The Relationship Between Blood Sample Volume and Diagnostic Sensitivity of Blood Culture for Typhoid and Paratyphoid Fever: A Systematic Review and Meta-Analysis

Antillón, Marina; Saad, Neil J.; Baker, Stephen; Pollard, Andrew J.; Pitzer, Virginia E.

doi:10.1093/infdis/jiy471

Cited by 69 publications

(78 citation statements)

References 46 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Missed cases can occur when patients with fever do not seek medical care, attend a clinic that is not part of the study surveillance programme, or seek medical care but do not receive a blood culture test required for diagnosis. In addition, blood culture tests have poor sensitivity [3], especially in settings where self-treatment with widely available antibiotics may occur prior to blood culture.…”

Section: Introductionmentioning

confidence: 99%

“…[4] As a minimum, crude incidence estimates are often adjusted for the poor sensitivity of blood culture tests; [5] among those with typhoid fever, only around 60% of individuals who receive a blood culture are expected to test positive. [3] Additionally, incidence can be adjusted to account for missed cases using inflation factors based on data from community surveys or other sources of information on health-care seeking behaviour. [6,7] However, incidence estimates also need to be adjusted for the number of patients who have typhoid fever meeting pre-specified eligibility criteria and attend a surveillance facility but do not receive a blood culture.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Under-detection of blood culture-positive enteric fever cases: The impact of missing data and methods for adjusting incidence estimates

et al. 2020

View full text Add to dashboard Cite

BackgroundIn surveillance for typhoid fever, under-detection of cases occurs when patients with fever do not seek medical care, or seek medical care but do not receive a blood test. Missing data may result in incorrect estimates of disease incidence. MethodsWe used data from an ongoing randomised clinical trial of typhoid conjugate vaccine among children in Nepal to determine if eligible patients attending our fever clinics who did not have blood taken for culture had a lower risk of disease than those who had blood drawn. We assessed clinical and demographic predictors of having blood taken for culture, and predictors of culture-positive results. Missing blood culture data were imputed using multiple imputations. ResultsDuring the first year of surveillance, 2392 fever presentations were recorded and 1615 (68%) of these had blood cultures. Children were more likely to have blood taken for culture if they were older, had fever for longer, a current temperature �38 degrees, or if typhoid or a urinary tract infection were suspected. Based on imputation models, those with blood cultures were 1.87 times more likely to have blood culture-positive fever than those with missing data. ConclusionClinical opinion on the cause of the fever may play a large part in the decision to offer blood culture, regardless of study protocol. Crude typhoid incidence estimates should be adjusted PLOS Neglected Tropical Diseases | https://doi.org/10.1371/journal.pntd.0007805 January 16, 2020 1 / 12 OPEN ACCESS Citation: Voysey M, Pant D, Shakya M, Liu X, Colin-Jones R, Theiss-Nyland K, et al. (2020) Under-detection of blood culture-positive enteric fever cases: The impact of missing data and methods for adjusting incidence estimates. PLoS Negl Trop Dis 14(1): e0007805. https://doi.org/ 10.for the proportion of cases that go undetected due to missing blood cultures while adjusting for the lower likelihood of culture-positivity in the group with missing data. Author summaryTyphoid fever is a serious illness caused by a bacterial infection in the blood. Typhoid spreads through contaminated water sources, poor sanitation or poor hygiene, and occurs most often in low-resource environments, with children being most at risk. It is hard to determine how common typhoid infections are in low-resource setting as there are many pathogens that can cause diseases with similar characteristics, and not all patients present to health-care facilities. The culture test to detect the presence of bacteria in the blood is poorly sensitive, costly to perform, and not available in all facilities. Therefore, true disease cases often go undetected, resulting in an underestimation of the true burden of disease. We examined factors associated with blood culture collection in fever patients attending typhoid surveillance clinics in Kathmandu, Nepal. We aimed to determine whether those who did not have a blood culture were different in terms of clinical and demographic characteristics to those who did have blood taken for culture and, additionally, whether they were m...

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Under-detection of blood culture-positive enteric fever cases: The impact of missing data and methods for adjusting incidence estimates

et al. 2020

View full text Add to dashboard Cite

show abstract

“…One contributing factor to uncertainty about the burden of disease is the lack of reliable diagnostic testing. The most consistently valid method for laboratory diagnosis is blood culture, estimated to be only 61% sensitive [ 7 ] in a recent meta-analysis, and may be dependent on sample volume [ 8 ]. In many low- and middle-income countries, blood culture is also largely unavailable, particularly in rural areas.…”

mentioning

confidence: 99%

Phase I of the Surveillance for Enteric Fever in Asia Project (SEAP): An Overview and Lessons Learned

