Seun's fever had been present for nine days — unusually sustained, different in character from the malaria episodes he'd had before. Two rounds of malaria medication had made no difference. A Widal test and careful history pointed to typhoid.
University student, Akoka. Presented with 9-day history of sustained fever.
Enteric Fever (Typhoid)Seun's fever started on a Monday. By Wednesday he had bought Lonart from a pharmacy and taken the first two tablets. The fever did not shift. He completed the 3 remaining tablets in the blister — not even a full course — and waited.
By day 6 the fever was unchanged. A friend suggested he try a different malaria drug. He bought co-artemether from a different pharmacy and took a 2-day course. Still no improvement.
On day 9 his mother drove him to Mascot Healthcare. He was thin, hollow-eyed, and had lost approximately 3 kg. The attending doctor examined his abdomen carefully before asking him to remove his shirt — the faint rose spots on his trunk confirmed what the history already suggested.
Seun had experienced malaria before. This, he kept telling himself, felt different — but he could not say exactly how.
Not the spiking pattern of malaria — more constant, present morning and evening.
Persistent and dull, not the acute pounding of malaria.
Central cramping, intermittent — worse after eating.
Constipation for 5 days, then 3 days of loose stools.
Faint pink macules noted on his abdomen — he had assumed they were heat rash.
The challenge with enteric fever in Lagos is that its early symptoms — fever, headache, malaise — are almost identical to uncomplicated malaria. Most patients, and many community pharmacies, default to malaria treatment.
The key clinical difference Seun had noticed but not acted on: the fever was constant, not spiking. Malaria fever rises and falls. Typhoid fever is more sustained. He had also not had the rigors — the shivering episodes — that he remembered from previous malaria.
Widal test at Mascot Healthcare: O titre 1:160, H titre 1:80 — consistent with active typhoid in the clinical context. Seun's malaria RDT was negative, confirming the malaria drugs had been targeting the wrong pathogen entirely.
The rose spots on his abdomen — typhoid rose spots, a pathognomonic sign of Salmonella typhi bacteraemia — had been present for at least 3 days. He had thought they were a reaction to one of the medications.
Widal test: O 1:160 / H 1:80. Malaria RDT: negative. Clinical picture: sustained fever, abdominal symptoms, rose spots, constipation then diarrhoea. Diagnosis: enteric fever (typhoid).
A full course of prescribed medication. Oral rehydration. High-calorie soft diet recommended. Advised to avoid all raw food and water from street vendors during treatment and recovery.
Review at day 5 to assess fever response and tolerability. Advised to complete the full course and attend if any abdominal pain became acute or severe.
Fever resolved by day 4 of antibiotics. Seun completed the full course. His weight began recovering at the 2-week mark. He has since started boiling all drinking water and eating at home more consistently.
Malaria and typhoid co-exist in Lagos and share many early symptoms. When a patient presents with fever, headache, and malaise, both diagnoses must be considered — especially if malaria treatment has not worked.
The distinguishing features — sustained rather than spiking fever, relative bradycardia, abdominal signs, and the characteristic rose spots — point clearly to typhoid. A Widal test, though imperfect, is affordable, rapid, and available at Mascot Healthcare for ₦2,500.
If fever does not respond to two rounds of appropriate malaria treatment, do not buy a third round. Attend a clinic for a proper differential diagnosis. Typhoid requires antibiotics, not antimalarials — and delays increase the risk of serious complications.
Walk in to Mascot Healthcare, Akoka — same-day consultation, transparent pricing, 4.9★ rated.