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
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CASE PRESENTATION

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

Visite ER : February, 17th 2017

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ANAMNESIS
Chief Complaint: fever

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 History of Presenting Ilness
Patient present with fever, the
4 days before temperature rises especially when
admission afternoon and night and 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

4 days before
Vomitus (+), 2-3x/ day, vomitus contain
admission water and food, amonts + cup

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 History of Presenting Ilness
2 days before
Diarhea (+), 1x, water > dregs, dregs
admission colour yellow, slime (-), blood (-)
The temperature rises even higher

Patient only consumed antipiretic to treat the

complaints since 6 days before hospitalized but
The day of the the complaint does not improved and also had
admission
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
Hospital and advised to be hospitalized because
of high temperature. 6
 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.

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 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

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Physical Examination

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 General Moderate pain
appearance

Consciousness
and Mental Compos mentis and well oriented
Statse

Weight : 69 kg
Anthropometr
Height : 163 cm
y
Nutrition status : Obesity

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 Nutritional State

Weight/Age: >3SD

Height/Age: >3SD

BMI/Age: >2SD

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 Vital Sign

BP 110/70 mmHg

HR 88 x/m, regular
RR 22 x/m
T 38,2o C
pain 3

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 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 is no
wheezing
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 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

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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 /mm3 150.000-400.000 /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: (-) (-)
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 DIAGNOSIS

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

WORKING DIAGNOSIS
Typhoid fever + Obesity

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 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)

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

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Urinalisis (February, 18st 2016)

Makroskopik
Colour : Dark Yellow
Kejernihan : mild Mikroskopik
turbid
Berat jenis : 1,015
Eritrosit : (1-2)
pH : 5,0 Leukosit : (0-1)
Lekosit : (-)
Epitel : (+) (2-6)
Nitrit : (-)
Protein : (-) Silinder : (-)
Glukosa : (-) Kristal : (-)
Keton : (-)
Urobilinogen : (-) Lain-lain : (-)
Bilirubin : (-)
Blood : (+)
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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/mm3

million/mm3
Haemoglobin 13,6 g/dl 12,5-16,1 g/dl
Haematocrite 39,3 % 36-47%
Trombocyte 263.000 /mm3 150.000-400.000
/mm3
% Limfosit 17.8 % 15-50%

% Granulosit 79.4 % 35-80%)

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 Follow Up
Tanggal S O A P

18/2/2017 No fever in 12 hours TD: 120/80 Typhoid + - Continue therapy

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

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

Final diagnosis
Typhoid fever

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 PROBLEM OF CASE

Diagnosis

Treatment

Prognosis
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 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

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 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.

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 Treatment
Medication Function

IVFD RL 20 drops/m Avoid dehidration, facilitate administration of drug

(macro) by IV injection
Cefotaxime 3x1500 mg iv Broad-spectrum antibiotic

Ranitidin 2x50 mg iv Treat and prevent intestinal and gastric ulcer

Ondancetron 3x6 mg iv Prevent nausea and vomiting

PCT tab 3x500 mg iv Antipyretic, analgetic

Dexametason 3x2 mg Corticosteroid, antiinflamation

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

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 Prognosis

Ad bonam
Ad Vitam There is no life threatening
condition

Ad Ad bonam
Functionam Functional vital organ

Ad Dubia ad bonam
Sanactionam Relaps probability

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