Group 9

Natasya Lidia Putri : 2111311036

Hafizah Rahmadani : 2111311021

Refi Mariska : 2111312021

Zahara Aulia Presly : 21113130

Angellita Verzir : 2111313021

Ifda Melyana Savitri : 2111312003

Typhus

A. Defenition

Typhoid or typhus is a bacterial infection of the small intestine and

sometimes the bloodstream caused by the bacteria Salmonella typhosa or Salmonella
paratyphi A, B and C, but it can also cause gastroenteritis (inflammation of the
stomach). In the community this disease is known as Typhoid or typhus, but in the
medical world it is called typhoid fever or Typus abdominalis because it is associated
with the intestines in the stomach (Widoyono, 2002).
Typus abdominalis is an acute infectious disease that usually affects the digestive tract
with symptoms of fever lasting more than 1 week, indigestion and impaired
consciousness (Sudoyo, 2009).
ETIOLOGY
Typhus abdominalis is a disease that is transmitted through food and drink
contaminated with the bacteria Salmonella typhosa (food and water borne disease). A
person often suffers from typhus, this indicates that he consumes food or drink
contaminated with this bacteria. Salmonella thyposa as a species, belongs to the
kingdom Bacteria, Phylum Proteobacteria, Classis Gamma proteobacteria, Order
Enterobacteriaceae, Familia Enterobacteriacceae, Genus Salmonella. Salmonella
thyposa is a gram-negative bacteria that moves with vibrating hair, has at least three
types of antigens, namely: antigen 0 (somatic, consisting of a lipopolysaccharide
complex), antigen H (flagella) and antigen V1 (hyaline, membrane protein). In the
patient's serum there are anti-glutanin substances against these three types of antigens
(Zulkhoni, 2011).

B. Causes of the thypus

 Typhoid is an acute disease caused by the bacterium Salmonella typhi. These
bacteria are usually found in contaminated water or food. In addition, these bacteria
can also be transmitted from infected people.

A person who is infected with the bacteria that causes typhoid can spread
throughout the body which can affect many organs of the sufferer's body. People
infected with typhoid/typhoid fever can transmit the bacteria through faeces and urine,
eating and drinking contaminated with urine or faeces of typhus sufferers. Or
consuming food handled by people who are experiencing typhoid and have not been
declared cured by a doctor, typhoid fever is a bacterial infection that can spread
throughout the body and affect many organs. Without prompt and proper treatment,
this disease can lead to serious complications that can be fatal.

C. Signs and symptoms

a. Fever

Fever or fever is the main symptom of typhoid. At the beginning of the illness,
the fever is mostly vague, then the body temperature often fluctuates. Morning lower
or normal, afternoon and evening higher (intermittent fever). From day to day the
intensity of the fever is getting higher and accompanied by many other symptoms
such as headaches (dizziness) which are often felt in the frontal area, muscle aches,
aches, insomnia, anorexia, nausea and vomiting. In the second week the intensity of
the fever is getting higher, sometimes continuously (continuous fever). If the patient
improves, at the 3rd week the body temperature gradually drops and can return to
normal at the end of the 3rd week. It should be noted that the typical fever is not
always present. The type of fever becomes irregular. This may be due to treatment
interventions or complications that may occur early. In children, especially toddlers,
high fever can cause seizures.

b. Digestive System Disorders

Often found bad breath due to a long fever. Lips are dry and sometimes chapped.
The tongue looks dirty and is covered with a white membrane. The tip and edges of
the tongue are reddish and tremors (coated tongue or white membrane), and are rare
in children. In general, patients often complain of abdominal pain, especially the
epigastric region (heartburn), accompanied by nausea, nausea and vomiting. At the
beginning of the illness is often meteorismus and constipation. In the following week,
sometimes diarrhea occurs.

c. Consciousness Disorder

Generally there is a disturbance of consciousness which is mostly in the form of

mild loss of consciousness. Often found apathetic consciousness with consciousness
such as foggy (typhoid). When clinically severe, the patient is often somnolence and
coma or with symptoms of psychosis (organic brain syndrome). In patients with toxic,
the symptoms of delirium are more prominent.

d. Hepatosplenomegaly

The liver and/or spleen are often found to be enlarged. The heart feels supple and
tender.

e. Relative bradycardia and other symptoms

Bradycardia is relatively infrequent, perhaps because the technical examination is

difficult. Relative bradycardia is an increase in body temperature that is not
accompanied by an increase in pulse rate. The benchmark that is often used is that
every 10°C increase in temperature is not followed by an increase in rose spots which
are usually found in the upper abdominal region, and sudamia, as well as clinical
symptoms related to complications that occur. Rose spots in children are very rare,
even epistaxis is more common.

