Typhoid fever among febrile Nigerian patients: Prevalence, diagnostic performance of the Widal test and antibiotic multi-drug resistance

Abstract

<jats:p>BackgroundOver-dependence on clinical presentation and/or the Widal agglutination test for the diagnosis of typhoid fever in developing countries can lead to antibiotic abuse. In Nigeria, the antibiotic resistance of typhoid organisms is poorly characterized. In this study, we determined the prevalence of culture positivity among patients suspected of having typhoid fever, evaluated the diagnostic value of the Widal test and the burden created by the multi-drug resistance of typhoid organisms in South-East Nigeria. MethodologyThis was a prospective and case-controlled study carried out between 2013 and 2016. We acquired samples of blood/stool/urine cultures, and data relating to the Widal agglutination test and malaria parasites from 810 febrile patients (suspected of having typhoid) and 288 apparently healthy controls. Individuals with a history of antibiotic use within the previous 14 days were excluded. We then carried out antibiotic susceptibility tests on all isolates. Multi-drug resistance was defined as a resistance to ≥3 of the antibiotics tested. We determined the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Widal test for typhoid laboratory diagnosis compared to bacterial culture which is the gold standard. A P-value &lt;0.05 was considered to be statistically significant. ResultsThe mean age of typhoid suspects was 33.1±6.5 years and 50.7% were women. Of the 810 typhoid suspects tested, 114 (14.1%) had positive cultures for the typhoid organisms Salmonella enterica serovar paratyphi (72) and S. enterica serovar Typhi (42). Sample-specific rates of culture positivity were as follows: stool (72; 8.9%), blood (21; 2.6%) and urine (21; 2.6%), P&lt;0.001. None of the controls had typhoid isolates. The sensitivity, specificity, PPV and NPV of the Widal test were 49.1%, 90.7%, 46.2% and 91.6%, respectively. Malaria parasitaemia was detected in 180 (22.2%) febrile patients, out of whom 115 (63.9%) had a positive Widal test for O/H antigens vs. 1% (6/630) in those with negative malaria parasite test results (P&lt;0.001). The rate of false-positive Widal titres was 48%. Antibiotic multi-drug resistance was detected in 52.6% of patients. The antibiotics with the highest susceptibility were ciprofloxacin, levofloxacin and meropenem (all 100% susceptibility) and ceftriaxone (95.6% susceptibility). ConclusionOur data showed that while typhoid fever is common in Nigeria, malaria is more prevalent. Our analysis showed that the Widal test performed poorly as a diagnostic test and that the burden created by multi-drug resistance was high. Our data indicate that periodic surveillance of antibiotic susceptibility is critical for optimal typhoid therapy.</jats:p>

Eosinopenia in Patients With Typhoid Fever: A Case-Control Study

“…In our study, there were 99 male and 101 female participants. This result is relatively similar to another study in which 50.7% of the participants were women [13]. The mean age of the participants in the study was 32.04±16.30 years.…”

“…The mean age of the participants in the study was 32.04±16.30 years. Our population was relatively younger when compared to participants from a 2019 study who had a mean age of 33.10±6.50 years [13]. This implies that in non-pediatric age groups, the age of presentation might vary depending on geographical factors.…”

“…In one of the studies conducted in Hyderabad, 486 cases had been identified from three major hospitals of the region and all of these cases were resistant to ceftriaxone using culture yield, but the study did not comment regarding white blood counts [12]. In another study, the number of Pakistani patients was found to be as high as 5,372 [13].…”

Iron Deficiency Anemia and Serum Hepcidin Level in Children with Typhoid Fever: A Case–Control Study

“…We used a negative saline control for each batch of Widal's tests. 28 With regard to blood cultures, 2 to 4 mL blood was directly inoculated in BacT/Alert culture bottles, and then incubated in the Bact/Alert automated system (Biomérieux, United States) for 5 days. Later on, subculture was done on Mac-Conkey and Salmonella-Shigella agar and incubated for 18 to 24 hours at 37°C.…”

On Optimal Control and Cost-Effectiveness Analysis for Typhoid Fever Model

“…According to the most recent estimates, between 11 and 21 million cases of typhoid and 128,000 to 161,000 typhoid related-deaths occur annually worldwide (WHO, 2019;Browne et al, 2020;Espinoza et al, 2019). Globally, 10.9, 12.5, 26, 22 and 25.9 million new cases of typhoid fever ; and 116.8, 149, 190, 210 and 181 thousand typhoid-related deaths in 2017, 2015, 2010, 2000 and 1990 respectively (Mather et al, 2019;Amicizia et al, 2019;Radhakrishnan et al, 2018;Buckle et al, 2012;Mukhopadhyay et al, 2019;Deksissa et al, 2019;Ohanu et al, 2019). A bulk of these burdens is borne by the developing sub-Saharan African countries.…”