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Is my child suffering from typhoid?

Q: My son is four years old, weighing 15 kg. He is suffering from fever from the last ten days. His body temperature goes up to 103-104 ºF. The Widal test shows 1/80 positive, while reports for malaria and dengue are negative. There is no urinary infection. I reside in Kolkata. Is 1/80 positive a typhoid case for Kolkata? The doctor has prescribed him Taxim-O DT 100 mg (two doses per day) and Azithrol 200 mg (one dose per day). Today I went to another doctor, who told me that 1/80 positive is a typhoid case for Kolkata. He prescribed Taxim-O DT 150 mg (two doses per day) and Oflomac Forte syrup 7.5 ml two times daily. I am confused. Which prescription should I follow? What is the actual dose for my kid?

A:Unfortunately, Widal test is not very reliable. In fact, it has been discarded in most countries. The problem with this test is that it gives too many false-positive results, i.e. it is positive even when there is no typhoid fever and equally too many false-negatives, i.e. it is negative when there is typhoid. The gold standard test is blood culture (in 90% of cases there will be growth of typhoid germs). In addition, urine and stool (generally positive in the second week of fever) can also be cultured apart from PCR (polymerase chain reaction) test, if available. Assuming that Widal was the only available test, 1/80 is borderline; 1/160 and 1/320 is more diagnostic. The problem is that typhoid germs are commonly found in India (including Kolkata) and by subclinically infecting persons (without any fever or other signs and symptoms), create antibodies in otherwise healthy individuals, which will give 1/80 levels. The other advantage, apart from a firm diagnosis, of blood, urine and stool culture is that not only are germs grown, but their sensitivity can also be determined so that appropriate antibiotic can be prescribed. Needless to say a good clinical history along with physical examination (pulse rate, rose spots , enlargement of liver and/or spleen) and simple blood tests (white cell count, LFTs, ECG showing non-specific ST and T wave abnormalities) can be helpful. If blind therapy (i.e. without knowing the sensitivity of the germs) is to be instituted, then Ceftriaxone (sold as Powercef) injections (50 mg per kg of the body weight in a single or two divided doses) or Azithromycin (Aziwok Kidtab) 20 mg per kg of the body weight in a single daily dose by mouth are the two options. Cefixime (Cefinar DT) can also be given. Only one antibiotic is adequate along with B-complex vitamins and Paracetamol (Crocin) to control fever. Though Oflomac (ofloxacin) should not be used in children and growing adolescents due to its serious, adverse effects on bones, it is frequently used for treating typhoid fever, but its use is decreasing due to emergence of drug resistance. Its use in children is not recommended. You may wish to take another opinion from a good paediatrician.

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