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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Does The Following Widal Test Result Suggest?

Dear Doctor, Good Day! Ref: Age: 7Y 2M Weight: 41.5 KG Sex: F Lives in: Dhaka, BD (South Asia) My daughter has been suffering from mild fever since 4/21. Only Paracitamol drugs given till when she attacked by higher fever like 104 degree farenhite fever with headache. Then took a serological Widal test on 4/27 and got the below result: TO 1: 160 TH 1: 80 AH 1: 80 BH 1: 160 Per local physician’s advice, from 4/27 night she started to take antibiotic CefiximeTrihydrate Suspension 100 mg/ ML. The dosage is 20 ML/Day (each dose 10 ML two times per day). This is midday of 4/29 locally. Already 4 dosages completed. My question, how more days she will suffer for 2/3 times per day high fever even with 106 F temperature, trembling before fever coming, headache, tendency of vomiting? Many thanks in advance. Best regards.
Mon, 20 Feb 2023
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General & Family Physician,  's  Response
Hi,

Usually resolution of fever in enteric fever may take 3-7 days of start of treatment with proper anti-biotic drug. Hence, we should not expect resolution of fever, just after 2 days. Also, in my opinion, your dosage of cefixime, also does not seem proper. Normal dose of children below 45 kg in typhoid case is 4 mg/Kg body weight, two times a day.

Above all, Widal test is not only positive in enteric fever, but also, it may be positive in other body conditions also, particularly in intestinal infections. One serological Widal test is not diagnostic of enteric fever, rather increasing titer in repeat test at least after a period of 5 days of the first test is diagnostic of typhoid.

Hence, I will advise you to wait for the fever to subside with a proper dose of cefixime and go for a repeat test after 5 days. If the titer is not increasing or the fever is not resolving, then, it is always better to go for culture and sensitivity of blood, including for salmonella typhi. This may be all the more necessary, as many a times the bacteria may be resistant to the antibiotic, we are giving to our child and this may help in selecting the appropriate antibiotic, which may be effective in present condition.

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Satnarain Bansal, General & Family Physician
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What Does The Following Widal Test Result Suggest?

Hi, Usually resolution of fever in enteric fever may take 3-7 days of start of treatment with proper anti-biotic drug. Hence, we should not expect resolution of fever, just after 2 days. Also, in my opinion, your dosage of cefixime, also does not seem proper. Normal dose of children below 45 kg in typhoid case is 4 mg/Kg body weight, two times a day. Above all, Widal test is not only positive in enteric fever, but also, it may be positive in other body conditions also, particularly in intestinal infections. One serological Widal test is not diagnostic of enteric fever, rather increasing titer in repeat test at least after a period of 5 days of the first test is diagnostic of typhoid. Hence, I will advise you to wait for the fever to subside with a proper dose of cefixime and go for a repeat test after 5 days. If the titer is not increasing or the fever is not resolving, then, it is always better to go for culture and sensitivity of blood, including for salmonella typhi. This may be all the more necessary, as many a times the bacteria may be resistant to the antibiotic, we are giving to our child and this may help in selecting the appropriate antibiotic, which may be effective in present condition. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Satnarain Bansal, General & Family Physician