Misdiagnosis of typhoid and dengue fevers leads to antibiotics resistance in India

Syed Akbar
Hyderabad:  Cases of misdiagnosis of typhoid and dengue fevers
have been on the rise in the city, subjecting patients to a prolonged
antibiotic regimen. While typhoid fevers are over-diagnosed, dengue
fever is mostly under-diagnosed. Moreover, there are many cases of
false-positive or false-negative typhoid and dengue cases in the
State. This explains prolonged fever cases of late, some patients
suffering from high temperature for as long as a month.

Proper diagnosis of fevers has now become necessary with the Indian
Council of Medical Research planning to come out with strict
guidelines on antibiotic abuse in the country. The Pharmacy Council of
India has also drafted a Bill on rational use of antibiotics. Thanks
to misdiagnosis of fevers, doctors start antibiotic treatment and
change the regimen only when the problem fails to subside. This leads
to overburden of antibiotics on patients.

“The best way of diagnosing typhoid fevers is through blood culture
test. Though it takes 48 hours for the result, the diagnosis is
accurate and there is no scope for false-positive or false-negative
reports unlike in the Widal test for typhoid. Since the result from
blood culture test is accurate, doctors can easily diagnose the fever
and take up treatment accordingly,” said Dr Aftab Ahmad, expert in
internal medicine.

In many cases, Widal test for typhoid is conducted in the first week
of the onset of fever. City doctors warn that Widal test in the first
week gives false reports. The ideal time is to go in for the Widal
test in the second week of onset of fever. “Patients often rush in for
diagnostic tests in their anxiety to know the problem. They bring the
reports and based on them doctors start the treatment. The confusion
begins when the reports are either false-positive or false-negative,”
said senior physician Dr M Ramachandra Murthy.

It takes some time, often seven to 14 days, for the antibody levels to
be detected in serological tests. And during this time, antibiotics
are prescribed without a restriction, causing antibiotic resistance in
the patient. Since Widal is simple to use and inexpensive, doctors
often prescribe it, even though they know that it is neither specific
nor sensitive.