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typhoid fever Widal test diagnosis Salmonella typhi
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iron deficiency anemia microcytic hypochromic CBC RDW MCV MCH
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Here is a full interpretation of Miss Shagufta Gauhar's (17F) lab reports:
Overall Diagnosis
Primary: Enteric Fever (Typhoid) + Concurrent Iron Deficiency Anemia
Report 1: CBC (Complete Blood Count)
| Parameter | Patient Value | Reference Range | Status |
|---|---|---|---|
| Haemoglobin | 9.6 gm% | 12–16 | ⬇ LOW |
| RBC Count | 4.40 M/cumm | 3.8–5.8 | Normal |
| Total WBC | 9800 /cumm | 4000–10000 | Normal (upper end) |
| Neutrophils | 71% | 40–70 | ⬆ Slightly HIGH |
| Lymphocytes | 21% | 20–45 | Normal |
| Eosinophils | 03% | 1–6 | Normal |
| Monocytes | 05% | 1–10 | Normal |
| Basophil | 00% | 0–1 | Normal |
| HCT/PCV | 30.8% | 37–47 | ⬇ LOW |
| MCV | 70.1 fL | 76–100 | ⬇ LOW (Microcytic) |
| MCH | 21.9 pg | 27–32 | ⬇ LOW (Hypochromic) |
| MCHC | 31.2 g/dL | 32–36 | ⬇ LOW |
| RDW-CV | 16.1% | 11–16 | ⬆ Slightly HIGH |
| Platelet Count | 264000 | 150000–400000 | Normal |
What this means:
Microcytic Hypochromic Anemia — The combination of low Hb (9.6), low MCV (70.1), low MCH (21.9), low MCHC (31.2), and elevated RDW (16.1) is the classic pattern of Iron Deficiency Anemia (IDA).
- The elevated RDW is a key distinguishing feature. As noted in Harrison's (p. 2889), RDW is generally elevated in iron deficiency but normal in thalassemia — this points away from thalassemia and toward IDA.
- In a 17-year-old girl, the most common cause is inadequate dietary iron intake or menstrual blood loss.
- Hb of 9.6 g% = moderate anemia (WHO: mild 10–11.9, moderate 7–9.9).
- The WBC of 9800 with neutrophilia (71%) is consistent with a bacterial infection (typhoid).
Report 2: CRP
| Parameter | Patient Value | Reference Range | Status |
|---|---|---|---|
| CRP | 1.14 mg/L | 0–6 | Normal |
What this means:
CRP is a non-specific acute-phase inflammatory marker. At 1.14 mg/L, it is within normal limits. This may seem surprising given the positive Widal, but:
- In early or treated typhoid, CRP can be only mildly elevated or normal.
- It suggests the inflammatory response is not highly active at this moment, or antibiotics may have already been started.
Report 3: Widal Tube Test (Serology)
| Antigen | 1:20 | 1:40 | 1:80 | 1:160 | 1:320 |
|---|---|---|---|---|---|
| S.Typhi O | + | + | + | + | – |
| S.Typhi H | + | + | + | – | – |
Result: Widal Test POSITIVE
What this means:
- S.Typhi O antigen positive up to 1:160 — this is the somatic (body) antigen, and a titre ≥1:80 in an active infection is considered diagnostic.
- S.Typhi H antigen positive up to 1:80 — this is the flagellar antigen. A titre ≥1:80 can also indicate active or past infection.
- The O antigen titre of 1:160 is the more significant finding here and strongly suggests active typhoid fever (Salmonella Typhi infection), as noted in Bailey & Love's (p. 112).
Important caveat: In endemic areas like the Indian subcontinent, baseline titres can be elevated due to prior exposure or TAB vaccination. A rising titre on repeat testing 1–2 weeks later is more definitive. Blood culture remains the gold standard.
Putting It All Together
This 17-year-old female has two concurrent conditions:
1. Enteric Fever (Typhoid)
- Positive Widal (O titre 1:160, H titre 1:80)
- Mildly elevated neutrophils
- Requires antibiotic treatment: typically ceftriaxone IV or azithromycin oral (depending on local resistance patterns). Ciprofloxacin resistance is common on the Indian subcontinent.
2. Iron Deficiency Anemia
- Hb 9.6, MCV 70.1, MCH 21.9, elevated RDW — classic IDA pattern
- Requires oral iron supplementation (ferrous sulfate 200 mg BD or TDS) along with dietary counseling (iron-rich foods: leafy vegetables, lentils, meat, vitamin C to enhance absorption).
- Menstrual history should be reviewed.
Recommended Next Steps
- Blood culture — to confirm S. Typhi and check antibiotic sensitivity.
- Serum ferritin, serum iron, TIBC — to confirm IDA and assess iron stores.
- Repeat Widal in 1–2 weeks if clinical suspicion remains with initial borderline results.
- Antibiotic therapy for typhoid as prescribed by the treating physician.
- Iron supplementation for anemia.
⚠️ This analysis is for educational purposes. Please consult the treating physician for clinical decisions and prescriptions.
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