Utility of A Single Widal Test in The Diagnosis of Typhoid Fever

Alam, Abm Shahidul; Rupam, Fahim Ahmed; Chaiti, Farhana

doi:10.3329/bjch.v35i2.10377

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…The poor diagnostic performance of a single Widal test in endemic regions has been demonstrated in other studies13,19,33,34,44. In contrast to these observations, two studies carried out in endemic settings in India (PPV=91%, NPV=31%) and Bangladesh (PPV=81.1%, NPV=31.7%) found that a single Widal test was a relevant diagnostic tool for typhoid fever32,45. One of these previous studies found that the cut-off titre for a positive test was 1:80 for both O and H antigens32.…”

Section: Discussionmentioning

confidence: 93%

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

et al. 2019

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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 <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<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<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.

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Section: Discussionmentioning

confidence: 93%

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

et al. 2019

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“…Variable sensitivity and specificity of Widal test was documented in different studies and its role as a diagnostic tool is still debatable. However, some studies conducted in Tanzania, Vietnam, Bangladesh, India during different periods of time stated that Widal test could be relevant as a diagnostic tool and could be an alternative to blood culture [14][15][16][17]. On the other hand, findings of other studies conducted in Pakistan, Nepal, South Africa, Tanzania, and Ethiopia indicated that Widal test alone might not be suitable to diagnose enteric fever as it could produce false positive results [18].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, findings of other studies conducted in Pakistan, Nepal, South Africa, Tanzania, and Ethiopia indicated that Widal test alone might not be suitable to diagnose enteric fever as it could produce false positive results [18]. But scenario is quite different in developing countries like Bangladesh where Widal test is still used widely as facility of culturing organism is limited to only in tertiary care hospitals, lack of trained personnel and prohibitively high cost of culture compared to serological test [16].…”

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of rapid Salmonella Typhi IgM/IgG and Widal test for the diagnosis of enteric fever

Akter¹,

Yeasmin²,

Alam³

et al. 2020

IMC J Med Sci

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Background: Accurate and early diagnosis of enteric fever is a diagnostic challenge where facility for blood culture is not available. As a result, Widal test is still used widely in resource limited settings. Recently, user-friendly rapid immunochromatographic tests (ICT) have been introduced for quick diagnosis of enteric fever. So, we evaluated sensitivity and specificity of an immunochromatography based Salmonella Typhi IgM/IgG test kit and Widal test compared to blood culture for the diagnosis of enteric fever. Method: The study was conducted in the Department of Microbiology, Ibrahim Medical College (IMC) and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from June 2017 to September 2017. Clinically suspected enteric fever cases were included. Blood culture, Widal and Salmonella Typhi IgM/IgG detecting ICT were employed for the diagnosis of enteric fever. Results: Out of 71 suspected cases of enteric fever, blood culture was positive in 36 cases (50.7%) while 42 (59.15%) and 35 (49.29%) cases were positive by Widal test and ICT respectively. Widal and ICT had sensitivity and specificity of 100% and 89.9% and 82.9% & 91.4% respectively. Conclusion: Findings of the study suggest that both Widal and immunochromatographic tests can be used interchangeably for rapid diagnosis of enteric fever. Ibrahim Med. Coll. J. 2020; 14(1): 18-25

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“…Classically four-fold rise of antibody in paired sera is considered diagnostic of typhoid fever [4]. But paired sera are often difficult to obtain and specific chemotherapy has to be instituted on the basis of a single Widal test [5]. The aim of the present study was to determine the baseline titer of healthy population of Dehradun city.…”

Section: Introductionmentioning

confidence: 99%

Determination of baseline Widal titre among apparently healthy population in Dehradun City

Kataria¹

2013

IOSR-JPBS

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Utility of A Single Widal Test in The Diagnosis of Typhoid Fever

Abstract: Abstract

Cited by 8 publications

References 14 publications

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

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

Comparative evaluation of rapid Salmonella Typhi IgM/IgG and Widal test for the diagnosis of enteric fever

Determination of baseline Widal titre among apparently healthy population in Dehradun City

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