Typhoid fever in Indonesia clinical picture, treatment and status after therapy

Typhoid fever is an acute systemic infectious disease caused by Salmonella typhi. It is one of the emerging infectious disease which WHO has put a global alert warning globally. This disease is endemic in most big cities in Indonesia. According to the data from the hospitals of those cities, the main clinical features are fever, together with: headache (27-72%), dizzines (67-96%), cough (26-41%), nausea (56-61%) vomiting (37-41%)), anorexia (37-97%), constipation (27-72%), abdominal discomfort (6-70%), relative bradycardia (8-44%), coated tongue (41-100%), hepatomegaly (58-82%), splenomegaly (30-38%), and loss of sensorium (24-43%). Luecopenia was reported between 16.7%-56%. The complications were: intestinal bleeding (1.5-14%), intestinal perforation (2.5-4%), septic shock (5.4-6.9%), bronchopneumonia (2.2-4.6%), myocarditis (2.6-5%), DIC (2.2-4.6%), hepatitis (1.8-5%), and pancreatitis (0.1%). The drug of choice is still chlorampenicol, but because of its inferiority, i.e relapse (up to 15%), aplastic anemia (1 of 100.000 cases), and chronic/permanent carriers (2-5%). Quinolone will he the drug of choice in the future. An investigation carried out among typhoid patients treated with chloramphenicol in Surabaya yielded 11.8% convalescent carriers and 0.97% chronic carriers. The preventive measures including: improvement of environment sanitation (safe drinking water, hygienic WC, supervision of restaurant, supervision of food, of food ice and milk industries), improvement of personal hygiene (public health education), carriers control and vaccination of high risk group population.