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WIDAl Test Result Showed S.Typhi "O": Positive 1 In 40 Diln And S.Typhi "H":Positive 1 In 40 Diln. What Does This Mean?

Posted on Fri, 29 Nov 2013

Question: Dear doctor, My daughter (8 yrs old) had a fever consistently ranging between 99-102 for the last 3 days. After 3 days she started having few rashes in hand and back. I only gave paracetmol tablets during the 3 days. When I took my daughter to doctor after 3 days she asked to take blood test. The blood report has come today and I have to yet take my daughter with the report to the Doctor. I am worried on the Widal result showing positive and ESR and PCV in varying range. Need suggestion based on the below report what remedy is preferred and is what does this reading mean. What could be the cause of the Widal Positive result? How long does it take to get back normal widal result? What food is preferred for this result? MICROBIOLOGY WIDAL (SLIDE AGGLUTINATION) S.Typhi "O" : Positive 1 in 40 diln. S.Typhi "H" : Positive 1 in 40 diln. S.Paratyphi "AH" : Negative 1 in 20 diln. S.Paratyphi "BH" : Negative 1 in 20 diln. Remarks : Titer of 1 : 80 and more are significant. Raising titers by four fold in a week are more Significant than single estimation. Lower titers are seen in vaccination and past infection. ESR Specimen : CITRATED BLOOD Method : Westergren 1 Hour : 41 mm (Male : 5 - 15 mm Female : 5 - 20 mm) HAEMOGRAM BLOOD - HAEMATOLOGY CBC Specimen : EDTA BLOOD Method : Automated - Flowcytometry,SLS Hb&Abs cytometry Haemotocrit(PCV) : 35.7 % (Male : 42 - 50 % Female : 36 - 45 %) MCH : 26.8 pg 27 - 31 pg Platelets Count : 3.03 Lakhs/Cmm (1.5 - 4.5) Thanks.

Answered by Dr. E Venkata Ramana (25 minutes later)

Brief Answer: Widal test is negative. Detailed Answer: Hi XXXXXXX Thank you for your query on Healthcare Magic. The Widal test is negative as the titres are less than 1 in 80 dilutions. The fever with rash on her hands and back looks like a viral fever. ESR is a nonspecific test and it is raised in many infections and its raise is not suggestive of a particular disease. PCV of 35.7% is not a worrying finding and it is related to presence of a slightly low hemoglobin. What is important is the total WBC (white blood cell)count and its differential count. But you did not mention these values in your query. I suggest you to upload these values in your follow up query. So Widal is not positive and nothing to worry. You can give her soft diet for easy digestion. Give paracetamol tablet for fever in prescribed dose every 8th hourly depending on the presence of fever. Consult the pediatrician for follow up clinical examination, interpretation of test results, and to prescribe medication. 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

Follow up: Dr. E Venkata Ramana (24 minutes later)

Thanks Doctor for the reply. I'm relieved that my daughter is not having typhoid as the Widal test is Negative. I thought that she had Typhoid as it was mentioned positive for S.Typhi O/H. Now seeing your reply I am relieved now. I will follow up with my Doctor for the Viral fever. I have uploaded the Report (0000.pdf). Could you please update on total WBC count and its differential count based on the uploaded report. What should be done to make the count normal. Could this count be due to the viral fever? Thanks.

Answered by Dr. E Venkata Ramana (1 hour later)

Brief Answer: WBC count and Differential count is normal. Detailed Answer: Hi XXXXXXX Thank you for getting back and uploading the reports. I went through the reports you have attached along with this query. The WBC count and the differential count is within normal limits. All the reports you attached are normal except for an elevated value of ESR which in turn is a nonspecific test. The important thing is to be in follow up with her pediatrician till she recovers completely from the fever and to use the prescribed medications as per the advice. 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

Follow up: Dr. E Venkata Ramana (2 days later)

Hello Doctor, Thanks for the information on WBC count and Differential count. I had followed up with my Doctor and the Doctor prescribed only medicine for fever(paracetomol) and alergic syrup(alerid) for rash. The rash is still there and have not gone even after taking the alerid syrup for past 3 days. Moreover my daugter is not having fever all through day and only after 8 PM she gets fever in the ragnge of 102 which becomes normal again in the morning. She also starting having vomiting from yesterday. What could be the cause of only Night fever and the rashes continuing. My doctor has gone out of station for couple of days and I'm worried what should be done. Some of my relatives say that the rash could be Baby like Chicken pox. Please help what could be problem. I am also planning to take to other Doctors available till my Doctor come back based on your advice. Thanks.

Answered by Dr. E Venkata Ramana (4 hours later)

Brief Answer: Consult pediatrician for follow up Detailed Answer: Hi XXXXXXX Thank you for getting back. Viral fevers usually lasts for 5 days to 1 week. Vomiting could be because of gastritis which may a part of the illness. She needs follow up with another pediatrician if the regular doctor is not available to look for the cause fever and vomitings. You can give an oral anti emetic syrup like ondansetron in prescribed dose to control vomitings and give sips of oral rehydration solutions such as Pedialyte to prevent dehydration. Chicken pox usually presents with fluid filled vesicular rash and these lesions will form scabs. It wont present like a red erythematous flat rash. If the fever is persisting tests like complete blood picture, widal test, malarial parasite to be repeated with the advice of pediatrician. A complete urine examination will rule out the presence of urine infection. Therefore I suggest you to consult the pediatrician for reevaluation and follow up. 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