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Suggest treatment for recurrent typhoid

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Posted on Thu, 24 Jul 2014
Question: my wife is suffering from typhoid since last 2.5 years even after continuous treatment of different antibiotic from many doctors. She has symptoms like headache, slight fever about 99.00. Her fever was never very high since starting & also she does not having symptoms of indigestion or abnormal bowel function. But she is suffering from fever and feeling weakness day day since last 2.5 years. Many almost all types of other tests has been carried out but always found only Typhoid - Positive. Please give suggestion / treatment. we very worried
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Answered by Dr. T Chandrakant (2 hours later)
Brief Answer:
treatment if blood culture for typhoid is positive

Detailed Answer:
Namaskar.
Thanks for your query.

This is the commonest problem in countries like XXXXXXX where Typhoid is a common disease.
Typhoid is a disease wherein the body takes the care of the disease , we as Doctors just help for early and permanent cure. The ''natural history'' of typhoid is well studied in XXXXXXX

Widal is a test in which we detect the antibodies the body has produced after exposure to the bacteria which cause the Typhoid Fever.
Since these antibodies are produced by the body in response ( fight against) the typhoid bacteria, they remain in the body for a variable time in different individuals.
So they can be detected for quite sometime even after the patient is 'cured '
from Typhoid.
No one can be suffering from typhoid for two and half years without complications. Even though the patient is not treated at all, he will be taken care by the body's fighting mechanism within a maximum of 6 weeks. But the antibodies will be circulating in the body for a very long time ( which are detected in the Widal test).

The only confirmatory test of typhoid in the body is : Culture and sensitivity of the blood/ urine / stool.

The treatment should be given only if the blood culture is positive.

Your wife should be investigated for the Typhoid and more importantly for other diseases like Tb, liver ailment, kidney problems, The specific cause for the mild fever has to be found out.

So do not worry.
She may not need the treatment at all .

Fever and weakness can occur anytime, the reasons are varied.

Treatment of Typhoid is given only if the blood culture test is positive. Otherwise to find another reasons for fever and headache.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. T Chandrakant (5 hours later)
Sir, We have already go for blood culture method and it is shocking that blood culture method is also and always showing typhoid positive each and every time. Many other almost all type of tests had been carried out by doctors but always only found typhoid positive rests were normal. Even ct scan has been carried by appolo hospital XXXXXXX but that was also normal. We are in confusing badly that what should be do for cure. I am worried very that what is it? How she will overcome? Her health is continuously down... Please help and give any effective treatment . She had been also treated by insections of several antibiotics but after some time of treatment again typhoid.. why.. please help..
doctor
Answered by Dr. T Chandrakant (5 hours later)
Brief Answer:
Basics to be implemented

Detailed Answer:
Thanks for your feedback.

Well, if the blood ''culture is positive'' then ''sensitivity'', must also be done and I suppose the Doctors would have treated according to this report also.

It is good that CT scan is normal- Is size of the liver and spleen also normal? please post the report of Widal, Blood culture and sensitivity and CT scan. You can attach to this query. On CT scan: Usually the liver and the spleen are always enlarged in Typhoid and the last (terminal) Part of the Small Intestine is either swollen or will show some changes also the lymph nodes in this area should have been enlarged.

Now: because many antibiotics are already given, the clinical and pathological picture will be drastically changed.
Yet I would like to know : the symptoms in the initial ( first attack) period and what are her symptoms now? And a list of antibiotics given till now.

Typhoid is a feco-oral disease, meaning the bacteria always gain entry through the food or the liquids, beverages, water; for that matter through anything that is taken orally.

She should strictly avoid outside food. Should take home-made freshly prepared food only.
She also should take water which had been ''boiled'' for minimum of ''20 minutes''. This means the boiling should continue for more than 20 minutes. after the real boiling starts. No other water at all. No other beverages at the moment.
This will help to stop the reinfection, which is very common. She should wash her hand with soap water or Betadine scrub frequently- particularly after every visit to bathroom and before food. Nails should be pared well.

Many times the small cares help to cure the biggest of the medical diseases.

The other route is as you know the reinfection or re-activation through the bacteria which remain in the biliary system. That is why all the patients of typhoid should be given curative dose in the form of Amoxicillin or so for a period of three weeks.
The problem is all the diseases change their presentation, susceptibility pattern, clinical picture, sensitivity to a particular set of antibiotics and so on.

Another reason is the resistance power of the patient: She is staying with so many people in the house and a society, but she alone is suffering; this indicates her resistance power is very low to fight against a particular resistance. You will have to discuss this in details with your treating Doctor and to rule out co-existing problems like tuberculosis, diabetes and other chronic medical problems.
Hopefully they all are negative as she must have been subjected to so many tests. Yet go for a Quantiferon gold test for TB and X-ray chest if not yet done.

Is she Given Chloramphenicol or Erythromycin; works in some cases of resistant typhoid.

Mutivitamins with Ginseng, Vit D in the form of calcirol and Vit A in therapeutic doses help.

You have to discuss all these points with your Doctor. Discuss, please do not argue with them.

I have tried to give you such points - they are very basis so forgotten by many and all. Follow them to help her get well soon.

Please feel free to discuss/ consult/ share more.We can get her out of her problems.


Above answer was peer-reviewed by : Dr. Prasad
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Dr. T Chandrakant

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Practicing since :1984

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Suggest treatment for recurrent typhoid

Brief Answer: treatment if blood culture for typhoid is positive Detailed Answer: Namaskar. Thanks for your query. This is the commonest problem in countries like XXXXXXX where Typhoid is a common disease. Typhoid is a disease wherein the body takes the care of the disease , we as Doctors just help for early and permanent cure. The ''natural history'' of typhoid is well studied in XXXXXXX Widal is a test in which we detect the antibodies the body has produced after exposure to the bacteria which cause the Typhoid Fever. Since these antibodies are produced by the body in response ( fight against) the typhoid bacteria, they remain in the body for a variable time in different individuals. So they can be detected for quite sometime even after the patient is 'cured ' from Typhoid. No one can be suffering from typhoid for two and half years without complications. Even though the patient is not treated at all, he will be taken care by the body's fighting mechanism within a maximum of 6 weeks. But the antibodies will be circulating in the body for a very long time ( which are detected in the Widal test). The only confirmatory test of typhoid in the body is : Culture and sensitivity of the blood/ urine / stool. The treatment should be given only if the blood culture is positive. Your wife should be investigated for the Typhoid and more importantly for other diseases like Tb, liver ailment, kidney problems, The specific cause for the mild fever has to be found out. So do not worry. She may not need the treatment at all . Fever and weakness can occur anytime, the reasons are varied. Treatment of Typhoid is given only if the blood culture test is positive. Otherwise to find another reasons for fever and headache.