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Can Malaria Come After Typhoid?

Posted on Sat, 19 Apr 2014

Question: Hi Doc, My wife was diagnosed with typhoid last month middle. In fact, we even don't know it was typhoid and we travelled to native(unknowingly) and after coming back only typhoid was confirmed. It was bit severe(1:160).Then she was on medication and took bed rest for almost two weeks (she went for office only twice after two weeks).The doc also took tests for dengue & it was negative.After taking medications, she again got fever and went to the doc. She also had shivers in the eve (for 2 days) and doc advised us for admission. I then sent her to her native to check with another doc(due to personal reason) & there she explained everything. The doc told that now its almost 1.5 months so typhoid should have been cured & based on her symptoms suggested it could be malaria also. The doc checked for jaundice & there was no symptoms of that. My wife has given urine culture for testing and has given some medicines also for malaria. I was wondering whether malaria can come after typhoid(something which I have unheard of).. Please explain

Answered by Dr. Rakesh Karanwal (43 minutes later)

Brief Answer: Possibiolity of Typhoid is unlikely Detailed Answer: Hi friend, Thanks for your query. Firstly, I presume that the diagnosis of Typhoid was made by the treating doctor, based on Widal's test. May I inform you that Widal's is a non-specific test and can be positive is several other conditions. The TO titers of 1:160 do not necessarily mean Typhoid. I too agree with your second doctor regarding possibility of Malaria (particularly, Vivax Malaria) as the most likely cause. Other possibilities are, silent Tuberculosis, chronic urinary infection or partially treated septicemia (infection having spread into the blood). I strongly feel that- instead of RANDOMLY treating your wife - her doctor should get the following SPECIFIC investigations done : * Malarial antibodies (Malaria is very common in coastal regions) * Chest X-ray for Tuberculosis * Abdominal ultrasound for suspected Liver abscess, Gall Bladder or kidneys' infection * Test for microfilaria (which is very common in coastal regions) * Blood Culture for evidence of a SPECIFIC bacteria causing septicemia * A needle biopsy of the most prominent Lymph Node (if present), for TB/Lymphoma of the Lymph Nodes. These investigations cover ALL possibilities. Let the urine culture report come. Based on the tests' reports, SPECIFIC treatment should be initiated by her treating doctor. In the meanwhile, pending suggested tests and urine culture report, a 10 days' RADICAL ANTI-MALARIAL COURSE may be started immediately. Consult your doctor and apprise him of my opinion. I am certain that he will agree with me; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. Hope I have addressed your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Take care, Col (Dr.) Rakesh Karanwal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (33 hours later)

Hi Doctor, Thanks for your reply. As of today (Mar 12th), my wife has been advised for bed admission and she is kept under observation for the next 48 hours. She still has fever around 100. Meanwhile, the urine report has arrived and it was all negative ruling out the possibility of any urinary infection. The doctor has already provided antibiotics for malaria as first level of treatment & told us only after 48 hours they will decide on the next level of treatment if fever is still present. My wife has also requested for a blood test tomorrow to double confirm that this is not a typhoid relapse. I hope we are under the right treatment. I would also like to know the recovery period in case if its malaria and the diet plan to be followed(For eg. rest for 2 weeks, no oil & no spicy food etc). Thanks

Answered by Dr. Rakesh Karanwal (59 minutes later)

Brief Answer: She can take normal diet. 2 weeks' rest required Detailed Answer: Hi, Now that the urine report has ruled out UTI, I only hope that the treating doctor orders for the specific tests as advised by me. In case it is malaria, your wife should start recovering within 3-5 days of starting anti-malarial treatment. She would thereafter need around 2 weeks of rest from the day her fever disappears. Diet restriction has no role in malaria. So, she can have a normal diet, whatever she tolerates or desires.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (14 hours later)

Hi Doctor, Thanks for the reply. Spoke to my wife and she told the doc didn't do any blood test today. Her temperature is also normal today.She is still being monitored. Ideally the doc should have taken blood smear for confirming if its malaria by this time, right? And one more doubt: Given that she has taken anti-malarial tablets, obviously the temp will be less for the next 48 hours. What if she again gets fever after 3/4 days (for god's sake I don't want this to happen).. I am bit worried.. The only way to confirm if its malaria or typhoid relapse is through blood test ONLY right? (Also, forgot to inform you earlier when we checked for typhoid with our 1st doctor after taking typhoid medicine she again got fever & when we checked with the doc , he again asked her to take injection for 3 days like the initial one. Even after taking the injection, my wife had temp of 100 & then only the 1st doctor advised us for bed admission & told that we are missing something and this may not be typhoid).

