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On 27 September 2017 my son developed high grade fever(103f).As

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Pediatrician, Pulmonology
Practicing since : 2003
Answered : 6682 Questions
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On 27 September 2017 my son developed high grade fever(103f).As it was not subsiding with Dolo 650 mg and sponging,he was hospitalised. There he was treated with monocef 1gm BD.and PCM 1gm SOS for 8 days.All his reports were normal, including typhidot. Nothing was detected. Now on 28 October 2017 he again developed high grade fever with same symptoms as that of previous fever. Now he is again admitted and his widal is now positive . In his CT is show that he has swelling in his intestine. He is now being treated for that.His fever has subsided on 3 rd day but medication is still on. Please inform us why typhoid was not detected last time and how we can be sure that this is correct diagnosis. Please also enlighten us how we will make sure that treatment is complete and repeating of fever will not be there. Please advise
Posted Tue, 28 Nov 2017 in Medicines and Side Effects
 
 
Answered by Dr. Sumanth Amperayani 40 minutes later
Brief Answer:
The gold standard dignostic test for typhoid is blood culture

Detailed Answer:
Hi... I understand your concern.

1. The gold standard diagnostic test for Typhoid is not Widal or Typhidot. It is blood culture. I would like to know if blood culture was done in both the instances.

2. Will explain you certain facts regarding Widal test. It should be done only after 7 days of high grade fever and not before that. It should be done only on 8th day and above. Again one more fact is that - Widal is done in 2 methods. One is slide test - which is inferior and not to be followed. The results will be available immediately. Second is tube method. The results will take 24 hours or more and needs good laboratory technician's expertise to give the report. The report will be available in dilutions/ multiples of 80...like 1:80/ 1:160/ 1:320/ 1:640 etc.

3. In our XXXXXXX scenario, if the TUBE WIDAL TEST DONE AFTER 7 DAYS OF FEVER IS CONSIDERED AS POSITIVE ONLY IF IT IS POSITIVE IN 1:160 DILUTIONS AND MORE...or another possibility is that the initially negative Widal test may turn out to be positive after 4 weeks. (In medicine we call this - doubling of titres in 4 weeks).

4. Now coming to the issue of Widal being positive now. If the original fever in September had been really Typhoid, the titres of Widal test keep raising for another 6 -8 weeks and then only come down. So it is possible that - this 2nd fever is just a viral illness and the initial Widal test is only showing doubling of titres and is just an indication of Typhoid of last month.

5. Please let me know if at any time in these 2 instances - whether blood culture has been done or not and if so what are the results.

6. Meanwhile I will explain you how a vial illness behaves so that you can be more confident as many times - 95% of the times - childhood illnesses are viral and not bacterial.

Fever of few days without any localizing signs could as well a viral illness. Usually rather than fever, what is more important is the activity of the child, in between 2 fever episodes on the same day. If the kid is active and playing around when there is no fever, it is probably viral illness and it doesn't require antibiotics at all. Once viral fever comes it will there for 4-7 days. So do not worry about duration if the kid is active.

Regards - Dr. Sumanth



Above answer was peer-reviewed by
 
Follow-up: On 27 September 2017 my son developed high grade fever(103f).As 5 hours later
Please note that my son is of 21 years . Blood culture was done on 28 September 2017and report was given on 01 October 2017.It was normal reporting with No Aerobic pyogenic organism grown after 48 hrs at 37 ^c . Please also note that this time on 30 October2017 CT scan of abdominal was done and intestine wall thickness and swolling was reported in CT scane report. Please advise if any other test is needed.presently he is being treated with antibiotics of Ciprofloxacin group for last five days. Please advise
 
 
Answered by Dr. Sumanth Amperayani 33 minutes later
Brief Answer:
Suggested the possibilities - after you updated the age

Detailed Answer:
Hi...with blood culture being inconclusive and showing no growth and with the background of intestinal swelling on CT scan and also keeping in mind the age and recurrent fever - I would like to consider -

1. Inflammatory Bowel disease
2. Abdominal TB
3. Recurrent viral illness
4. Typhoid or enteric fever

Leave alone the last two, but we need to rule the first and 2nd possibilities definitely.

I suggest -

1. Chest X-ray
2. Expectorated sputum examination for GeneXpert MTB
3. CBC/ ESR/ CRP
4. Fecal Calprotectin
5. I suggest an expert adult gastroenterology consult based on these tests.

Regards - Dr. Sumanth


Above answer was peer-reviewed by
 
Follow-up: On 27 September 2017 my son developed high grade fever(103f).As 3 days later
He is treated with Cefepime & aTazobactam 2 gm TDS and he is responding as he is not having fever from last five days but his medication is continuening as it is second instance of fever with same symptoms. Treatment is based on positiveness of Widal test. The swelling in intestine is also reported less in second CT scan. Please advice is this treatment in right direction and how long will it continue as it is already 10 days under medication and 7 days without fever.please ad vice
 
 
Answered by Dr. Sumanth Amperayani 58 minutes later
Brief Answer:
Treatment response is a proof that the treatment is going correctly

Detailed Answer:
Hi... I understand your concern. By what you say as the fever has come down and he is feeling better, I should say that the treatment is going on in the right direction.

The 2nd CT Scan showing decrease swelling in the intestine is also a positive thing.

If I was his physician I would treat with the same IV antibiotics in the same dose for a total period of 14 days.

Regards - Dr. Sumanth
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