CASE REPORT

TYPHOID FEVER (A01.0)

By:
Alvin Pratama Jauharie (I11111063)

LECTURER :
dr. Hilmi Kurniawan Riskawa, Sp.A, M. Kes

Department of Pediatric
Kartika Husada Hospital
Faculty of Medicine Tanjungpura University
2017

1
CASE PRESENTATION

2
Identity
Name : Mr. A
Sex : Male
Age : 12 years
Religion : Islam

Visite ER : February, 17th 2017

3
ANAMNESIS
Chief Complaint: fever

4
History of Presenting Ilness
Patient present with fever, the
temperature rises especially
4 days before when afternoon and night and
admission drops by the subsequent
morning. Fever drops just a while
with antipiretik administration
Accompanied by, headache,
cough, stomach ache, nausea,
decrease appetite for food and
drink
Vomitus (+), 2-3x/ day, vomitus
4 days before contain water and food, amonts
admission
+ cup
5
History of Presenting Ilness
Diarhea (+), 1x, water > dregs,
2 days before
dregs colour yellow, slime (-),
admission blood (-)
The temperature rises even
higher

Patient only consumed antipiretic to

treat the complaints since 4 days
The day of the before hospitalized but the complaint
admission
does not improved and also had
vomitus since 4 days, diarhea 2 days
ago, and no defecation since 1 days,
so the patient was brought to
Emergency Room of Kartika Husada 6
Hospital and advised to be
History of Presenting Ilness
Other complaints such as retro
orbital pain, joint pain, night sweats,
rash, nosebleed and gums bleeding
denied by patient
There was no loss of consciousness,
and seizure

7
 Past History
There was no history of asthma,
allergy and trauma.
There was no history of the same
complaint.
Patient hospitalize 2 years ago in RS
Kartika Husada because dengue
fever

8
 Family History
There was no family members of
patients that has the same
complaints as the patient at this
time
The patient's family also did not
have a history of asthma, allergies,
and long cough.

9
 Medical History
The patient earlier consume
antipyretic but the complaint not
reduced after taking the drug for a
while.

10
History of pregnancy and childbirth

Mother had normal pregnancy.

Aterm, spontaneous, at Hospital, midwife assist,
crying immediately.
History of growth and development are age
appropriate.
Basic immunization completed

11
Physical Examination

12
 General
appearanc Moderate pain
e

Conscious
ness and Compos mentis and well
Mental oriented
Statse

Weight : 69 kg
Anthropo Height : 163 cm
metry
Nutrition status : Obesity

13
 Nutritional State

Weight/Age
:
>3SD

Height/Age: >3SD

BMI/Age: >2SD

Conclusion: Obesity
14
 Vital Sign

BP 110/70 mmHg
HR 88 x/m, regular
RR 22 x/m
T 38,2o C
n 3
pai

15
 Generalized State
Head : Normocephal
Eyes : Conjunctiva not anemic, sclera not icteric, eyes not
sunken
Ear : There is no secrete, auricula not hyperemic, tympani
membrane intact
Nose : There is no secrete, nasal mucosa not hyperemic
Mouth : Mucousa of the mouth dan lips moist, dirty tongue
Throat : Hyperemic Pharyng, (-) tonsil T1/T1,
Neck : Lymph node enlargement (-)
Chest : there is no retraction
Lung
Inspection : Symmetric shape and motion
Palpation : Same tactile fremitus of right and left lung
Percution : Sonor in both lung fields
Auscultation : Vesicular breath, there is no crackles, there 16
is
 Generalized State
Heart : Heart sounds S1 dan S2 is regular, there is no
murmur, there is no gallop
Abdomen
Inspection : Flat, soepl, no mass
Auscultation : Bowel sound normal
Percution : Timpani in all field of abdomen
Palpation : Liver and spleen not palpable, there is
tenderness at epigastric hipokondrium dextra, and
umbilicus region, there is no ascites
Anus and genitalia: Male genitalia, there is no abnormality
Extremities : Warm, Capillary Refill Time (CRT) less
than 2 second, there is no cyanosis nor edema
17
Laboratory examination
February 17th , 2017
Haematology Value Normal Value
Leucocyte 9.900/mm3 4.000-12.000 /mm3
Erytrocyte 4.82 3,5-5,5 million/mm3
million/mm3
Haemoglobin 13,1 g/dl 12,5-16,1 g/dl
Haematocrite 37,5 % 36-47%
Trombocyte 230.000 150.000-
/mm3 400.000 /mm3
% Limfosit 18.8 % 15-50%
% Granulosit 73.9 % 35-80%)
Blood chemical examination Value Normal Value
Blood glucose 110 mg/dl 100-200 mg/dl
Widal H: 1/100 (-)
O: (-) (-)

18
 DIAGNOSIS

DIFFERENTIAL DIAGNOSIS
Typhoid fever
Urinary Tract Infection
Dengue fever
+Obesity
Malaria
Influenza

