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What does the Widal test report indicate?

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Posted on Thu, 21 May 2015
Question: Hello doctor, my 6.5 year old doctor is suffering from high fever for last 3 days. As suggested by paediatrician we have done urine and blood tests. UTI, dengue, malaria has come negative. Meanwhile doctor has started augmentin and we have completed 4 doses also till now.
Today typhoid report came which says
S.typhi O as 1:80
S.typhi H as 1:160
Rest all parameters showed negative.
She also has some throat infection.

Doctor suggested to continue with augmentin only. Just wanted to know whether she has typhoid? And whether augmentin is the right drug ?
doctor
Answered by Dr. Pradeep Kumar Jain (47 minutes later)
Brief Answer:
This report is not conclusive,better drugs are available

Detailed Answer:
Hello

Thanks for the query

The most common cause of fever is a viral illness(usually upper respiratory tract infection) in this age group.
I investigate thoroughly before starting antibiotic if condition is not serious as antibiotic can alter the report positivity.
The widal is not considered to be diagnostic for typhoid as it shows a high false positive and false negative result.Now a days better investigation like Typhidot is available with much higher sensitivity.The O and H titre of typhoid report suggest active and inactive infection respectively.A titre of 160 or above of 'O' antibody is considered to be of value.So this report is not conclusive for typhoid.
The common presentation of typhoid is abdominal discomfort,loose stool and not throat infection.So in the current scenario I would like to get a Typhidot and blood culture test done to confirm or rule out typhoid infection.

In viral infection fever usually persists for 4-5 days.I would suggest you to make a temperature chart to monitor the fever whether it is improving or deteriorating.
Augmentin contains amoxycillin and it can be given in typhoid fever but because of emergence of resistant variety the XXXXXXX Academy of Pediatrics has recommended Cefixime to be used as first line in typhoid fever.
I would like to continue the augmentin( it works well in upper respiratory infection)as she is already getting this and diagnosis is not conclusive.I shall get the test done as suggested.
Monitor for the temperature and general condition of the child if it is deteriorating then she would need to be reevaluated by a pediatrician and then management will be needed accordingly.
I shall be glad to answer if you have any more query.
Wish your child speedy recovery
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pradeep Kumar Jain (39 minutes later)
Thank you doctor for the reply.

Last 3 days she was having high fever every 4 hour but since yesterday night after 3 doses of augmentin we have observed that she is getting high fever after 7-8 hour interval.... which we assume is a sign of imprpvement... are we correct?

Also she doesn't have any loose stool problem just some gastric trouble which we believe is as she is not eating or drinking much. She does burp & feels comfortable. Based on this can we rule out typhoid?
doctor
Answered by Dr. Pradeep Kumar Jain (8 minutes later)
Brief Answer:
It is difficult to rule out or confirm typhoid at this stage

Detailed Answer:
Thanks for the follow up

This may be just a viral upper respiratory tract infection.The initial two to three days the spikes are very high in viral fever.As she is improving I would like to continue the present treatment and monitor for fever and general condition.
Even amoxycillin and fever can cause abdominal discomfort.So I suggest you to give probiotics like prowel or darolac orbifilac to combat the effect of amoxycillin. Encourage her for increased fluid intake as this helps in controlling fever also.
If the condition deteriorates or fever persist get her evaluated by a pediatrician.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Pradeep Kumar Jain

Pediatrician, Cardiology

Practicing since :2006

Answered : 2069 Questions

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What does the Widal test report indicate?

Brief Answer: This report is not conclusive,better drugs are available Detailed Answer: Hello Thanks for the query The most common cause of fever is a viral illness(usually upper respiratory tract infection) in this age group. I investigate thoroughly before starting antibiotic if condition is not serious as antibiotic can alter the report positivity. The widal is not considered to be diagnostic for typhoid as it shows a high false positive and false negative result.Now a days better investigation like Typhidot is available with much higher sensitivity.The O and H titre of typhoid report suggest active and inactive infection respectively.A titre of 160 or above of 'O' antibody is considered to be of value.So this report is not conclusive for typhoid. The common presentation of typhoid is abdominal discomfort,loose stool and not throat infection.So in the current scenario I would like to get a Typhidot and blood culture test done to confirm or rule out typhoid infection. In viral infection fever usually persists for 4-5 days.I would suggest you to make a temperature chart to monitor the fever whether it is improving or deteriorating. Augmentin contains amoxycillin and it can be given in typhoid fever but because of emergence of resistant variety the XXXXXXX Academy of Pediatrics has recommended Cefixime to be used as first line in typhoid fever. I would like to continue the augmentin( it works well in upper respiratory infection)as she is already getting this and diagnosis is not conclusive.I shall get the test done as suggested. Monitor for the temperature and general condition of the child if it is deteriorating then she would need to be reevaluated by a pediatrician and then management will be needed accordingly. I shall be glad to answer if you have any more query. Wish your child speedy recovery Regards