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

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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

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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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