Understanding

Typhoid fever or often called abdominal typhus is an infectious disease of the digestive tract
which is a multi-functional system caused by salmonella typhi (Cahyono,2010)
Etiology
According to Widagdo (2011) the cause of typhoid fever is salmonella typhy, including the
genus salmonella belonging to the family Enterobacteriaceae. Salmonella is active, trunk
shape, does not form spores, without capsules, gram (-). Resistant to various chemicals,
withstands several days / months at room temperature, waste materials, dry food ingredients,
pharmaceutical ingredients and feces.
Symptoms
The incubation period of typhus fever lasts between 10-14 days. The symptoms that appear
vary greatly from severe to severe, from asymptomatic to reflecting a typical disease. In the
first patient found fever and headache, dizziness, muscle pain, anorexia, nausea, vomiting,
obstipation or diarrhea, feeling of discomfort, coughing and epistaxis.
Pathogenesis
Salmonella typhi and Salmonella paratyphi enter the human body through food contaminated
with germs. Some germs are destroyed by stomach acid and some of them enter the small
intestine and multiply. If the mucosal humoral immunity response IgA is not good, the germs
will penetrate epithelial cells, especially M cells, and then into the lamina propia. In the
lamina propia germs multiply and phagocytes by phagocytic cells mainly by macrophages.
Germs can live and multiply inside the macrophage and are subsequently brought to the distal
ileal cherry plaque and then to the mesenteric lymph nodes. Then through the germ thoracic
duct contained in this macrophage enters the blood circulation (resulting in the first
asymptomatic bacteremia) and spreads to all the reticuloendothelial organs of the body,
especially the liver and spleen. In these organs germs leave phagocytic cells and then
multiply in the outer or sinusoidal space and then enter the blood circulation again resulting
in bacteremia the second time with signs and symptoms of systemic infectious diseases, such
as fever, malaise, myalgia, headache and stomach ache.

Epidemiology
Typhoid fever is caused by Salmonella typhi, a Gram-negative bacterium. A very similar but
often less severe disease is caused by the Salmonella serotype paratyphi A. In most countries
in which these diseases have been studied, the ratio of disease caused by S. typhi to that
caused by S. paratyphi is about 10:1
Typhoid fever remains a global helath problem for Salmonella typhi. It is difficult to estimate
the real burden of typhoid fever in the world because the clinical picture is confused with
many other febrile infections, and the disease is underestimated because of the lack of
laboratory resources in most areas in developing countries. As a result, many cases remain
under-diagnosed. In both endemic areas and in large outbreaks, most cases of typhoid fever
are seen in those aged 3–19 years.
Humans are the only natural host and reservoir. The infection is transmitted by ingestion of
faecally contaminated food or water. The highest incidence occurs where water supplies
serving a large population are faecally contaminated. The incubation period is usually 8–14
days, but may rangefrom 3 days up to 2 months. Some 2–5% of infected people become
chronic carriers who harbour S. typhi in the gall bladder. Chronic carriers are greatly involved
in the spread of the disease. Many mild and atypicalinfections occur and relapses are
common. Patients infected with HIV are at a significantly increased risk of severe disease due
to S. typhi and S. Paratyphi
Prevention
According to Nelwan (2012) the prevention strategy used is always to provide food and
beverages that are not contaminated, personal hygiene, especially concerning hand hygiene
and the environment, good sanitation, and the availability of clean water everyday. This
prevention strategy
becomes important along with the emergence of cases of resistance. In addition to the above
strategies there are existing vaccines, namely:
1. Vi Polysaccharide vaccine
This vaccine is given to children aged over 2 years with subcutaneous or intra-muscular
injections. This vaccine is effective for 3 years and is recommended for revaccination every 3
years. This vaccine provides protection efficacy of 70-80%.
2. Ty21a vaccine
This oral vaccine is available in enteric and liquid salts given to children aged 6 years and
above. The vaccine is given 3 doses each in 2 days. Antibiotics are avoided 7 days before and
after vaccination. This vaccine is effective for 3 years and provides 67-82% protection
efficacy.
3. Vi-conjugate vaccine
This vaccine is given to children aged 2-5 years in Vietnam and provides 91.1% protective
efficacy for 27 months after vaccination. Efficacy of this vaccine persists for 46 months with
an effective protection of 89%
DAFTAR PUSTAKA
Nelwan. (2012) Tata Laksana Terkini Demam Tifoid. Jakarta: Departemen Ilmu penyakit
Dalam. [Serial Online] http://www.kalbemed.com/Portals/6/05_192CME_1%20Tata
%20Laksana%20Terkini%20Demam%20Tifoid.pdf. Iakses Tanggal 30 Oktober
2018
Cahyono et al. (2010).Vaksinasi H. Prabawa. Yogyakarta: Penerbit Kanisius.