Comparison of passive haemagglutination test with Widal agglutination test for serological diagnosis of typhoid fever in an endemic area.

Coovadia, Yacoob; Singh, Vikas; Bhana, R H; Moodley, N

doi:10.1136/jcp.39.6.680

Cited by 24 publications

(18 citation statements)

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“…1 We excluded all cases in whom diagnoses of typhoid fever were confirmed by the results of the Widal tests, despite the fact that the background antibody titers among healthy subjects in this area are very low and few are vaccinated with typhoid-paratyphoid vaccine. 36 This is because we could not exclude the possibility of any difference that may exist between males and females 37 in terms of background antibody titers, degree of specific anamnestic response, maximum antibody titer, generation of nonspecific cross-reactive antibody, or a combination thereof. Furthermore, when one considers the entire study population and each sex group separately, serologically diagnosed cases were found to differ from blood culture-positive cases in terms of certain clinical features, laboratory findings, and complications (Khan M and others, unpublished data).…”

Section: Discussionmentioning

confidence: 99%

Influence of sex on clinical features, laboratory findings, and complications of typhoid fever.

Khan

Coovadia²,

Connolly³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. Clinical features, laboratory findings, and complications of typhoid fever were correlated with sex through a retrospective case note review of 102 hospitalized culture-positive patients in Durban, South Africa. Intestinal perforation (P ϭ 0.04), occult blood losses in stools (P ϭ 0.04), and a mild reticulocytosis in the absence of hemolysis (P ϭ 0.02) occurred more frequently in males than in females. A single pretreatment Widal O antibody titer Ն 1:640 was also a statistically significant occurrence in males (P ϭ 0. 006). Female patients were significantly more severely ill (P ϭ 0.0004) on admission and had chest signs consistent with bronchopneumonia (P ϭ 0.04), transverse myelitis (P ϭ 0.04), abnormal liver function test results (P ϭ 0.0003), and abnormal findings in urinalyses (P ϭ 0.02). Typhoid hepatitis (P ϭ 0.04) and glomerulonephritis (P ϭ 0.02) were present significantly more frequently in females. Whether these differences were due to differences in host's immune response to acute infection need to be determined in a prospective study.Even before the introduction of chloramphenicol in clinical practice, typhoid fever was well recognized as being extremely diverse in its clinical presentation. 1 Classic descriptions of typhoid fever in untreated cases have portrayed a multistage disease, with increasing temperature and bacteremia in the first week; rose spots, abdominal pain, and splenomegaly in the second week; abdominal complications of bleeding and perforation in the third week; and resolution or progression to death after the third week. 2 However, the pattern of disease as seen presently in many parts of the world bears little resemblance to the initial classic description. 3 Certain host-related and microbial factors have been proposed to explain this diversity. 3 It has been previously reported that the patient's age plays an important role in determining the clinical course of typhoid fever. 4 However, the role of the sex of the patient is less emphasized in the literature. On the other hand, we consider it to be an important issue in view of the fact that typhoid fever is increasingly being reported to be more common in women than men in KwaZulu, Natal. 5-7 Therefore, a retrospective study was undertaken to examine the influence of sex in determining the clinical features, laboratory findings, and complications of typhoid fever. MATERIALS AND METHODSA retrospective case note review was undertaken of 102 confirmed cases of typhoid fever treated at King Edward VIII Hospital in Durban, South Africa over a three-year period ending December 31, 1995. The study was reviewed and approved by the Ethics Committee of the University of Natal Medical School. Informed consent of the subjects was not required due to the retrospective nature of the study and because no personal identifiers were used. In all of these cases, diagnoses of typhoid fever were confirmed by isolation of Salmonella typhi from the blood. Patients' charts were reviewed for data pertaining to demographic, clinical, and labor...

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Section: Discussionmentioning

confidence: 99%

Influence of sex on clinical features, laboratory findings, and complications of typhoid fever.

