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Feverish Feeling, Sore Throat. Done With Widal Test. Paratyphoid?

Posted on Fri, 4 Oct 2013

Question: I am MAle , 53 years, 68 Kg. A week ago i developed a mild sore throat, and feverishness. The thermometer showed normal to 99.2 F . No other symptom, except a mild cold. ( I do get cold /cough attacks 2/3 times a year, and sometimes that converts to a mild fever that lasts a week with general malaise). This time also I thought it was another of those episodes.. However this morning I got a CBC, Urine and Widal done. 1st two tests were normal...Widal test results shows as follows:
Typhi O Non reactive
Typhi H at 1:40
PAra Typhi AH at 1: 1:160
PAra Typhi BH Non reactive
( I have taken no medication ,except an occasional paracetamol) in the last week.
My question is that is the result indicative of Paratyphiod....or it is just a cold/ sinusitis problem. Clinaically I have no symptoms ..no cough, good appetite, no aches / no nausea etc.
Pls advise, based on above, do I have typhoid/ paratyphoid?

Answered by Dr. Guru (28 minutes later)

Brief Answer:
Based on your symptoms I suspect Common cold

Detailed Answer:
Hi,

Thank you for consulting HealthcareMagic!

Based on your symptoms I suspect that you have Common cold. Widal test has lot of limitations and it is difficult for you to understand even if I give an explanation how it is interpreted. There are many debates about its proper interpretation and sensitivity, particularly in endemic areas like some parts of India. I personally do not rely completely on widal test for typhoid/paratyphoid fever. I also suggest that blood culture will be a good idea to diagnose and confirm these. As you are concerned about typhoid/paratyphoid, I suggest you to undergo blood culture.

Your treating doctor will keep in mind about lot of other things from the physical examination, clinical course of symptoms, the time when widal test is done etc to get a correct diagnosis whether the fever is because of typhoid fever or not. Widal test is not for the confirmation of typhoid fever.

Hope I have answered your query. Let me know if I can assist you further. If you are satisfied please proceed with closing and rating this answer.

Wish you a good health!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Guru (49 minutes later)

Dr Vasanth ,Thanks for the response. I also want to believe that it may be common cold, but the count of 1;160 for Para typhi AH has me a bit worried.
I do plan to go in for blood culture as u suggest, but I was told that it rarely come +ve unless it is a v v acute case. Is this correct?
In any case do yu suggest that I start an antibiotic treatment? Like Cepodem AZ? or some other ?
Also pl advise , that if u have typhoid, you are supposed to have complete bed rest? I have been told that it is not at all recommended any physical activity.. If so when can one commence normal activity

Thanks

Answered by Dr. Guru (10 hours later)

Brief Answer:
Complete bed rest is not required in typhoid

Detailed Answer:
Hi,

Thanks for the follow up!

Yes, Salmonella paratyphi is very rare compared to Salmonella typhi(the commonly called typhoid fever).

Complete and total bed rest is not required in typhoid. If confirmed, it can be easily treated. However, avoiding strenuous activities is always good in these kind of fevers It would be unethical and inappropriate to prescribe you scheduled drugs(antibiotics) without doing a proper examination. Your doctor will advise you about these drugs.

Hope I have answered your query. If you are satisfied please proceed with closing and rating this answer.

Wish you a good health!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Guru (1 hour later)

Thanks Doc
One of my queires you missed answering ...I am reproducing below..

I do plan to go in for blood culture as u suggest, but I was told that it rarely come +ve unless it is a v v acute case. Is this correct?

Also pl advise if Typhi Dot test is a good test for determining the infection. (I got the infection 8 days ago- and so Blood culture may not show up)
Pl advise

Answered by Dr. Guru (2 hours later)

Brief Answer:
Yes, it is rare to get such a result about S. para

Detailed Answer:
Hi,

Thanks for the follow up!

Yes, it is rare to get such a result about S. paratyphi. However, as I previously mentioned that there are many debates about its proper interpretation and sensitivity, particularly in endemic areas like some parts of India. I recommend to go for confirmation of diagnosis and only after recommendation of your treating doctor go for empiric antibiotics.

You were saying that you got infection 8 days ago, but actually one cannot be sure about that, just based on some non specific symptoms. Typhi Dot test also lacks sensitivity and specificity. Even blood cultures are positive only in about 40 to 60 % of cases. Your treating doctor would keep in mind about the progression and characteristics of the symptoms you are going through and would treat accordingly based on all these and physical findings in particular.

Hope I have answered your query. If you are satisfied please proceed with closing and rating this answer.

Wish you a good health!

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar