A.

Definition
Typus abdominalis is an acute infectious disease that usually affects the digestive
tract with symptoms of fever for more than 7 days, digestive disorders and and
disturbance of consciousness (Mansjoer, 2000). Typhoid fever is an infectious disease
that is acute, which is characterized by bacteremia, changes in the reticuloendothelial
system that is diffuse, the formation of microabses and ulceration of peer nodes in the
distal ileum. (Soegeng, 2002).
Abdominal typhus is a systemic infection characterized by fever, headache,
lethargy, anorexia, relative bradycardia, sometimes enlargement of the spleen / liver /
both (Djauzi & Sundaru; 2003). Typhus Abdominalis is an acute infectious disease that is
usually found in the digestive tract with symptoms of fever for more than one week and
there is disturbance of consciousness (Suryadi, 2001).

B. Etiologi
Bacteria Salmonella Thypi A, B, C, these germs are abundant in feces, human feces
and food or drinks that are exposed to germs carried by flies.
The main source of this disease is a dirty and unhealthy environment. Unlike viruses that
can fly in the air, these bacteria live in poor sanitation such as slums, food drinks that are
not hygienic "these germs enter the human body through the mouth, then attack the body
especially the digestive tract."

C. Clinical Manifestation

The incubation period is 10-14 days. This disease has the typical signs of a fast
journey that lasts approximately 3 weeks. Symptoms of Typhoid Fever include the
following:
1. Fever > 1 week, especially at night
Fever is not too high and lasts for 3 weeks. The first week of increased body
temperature fluctuates. Usually the body temperature rises at night and decreases in
the morning. In the second week the body temperature continues to rise and in the
third week the temperature gradually drops and returns to normal.
2. Headache
3. Malaise
4. Letargi
 5. Dirty tongue
6. Dry, cracked lips (regaden)
7. Nausea, vomiting
8. Abdominal pain
9. Muscle aches
10. Anorexia
11. Hepatomegaly, splenomegaly
12. Constipation, diarrhea
13. Decreased awareness
14. Macular rash, roseola (reddish spots) due to basil emboli in capillaries
15. Epistaxis
16. Bradikardi
17. Delirious (delirium)

Other clinical manifestation are fever up and down around 39-40 C. Complaints among
other things:
1. Loss of appetite
2. Headaches
3. Aching and weak all over the body
4. lethargy (a state of reduced ability to concentrate or concentration of the mind so that it
becomes confused and not sensitive to pain)
5. Continuous diarrhea, chest pain and stomach section

D. Diagnostic Check
1. WBC examination
In some literature it is stated that typhoid fever has leukopenia and relative
lymphocystosis but in fact leukopenia is not often found. In most cases of typhoid
fever, the number of leukocytes in the peripheral blood supply is within normal limits
and sometimes even leukocytes even though there are no complications or secondary
infections. Therefore examination of leukocyte counts is not useful for diagnosing
typhoid fever.
 2. SGOT and SGPT examination
Sgot and Sgpt in typhoid fever often increase but can return to normal after recovery
of typhoid.

3. Blood culture
If the blood culture is positive it indicates typhoid fever, but if the negative blood
culture does not rule out typhoid fever. This is because blood culture results depend
on several factors:
a. Laboratory examination techniques
The results of the examination of one laboratory are different from other
laboratories, this is caused by differences in the techniques and culture media used.
A good blood sampling time is when the fever is high, which is when bacteremia is
taking place.
b.During the examination during the course of the Disease
Blood culture for salmonella thypi is especially positive in the first week and
decreases in the following weeks. At the time of recurrence, the blood culture can
be positive again.
c. Vaccination in the past
Vaccination against typhoid fever in the past can cause antibodies in the client's
blood, these antibodies can suppress bacteremia so that negative blood cultures.
d.Treatment with anti-microbial drugs
If the client before the blood culture has obtained anti-microbial drugs the growth of
germs in the culture medium is inhibited and the culture results may be negative.

4. Widal Test
The widal test is an agglutination reaction between antigens and antibodies
(agglutinin). Aglutinin that is specific to salmonella thypi is present in client serum
with typhoid also found in people who have been vaccinated.

E. Management
1. Care
a. Client is rested 7 days until fever or 14 days to prevent complications of intestinal
bleeding.
 b. Gradual mobilization if there is no heat, according to the recovery of the
transfusion if there are bleeding complications.

2. Diet
a. Appropriate diet, enough calories and high in protein.
b.In patients with acute can be given filter porridge.
c. After being free of fever given a coarse pulp for 2 days then the team rice.
d.Continue with ordinary rice after the patient is free from fever for 7 days.

3. Drugs
a. Chloramphenicol.
The dose given is 4 x 500 mg per day, can be given orally or intravenously, up to
7 days free of heat
b. Tiamfenikol.
The dose given is 4 x 500 mg per day.
c. Cortimoxazol.
2 x 2 tablets (one tablet contains 400 mg sulfamethoxazole and 80 mg
trimethoprim)
d. Ampicillin and amoxicillin.
Doses range from 50-150 mg / kg body weight, for 2 weeks
e. Third Generation Cephalosporins.
Dose 3-4 grams in dextrose 100 cc, given for ½ hour per infusion once a day, for
3-5 days
f. Fluoroquinolone Group
1) Norfloxacin: a dose of 2 x 400 mg / day for 14 days
2) Siprofloxacin: dose of 2 x 500 mg / day for 6 days
3) Ofloxacin: a dose of 2 x 400 mg / day for 7 days
4) Pefloxacin: a dose of 1 x 400 mg / day for 7 days
5) Fleroxacin: dose of 1 x 400 mg / day for 7 days
6) A combination of antibiotic drugs. Only indicated in certain circumstances
such as: toxic typhoid, peritonitis or perforation, septic shock, because it has
been proven that often found two kinds of organisms in blood cultures other
than Salmonella typhi. (Widiastuti S, 2001).
F. Prevention
1. Avoid consuming edge snacks
2. Get enough rest 7-8 hours a day
3. Exercise regularly 3-4 times a week for half an hour to an hour
4. Boil drinking water until boiling
5. Wash your hands before eating
6. Don't make the family toilet close to drinking water sources.
7. Burn or dispose of trash in its place.
8. Immunization
9. Washing hands with 6 steps according to WHO:
a. Pour the handrub liquid into the palm of the hand then rub and rub the palms gently
in a circular direction.
b. Also rub and rub the backs of your hands alternately
c. Rub between fingers until clean
d. Clean the tips of your fingers alternately with each other locked
e. Rub and turn your thumbs alternately
f. Place the tip of the finger into the palm of the hand then rub gently