How Is Typhoid Treated ?

Posted on Thu, 12 Apr 2012

Question: Hi,
On 13th July '11 I started with fever (101 deg). On 15th July, my doctor recommended me to get Typhoid tested. 15th July evening typhoid igm was positive. He started a course of Zanocin 200 for 5 days along with paracetamol. My Fever was under control by third day (17th/18th July). On 20th July, he prescribed me to continue with Zanocin 200 for 3 more days. Fever didnt appear again after 20th July. However I felt weakness for 2 weeks (till 28th July). Since 15th July, he had suggested me to go soft on diet (no fibre, etc.). I am still continuing with that soft diet.

1) I got my typhoid igm again tested today (30th July). It is still showing as positive. I am concerned, Is that still a problem?
2) I observe that my digestion has still not recovered. What do you suggest?
3) For how long should I continue with soft diet? When can I start with regular home made diet? (and how/what to start to make it regular?)

Answered by Dr. Kiran Kumar (35 minutes later)

Hi XXXXXXX

Thanks for your query.

Your Typhoid IgM will be positive for atleast 3 months. IgM is an antibody which is formed in response to infection. These antibodies persist in body even after the disease is cured/controlled. In clinical practice, however, we do not prescribe the use of Typhoid IgM as it can be falsely elevated in other unrelated fevers as well.

It will take about 4 - 6 weeks for the GI system to normalize. A low fiber diet is suggested because there are chances of injury and perforation to intestine if you consume normal diet.

So be reassured.
If you have not had fever, then, it means you are cured.
Slight GI Disturbance is normal and will resolve in couple of weeks.

Hope this answers your query.
Thanks and Regards

Dr Kiran

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Kiran Kumar (16 hours later)

Thanks Doctor
Kindly help me in understanding this further - "however, we do not prescribe the use of Typhoid IgM as it can be falsely elevated in other unrelated fevers as well".

Regarding the diet, I am currently eating the following things (with less oil) - potato, pulses, cooked XXXXXXX veg, rice, curd, chapati, bread, juices, banana, mango. Kindly suggest how should I increase the diet (in what form, and in what time duration)

Answered by Dr. Kiran Kumar (5 hours later)

Hi XXXXXXX

The gold Standard Tests for diagnosis of Typhoid Fever is as follows

1. Blood Cultures in First Week of fever
2. Blood and Urine Culture in 2nd Week
3. WIDAL is a test hich becomes positive only after 1st week of fever.

Typhidot test (Typhoid IgG and IgM) is a rapid diagnostic test for typhoid fever.
However, it lacks sensitivity and specificity.
In simple terms, sensitivity is 72% and specificity is 52%.

False positivity was due to number of factors including cross-reactions with Salmonella paratyphi A (46%) and other non-typhoidal fever who tested positive (45%).

Therefore, given a positive typhoid IgM, there is only 31% probability that the patient has typhoid fever. So I as a clinician do not use it for diagnosis.
Some do use it and its their insight and responsibility to justify it.

Your diet seems to be Ok. This has to go on for 3 weeks and after that you can start normal diet.

Take Care

Dr Kiran

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