to areas where typhoid fever is endemic Have close contact with someone who is infected or has recently been infected with typhoid fever Have an immune system weakened by medications such as corticosteroids or diseases such as HIV/AIDS Drink water contaminated by sewage that contains S. typhi

2.8

PREVENTION Wash your hands. Frequent hand washing is the best way to control infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food and after using the toilet. Carry an alcoholbased hand sanitizer for times when water isn't available. Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is. Wipe the outside of all bottles and cans before you open them. Ask for drinks without

ice. Use bottled water to brush your teeth, and try not to swallow water in the shower. Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can't peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely. Choose hot foods. Avoid food that's stored or served at room temperature. Steaming hot foods are best. And although there's no guarantee that meals served at the finest restaurants are safe, it's best to avoid food from street vendors it's more likely to be contaminated. Clean household items daily. Clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths. Avoid handling food. Avoid preparing food for others until your doctor says you're no longer contagious. If you work in the food service industry or a health care facility, you won't be allowed to return to work until tests show that you're no longer shedding typhoid bacteria. Keep personal items separate. Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water. Heavily soiled items can be soaked first in disinfectant.

Chapter III PERITONITIS

3.1 DEFINITION Peritonitis is a bacterial or fungal infection of the peritoneum, a silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen. The infection can be a complication of peritoneal dialysis. It can also be caused by peritoneal fluid buildup, another infection, inflammation or an injury. Whatever the cause, peritonitis requires prompt medical attention to fight the infection and, if necessary, to treat any underlying medical conditions. Treatment of peritonitis usually involves antibiotics and, in some cases, surgery. Left untreated, peritonitis can lead to severe, potentially life-threatening infection throughout your body. 3.2 ETIOLOGY Infection of the peritoneum can happen for a variety of reasons. Here are the most common causes of peritonitis: Peritoneal dialysis. Dialysis removes waste products and extra fluid from your blood when your kidneys can no longer adequately do so. With peritoneal dialysis, the network of tiny blood vessels in your abdomen (peritoneal cavity) is used to filter your blood. Peritonitis is the most common complication associated with peritoneal dialysis. An infection may occur during peritoneal dialysis due to unclean surroundings, poor hygiene or contaminated equipment.

Fluid buildup. Diseases that cause liver damage, such as cirrhosis, can result in a large amount of fluid buildup in your abdominal cavity (ascites). That fluid buildup is susceptible to bacterial infection. This type of peritonitis is called spontaneous peritonitis.

Secondary peritonitis When other medical conditions result in an infection that causes peritonitis, it's referred to as secondary peritonitis. These causes include: A ruptured appendix, stomach ulcer or perforated colon. Any of these conditions can allow bacteria to get into the peritoneum through a hole in your gastrointestinal tract. Pancreatitis. Inflammation of your pancreas (pancreatitis) complicated by infection may lead to peritonitis if the bacteria spread outside the pancreas. Diverticulitis. Infection of small, bulging pouches in your digestive tract (diverticulitis) may cause peritonitis if one of the pouches ruptures, spilling intestinal waste into your abdomen. Trauma. Injury or trauma may cause peritonitis by allowing bacteria or chemicals from other parts of your body to enter the peritoneum.

3.3

EPIDEMIOLOGY The infecting micro-organism was found in prospective skin swabs in six episodes, widely distributed and as the predominant, or equally predominant, organism at each site but was not detected in swabs taken more than 12 weeks before the episode of peritonitis; this suggests recent acquisition. Infecting strains were no more likely to be adherent or to produce slime than non-infecting strains, nor had they any other characteristic detected in our typing scheme that might lead to their detection before peritonitis developed.

3.4

SYMPTOMATOLOGY Signs and symptoms of peritonitis include: Abdominal pain or tenderness Bloating or a feeling of fullness (distention) in your abdomen Fever Nausea and vomiting Loss of appetite Diarrhea Low urine output Thirst Inability to pass stool or gas Fatigue

3.5 DIAGNOSIS Peritoneal fluid analysis. Using a thin needle, your doctor may take a sample of the fluid in your peritoneum (paracentesis). If you have peritonitis, examination of this fluid may show an increased white blood cell count, which typically indicates an infection or inflammation. A culture of the fluid may also reveal the presence of bacteria. Blood tests. A sample of your blood may be drawn and sent to a lab to check for a high white blood cell count. A blood culture also may be performed to determine if there are bacteria in your blood.

Imaging tests. Your doctor may want to use an X-ray to check for holes or other perforations in your gastrointestinal tract. Ultrasound may also be used. In some cases, your doctor may use a computerized tomography (CT) scan instead of an X-ray.

3.6

THERAPY AND TREATMENT To treat peritonitis, your doctor will likely prescribe an antibiotic medication to fight the infection and prevent it from spreading. The type and duration of your antibiotic therapy depend on the severity of your condition and the kind of peritonitis you have. You may need to be hospitalized for peritonitis that's caused by infection from other medical conditions (secondary peritonitis). Surgery is often necessary to remove infected tissue, treat the underlying cause of the infection and prevent the infection from spreading.

