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How can recurrent typhoid fever be treated despite taking IV antibiotics?

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Posted on Wed, 9 Dec 2020
Question: Hello doctor, My brother got typhoid around 2nd week of January. After taking antibiotic through IV, he was fine for about 2 weeks then he got admitted for high fever, temperature-104 degree. Yesterday he was fine so he was discharged after 11 days. But today he got fever again, now the temperature is 101.5. I have attached all the reports we have taken so far. Could you please help/guide us. Thanks in advance!
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Answered by Dr. Dr.Arnab (3 hours later)
Brief Answer:

If fever is persisting, then need to investigate further.

Detailed Answer:

Hello,

I've reviewed all the attached reports. Well, first of all, I couldn't find any reports of Typhoid here. As per these reports of Feb-March'18, no clear diagnosis can be made.

It's good that Dengue, leptospira was already ruled out. However, the CT finding is likely suggestive of some infectious pathology (can be a consequence of the previously diagnosed typhoid fever).

However, if there's just a single spike of fever, no need to worry, just give a single dose of PARACETAMOL 650mg after some food and observe.

However, if fever persists beyond this, then I'd advise you to report to his doctors immediately as there can be a secondary infection (after prolonged hospitalization, the body's immune response become lowered, and can catch a secondary infection).

I hope there's no I.V. line remaining still (if there's any make sure there's no redness/swelling around).

It can due to several other reasons (starting from the respiratory tract to abdominal, urinary tract or even blood borne).

To determine, some basic testing may also be done (only if the fever's persisting) eg. a repeat CBC with peripheral blood smear, Dual antigen for malaria, a fresh urine routine microscopy and culture (blood culture may also need to be repeated, to be decided by his doctor after the clinical check-up).

Is there any other complaint along with fever? Any pain abdomen/ nausea/ vomiting/ loose motion? Do check his body for any kind of skin-rashes also.

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Dr.Arnab (5 hours later)
Thanks dr...He is taking dolo 650, 3 per day as well. Attached few more reports as well. yesterday night he was having 101 temp, today around 4am he had some temperature but at present he was having only 98.9 temp. At present he is taking the tablets attached , as prescribed in the discharge summary. We are so confused about the next steps. Kindly advice.
doctor
Answered by Dr. Dr.Arnab (1 hour later)
Brief Answer:

Please follow as already advised earlier.

Detailed Answer:

Hello,

I couldn't find any new attachments, all of these were already reviewed. Perhaps remove some of the old ones and reattach the new ones.

Yes, things can be certainly confusing.

However, the next steps will remain the same as already explained earlier i.e. further extensive investigations, as well as serial check-ups, need to be done by his doctor/s (comprehensive involvement by Internal medicine, as well as Infectious disease specialist, should be sought) in order to get the diagnosis at first.

Things can proceed accordingly from there.

Hope I have answered your query.

Take care

Regards,
Dr Arnab Banerjee, Critical Care Specialist
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Dr.Arnab

Critical Care Specialist

Practicing since :2012

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How can recurrent typhoid fever be treated despite taking IV antibiotics?

Brief Answer: If fever is persisting, then need to investigate further. Detailed Answer: Hello, I've reviewed all the attached reports. Well, first of all, I couldn't find any reports of Typhoid here. As per these reports of Feb-March'18, no clear diagnosis can be made. It's good that Dengue, leptospira was already ruled out. However, the CT finding is likely suggestive of some infectious pathology (can be a consequence of the previously diagnosed typhoid fever). However, if there's just a single spike of fever, no need to worry, just give a single dose of PARACETAMOL 650mg after some food and observe. However, if fever persists beyond this, then I'd advise you to report to his doctors immediately as there can be a secondary infection (after prolonged hospitalization, the body's immune response become lowered, and can catch a secondary infection). I hope there's no I.V. line remaining still (if there's any make sure there's no redness/swelling around). It can due to several other reasons (starting from the respiratory tract to abdominal, urinary tract or even blood borne). To determine, some basic testing may also be done (only if the fever's persisting) eg. a repeat CBC with peripheral blood smear, Dual antigen for malaria, a fresh urine routine microscopy and culture (blood culture may also need to be repeated, to be decided by his doctor after the clinical check-up). Is there any other complaint along with fever? Any pain abdomen/ nausea/ vomiting/ loose motion? Do check his body for any kind of skin-rashes also. Hope I have answered your query. Let me know if I can assist you further.