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Diagnosed with Typhoid. Taking Pecef Duo 200, A2Z multivitamin. Having body ache and weakness. Is it necessary to take widal test again?

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I was diagnosed with Typhoid last month. The report said :
STO : Positive 1:160 Titre
STH : Positive 1:160 Titre
SPAH : Negative
SPBH : Negative

I was under the medication Pecef Duo 200, A2Z multivitamin and Acenex Plus. I took medications for 10 days. Then no medications for last 2 weeks. Now since last week I started feeling bodyache and severe weekness. This time there was no fever. The doctor asked me to go for widal test, which gave exactly same results which it gave the previous time. I was told that Pecef Duo may not have worked well, and so am prescribed Of 200 (Ofloxacin 200) for 7 days and Cobadex CZS for 2 weeks.
Should I go for widal test again after a week to see whether this medicine worked. What is the normal range for STO and STH which confirm that I am cured.

Posted Wed, 11 Sep 2013 in Infections
Answered by Dr. Venkat Sivayogi 21 hours later
Brief Answer:
widal test lost its significance now

Detailed Answer:
Welcome to Healthcare Magic,

Generally Typhoid fever is diagnosed on 2 important things
1.Clinical symptoms
2.Lab tests
Why I am giving all the details means both the clinical symptoms as well as lab tests are clubbed together to diagnose this condition.

Gradual increase of fevers day by day- known as step ladder fever is seen in typhoid fever along with it severe malaise,weight loss is also seen.

Coming to lab work- Widal test:
a) It has NO significance at all in the 1st week of typhoid fever. Because widal test is detection of antibodies formed in the blood against your typhoid bacteria. The antibodies will be formed only at the end of 1st week of fever. So widal test has significance only at the end of 1st week of fever.
b)Normal limits for O titre is 1:100 and H titre is 1:200, if the values are above these levels think about repeating the test after 2 days to see any further rise.
c)Single test has no significance- we need repeated tests to see the rise of titre values . For Ex: If you have 1:160 of O titre and 1:80 of H titre , it needs to be doubled up i.e 1:320 and O titre 1:160 when you take the test next time after 2 or 3 days. then only it becomes significant
d) Another important thing is - If you have already had an typhoid infection in the past, the widal test will come positive, because antibodies persists in your blood for upto 2to 3 years.

From this data, all I can say is don't rely completely upon widal test to diagnose the typhoid fever. More over in my clinic I never take widal test into consideration to diagnose typhoid. Not only mine,many of practicing physicians they don't rely upon widal test.

In my clinic , If I suspect a typhoid fever in a patient then I will go for blood culture test with in the 1st week - 90% of the patients become positive. The percentage decreases once time goes up above 1 week.

Now coming to your case, your test value is same as previous value even after antibiotic use -which means may be you don't have infection. Another thing is widal test has no significance at all to monitor whether you are responding to antibiotics or not.

Hope you are completely clarified now.
If you have any further queries let me know
In your case I suspect a possibility of viral fever after going through your clinical symptoms.
Above answer was peer-reviewed by
Follow-up: Diagnosed with Typhoid. Taking Pecef Duo 200, A2Z multivitamin. Having body ache and weakness. Is it necessary to take widal test again? 2 days later
Thanks Dr. Sivayogi for the detailed explanation.

I have gone through the Hemogram test as well, if that could give any more information. The results are :

Haemoglobin : 15.3 g%
Haematocrit : 44.4 %
RBC Count : 5 millions/cu mm
MCV : 89 fl
MCH : 30.6 pg
MCHC : 34.4 g/dl
TLC Count : 5400
Platelet count : 1.8
ESR : 22 mm/hr

Neutrophils : 53 %
Lymphocytes : 33.3 %
Eosinophiles : 6 %
Monocytes : 7.3 %

Impression :
RBC : are normocytic normochromic
WBC : are normal in total number with normal distribution and morphology.
Platelets : appear adequate in number

The current situation is that I do not get fever, though I am continuing with medicine Of 200 for 7 days as prescribed by doctor. Hence would need to know if the above blood report gives any indication if things are positive, and if there is any need to again do blood test after a week.
Answered by Dr. Venkat Sivayogi 6 hours later
Welcome back,

Your blood test report is absolutely normal. There is no need to worry about any thing. You can continue your antibiotic course as prescribed by your physician.

Wishing you good health,

Above answer was peer-reviewed by
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