A 2yr/m baby c/o high grade fever since 3 days with vomiting no/h/o loose motion reports are attached

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History insufficient to reach a diagnosis. However, take history regarding continuous /irritating cry, breast feeding, cough, running nose, redness of eyes, chills, defecation, urination, nature of fever etc. Examine for jaundice, lymph nodes, coating of tongue, abdominal tenderness, stare look, head nodding, chest exam for crepts /rhonchi, Nasal cavity and oral cavity for congestion or parotid swelling, blanching skin rash, any visible skin rashes, koplik spot etc. Advice basic tests like Routine blood with ESR, Bilirubin, Malaria slides and antigens. Advice other tests as par clinical details. REMEMBER, IN FIRST WEEK FEVER BLOOD CULTURE OR TYPHIDOT IS THE DIAGNOSTIC TEST FOR ENTERIC FEVER.... Widal has no diagnostic value. In dengue neither PLATELETS DECREASED nor HEMATOCRIT increased only LEUKOPENIA may be seen in first 3 days of fever. Measles to be ruled out easily with clinical features (FEVER + Downward PIN POINT RASHES + any of 3CS like COUGH /CORYZA /CONJUNCTIVITIS).

Fever 3 days nausea vomiting this looks to be viral fever and child may be dehyradeted hence nausea and vomiting so just hydrate the pt orally or iv give antiemetics like ondestron syp treat with ofloxacin and cefixim syp and pcm . Idont think given widal report has any significance you can repeat it after one week if pt does not response yes agree with dr Rao for +ve in 1:160 inference

Agreed sir. But sir difficult to comment as viral fever from just the history of fever. He didn't even say about any viral prodromes like running nose, headache, nasal or Oral mucosal congestion, throat pain etc.
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WIDAL positivity in TH TITRE OF 1: 160 is significant of past infection or in endemic area. Adv. CBC, CRP, MP ( QBC ) , URINE FOR ROUTINE AND MICROSCOPIC EXAM TREAT ACCCORDINGLY Mean while treat with pcm for fever and ondensetron for vomiting and ORS for loose motions.

Sir, is there any role of antibody titre (Widal) in first week to diagnose enteric fever?
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Typhoid fever.To see gradation of dehydration,if severe dehydration start IVF ( body weight×100ml) in 3 hours(avoid 5D),Inj Cefrrixone 375mg BD(AST)×7 days,Inj Onsansetron IV sos, Liquid diet, Breast feeding,Zinc 10mg BD×14 days, Probiotics sachet,Syp PCM 15mg/kg sos

enteric fever start iv ceftriaxone bd for days do typhi igm pct syruphelpful stool culture urine culture

Sir as we know stool culture /Urine culture in suspected enteric fever is done from or after 3rd weeks of fever.
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I think child must have mild fever since 5-6 days. And may be parents didnt notice abt it. And now the widal came positive. Acxording to symptoms and fhe report you should treat the patient accordingly. Admitt and start symptomatic and IV ceftriaxone. I think child will get better. And please dont choose this wild combination oflox and cefixime in this perticular child.

Complete history, examination, investigation, Give him antipyretic till diagnosis and treatment accordingly.

Agree with dr rao sir

I will like to wait for next few days if child is stable and responds to pcm. H titer only reminds of past s typhi infect or an anamenestic reaction. Better to do bactec at this stage.

Agree with Dr Raghavendra Rao

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