3.7 RISK FACTORS Factors that increase your risk of peritonitis include: Peritoneal dialysis. Peritonitis is common among people undergoing peritoneal dialysis. Other medical conditions. The following medical conditions increase your risk of developing peritonitis: cirrhosis, appendicitis, Crohn's disease, stomach ulcers, diverticulitis and pancreatitis. History of peritonitis. Once you've had peritonitis, your risk of developing it again is higher than it is for someone who has never had peritonitis.

3.8 PREVENTION Wash your hands, including underneath your fingernails and between your fingers, before touching the catheter Clean the skin around the catheter with antiseptic every day Store your supplies in a sanitary

Chapter IV The Correlation Between Typhoid Fever and Peritonitis on Children below 10 in West Jakarta in 2009
Typhoid fever is spread primarily through ingestion of contaminated water and food (especially dairy products and shellfish), and much less commonly by direct finger-tomouth contact with faeces, urine, or other secretions. Although concentrations of Salmonella typhi in the water or food may be too low to cause infections, the organisms may proliferate sufficiently when environmental conditions are favourable to cause infection. Incubation (10-14 days); ingestion, bacilli must first survive gastric acid. Thus, patients who ingest antacids, have had a gastrectomy, or have low gastric acidity for other reasons require fewer organisms for infection. Bacilli that survive gastric acidity attach preferentially to the tips of villi in the small intestine, onvade the mucosa immediately, or multiply in the lumen for several days before penetrating the mucosa. The bacilli then pass to the lymphoid follicles of the intestine and the draining mesenteric lymph nodes. Some organisms pass into the systemic circulation and are phagocytosed by the reticuloendothelial cells of liver and spleen. Bacilli invade and proliferate further within the phagocytic cells of the intestinal lymphoid follicles, mesenteric lymph nodes, liver, and spleen. During this initial incubation period, therefore, the bacilli are primarily sequestered in the intracellular habitat of the intestinal and mesenteric lymphoid system. Active invasion/bacteremia (1 week); Fastigium (1 week); Lysis (1 week) and Convalescence (several weeks). Following

Eventually the bacilli are released from the reticuloendothelial cells, pass through the thoracic duct, enter the blood stream, and produce a primary transient bacteremia and clinical symptoms. During this active invasion/bacteremic phase, bacilli disseminate to and proliferate in many organs, but are most numerous in organs that possess significant phagocytic activity, namely liver, spleen and bone marrow. Clinically, the patients develop fever, diarrhea or constipation, vomiting, abdominal distention, myocarditis, splenomegaly, leukopenia, and mental changes. The patients temperature follows a characteristic pattern. It remains normal during the incubation period, undergoes daily stepwise elevations during active invasion, remains high during fastigium, falls slowly (with fluctuations) during lysis, and remains normal during convalescence. During the bacteremic phase, patients typically have a spiking afternoon fever that increases daily (up to 105C) before stabilizing in the second or third week of illness. The high fever is often associated with prostration and delirium. In the final phase, usually 3 to 5 weeks after onset, the patient is febrile and exhausted, but recovers if there are no complications. Infection of Peyers patches leads to lymphoid hyperplasia, which can resolve without scarring or can progress to capillary thrombosis, with necrosis and ulceration (peritonitis).

Chapter V Conclusion
Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized countries. However, it remains a serious health threat in the developing world. Typhoid fever spreads through contaminated food and water or through close contact with someone who's infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea. Clinically, the patients develop fever, diarrhea or constipation, vomiting, abdominal distention, myocarditis, splenomegaly, leukopenia, and mental changes. The patients temperature follows a characteristic pattern. It remains normal during the incubation period, undergoes daily stepwise elevations during active invasion, remains high during fastigium, falls slowly (with fluctuations) during lysis, and remains normal during convalescence. During the bacteremic phase, patients typically have a spiking afternoon fever that increases daily (up to 105C) before stabilizing in the second or third week of illness. The high fever is often associated with prostration and delirium. In the final phase, usually 3 to 5 weeks after onset, the patient is febrile and exhausted, but recovers if there are no complications. Infection of Peyers patches leads to lymphoid hyperplasia, which can resolve without scarring or can progress to capillary thrombosis, with necrosis and ulceration (peritonitis). Peritonitis is a bacterial or fungal infection of the peritoneum, a silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen. The infection can be a complication of peritoneal dialysis. It can also be caused by peritoneal fluid buildup, another infection, inflammation or an injury.

BIBLIOGRAPHY

1. Accesed by July 1, 2009. Available at: http://www.histopathology-india.net/TyFev.htm 2. Accesed by July 1, 2009. Available at: www.eMedicine.com 3. Accesed by July 1, 2009. Available at: www.mayoclinic.com 4. Accesed by July 1, 2009. Available at: www.stujde.com 5. Mandell GL, et al. Peritonitis. In: Mandell GL, et al. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. Philadelphia, Penn.: Elsevier; 2005. http://www.mdconsult.com/das/book/body/1378913293/0/1259/540.html?tocnode=51378139&fromURL=540.html#4-u1.0-B0-44306643-4..50071-4--cesec2_2535. Accessed July 12, 2009. 6. Runyon BA. Treatment and prophylaxis of spontaneous bacterial peritonitis. http://www.uptodate.com/home/index.html. Accessed July 12, 2009.