Is my wife suffering from typhoid?

Q: My 25 years old wife's typhoid IgM is negative but typhoid IgG is positive. Is she suffering from typhoid? Her ESR is 42 mm (1st hour), TLC is 7400; platelets decreased to 1.34 lakhs and haemoglobin is 11.6. She is also suffering from neck and shoulder pain. I am taking Omiflox BD, calpol BD, Pecef 200 BD, Vizyloc BD, Febra plus 1/2 tab BD and Zidex cyrup BD. Please advise.

A:Serological investigations such as Typhoid IgG or IgM are not the best methods for the diagnosis of Typhoid or enteric fever. Generally the absence of IgM antibodies and presence of IgG antibodies is indicative of past exposure to the antigens of Typhoid which may have resulted from infection or vaccination. Because these antibodies can take some time to develop, the timing of the test may affect the results, the way it is interpreted. Moreover, serological cross reactions make meaningful interpretation often difficult.

The common symptoms of Typhoid include fever, abdominal pain, loss of appetite, dry cough, headache, rash (in some cases). The definitive diagnosis of Typhoid fever is through isolation of the bacteria (Salmonella enterica serotype Typhi) from Blood culture (an investigation which should ideally be done before antibiotics are started). Although generalized body ache may occur, pain at the sites you have mentioned may be related to some other causes. Other blood tests suggest that there is a decrease in platelet count and anemia (low haemoglobin), the ESR is also elevated. It seems from the list of medications your wife has been given that she is taking some antibiotics along with medicine to bring down her fever. It is difficult to exclude typhoid from the details provided. There are some common infections such as Dengue which may sometimes give rise to signs and symptoms which resemble typhoid (fever, body ache, low platelet). I suggest you visit your local doctor once again for follow up.