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VALUE OF ESR IN DIFFERENTIATINGTYPHOID FROM TUBERCULOSIS IN PATIENTS HAVING PYREXIA OF MORE THAN TWO WEEKS
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
When the patient continues to run fever after two weeks, many illnesses like flu, viral fevers, infectious fevers, viral hepatitis, amoebic liver abscess, pneumonias, pleural effusions, rheumatic fever, acute pyelonephritis etc. can be excluded.
Amongst many other causes of fever, malaria, typhoid and tuberculosis remain as differential diagnosis.
In my experience I find that at the end of two weeks, if ESR is nearly normal, the diagnosis of typhoid is more likely. If the ESR is high and around 50 mm, an X-ray chest should be repeated to exclude chest tuberculosis. But if the ESR is very high and around 90 or 100 mm, look out for extra pulmonary tuberculosis, with or without a positive HIV test. According to the literature, ESR is increased in malaria. At present, I have no comments on this finding.
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