D. Treatment medical

Until now, chloramphenicol is still the drug of choice for the treatment of
typhoid fever in Indonesia. The dose given to adult patients is 4 x 500 mg for up to 7
days free of fever. Other alternatives to chloramphenicol are: thiamphenicol (4 x 500
mg), cotrimoxazole (2 x 2 tablets for 2 weeks), ampicillin or amoxicillin (50-150
mg/kgBW for 2 weeks), third generation cephalosporins (eg ceftriaxone 3 -4 grams in
dextrose 100 cc for hours per infusion once a day for 3-5 days), and the
fluoroquinolone group (eg ciprofloxcacin 2 x 500 mg/day for 6 days).

Treatment medical

1. Chloramphenicol
2. Thiamphenicol
3. Cotrimoxazole
4. Amoxicillin
5. Third generation cephalosporins
6. Fluoroquinolone group

E. Treatment non Medical

1. Earthworm Extract
In each case of typhoid symptoms, earthworm extract was proven to work from two
sides, namely to kill the bacteria causing it and reduce the fever. Although it sounds a
little disgusting, several researchers have proven the antibacterial power of protein
extracted from earthworms that can inhibit the growth of gram-negative bacteria
such as Escherichia Coli, Shigella Dysenterica, Staphylococcus Aureus and Salmonella
Typi.

2. Bed rest

Bed rest (bed rest) is done in patients who need treatment due to an illness or
certain conditions and is an effort reduce activities that make the patient's condition
worsened. Instructions from the doctor will be given in the form of anything that can
be done and should not be done during bed rest. It all depends on the disease
suffered by the patient. Something is only asked to reduce activity, there are really
need to rest in bed and not allowed to do any activity (Kusumastuti, 2017). Bed rest
is recommended for patients with typhoid fever to prevent intestinal perforation or
bleeding complications intestines. Mobilization must be carried out gradually
according to the recovery of strength patients (Sakinah and Indria, 2016).

3. Low Fiber Soft Diet

Types of food to take care of is a low-fiber soft diet because typhoid fever,
disturbances in the digestive system. Food must be enough fluids, calories, protein,
and vitamins. Provide low-fiber food recommended, because of the food low fiber
will allow leave residue and can limit stool volume so as not to stimulate
gastrointestinal tract. In order to avoid urinary tract complications indigestion or
intestinal perforation recommended by giving filter porridge (Sakinah and Indria,
2016).

4. Keeping Clean

Habit of washing hands before eating is quite influential on the incidence of typhoid
fever, for that self-awareness is needed improve hand washing practices before
eating to prevent transmission of Salmonella typhi bacteria to in hand-touched food
dirty and wash hands after defecate so that dirt or feces that contain microorganisms
pathogens are not transmitted by hand to food (Andayani and Fibriana, 2018). Hands
must be washed with soap for at least 15 seconds rinsed and well dried (Upadhyay,
et al.,2015). Number of places sale of unfinished food meet health requirements in
Indonesia, such as poor hygiene, contribute to improvement number of cases of
typhoid fever (Purba, et al.,2016).

The habit of eating food outside Home is a risk factor Typhoid fever can be
transmitted when someone eats in a public place and the food is served by the
patient less latent (hidden) typhus keep clean while cooking, lead to bacterial
transmission Salmonella typhi on customers (Paputungan, et al., 2016). People who
have just recovered from typhoid still continue to excrete Salmonella typhi in feces
and urine up to 3 months after sick and can become chronic carriers if still contain
basil up to 1 year or more. For patients who do notadequately treated, carrier
incidents reported 5-10% and approximately 3% become a chronic career (Andayani
dan Fibriana, 2018). Need to improve hygiene individuals, especially washing hands
properly and correctly before eat, and reduce snacking habits or eating out of home
preparation. In addition, for the relevant agencies it is necessary to provide health
education about hygiene to reduce possibility of contamination foods that can cause
typhoid fever (Pramitasari, 2013)

F. Preventive Actions

Typhoid prevention can be done by maintaining personal and environmental

hygiene including:

1. Get in the habit of protecting food from disease-carrying animals such as flies,
cockroaches, and mice.
2. Wash hands with soap after using the toilet and before eating.
3. overcome buying snacks in places that are less clean.
4. Provide drinking water that meets the requirements.
5. Typhoid vaccination.

Don't forget to always maintain personal hygiene after activities. Also pay
attention to environmental sanitation to keep it clean so as not to be easily exposed to
diseases due to an unhealthy environment such as typhus.