Folia Medica Indonesiana
ISSN 0303-7932
Vol. 36 / No. 3 / Published : 2000-07
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Original Article :
Typhoid fever, a continuing health challenge in pediatrics
Author :
Abstract :
Typhoid fever, a septicemia infection caused by S. typhi, remains to be an important problem of morbidity and mortality in Indonesia. In the absence of reliable system of detection and notification, accurate epidemiological information on typhoid fever is difficult to obtain. This disease is also a challenge for the clinicians; it can either be a simple case of fever or complicated by gastrointestinal and neurological symptoms, leading to intestinal perforation, bleeding, coma and death. Understanding the course of the disease after entrance of the bacteria into the body is the basis for diagnostic approach of the disease. For areas where typhoid fever is commonly seen, early clinical recognition is mandatory to avoid severe complications and mortality. Laboratory diagnosis by identification of the S. typhi may sometimes be impractical, in that it takes several days to obtain the result. Moreover bone marrow aspiration, assumed to have the best results of bacterial isolation, is an invasive procedure and only performed for research. It seems that in the long run the ELISA test may replace the widal test as a diagnostic measure. The polymerase chain reaction (PCR), recently developed, provides another approach to the rapid and specific detection of bacterial DNA and may serve as a better diagnostic test. As far as treatment is concerned, studies in vitro have shown that most of the typhoid fever cases remain to be sensitive to chloramphenicol although in a small percentage resistance to commonly used antibiotics is seen. The use of the third generation cephalosporin (and quinolone) should be restricted to typhoid cases requiring second line therapy. From the typhoid control program point of view, public health experts do not consider all typhoid vaccines available at present as ideal. New products are waiting for confirmation of their safety, immunogenicity, and subsequent clinical testing. More recent methods have been utilized to improve the available vaccines or invent new products through modern genetic engineering. Combined vaccine (oral and parenteral) may result in better protection. An immunological approach on Javanese population in East Java indicated that there was an association between HLA antigen and susceptibility to typhoid fever, denoting the existence of genetic predisposition in which individuals with HLA antigen B7 and DR10 are prone to develop the disease.
Keyword :
Typhoid fever, Widal, ELISA, PCR, Typhoid vaccines, HLA,
References :
Archive Article
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Volume : 36 / No. : 3 / Pub. : 2000-07 |
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