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Fever, vomiting, dizziness. Labs positive for typhoid. Persisting symptoms with medicines. Is hospitalization required?

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Infectious Diseases Specialist
Practicing since : 2000
Answered : 180 Questions
Hello Doctor,
My mother, aged 43 is suffering from fever, vomiting and dizziness from last Tuesday. On Saturday we got her blood test report which reported as positive for typhoid
Widal test:
S. Typhi “ O” : Positive 1:40 diln
S. Typhi “ H” : Positive 1:40 diln
S. Para Typhi “ AH” : Negative 1:20 diln
S. Para Typhi “ BH” : Negative 1:20 diln
From Saturday night she is taking treatment for typhoid but still from yesterday night again she got high fever and started vomiting frequently. Even till now she is very dizzy and complains about severe abdominal pain and head ache along with severe pain in the jaws and is not even able to sit.
Medication that she is taking from Saturday night
Rabemex - DSR
Osflox 200
Medomol 650
Could you please advise me whether this is serious and she needs to be hospitalized since there is no improvement even after taking medicine? If hospitalization is not required, please let me know from when she will start recovering provided we follow the same medication.
Could you also please advice about the diet for her.
Thanks in advance.
Posted Sun, 9 Jun 2013 in Infections
Answered by Dr. Binod Kumar Pati 4 hours later
Thanks for posting your querry to XXXXXXX
In India a single widal result is not a very good indicator to diagnose typhoid and that too in the first week of fever.
However,the diagnosis can be confirmed, if a four fold rise in the antibody titer is demonstrated on a repeat widal test done 2 weeks after.
The definitive test for diagnosis is Blood culture. It has an added advantage of testing the susceptibility of the isolates to different antimicrobials.
Currently there are quinolone resistant isolates causing typhoid. Ciprofloxacin or Ofloxacin cannot kill such isolates.
In her case she may need a detailed examination of all the systems to see if we are not missing something other than typhoid. Some more investigations also may be required. Malaria has to be ruled out, if not done already.
Taking all of these into consideration, the best advice will be
1. Plan a visit to your physician as soon as possible and get a blood culture and sensitivity done.
2. Give her plenty of water and electrolytes; she will stay active. If she is unable to drink, take her to hospital; She may need iv fluid.
3. Fever can be controlled by antipyretics and cold sponging regardless of severity, provided dose and frequency is well adjusted.
Any food she like can be given, however a soft and easily digestible one is preferred.
Recovery from typhoid usually starts 3-4 days after therapy and completes after around 2 weeks, if appropriate therapy is instituted.

I think I am clear. If you have further querries, i will be happy to answer.
Thank you
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