Answered by Dr. Rakesh Karanwal (3 hours later)

Brief Answer: Ask the doctor to order tests advised by me Detailed Answer: Hi friend, Firstly, thorough physical examination of a patient is the cornerstone of diagnosis. I, sitting here a thousand km away, am totally handicapped as, I do not have the privilege to examine her. It's a good sign that your wife has no fever now. However, it is my sincere advice that, in case the fever recurs, persuade the treating doctor to order ALL TESTS RECOMMENDED BY ME, which cover all common possibilities, including Typhidot (for typhoid) and Blood for malarial IgG & IgM antibodies (which is totally specific for Malaria and much superior to blood smear.) Regarding your query, blood test is the only method for diagnosing both- malaria and typhoid. You may therefore, take out a print of the tests advised by me, and persuade the treating doctor to carry them out, if fever recurs. Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (14 days later)

Hello Doctor, Thanks for your reply. The consulting doc again took blood test (Typhoid, malaria & dengue) and also the blood culture. Luckily the result was negative. And last Sunday (Mar 23rd) again my wife had temp around 100. Then the consulting doc checked with another physician for advice. He listened to our entire treatment and told us that there is nothing to worry at all. He also mentioned that 100 is NOT FEVER. Only temp above 100 is FEVER. He advised for chest x-ray also. We took that also & the result was normal. My wife came back to Chennai today (Mar 28) and she told me that yesterday afternoon she had mild fever(100.4) and chillness & she checked with the doc again. Doctor has told her not to worry, take some rest & eat rich foods. My wife was also advised to check for 2 weeks & call the consulting doc after that. In case, if she gets fever in this time, doctor has informed us that he will prescribe some ATT medicines which can be taken orally as tablets for one month (if required). Otherwise she is fine. Wanted to check with you, whether the ATT tablets will help (if needed) in our case? Thanks

Answered by Dr. Rakesh Karanwal (31 minutes later)

Brief Answer: ATT tablets course should be the last resort Detailed Answer: Dear Mr. Raghuraman, I have once again gone through the entire sequence of events and the tests. I am still NOT convinced. Usually, the doctors in general, ask for blood film examination for malaria. I will recommend the following :- 1. Buy from the market yourself:- (a) 12 tablets of Tab FALCIGO (50mg) and give 2 tablets twice a day on first day; thereafter, one tablet twice a day for 4 days; Plus, (b) Tab MALIRID DS (15mg) one tablet daily after breakfast for 2 weeks. 2. If fever disappears in 2 weeks' time, there will be NO FURTHER requirement of treatment. 3. If fever persists (even if it is 100) even after completion of the 2 weeks' course, get her checked up by a gynecologist for Pelvic Inflammatory Disease (PID). 4. If the gynecologist rules out PID, then, a possibility of occult tuberculosis (generalized TB of the entire body) cannot be ruled out. In that case, a trial of ATT(EHRZ) should be given. HOWEVER, ONCE ATT IS STARTED, IT SHOULD BE GIVEN FOR 6 MONTHS. Otherwise, chances of developing resistance to these anti-tubercular drugs are very high. PLEASE DO FOLLOW my advice, as rendered repeatedly.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (1 hour later)

Hi Doctor, Thanks for the reply. We are married for 1.5 years and planning for baby. Suppose in worst case, if my wife is prescribed ATT tablets will that have any impact on our baby plans? Do we need to postpone anything? Please advise. Thanks

Answered by Dr. Rakesh Karanwal (2 hours later)

Brief Answer: Conception will have to deferred till she's on ATT Detailed Answer: Well. ATT treatment is a double-edged sword. Firstly, conception will have to be postponed till your wife is on ATT. Further, the flip side of the coin is: if at all, tubercular infection has involved reproductive organs, ATT will cure it before irreparable damage to the reproductive organs takes place.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar