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Suggest treatment for typhoid fever

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Posted on Tue, 20 Oct 2015
Question: Hi doctor i am XXXX 23 yrs old. I am feeling fatigue, weakness n all since last 4 days. I am not sure whether there is fever or not checked many times bt got fever very few times and much varying temperature ranges bw 97.5F to 99 F. Yesterday i hav gone through the Typhoid ELISA test.
I m Ig G negative and Ig M positive ie i hav acute typhoid fever. Rest things such as wbc RBC platelet count are normal. I hav taken Fepanil,Azifine, livopram that was suggested by doctor yesterday. Still i m feeling fluctuating mood fatigue n all.
PS i am feeling lill bit cold as well.

What u suggest?
doctor
Answered by Dr. Tushar Kanti Biswas (1 hour later)
Brief Answer:
Typhoid fever

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Your Typhoid ELISA test is positive for IgM indicating Typhoid fever.
However other than a positive culture (blood, bone marrow, other sterile sites, XXXXXXX spots, stool, or intestinal secretions) for S. typhi, no specific laboratory test including Typhoid ELISA test is diagnostic for Typhoid fever.
You have been placed on Oral azithromycin(Azifine) which is given as 1 g/d (PO) for 5 days as optimal treatment for fully susceptible strain of S. typhi and it
results in defervescence in 4–6 days, with rates of relapse and convalescent stool carriage of <3%.
However the pattern of fever (max 99 degre F) as you mentioned is not characteristic of typhoid fever.
Serologic tests have lower positive predictive values than blood culture and may be false positive.
In any case you need to complete the course of antibiotic as already prescribed for typhoid fever,

Moreover,the sensitivity of blood culture is only 40–80%, probably because of high rates of antibiotic use in endemic areas and the small number of S. typhi organisms (i.e.,<15/mL) typically present in the blood.I mean blood culture may be negative,in case of prior antibiotic use.
Feeling cold /chills may be there in 35–45% cases of typhoid fever.Feeling fatigue, weakness is part of acute febrile illness.It will pass off as you recover.
Fluctuating mood is unlikely to be due to neuro-psychiatric symptoms of typhoid fever.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Tushar Kanti Biswas (19 hours later)
you havnt suggested anything what to do?
my convern is if i m Ig m positive in ELISA SO WHY i am nt suffering from fever most of the times my temperature is 97.5F to 98.4 F. and i m feeling cold as well. i want to again ask whether there is any other diseases?
doctor
Answered by Dr. Tushar Kanti Biswas (2 hours later)
Brief Answer:
Typhoid fever

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
You might be in the convalescent stage of typhoid fever hence you are not having any fever now. IgM will remain positive for few weeks even if you have recovered from typhoid fever. Complete the course of antibiotic as prescribed by your doctor.
Your temperature remains as low as 97.5 °F (Subnormal temperature- below 98°F).You should go for Thyroid function tests also like serum T3,T4 and TSH to exclude pre-existing hypothyroidism.







Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Answered by
Dr.
Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1920 Questions

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Suggest treatment for typhoid fever

Brief Answer: Typhoid fever Detailed Answer: Hi, Thank you for your query. I can understand your concerns. Your Typhoid ELISA test is positive for IgM indicating Typhoid fever. However other than a positive culture (blood, bone marrow, other sterile sites, XXXXXXX spots, stool, or intestinal secretions) for S. typhi, no specific laboratory test including Typhoid ELISA test is diagnostic for Typhoid fever. You have been placed on Oral azithromycin(Azifine) which is given as 1 g/d (PO) for 5 days as optimal treatment for fully susceptible strain of S. typhi and it results in defervescence in 4–6 days, with rates of relapse and convalescent stool carriage of <3%. However the pattern of fever (max 99 degre F) as you mentioned is not characteristic of typhoid fever. Serologic tests have lower positive predictive values than blood culture and may be false positive. In any case you need to complete the course of antibiotic as already prescribed for typhoid fever, Moreover,the sensitivity of blood culture is only 40–80%, probably because of high rates of antibiotic use in endemic areas and the small number of S. typhi organisms (i.e.,<15/mL) typically present in the blood.I mean blood culture may be negative,in case of prior antibiotic use. Feeling cold /chills may be there in 35–45% cases of typhoid fever.Feeling fatigue, weakness is part of acute febrile illness.It will pass off as you recover. Fluctuating mood is unlikely to be due to neuro-psychiatric symptoms of typhoid fever. Regards Dr. T.K. Biswas M.D. XXXXXXX