Diagnostic Value of the Widal Test in Areas Endemic for Typhoid Fever

Levine, Myron M.; Grados, O; Gilman, Robert H.; Woodward, William E.; Solis-Plaza, Rene; Waldman, William

doi:10.4269/ajtmh.1978.27.795

Cited by 163 publications

(95 citation statements)

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“…In the regions where enteric fever is common, clinical diagnosis of typhoid fever is inadequate, as the symptoms it causes are non-specific and overlap with those of other febrile illness. Serological tests, predominantly the Widal test, are available but have very low sensitivity and specificity, and no practical value in endemic areas despite their continued use (Levine et al, 1978). Isolation of the causative organism remains the most effective diagnostic method in suspected typhoid fever (Zhou & Pollard, 2010).…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Detection and Antimicrobial Resistance Pattern of Salmonella in Sudan

Hussein¹,

Mohy-Eldin²,

Elmadiena³

et al. 2012

Salmonella - Distribution, Adaptation, Control Measures and Molecular Technologies

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Section: Introductionmentioning

confidence: 99%

Prevalence, Detection and Antimicrobial Resistance Pattern of Salmonella in Sudan

Hussein¹,

Mohy-Eldin²,

Elmadiena³

et al. 2012

Salmonella - Distribution, Adaptation, Control Measures and Molecular Technologies

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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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“…The test is only moderately specific for typhoid infection; however, studies from several areas, predominantly endemic for typhoid infection, demonstrate a significant variation in assay performance particularly when using a single Widal test result to make a typhoid fever diagnosis. Reasons for false-positive test results may include previous vaccination or exposure to natural infection, cross-reactivity with epitopes from other enterobacteriaceae or concomittant infections including malaria, typhus and other causes of bacteraemia (Reynolda et al, 1970;Levine et al, 1978;Olopoenia & King, 2000;House et al, 2001;World Health Organization, 2003;Omuse et al, 2010). Likewise, false-negative tests are also seen which may be due to previous antibiotic exposure or other medical conditions capable of reducing the antibody response generated.…”

Section: Serological Testsmentioning

confidence: 99%

“…Likewise, false-negative tests are also seen which may be due to previous antibiotic exposure or other medical conditions capable of reducing the antibody response generated. Widal tests are relatively inexpensive however, particularly in comparison to bacterial culture methods, and are therefore still widely used (Bakr et al, 2011) and are possibly of more benefit in non-endemic settings (Levine et al, 1978;Chew et al, 1992).…”

Section: Serological Testsmentioning

confidence: 99%