Barkume

Date

Saha

et al. 2018

The Journal of Infectious Diseases

View full text Add to dashboard Cite

ObjectiveThe objective of Phase I of the Surveillance for Enteric Fever in Asia Project (SEAP), a multiphase surveillance study characterizing the burden of disease in South Asia, was to inform data collection for prospective surveillance and to capture clinical aspects of disease.MethodsThrough a retrospective record review conducted at hospitals in Bangladesh, India, Nepal, and Pakistan, we examined laboratory and clinical records to assess the culture positivity rate for Salmonella Typhi and Salmonella Paratyphi, age and sex distribution, and antimicrobial susceptability in each country.ResultsOf all blood cultures performed in Bangladesh, India, Nepal, and Pakistan, 1.5%, 0.43%, 2%, and 1.49%, respectively, were positive for S. Typhi and 0.24%, 0.1%, 0.5%, and 0.67%, respectively, were positive for S. Paratyphi. A higher proportion of laboratory-confirmed infections in Bangladesh and Pakistan were aged ≤5 years, while India and Nepal had a higher proportion of participants aged 15–25 years. In all countries, the sex of the majority of participants was male. The majority of isolates in all countries were resistant to fluoroquinolones, with a high proportion also resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole.DiscussionEnteric fever remains endemic in South Asia. Data generated by this study can help inform strategies for implementation and evaluation of prevention and control measures.

show abstract

“…The latent class model indicates 73% sensitivity in the overall population (74% in children aged less than 17 years), in the high range of reported estimates. 10 However, in the absence of a secondary endpoint test to confirm PCR results, there is a non-neglectable risk of class membership misclassification (confirmed/suspected) in addition to the unbalanced weight of the respective tests. This might be counterbalanced by running the model with results from bone marrow culture and/or serological test results.…”

Section: Discussionmentioning

confidence: 99%

“…8 In current clinical practice in most endemic countries, blood culture and Widal test are the most common diagnostic procedures used despite poor sensitivity and specificity. 9 Indeed, blood culture sensitivity has been estimated at 59% of presumptive cases, ranging from 51% to 65% according to specimen volume, 10 whereas Widal test is hampered by the lack of standardization of reagents and/or misuse and misinterpretation of results. 11,12 Serological rapid diagnostic tests such as Typhidot-M or Tubex may represent some improvement over the Widal test, but still have suboptimal sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Clinical Evaluation of a Multiplex PCR for the Detection of Salmonella enterica Serovars Typhi and Paratyphi A from Blood Specimens in a High-Endemic Setting

Pouzol

Tanmoy

Ahmed

et al. 2019

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Enteric fever is a major public health concern in endemic areas, particularly in infrastructure-limited countries where Salmonella Paratyphi A has emerged in increasing proportion of cases. We aimed to evaluate a method to detect Salmonella Typhi (S. Typhi) and Salmonella Paratyphi A (S. Paratyphi A) in febrile patients in Bangladesh. We conducted a prospective study enrolling patients with fever > 38°C admitted to two large urban hospitals and two outpatient clinics located in Dhaka, Bangladesh. We developed and evaluated a method combining short culture with a new molecular assay to simultaneously detect and differentiate S. Typhi and S. Paratyphi A from other Salmonella directly from 2 to 4 mL of whole blood in febrile patients (n = 680). A total of 680 cases were enrolled from the four participating sites. An increase in the detection rate (+38.8%) in S. Typhi and S. Paratyphi A was observed with a multiplex polymerase chain reaction (PCR) assay, and absence of non-typhoidal Salmonella detection was reported. All 45 healthy controls were culture and PCR negative, generating an estimated 92.9% of specificity on clinical samples. When clinical performance was assessed in the absence of blood volume prioritization for testing, a latent class model estimates clinical performance ³ 95% in sensitivity and specificity with likelihood ratio (LR) LR+ > 10 and LR− < 0.1 for the multiplex PCR assay. The alternative method to blood culture we developed may be useful alone or in combination with culture or serological tests for epidemiological studies in high disease burden settings and should be considered as secondary endpoint test for future vaccine trials.

show abstract

The Relationship Between Blood Sample Volume and Diagnostic Sensitivity of Blood Culture for Typhoid and Paratyphoid Fever: A Systematic Review and Meta-Analysis

Cited by 69 publications

References 46 publications

Under-detection of blood culture-positive enteric fever cases: The impact of missing data and methods for adjusting incidence estimates

Under-detection of blood culture-positive enteric fever cases: The impact of missing data and methods for adjusting incidence estimates

Phase I of the Surveillance for Enteric Fever in Asia Project (SEAP): An Overview and Lessons Learned

Clinical Evaluation of a Multiplex PCR for the Detection of Salmonella enterica Serovars Typhi and Paratyphi A from Blood Specimens in a High-Endemic Setting

Contact Info

Product

Resources

About