CASE REPORT

TYPHOID FEVER
and

DHF GRADE I
Fathia Rachmatina 030.08.099

Patients Identity
Name Age Address Job Marital status Religion
Mr. I 20 Years old

Purwasari, Karawang Labor

Last education Senior High School

Single Moslem Sundanese

Ethnic

ANAMNESE
Autoanamnese on November,17th 2012 at 13.30

 fever since 5 days before hospitalized

Bitter taste in mouth and decreased appetite Abdominal pain at epigastrium region Nausea Fatigue and malaise Sweating at night

Mr. I, 20 years old,came to emergency department of RSUD Karawang after experiencing fever since 5 days before admitted to the hospital. The temperature of the body is increasing every day. He felt that high fever with shivered during the afternoon and the fever disappeared in the morning but never goes down to normal. Sweating at night is marked.

 Patient also complains abdominal pain at epigastric region, feels nausea, but no vomiting, bitter taste in mouth and decreased appetite. Because the lost of appetite, he feels his body weaken. Defecation was normal. Urination was normal

Same Symptoms (2011)

Hypertension (-)

Asthma (-)

Allergy (-)

Liver disease (-)

Kidney disease (-)

Maag (+)

Diabetes mellitus (-)

Same illness (-) Heart disease(-) Asthma (-) Hypertension (+) DM (-) Allergy (-)

Alcohol consumption (-) Smoking (-) Routine Excercise (-) Tattoos (-) Blood Transfusion (-) Injected drugs (-) Traditional beverages (-)

PHYSICAL EXAMINATION
November,17th 2012 at 13.30

General Condition
Appereance Conciusness Nutrition Antropometry
Weight Height BMI : 90 kgs : 170 cms : 31,1

: Moderate ill : Compos Mentis : Normal

Vital Sign
Blood Pressure
Normal

: 110/70 mmHg : 38 oc : 24x/ minute : 72x/ minute

Temperature
Increase

Respiration Rate
Increase

Heart Rate
Normal

Head

Normocephali, black hair, distributing evenly, not fall easily

Eyes
Mouth

Anemic conjunctiva -/-, Icteric sclera -/Pupil isocor Light reflex direct/indirect +/+ Palpebra edema -/-

Lip: cyanosis(-) pallor (-) Tongue: Coated Tongue with hyperemic edge Pharynx: hyperemic (-), symmetrical, uvula at midline Tonsil T1-T1

Ears
Nose

Normotia Secret -/ Cerumen +/+

Septum deviation (-), hyperemic mucous (-)

Neck

Lymph gland & Thyroid gland is not palpable JVP 5+1

Thoracal Examination-Heart
Inspection
Ictus cordis is invisible

PALPATION
Ictus cordis is palpable at 5th ICS LMCS
PERCUSSION
Right heart border : ICS III-IV LSD Left heart border : ICS V 1 cm medial LMCS Upper heart border : ICS III LPSS

AUSCULTATION
Reguler I-II absence of murmurs and gallop in hearts sound

Thoracal Examination-Lung
INSPECTION
Symmetrical in shape, spider navi -

PALPATION
Equal vocal fremitus

PERCUSSION
Sonor in both lungs
AUSCULTATION
Vesicular breathing sound in both lungs ronchi -/- wheezing -/-

Abdominal Examination
INSPECTION Flat, symmetrical, distended abdomen (-), icteric (-), ptechiae (-) PALPATION
Defense muscular (-) Pain on palpation at Epigastric, No enlargement of liver and spleen

PERCUSSION
Timpanic sound in abdomen, pain on percution (-)
AUSCULTATION
Bowel sound +, arterial bruit -, Venous hum -

EXTREMITIY

+ Warm acrals

Oedem

+
RUMPLE LEED

LABORATORY EXAMINATION
November 15th 2012
RESULT Hemoglobin Leucocytes Thrombocytes Ht
Differential Count Basophil 0 (0 1) %

Normal Range (12 17) g% (5.000 10.000)/L (150.000 450.000)/L (37 43) %

16,5 4.300 57.000 45

Eosinophil
Rod Neutrophil Segment Neutrophil

0
0 52

(1 3) %
(2 6) % (50 70) %

LABORATORY EXAMINATION
RESULT
Lymphocyte Monocyte 35 13

Normal Range
(20 40) % (2 8) %

Random Blood Glucose Ureum Creatinine

101 34,4 1,27

(80 140) mg/dl (10 45) mg/dl (0,4 1,5) mg/dl

LABORATORY EXAMINATION
November 16th 2012
RESULT Hemoglobin Leucocytes Thrombocytes Ht
Widal Salmonella Thyposa -

Normal Range (12 17) g% (5.000 10.000)/L (150.000 450.000)/L (37 43) %

15,6 5.600 34.000 44

Salmonella Paratyphi AO
Salmonella Paratyphi AH Salmonella Paratyphi BO

1/80 (+)

LABORATORY EXAMINATION
RESULT
Salmonella Paratyphi BH Salmonella Paratyphi CO 1/160 (+) -

Normal Range

Salmonella Paratyphi CH Anti Dengue IgG Anti Dengue IgM

Negatif (-) Negatif (-)

Resume
ANAMNESIS
, 20 yo, fever since 5 days before admitted to the hospital. the temperature is increasing every day. at afternoon, in the morning, but never goes normal. Sweating at night, abdominal pain at epigastric region, feels nausea, bitter taste in mouth and decreased appetite Patient denied cough, abdominal pain and any spontaneous bleeding.

PE
Blood Pressure: 110/70 mmHg Respiration Rate: 24X/minute Pulse Rate: 72x/minute, weak pulse Temperature: 38 C Tongue: Coated Tongue with hyperemic edge Pain on palpation at Epigastric Rumple Leed: +

LAB
Trombocyte 34.000/L

Ht 44%

Widal S. typhi BO 1/80 dan S. paratyphi BH 1/160.

Differential Diagnosis
Typhoid Fever

DHF Grade I
Measles Malaria Acute Hepatitis Virus

Working Diagnosis

TYPHOID FEVER and DHF GRADE I

Suggested Examination
1. Blood culture 2. Widal test 3. NS 1 4. Anti Dengue IgG dan IgM 5. HBsAg and anti HBsAg 6. SGOT/SGPT 7. Radiology: Thorax

Treatment (Medicamentosa)
IVFD RL 20 d.p.m Ceftriaxone 2 gr 1x1 inj Omeprazole 1x1 inj Sanmol 3x1 tab Sohobion 1x1 tab Kalnex 3x1 tab Cholescor 3x1 caps

Treatment (Non Medicamentosa)

Bed Rest

Good Nutrition

Prognosis
Ad vitam: ad bonam Ad Fungsionam : ad bonam Ad Sanationam : Dubia ad bonam