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Child has fever. Gave crocin and Azithral. No effect. Blood test shows S.Typhi O reactive 1:40. Typhoid?

My son is 7 yrs old and he is suffering from fever from last 15 days. Fever rises after 6-7 hours and when we give him a crocin fever was coming down. Initally doctor has given Moxclav for 5 days, then Azithral-xl200 for five days but condition is still same.Initally doctor has conduted all blood tests but all test are normal. Yesterday once again doctor has conduted Widal test (tube method) and maleria by card. Maleria is negative but S. Typhi O is reactive 1:40 and S.typhi H is reactive 1:40. Is he is suffuring from typhoid . Now doctor has given Cefolac-o 100DT twice a day. Pls suggest
Asked On : Mon, 1 Apr 2013
Answers:  2 Views:  96
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Pediatrician 's  Response
Thanks for your query.
In view of prolonged fever & not sure of diagnosis ? I can appreciate your anxiety.
Your son has been started on 3rd antibiotic empirically .
In my view treating in this way,without knowing what is being treated is not going to help.
Typhoid fever is still a good possibility & my advice would be to stop cefolac & continue with crocin as required.
After 48 hrs , send blood c/s,urine c/s,ESR,CRP,Typhidot M test & repeat malaria test.
It is also worth considering ultrasound of tummy as it can show enlarged nodes (supports typhoid) as well as any other cause of fever like localised pus collection or kidney infection.
Widal test report suggest that typhoid is unlikely but now a days this test is obsolete & typhoid is diagnosed mainly by blood c/s & typhidot test.
In this scenario apart from typhoid there is possibility of chronic infections like TB or chronic inflammatory condition or some connective tissue disorder.
In light of above information I advise you to discuss each point with your doctor & if required seek second medical opinion.
Once you have these test reports I would be happy to share my thoughts about the appropriate course of action.
Hope I could clarify the things .
Best wishes.
Answered: Mon, 1 Apr 2013
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Pediatrician Dr. E Venkata Ramana's  Response
Feb 2013

Thank you for your query on Healthcare Magic.

The widal test is negative and is not suggestive of Typhoid fever at present.

Inspite of investigations, antibiotics, and the fever is lasting more than 15 days, it is evaluated as Pyrexia of unknown origin.

But as the fever is lasting more than 15 days and there is no response to the antibiotics till now, the following problems to be ruled out:

1. Malaria- even though investigation is negative, empirical chloroquine treatment will help to treat the fever.

2. Tuberculosis- to be ruled out by doing ESR, Mantoux test, and chest X-ray

3.Pneumonia- by doing a chest X-ray

4. Infections like Dengue fever, leptospirosis, rickettsial fever, and Brucella will present with prolonges fevers. So these can be ruled out by doing serological tests if the fever is still persisting.

5. Urinary infections- by doing complete urine examination and urine culture and sensitivity.

6. And finally if the fever is persisting peripheral smear for abnormal cells, bone marrow study, collagen profile to look for any malignancy, rheumatoid and collagen vascular problems to be ruled out.

So I advise you to be in regular follow up with the Pediatrician till the complete evaluation to diagnose the problem and for complete treatment.

Hope I have answered your query.

Answered: Tue, 2 Apr 2013
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