Explain the report along with possible diagnosis
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python3 -c " import pdfplumber with pdfplumber.open('/tmp/workspace/attachments/11243b4a-02a0-430b-8af7-244c246b9dd1/Mr.sohail khan 5873-2026-07-15.pdf') as pdf: for i, page in enumerate(pdf.pages): print(f'--- PAGE {i+1} ---') text = page.extract_text() print(text) tables = page.extract_tables() for j, table in enumerate(tables): print(f' [Table {j+1}]') for row in table: print(' ', row) "
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I now have sufficient information to provide a thorough explanation. Let me compile the full analysis.
Lab Report Analysis - Mr. Sohail Khan (Age 23, Male) | July 15, 2026
Report Summary
The report contains two panels: a Complete Blood Count (CBC) and a Serology panel (Widal test + Dengue screen).
CBC Findings - Detailed Breakdown
| Parameter | Result | Reference Range | Status |
|---|---|---|---|
| Haemoglobin | 13.4 g/dL | 11.5-16.5 | Normal |
| Total WBC | 10,200 /cumm | 4,000-11,000 | High-normal / borderline |
| Neutrophils | 86% | 40-75% | HIGH (H) |
| Lymphocytes | 07% | 20-50% | LOW (L) |
| Monocytes | 05% | 3-10% | Normal |
| Eosinophils | 02% | 1-5% | Normal |
| Basophils | 00% | 0-1% | Normal |
| RBC Count | 4.88 mil/cumm | 3.9-5.6 | Normal |
| PCV/HCT | 42.9% | 38-50% | Normal |
| MCV | 87.91 fL | 82-96 | Normal |
| MCH | 27.46 pg | 27-32 | Normal |
| MCHC | 31.24 g/dL | 33-37 | LOW (L) |
| RDW-CV | 11.3% | 11.5-14.5 | LOW (L) |
| Platelet Count | 2.65 Lacs/cumm | 1.5-4.5 | Normal |
| MPV | 11.1 fL | 6.5-12 | Normal |
Key CBC Abnormalities
- Neutrophilia (86%) - Significantly elevated, indicates an active bacterial infection or inflammatory response
- Relative Lymphopenia (7%) - Markedly low; lymphocytes are being "crowded out" proportionally; also seen in acute bacterial infections and typhoid
- Borderline leukocytosis (10,200) - Total WBC count is at the upper limit, consistent with bacterial infection
- Low MCHC (31.24 g/dL) - Mildly reduced, suggests a mild degree of hypochromia, possibly early iron deficiency or haemodilution
- Low RDW-CV (11.3%) - Marginally below normal; iron deficiency typically raises RDW, so this likely reflects mild nutritional anaemia in its early stage or a normal variant
Serology Findings
Widal Test
| Antigen | Titer | Significance |
|---|---|---|
| S. Typhi "H" (flagellar) | 1:80 | Borderline / equivocal |
| S. Typhi "O" (somatic) | 1:160 | Significant / Positive |
| S. Typhi "AH" (paratyphi A H) | Negative | Normal |
| S. Typhi "BH" (paratyphi B H) | Negative | Normal |
Interpretation:
- In an endemic area (such as the Indian subcontinent), a single Widal "O" titer of 1:160 or above is generally considered significant for active typhoid infection
- The "O" (somatic) antibody of 1:160 is the more clinically relevant marker for active/recent infection - "O" antibodies appear earlier (day 6-8) and are more specific for current disease
- The "H" (flagellar) antibody at 1:80 is borderline; "H" antibodies can persist for months-years after prior infection or vaccination, so they are less specific
- A 4-fold rise in paired sera (acute + convalescent) would be even stronger evidence, as noted in [Sleisenger & Fordtran's Gastrointestinal and Liver Disease]
- As [Park's Textbook of Preventive & Social Medicine] states: "The test has only moderate sensitivity and specificity. It can be negative in up to 30% of culture-proven cases of typhoid fever"
Dengue Screen
All three markers (NS1 antigen, IgM, IgG) are negative - dengue is effectively ruled out at this time, though the report's own note cautions that early dengue (within the first 7 days) can give false negatives.
Possible Diagnosis
Primary: Enteric Fever (Typhoid Fever) - HIGH SUSPICION
The combination of:
- Positive Widal O titer (1:160)
- Neutrophilia with relative lymphopenia
- Borderline leukocytosis
- Dengue ruled out
...in a young male from likely an endemic region (advised by a physician with the Indian naming convention) strongly points toward typhoid fever caused by Salmonella enterica serovar Typhi.
Classic typhoid features per [Red Book 2021 - Committee on Infectious Diseases]: fever, headache, malaise, anorexia, abdominal pain, hepatomegaly, splenomegaly, and rose spots.
Important caveat: As both the textbooks and the CDC note, the Widal test is a screening test only. False positives can occur in malaria, typhus, other bacteraemias, and cirrhosis. Blood culture remains the gold standard for confirming typhoid.
Differential Diagnoses to Consider
| Diagnosis | Supporting Features | Against |
|---|---|---|
| Typhoid fever | O titer 1:160, neutrophilia, lymphopenia, borderline leukocytosis | Widal alone not confirmatory |
| Other bacterial infection (UTI, pneumonia, abscess) | Neutrophilia + leukocytosis | No Widal positivity expected |
| Early dengue (day 1-7) | Dengue NS1/IgM/IgG negative - but note early false negatives | All dengue markers negative, no thrombocytopenia |
| Malaria | Can cause false-positive Widal; fever | No malarial parameters tested here |
| Paratyphoid fever | AH and BH are both negative | Ruled out by serology |
Recommendations (to discuss with Dr. Biswajit Biswas)
- Blood culture - Send immediately (before starting antibiotics); this is the gold standard for confirming typhoid
- Repeat Widal in 5-7 days - A 4-fold rise in O titer would confirm active infection
- Rule out malaria - Peripheral smear / RDT for malaria (can cause false-positive Widal and similar CBC picture)
- Liver function tests - Typhoid commonly causes hepatitis
- Urine examination - To rule out concurrent UTI
- If dengue symptoms persist - Repeat dengue test after 3-5 days as recommended in the report
Disclaimer: This interpretation is for educational purposes. Clinical correlation is mandatory. Only the treating physician (Dr. Biswajit Biswas) should make treatment decisions based on the full clinical picture, physical examination findings, and symptom history.
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