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Child Having Fever And Treated For Viral Infection. All Test Reports Are Normal. Suggest Further Treatment?
Question: My Daughter is 6 yrs old . She started having fever from 1 Oct 2013 and after two days we consulted the Doctor(MD{Paeds}) he keeps treating for viral infection (No Antibiotics) and asked us to come after 4 days if the problem persists. On 7 Oct 2013 we met him again as the high fever was not subsiding . He recommended following tests :- CBC, Malarial Parasite ,and NS 1 Antigen. All the reports were normal . As one of my Dr friend suggested to go WIDAL also. That report suggest S Typhi 'O' 1/160 + , S Typhi 'H' 1/80 + , S Para Typhi 'AH' 1/20+, S Para Typhi 'BH' 1/20+. We changed the Dr and went to another one (MBBS, DCH) . He started the treatment with Cefixime Oral Suspension 100mg (10ml Twice a Day) ; Ofloxacin Oral Solution 100 mg (5ml Twice a Day) and Paraetamol for fever. After 10 days of treatment she recovered from fever fully and gone WIDAL again.
Surprisingly the WIDAL test gives the same reading as it was there in the earlier report.
Pls suggest me how to go forward. Is the infection remain at same levels without fever.
Surprisingly the WIDAL test gives the same reading as it was there in the earlier report.
Pls suggest me how to go forward. Is the infection remain at same levels without fever.
Brief Answer:
Widal will be positive for 3 to 4 months.
Detailed Answer:
Hi XXXX,
Thank you for your query on Healthcare Magic.
I went through the history of your daughter complaints.
Your daughter widal test is positive which suggestive of Typhoid fever.
As the child received appropriate antibiotics (cefixime & ofloxacin) for 10 days, she recovered from Typhoid infection and now free from fever.
As there is no fever at present, it indicates that the infection is completely treated.
Coming to Widal test, this test is done to detect antibodies against salmonella bacteria. Even though the infection is completely treated with antibiotics, the increased antibodies will persist in the body for 3 to 4 months.
Widal test is an indirect test which measures antibodies and the antibodies will present in the body for 3 to 4 months even the infection is cured completely. So Widal test will show positivity for this duration.
So if you repeat Widal test, it will be positive because of presence of antibodies in the blood.
Nothing to worry about the repeat Widal test as the child is not having fever now.
Hope I have answered your query, if you have any clarification please let me know.
Regards.
Widal will be positive for 3 to 4 months.
Detailed Answer:
Hi XXXX,
Thank you for your query on Healthcare Magic.
I went through the history of your daughter complaints.
Your daughter widal test is positive which suggestive of Typhoid fever.
As the child received appropriate antibiotics (cefixime & ofloxacin) for 10 days, she recovered from Typhoid infection and now free from fever.
As there is no fever at present, it indicates that the infection is completely treated.
Coming to Widal test, this test is done to detect antibodies against salmonella bacteria. Even though the infection is completely treated with antibiotics, the increased antibodies will persist in the body for 3 to 4 months.
Widal test is an indirect test which measures antibodies and the antibodies will present in the body for 3 to 4 months even the infection is cured completely. So Widal test will show positivity for this duration.
So if you repeat Widal test, it will be positive because of presence of antibodies in the blood.
Nothing to worry about the repeat Widal test as the child is not having fever now.
Hope I have answered your query, if you have any clarification please let me know.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for ur reply and it is Highly satisfactory and logical.I understand ur point Dr. But ,After seeing the repeated WIDAL test report ,the Dr from which we are getting the treatment said to continue with the Antibiotics mentioned earlier and infact added one more namely Septran (Co-trimoxazole Oral Suspension IP 7.5 ml Twice a day) for ten days further from yesterday and also asked us to go to another pathology for the test again.
Should we go for the test again now OR should we go for the test after 3-4 months . As the treating Dr scared us that in some cases the Bacteria may persists for lifetime and create further damage.
Regards
Maniesh
Should we go for the test again now OR should we go for the test after 3-4 months . As the treating Dr scared us that in some cases the Bacteria may persists for lifetime and create further damage.
Regards
Maniesh
Brief Answer:
Give antibiotic as adviced.Discuss about Widal.
Detailed Answer:
Hi XXXX,
Thank you for getting back.
Coming to antibiotic treatment in Typhoid fever, antibiotics has to be continued for 10 to 14 days.
Therefore I suggest you to give the two antibiotics (cefixime and ofloxacin) for another 4 days (to complete the course of 14 days).
In addition to antibiotics adequate res, soft bland diet, and hydration are important.
As the child is not having fever at present, this means she responded to the antibiotics.
