REFERAT: DEMAM TIFOID DENGAN TROMBOSITOPENIA BERAT

Abstract

Typhoid fever, often called typhus by people, is an acute infectious disease caused by gram-negative bacteria Salmonella typhi (96%) or Salmonella paratyphi (4%). Typhoid fever can be transmitted from one person to another. Typhoid fever is transmitted through feces (fecal-oral) and is closely related to a person's hygiene. The epidemiology of typhoid fever is highest especially in South Asian and African countries, especially in countries with many slums and poor sanitation. At the beginning of the disease, the fever is mostly vague, then body temperature often fluctuates. Morning is lower or normal, afternoon and evening higher (intermittent fever). Fever is step-ladder in nature where day by day the intensity of the fever increases accompanied by many other symptoms such as headache, muscle pain, aches, insomnia, anorexia, nausea and vomiting. In the 2nd week the intensity of the fever increases, sometimes continuously. If the patient improves, then in the 3rd week the body temperature gradually decreases and can return to normal at the end of the 3rd week. In severe typhoid fever, decreased consciousness, seizures, and jaundice can be found. Hematology examination for typhoid fever is not specific. Until now, the gold standard for diagnosing typhoid fever is culture examination. The selection of specimens for culture as a supporting diagnosis in the first week of fever and early second week is blood, because bacteremia still occurs. The most frequently performed antibody examinations today include the Widal test, Hemagglutinin (HA) test, Countercurrent immunoelectrophoresis (CIE), and rapid tests (Typhidot, TUBEX). Typhoid fever is a disease caused by the bacteria Salmonella typhi, paratyphi A and paratyphi B. Therefore, definitive therapy for typhoid fever is the administration of appropriate antibiotics accompanied by supportive therapy and symptomatic therapy according to the symptoms caused. Thrombocytopenia is a platelet count below the lower limit of normal. A normal platelet count is 150 - 450 x 109/L. Thrombocytopenia refers to a decrease in the platelet count to <150 x 109/L, although clinically significant bleeding is not seen until the count falls well below 50 x 109/L. The presence of thrombocytopenia is thought to be the result of bone marrow suppression, peripheral damage to the reticuloendothelial system, autoimmuneinduced damage, and Salmonella endotoxin-induced thrombocytopenia. Bone marrow suppression, especially during the early septicemic phase of infection, is believed to be the cause of thrombocytopenia. Thrombocytopenia is also caused by invasion of hematopoietic organs by S. typhi causing hematopoiesis depression. Typhoid fever that causes severe thrombocytopenia (platelet count <50 x 109/L) makes patients susceptible to bleeding disorders such as gastrointestinal bleeding and intracranial bleeding. There are no studies or guidelines that discuss the management of severe thrombocytopenia in typhoid fever. Several case reports describe platelets will quickly return to normal after starting antibiotic therapy without the need for platelet transfusion.