I am typhoid positive 17 y/o male, its been since june or july of 2025

I am typhoid positive 17 y/o male, its been since june or july of 2025, i have been good on between, but its positive since then. I may have some symptoms which are usually of tuberculosis, like night sweat (sweating too a day time), fever bht very low or never, chest pain (sometimes, somedays when eating outside food), weight loss-unusual as according to my diet, and im also feeling lazy, sleeps more than usual 8 hours, mainly in day time too, and little bit of weakness

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typhoid positive for months chronic carrier teenager night sweats weight loss tuberculosis coinfection

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Understanding Your Situation: Chronic Typhoid + TB-like Symptoms

First, an important note: Please see a doctor as soon as possible. The combination you're describing — months-long typhoid positivity, weight loss, night sweats, chest pain, fatigue, and excessive sleep — needs in-person clinical evaluation and testing. This response will help you understand what's going on and what to tell your doctor.

What Does "Typhoid Positive Since June/July 2025" Mean?

Being typhoid-positive for nearly a year most likely means one of two things:

1. Chronic Typhoid Carrier State

Harrison's Principles of Internal Medicine (22E) explains this clearly:

"The 2–5% of patients who develop chronic carriage of… S. Typhi [excrete the organism for ≥12 months]."

Chronic carriage happens when Salmonella Typhi hides in the gallbladder (often sheltered in bile or gallstones), continuing to test positive even though the acute fever has resolved. Risk factors include:

Gallbladder disease or gallstones
Female sex, older age — but it can happen in teenagers too
Incomplete or inadequate antibiotic treatment of the original infection

You've described feeling "good in between," which fits a carrier state: the bacteria are still there, but not causing a full-blown acute illness at all times.

2. Relapse or Inadequately Treated Infection

Harrison's notes relapses occur in 2–20% of treated patients, usually 2 weeks after finishing antibiotics, with milder symptoms than the original illness. If the original infection wasn't fully treated (wrong antibiotic, wrong duration, multidrug-resistant strain), it can smoulder.

Your Symptoms — What They Could Mean

Your symptoms are concerning for more than just chronic typhoid. Here's how to interpret each:

Symptom	Chronic Typhoid	Tuberculosis (TB)	Other causes
Night sweats (also daytime)	Can occur during bacteremic phases	Classic "B symptom" of TB	Lymphoma, other chronic infections
Very low/no fever	Fits chronic carrier	Can occur in TB	—
Chest pain (especially with outside food)	Not typical	Can occur (pleuritis)	GERD, musculoskeletal
Unusual weight loss	Yes, during active phases	Classic TB symptom	Malnutrition, malabsorption
Fatigue, sleeping >8 hrs, daytime sleep	Systemic infection	Yes	Anemia, other chronic illness
Weakness	Yes	Yes	Nutritional deficiency

Night sweats + weight loss + fatigue in a teenager living in an endemic area = tuberculosis must be ruled out. This is not optional — TB and typhoid can coexist, and TB can be "quiet" (paucibacillary or early pulmonary TB) for months before becoming obvious.

Why TB Must Be Ruled Out Separately

Typhoid does NOT cause typical TB symptoms like productive cough, hemoptysis (coughing blood), or chest X-ray infiltrates. Your night sweats and weight loss could be explained by chronic typhoid, but because you're a teenager in a likely-endemic area:

TB is extremely common in South/Southeast Asia and Africa
TB in adolescents can be smear-negative (hard to detect on sputum test alone)
The symptoms overlap almost completely

A paper in Journal of Infection and Public Health even described typhoid spondylodiscitis mimicking TB in a teenager, emphasizing how these infections can look alike.

What Tests You Need RIGHT NOW

Tell your doctor you want all of the following:

For Typhoid:

Stool culture — to confirm active carriage (blood culture is less sensitive at this stage)
Bone marrow culture — most sensitive (90%), especially if on antibiotics
Widal test alone is unreliable — if that's how you've been "confirmed," it needs a blood or stool culture to verify

For TB:

Chest X-ray — mandatory
Mantoux test (TST) / IGRA (TB Gold test) — to check for TB infection
Sputum AFB smear + culture — if you have any cough
Complete blood count (CBC) — to check for anemia, lymphocytosis

General:

Liver function tests (typhoid can affect the liver)
Abdominal ultrasound (to check gallbladder/gallstones — a key driver of chronic carriage)
ESR and CRP (inflammatory markers)

Treatment for Chronic Typhoid Carriage

According to Harrison's:

"Patients who develop chronic carriage of fluoroquinolone-susceptible S. Typhi can be treated for 4 weeks with oral ciprofloxacin or other fluoroquinolones, with an eradication rate of ~80%."

For fluoroquinolone-resistant strains (increasingly common in South Asia — PMID 41990105 confirms rising AMR in India):

Azithromycin for 4 weeks is an alternative
If gallstones are present, surgery (cholecystectomy) may be needed alongside antibiotics for permanent eradication

Important: At 17, fluoroquinolones are sometimes used with caution (joint concerns in adolescents), but are generally considered acceptable for serious infections. Your doctor will decide based on susceptibility testing.

About the Chest Pain

Chest pain when eating outside food specifically is more likely gastrointestinal — either:

GERD/gastritis (typhoid and its treatment with antibiotics can damage the stomach lining)
Hepatosplenomegaly causing discomfort when full
Less likely: pleuritis from TB

Still worth telling your doctor about.

The Fatigue and Excessive Sleep

Sleeping more than 8 hours, daytime sleepiness, and weakness in a chronic infection are caused by:

Cytokine-driven fatigue — your immune system fighting bacteria releases IL-6, TNF-α, causing systemic malaise
Nutritional depletion — chronic infection uses up calories, iron, and proteins
Possible anemia — chronic infections often cause anemia of chronic disease
Possible low vitamin D or B12 — common in South Asian teenagers

A CBC and ferritin level will clarify this quickly.

Summary Action Plan

See a doctor this week — bring all your previous test reports
Demand a chest X-ray and TB test — do not let this get dismissed
Get a stool culture to confirm ongoing S. Typhi shedding
Get an abdominal ultrasound to check for gallstones
Do NOT take antibiotics without a prescription — resistance is a serious concern
Avoid handling food for others — as a potential carrier, you can unknowingly spread typhoid

Sources: Harrison's Principles of Internal Medicine 22E (2025); Yamada's Textbook of Gastroenterology 7E; Red Book 2021 (AAP Committee on Infectious Diseases); CDC Yellow Book (Typhoid & Paratyphoid Fever); PubMed PMID 41335321 (Chronic carriers and multidrug resistance in typhoid fever, 2026)

Disclaimer: This is medical information, not a diagnosis or prescription. You must see a qualified physician for proper evaluation.

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