Q: I am 26 years old. I was diagnosed with typhoid a month back (temperature not more than 100, but had cough along with sputum) through Widal test (1:160). But the blood culture report was negative. After two weeks of injection and medication (Ciprofloxacin), I underwent the Widal test again and got 1:20. Also, I underwent the Mantoux test and the report was negative. Now, I am back to work, but still have temperature in the evening (around 99.4). In the morning, temperature is around 97. Now, I have three questions: (a) What could be the reason for this fluctuating temperature? (b) Can I have fatty and oily food? and (c) Can I consume alcohol? My test report also showed that my ESR was below 20 and no liver and spleen enlargement. My chest X-ray was normal. I have no body pain. There is no significant loss of weight. Also, my stomach is normal (no spicy and oily food included in the diet).

A:Widal test is a poor diagnostic modality for typhoid, and its interpretation requires skill as well as repeat titres. The eight-fold fall in titre over a period of two weeks is highly unlikely and may reflect poor laboratory reproducibility. Blood cultures provide the definitive diagnosis of typhoid, but a single blood culture can only pick up 70-75% cases. Multiple blood cultures along with cultures of urine, stool and/or bone marrow (according to the clinical stage of the illness) can diagnose nearly all cases, depending on the patient profile. Since the fever is persisting with a diurnal variation, it could be possible that you may not have typhoid at all. A detailed clinical evaluation by your doctor followed by relevant investigations may be able to pinpoint the cause of the fever. Also, you are slightly overweight according to your height, so high calorie foodstuff, especially fatty and oily food should be avoided. The decision to consume alcohol is a personal one but your liver status and your medical status would dictate any medical contraindication, but in your current clinical condition, it would be prudent to abstain.