Khan

Coovadia²,

Connolly³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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“…Results of the Widal test have demonstrated to vary between different areas and in time, due to variation in background levels as well as a result of variation in the quality of the antigen. [3][4][5][6][7][8][9][10][11][12] The need for a rapid and inexpensive laboratory test for early and accurate diagnosis of patients with typhoid fever has prompted the exploration of a variety of serologic and antigen detection methods, including counter immunoelectrophoresis, 13,14 enzyme-linked immunosorbent assay (ELISA), [15][16][17][18] dot immunoassay, 16,[19][20][21] hemagglutination, 22 and coagglutination. 23 However, these assays are not very easy to perform, not rapid, require special equipment or skills, or depend on electricity and on refrigeration for storage of components.…”

Section: Introductionmentioning

confidence: 99%

Simple dipstick assay for the detection of Salmonella typhi-specific IgM antibodies and the evolution of the immune response in patients with typhoid fever.

Hatta

Goris²,

Heerkens³

et al. 2002

The American Journal of Tropical Medicine and Hygiene

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Abstract. Application of a dipstick assay for the detection of Salmonella typhi-specific IgM antibodies on samples collected from S. typhi or S. paratyphi culture-positive patients at the day of admission to the hospital revealed the presence of specific IgM antibodies in 43.5%, 92.9%, and 100% for samples collected 4-6 days, 6-9 days, and > 9 days after the onset of fever, respectively. The mean sensitivity for samples collected an average of 6.6 days after the onset of fever was 65.3%. Culture was positive in 65.9% of the cases with a final clinical diagnosis of typhoid fever. Testing of paired serum samples from culture negative patients with a final clinical diagnosis of typhoid fever resulted in staining of the dipstick in 4.3% of the samples collected at the day of admission to the hospital and in 76.6% of the samples collected one week later, thereby provided strong supporting evidence of typhoid fever by demonstrating seroconversion in a large proportion of the patients. The dipstick assay may thus also be useful for the serodiagnosis of culture-negative patients with clinical signs and symptoms consistent with typhoid fever. The advantages of the dipstick assay are that the result can be obtained on the same day allowing a prompt treatment, that only a small volume of serum is needed, and that no special laboratory equipment is needed to perform the assay. The stability of the reagents of the dipstick and the simplicity of the assay allows its use in places that lack laboratory facilities.

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“…Two studies indicated that the passive haemagglutination test (70% sensitive and 92% specific) is comparable with the Widal test [17,18]. Recently, a novel microplate agglutination assay using the absorbed sheep red blood cells to enhance the Widal test reactivity appeared to be a useful alternative technique (19).…”

Section: Diagnosis Methods Of Typhoid Fevermentioning

confidence: 99%

Typhoid fever: misuse of Widal test in Libya

Zorgani

Ziglam

2014

J Infect Dev Ctries

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The worldwide gold standard of diagnosing of enteric fever depends on the isolation of Salmonella enterica serovar Typhi from a patient's bone marrow and/or blood culture. In Libya clinicians are heavily dependent on the Widal test for diagnosis of enteric fever which has been used without determining the locally appropriate threshold titer, because the laboratories lack the skilled, experienced personnel and appropriate facilities to detect and serotype Salmonella isolates. To improve the diagnosis process, clinical management and reliability of public health measures, there is an urgent need for the effective training of laboratory technicians and to provide resources to culture Salmonella species according to published guidelines. Clinicians should understand the limitations of Widal test and recognize that it cannot be expected to give a reliable diagnosis.

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Comparison of passive haemagglutination test with Widal agglutination test for serological diagnosis of typhoid fever in an endemic area.

Cited by 24 publications

References 10 publications

Influence of sex on clinical features, laboratory findings, and complications of typhoid fever.

Influence of sex on clinical features, laboratory findings, and complications of typhoid fever.

Simple dipstick assay for the detection of Salmonella typhi-specific IgM antibodies and the evolution of the immune response in patients with typhoid fever.

Typhoid fever: misuse of Widal test in Libya

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