TYPHOID FEVER

A CASE PRESENTATION
CREATED AND
PRESENTED BY:

Noviana Estikasari.
CONSULTANT:
Irman Permana, Dr., Sp.A.
PEDIATRIC STATION OF WALED
HOSPITAL
MEDICAL FACULTY OF UNSWAGATI
CIREBON
2015

Patients Identity:
Name

:An. R.
Age
:10 years old
Sex
: Male
Address
: Karang Mekar
Marriage Status
:Single
Religion
:Islam
Date Entering Hospital :October 24th,
2015

ANAMNESIS
Chief

Complain : The patient presented with fever

History of Present Illness :
A male Child was brought by her parents to the emergency
care unit of Waled Regency Hospital with fever, perceived
about seven days ago. The fever felt since Saturday after
the patient came back from school (October 17 th, 2015).
The fever suffered was fluctuating arise especially in the
ninght and decreases in the morning.
The Patient also complained of diarrhoea, for about 4 times
per day. The stool was loose and watery, without mucous
and blood. Beside that, the patient also complained of
nausea and body weakness.
The patient was brought by her parents to a nearest
primary health care facility, but the symptoms arent
improve with the treatment.

Past Medical History

The

Patient was never suffer from same

complain before

Family History
None

of the family member has the same complaint

or has ever been hospitalized for the same
complaint (-)

Social and Economy History

The

Patient rarely eat the meal cooked by her

mother and prefer to consume unhealty snacks
after school.

History of Mothers Pregnancy and

Childbirth
The patients mother: routine checkups in
the village midwife
History of illness during pregnancy (-)
The Mother denied any consumption of other
medicine but the supplemental medication
from
the checkups
History
of Mothers Pregnancy and
Childbirth
Perinatal and Post natal:
The patient was born spontaneously, term
gestational age, and the delivery was helped
by a midwife.
The patient was spontaneously cry at birth

Feeding History
0

6 months : Breastmilk
7 months : Milk Porridge
8 Months : Tim Rice
9 Months : Porridge
12 Months : Solid Food

Immunization
Hepatitis
BCG

:3x

:1x
Polio
:4x
DPT
:3x
Measless Vaccine :1x

History of Growth and Development

Age
4 months
8 months
1 year old

Growth and Development

Able to lying on her stomach
Able to sit down
Able to walk

Physical Examination

(+)
Findings

General Examination:
General Appearance: Moderately ill
Consciousness Level: Full consciousness (E4 V5
M6)
Vital Sign:
Heart Rate : 132x/minute
RR
: 24 x/minute
Temp
: 39,1oC
Anthropometry:
BW: 26 kg

Local Examination
Head
Eyes : Conjunctival Pallor
ScleralIcterus
-/Neck
Lymphadenopathy
-/-

-/-

Thorax
Inspection
Normothorax, symmetrical, brown skin,
intercostal retraction (-), apex beat is unseen
Palpation
Tenderness (-), Normal apex beat force,
symmetrical tactil fremitus.
Percussion : Sonor on the whole of the lung
field
Auscultation : BVS +/+, Wheeze (-/-). Rhonchi
(-/-),
Symmetrical Vocal Fremitus
Chordis :
1st & 2nd Heart sound are regular, no murmur, no
gallop.

Abdomen, Extremities and Skin

Abdomen :
Brown skin, Soft, distention (-), Epigastric
retractions (-)
Normal bowel sounds
Epigastric tenderess
+
+
Liver and spleen is not palpable
Skin turgor reverse rapidly
Extremities :
Warm
Acrocyanosis -/ Capillary refill time <2v
Pretibial edema (-/-)

Resume:
A 10 years old male child was brought to
Emergency Care Unit of Waled Hospital with fever,
perceived 7 days ago. The fever type was remitten.
Nausea and body weakness are also present.
He was brought to the first healt care facility but
the symptoms doesnt improve with the treatment.
These are the findings from physical examination.
The general appearance was moderately ill, the
level of consciousness full level of consciousness
(E4V5M6).
HR: 132; RR: 24; Temp: 39,1oC. BW: 26 kg;
From the abdominal examination, epigastric
tenderness was found.
EXAM.

Differential Diagnosis
Dengue

Fever
Typhoid Fever
LABORATORY TESTING>>>
Routine Blood Test

Value

Haemoglobin

9,8

Leucocyte

3,1

Erythrocyte

4,2

Hematocrit

29

Platelet

168

MCH

23

MCV

70

LABORATORY TESTING>>>
Routine Blood Test

Value

Basophil

Eosinophil

Lymphocyte

20

Monocyte

Segment

73

Stab

IMUNOSEROLOGI
Widal

S.
S.
S.
S.
S.
S.
S.
S.

typhi O
Paratyphi
Paratyphi
Paratyphi
typhi H
Paratyphi
Paratyphi
Paratyphi

= 1:320
A-O = 1: 320
B-O = 1:320
C-O = 1: 160
= 1:320
A-H = 1:160
B-H = 1:320
C-H = 1:00

Working

Diagnosis: Typhoid Fever

Therapy:
IVFD RL 3 cc/Kg Body Weight/hour
Paracetamol 4x300 mg iv
Ceftriaxon 2x1 gr iv
Diet contains liquid food, 8 x 150 cc

Prognosis :
- Quo ad Vitam : Ad bonam
- Quo ad Functionam : Ad bonam
- Quo ad Sanationam : Ad bonam
Education
Bed Rest during Fever
Liquid diet during illness

Many Thanks