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Can a person be diagnosed with typhoid even when there is no fever?

Q: My report shows S Typhi O 1:80 & S Typhi H 1:160. Titres are significantly raised & Widal test is positive. But strangely, I don't have any fever. Is it possible that a person can have typhoid without fever. I am feeling very weak and have an upset stomach & my urine report shows pus cells -uncentrifuged - occassionally seen; Centrifuged 2-4\hpf, light traces of protein. Is there something to worry about? Why am I not having fever, which is a major symptom of typhoid?

A:You cannot be labelled as having typhoid on the basis of the Widal test, which is a poor indirect evidence of infection, since the test has inherent pitfalls, and is difficult to interpret. Ideally serial titres have to be done at an interval of 2-3 weeks, to document a four fold rise. In the absence of this, single titres of >1:200 are considered significant. Also, the O agglutinins are first to appear and H agglutinins appear later and last for a longer time after the infection. These titres would also be high if you have taken the typhoid vaccine. I would like to reassure you that your tests are not indicative of typhoid, and there is nothing to worry about. However, stay in touch with your doctor in case you develop any other symptoms of infection like fever.

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