WORKING DIAGNOSIS
Typhoid fever + Obesity

19
 TREATMENT

Bed Rest
Intra Venous Fluid Drop (IVFD) Ringer Lactate 20
drops/minute (macro)
Cefotaxime 3x1500 mg Intra Venous (IV)
Ranitidin 2x50 mg Intra Venous (IV)
Ondancetron 3x6 mg Intra Venous (IV)
Dexametason 3x2 mg Intra Venous (IV)
Paracetamol tablet 3x500 mg Per Oral (PO)

20
 Advice
Blood culture
Tubex test
Urinalisis
Urine culture
Rapid test Malaria
Peripheral blood smear

21
Urinalisis (February, 18st
2016)
Makroskopik
Colour : Dark Yellow
Kejernihan : mild
Mikroskopik
turbid Eritrosit : (1-
Berat jenis : 1,015 2)
pH : 5,0
Leukosit : (0-
Lekosit : (-)
Nitrit : (-)
1)
Protein : (-) Epitel : (+) (2-
Glukosa : (-) 6)
Keton : (-)
Silinder : (-)
Urobilinogen : (-)
Kristal : (-)
Bilirubin : (-)
Blood : (+) Lain-lain : (-)
22
Laboratory examination
February 18th , 2017
Haematology Value Normal Value
Leucocyte 8.700/mm3 4.000-12.000
/mm3
Erytrocyte 5.04 3,5-5,5
million/mm million/mm3
3

Haemoglobin 13,6 g/dl 12,5-16,1 g/dl

Haematocrite 39,3 % 36-47%
Trombocyte 263.000 150.000-
/mm3 400.000 /mm3
% Limfosit 17.8 % 15-50%
% Granulosit 79.4 % 35-80%)

23
 Follow Up
Tanggal S O A P
18/2/2017 No fever in 12 TD: 120/80 Typhoid - Continue therapy
HR-2, HS- hours (with mmHg; RR: +
4 antipiretic), last 20 bpm; HR : obesity
fever at 00.00. 82 bpm; T:
cephalgia (+) 36,70 C ; W:
lessen, cough 69 kg.
(+), sputum (-), Abdomen:
vomitus (-), tenderness ar
stomachache epigastrium,
(+), no -Discharge from
19/2/2017 defecation for 2 TD: 110/70 Typhoid hospital
HR-3, HS- days. Little food mmHg; RR: + - Ciprofloxacin
5 intake 22 bpm; HR : obesity tablet 2x500 mg
90 bpm; T: PO
No fever in 36 36.4oC; - Sanmaag syrup
hours (with W : 69 kg 3x1 Cth PO
antipiretic), Abdomen: -Ranitidin tablet
cephalgia (-), tenderness ar 2x150 mg PO
cough (-), epigastrium, -Paracetamol
vomitus (-), tablet 3x500 mg
stomachache (+) PO 24
Prognosis

Ad Vitam : Ad Bonam
Ad Functionam : Ad Bonam
Ad Sanactionam : Dubia ad Bonam

Final diagnosis
Typhoid fever

25
 PROBLEM OF CASE

Diagnosis

Treatment

Prognosis
26
 This Case
A boy, 12 y.o with continuous fever,
increasing temperature on afternoon to
night, had cough, vomitus, abdominal
pain, no defecate for 2 days, decreasing
appetite,.
38,2 C on temperature, dirty tounge (+),
abdominal tenderness (+) ar epigastric,
hipocondriac dextra et sinistra and
umbilicus
in widal but not significant
27
 Diagnosis
Typhoid fever :
Remitten fever with step ladder pattern, high temp at final
first week, fever continous to rise at second week, malaise,
anorexia, abdominal pain, diarrhea or constipation, vomitus,
typhoid tongue, meteorismus, hepatosplenomegali,
anemia, leukopenia, could be trombositopenia, S typhi O
titer 1/200 or 4 times up titer.
O antibody 6-8 days from onset
H antibody 10-12 days from onset

Typhoid fever in pre-school age can happen atypical or

mild because reticuloendothelial system still in progress to
be mature.

28
 Treatment
Medication Function
IVFD RL 20 drops/m Avoid dehidration, facilitate
(macro) administration of drug by IV injection
Cefotaxime 3x1500 Broad-spectrum antibiotic
mg iv
Ranitidin 2x50 mg iv Treat and prevent intestinal and gastric
ulcer
Ondancetron 3x6 mg Prevent nausea and vomiting
iv
PCT tab 3x500 mg iv Antipyretic, analgetic
Dexametason 3x2 mg Corticosteroid, antiinflamation

29
 Education
Reduce activity at home for one
week
Healthy life style
Hygine and Sanitation
Control body weight

30
 Prognosis

Ad bonam
Ad Vitam There is no life threatening
condition

Ad Ad bonam
Functiona Functional vital organ
m

Ad Dubia ad bonam
Sanactiona Relaps probability
m

31
TERIMA KASIH

32