Q: My 21 years old sister has suffered from typhoid twice in the last couple of months. It relapsed 15 - 20 days after the first attack. She suffered with temperatures of 103, 104 and even 105 degree; she had headache and constipation too. Now, she appears alright with no fever. However, the blood test done recently confirmed the presence of a few bacterias in her body that caused typhoid. It means she is still carrying the germs which could be fatal. What are the steps we should take now? Whom should we consult to get her treated?

A:You have not given details of the test, which has found traces of the bacteria in her blood. Most likely this would have been the widal test and not blood culture (which detects the presence of live bacteria in the blood, and is a direct evidence of infection) since it is practically impossible to have asymptomatic bacteraemia in typhoid. Widal test on the other hand is an indirect evidence of infection and looks at antibodies against the salmonella bacteria, and this can be positive either during an active infection, after an active infection, after immunisation or due to an anamnestic response to an unrelated infection. Therefore interpretation of Widal requires clinical correlation as well as repeats titres for confirmation after 2-3 weeks. However, in your sister's case, you do no need to worry if she has been adequately treated with antimicrobials against the bacteria for a sufficient time period according to the sensitivity pattern. The only precaution that should be taken is to get an abdomen ultrasound to look for gallstones to check for biliary carriage. A Medical specialist is adequately trained to manage typhoid fever, though if an infectious disease specialist is available you could consult him.