Yes, I agree with the doctor as in Typhoid fever, there is a chance of persistence of bacteria in the body.
Persistence of bacteria in body presents as carrier state (less than 2% of infected children) or relapse(2-4% of infected children).
In carrier state, there will be no fever and antibiotics are not required. But in relapses, the child will present with fever in addition to positive Widal test which again requires treatment with antibiotics.
Therefore I suggest you to continue the medication as prescribed by the doctor to treat the infection.
I personally don't advice my patients for the repetition of Widal test if they are responding to antibiotics. But appropriate antibiotics has to be given for at least 2 weeks which will treat the infection.
But if the child gets fever later and it is persisting, then I suggest to repeat the Widal test to look for the relapse of infection.
Therefore I suggest you to consult the pediatrician and discuss your concerns about the test and treatment.
Hope I have answered your query, if you have any clarification please let me know.
Regards.
Give antibiotic as adviced.Discuss about Widal.
Detailed Answer:
Hi XXXX,
Thank you for getting back.
Coming to antibiotic treatment in Typhoid fever, antibiotics has to be continued for 10 to 14 days.
Therefore I suggest you to give the two antibiotics (cefixime and ofloxacin) for another 4 days (to complete the course of 14 days).
In addition to antibiotics adequate res, soft bland diet, and hydration are important.
As the child is not having fever at present, this means she responded to the antibiotics.
Yes, I agree with the doctor as in Typhoid fever, there is a chance of persistence of bacteria in the body.
Persistence of bacteria in body presents as carrier state (less than 2% of infected children) or relapse(2-4% of infected children).
In carrier state, there will be no fever and antibiotics are not required. But in relapses, the child will present with fever in addition to positive Widal test which again requires treatment with antibiotics.
Therefore I suggest you to continue the medication as prescribed by the doctor to treat the infection.
I personally don't advice my patients for the repetition of Widal test if they are responding to antibiotics. But appropriate antibiotics has to be given for at least 2 weeks which will treat the infection.
But if the child gets fever later and it is persisting, then I suggest to repeat the Widal test to look for the relapse of infection.
Therefore I suggest you to consult the pediatrician and discuss your concerns about the test and treatment.
Hope I have answered your query, if you have any clarification please let me know.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir , I got ur point to continue Antibiotics (Two of them) for 14 days which we will do. But my only concern here is , as the treating Dr asked earlier to discontinue the antibiotics after ten days and repeat the WIDAL as the fever subsided and after just knowing about the same reading of the WIDAL (Although no fever for last one week) , yesterday he asked to continue Antibiotics for ten more days and show him the report of another pathology by today. As he said Titrate should have reduced if the infection is not there.
But as you are saying if the fever is not there means infection has been treated (Seems more logical to a Layman like us).
Confused what to do.
But as you are saying if the fever is not there means infection has been treated (Seems more logical to a Layman like us).
Confused what to do.
Brief Answer:
Titers will decrease slowly over 3 to 4 months.
Detailed Answer:
Hi XXXX,
Thank you for getting back.
I can understand your concern and dilemma.
What I suggest you to complete the course of antibiotics of 14 days.
Widal test is used to diagnose Typhoid fever if the clinical picture is suggestive of typhoid fever such as prolonged fever.
If the fever is subsided, activity, appetite, and general condition of the child is normal, then it is suggestive of response to antibiotics.
And Widal test is not used to monitor the response to antibiotic as the antibodies will persist for a few months even after the disease is completely treated.
Widal titers will decrease gradually as the antibodies get cleared from the body over few months, so these titers can't be used as indicator for the response to treatment.
Still you are confused, I suggest you to take a second opinion from a XXXXXXX pediatrician in your locality.
Hope I have answered your query, if you have any clarification please let me know.
Regards.
Titers will decrease slowly over 3 to 4 months.
Detailed Answer:
Hi XXXX,
Thank you for getting back.
I can understand your concern and dilemma.
What I suggest you to complete the course of antibiotics of 14 days.
Widal test is used to diagnose Typhoid fever if the clinical picture is suggestive of typhoid fever such as prolonged fever.
If the fever is subsided, activity, appetite, and general condition of the child is normal, then it is suggestive of response to antibiotics.
And Widal test is not used to monitor the response to antibiotic as the antibodies will persist for a few months even after the disease is completely treated.
Widal titers will decrease gradually as the antibodies get cleared from the body over few months, so these titers can't be used as indicator for the response to treatment.
Still you are confused, I suggest you to take a second opinion from a XXXXXXX pediatrician in your locality.
Hope I have answered your query, if you have any clarification please let me know.
Regards.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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