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Fever, shivering and coldness, widal test for H antigen 1:160 and O antigen 1:80 dilution, typhoid.

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General & Family Physician
Practicing since : 2003
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Hello Sir,
My query is about my brother who is having fever for last 3 days. Temperature goes till 103-104 Fahrenheit. vomiting is also there intermittently. Fever, generally comes with shivering and coldness. We have done widal test for him and for H antigen : 1:160 and for O antigen 1:80 dilution has come. I am worried whether its a positive result for typhoid. And if it is how long he has to take antibiotics and other medicines. What kind of diet he should take in this condition.
Posted Sun, 6 May 2012 in General Health
Answered by Dr. Deepak Anvekar 31 minutes later

The presentation of the history and the widal test resports indicate that your brother has indeed Typhoid fever.

The Widal test is positive if there is a four fold increase in the titer (e.g., from 1:40 to 1:160) in the course of the infection. In your brothers case, since the titer of O antigen (1:160) and that of H antigen (1:80) is higher, he is indeed having typhoid.

Hence He might need treatment with medications called Fluoroquinolones (Eg Ofloxacin or Ciprofloxacin) for at least 2 weeks duration.

In the mean time, Ibuprofen can be given to reduce the fever, body pain, etc. This medication of 400 mg dose, can be taken 3 times in day, once every 8 hours.

In addition, Cold sponges , adequate rest and plenty of oral fluids are essential.

High calorie diet is prescribed to maintain the weight or to gain weight.
Caloric requirement may be as high as 2500-3000 Kcal per day.
Drink boiled and properly filtered water.
Increase fluid intake – glucose water, soups, fresh juices, coconut water.
Daily requirement of protein ranges from 80-120 gms to make up for tissue wasting. Good quality proteins like egg and milk should be incorporated.
Minerals especially calcium, iron and phosphorus is to be provided liberally as they help in regeneration of cells, blood and body fluids.
Diet must be planned judiciously to provide good dose of vitamins especially vitamin A and vitamin C as these are essential for the regenerative purpose.
High fluid and soft diet in small frequency is recommended.
Food must be appetizing and made after considering the likes and dislikes of the patient.
Fatty, highly fibrous and very spicy foods should be avoided as they are hard to digest.
Avoid- tea, spicy food, coffee, alcohol and soft drinks.

Foods recommended include:-

1. Plenty of juices, soups, beverages and plain water (2.5 to 5liters desirable)
2. Milk and milk based beverages
3. Low fiber foods such as refined cereals and their products, dehusked pulses, well cooked fruits, vegetables in soft and puree form and potatoes.
4. Foods providing proteins of high biologic value e.g. eggs, soft cheeses, tender meats, fish, poultry etc.
5. Plain gelatin based desserts, sugars, honey and XXXXXXX

You might consult a doctor who can examine him and prescribe the proper antibiotics and supportive medications.

I hope this helps.
Above answer was peer-reviewed by
Follow-up: Fever, shivering and coldness, widal test for H antigen 1:160 and O antigen 1:80 dilution, typhoid. 21 hours later

I appreciate your response and advice. We consult here one doctor also in person. He also suggested the same medicine as you have. We have started the medication as you have prescribed, But thing is that he is having continuously 101-104 Fahrenheit temperature for last 18 hrs. and once or twice he had vomited also.
Dr. XXXXXXX shall we take him to hospital or shall we wait for one more day.

condition is kind of SOS, so Doctor, I will be very great full if you respond as soon as possible.

Answered by Dr. Deepak Anvekar 6 minutes later

Thanks for the follow up.

Yes, It is time for you to take him to the hospital, as his symptoms will not be manageable at home.

He will receive proper care and IV fluids and antibiotics at the hospital which will help him recover sooner.

I hope this helps to make up your decision.

Wishing your brother a speedy recovery.


Dr Anvekar.
Above answer was peer-reviewed by
Follow-up: Fever, shivering and coldness, widal test for H antigen 1:160 and O antigen 1:80 dilution, typhoid. 4 hours later
Dear Dr. Anvekar,

Thanks alot for your immediate response. I believe you people are really providing great help and this is really appreciable. I thought, I should tell you the current status. I took my brother to hospital and there doctor has recommended to continue with the same medicine (oflaxacin) and has advised for bath when fever is high, as well suggested to increase the dose of paracetamol.
Mr. Anvekar, my concern is now that in typhoid, vomiting with prolonged high fever are common symptoms and further to prevent infection, what should be the major precautions are advised. Doctor, I am bothering you too much, but one more thing if you don't mind. What is the possibility of relapsing the infection and how long generally it will take to recover fully in such conditions.

Answered by Dr. Deepak Anvekar 17 minutes later

Thanks for the follow up,

After an episode of confirmed typhoid fever, complete recovery can take upto 3-4 weeks. In case complications have developed, this period can be prolonged.

But once a person recovers, he develops immunity (antibodies) which is protective for about 2-3 years.

However, excessive inoculum of infection from food sources can overcome this immunity. Thus, typhoid can recur in future, either after years or if the infective dose in food is very high.

Hence typhoid vaccine, every 2-3 years would provide protection against reinfection.

OTHER PRECAUTIONS INCLUDE:- Drink plenty of filtered water each day. Drink bottled water or boil any water before you use it. You should drink between to six to eight glasses of water each day to keep your body free of any toxins.

Make sure all the foods you eat are cooked thoroughly, especially Non vegetarian food. Also, only consume vegetables and fruits that are peeled or cooked. Be careful when eating at restaurants and fast-food places that your food is prepared properly. Avoid spicy and oily food till he recovers completely from the fever.

Practice good hygiene by washing your hands thoroughly after using the rest room and make sure not to come into contact with germs. It's also helpful to exercise daily and to take vitamin C to help keep your immune system healthy.

I hope these tips will help to make your health decisions easier.


Dr Anvekar.
Above answer was peer-reviewed by
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