Evaluation of Serological Diagnostic Tests for Typhoid Fever in Papua New Guinea Using a Composite Reference Standard

Siba, Valentine; Horwood, Paul F.; Vanuga, Kilagi; Wapling, Johanna; Sehuko, R; Siba, Peter; Greenhill, Andrew R.

doi:10.1128/cvi.00380-12

Cited by 52 publications

(47 citation statements)

References 25 publications

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“…A recent evaluation of typhoid fever diagnostic tests detected S. Typhi in ~8% of febrile patients [21]. It is well recognised that S. Typhi can be carried asymptomatically; thus it is not possible to ascertain whether S. Typhi was the cause of diarrhoea in our culture positive study participants.…”

Section: Discussionmentioning

confidence: 63%

“…Nonetheless, our failure to isolate NTS is not appreciably different to that of previous findings in this setting. Moreover, we have not detected NTS in febrile patients in the general population [21] or in the HIV-positive population in this setting (unpublished data). Antibiotic resistance was common in Shigella spp.…”

Section: Discussionmentioning

confidence: 99%

“…It is well recognised that S. Typhi can be carried asymptomatically; thus it is not possible to ascertain whether S. Typhi was the cause of diarrhoea in our culture positive study participants. However, in this setting diarrhoea is commonly associated with typhoid fever, with a high proportion of confirmed typhoid fever positive patients in the recent diagnostic evaluation [21] self-reporting diarrhoea as a symptom (unpublished data). Regardless of whether S. Typhi contributed to diarrhoea, our data provide further evidence that S. Typhi continues to circulate in this population and contribute to the overall burden of enteric diseases.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic resistant Shigella is a major cause of diarrhoea in the Highlands of Papua New Guinea

Greenhill

Guwada

Siba

et al. 2014

J Infect Dev Ctries

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Introduction: Diarrhoea remains a major cause of illness in Papua New Guinea (PNG); however, little is known about its aetiology. As a result of the cholera outbreak that spread throughout PNG in 2009-2011, we conducted diarrhoeal surveillance in Eastern Highlands Province. Methodology: Following informed consent and a brief questionnaire, participants provided a stool sample or duplicate rectal swabs. Samples were tested for common bacterial pathogens Salmonella spp., Shigella spp., Vibrio spp., Campylobacter spp. and Yersinia enterocolitica using established culture methods. Enteric parasites were detected using microscopy. Results: A total of 216 participants were enrolled; where age was recorded, 42% were under 5 years of age, 6.7% were 5 to 17 years of age and 51.3% ≥18 years of age. One or more pathogens were detected in 68 (31.5%) participants, with Shigella (primarily S. flexneri) being the most commonly isolated (47 of 216 participants). Enteric parasites were detected in 23 of the 216 participants, occurring as a co-infection with another pathogen in 12 of 23 cases. No Vibrio cholerae was detected. Shigella isolates were commonly resistant to ampicillin, tetracycline, co-trimoxazole and chloramphenicol. Conclusions: Shigellae, specifically S. flexneri, are important pathogens in the highlands of PNG. While most studies in low-income settings focus on childhood aetiology, we have demonstrated the importance of Shigella in both children and adults. Enteric parasites remain present and presumably contribute to the burden of gastrointestinal illness. While improvements in sanitation and hygiene would help lower the burden of all aetiologies of infectious diarrhoea, additional control strategies targeting Shigella may also be warranted.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Antibiotic resistant Shigella is a major cause of diarrhoea in the Highlands of Papua New Guinea

Greenhill

Guwada

Siba

et al. 2014

J Infect Dev Ctries

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“…3 Furthermore, Rapid diagnostic test (RDT), a serologic test which detects the presence of immunoglobulin M (IgM) specific to bacterial antigen Salmonella typhi (S. typhi), is popular in recent years; however, it remains controversial due to the variability of its performance (sensitivity and specificity) among many studies and countries. [4][5][6][7][8][9][10][11] There are no studies about this diagnostic test both in Indonesia and children group. Hence, this study was conducted to assess the validity of IgM anti S. typhi serologic test in childhood typhoid fever.…”

Section: Introductionmentioning

confidence: 99%

Validity of Immunoglobulin M Anti Salmonella typhi Serologic Test in Childhood Typhoid Fever

Marsela¹,

Setiabudi²,

Indrati³

2017

amj

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Background: Typhoid fever, which mostly affects children, remains a major health problem in developing countries. Early diagnosis will help the management and thus, reduce morbidity and mortality. However, a rapid diagnostic test that detects the presence of immunoglobulin M (IgM) directed towards Salmonella typhi (S. typhi) antigen remains controversial despite its popularity. This study was aimed to assess the validity of IgM anti S. typhi serologic test in childhood typhoid fever. Methods: This retrospective diagnostic test, used blood culture as gold standard. Forty-one typhoid fever children with fever of 1-14 days admitted to Dr. Hasan Sadikin General Hospital Bandung from 2013 to 2015 were recruited. Diagnosis of typhoid fever is made clinically. Data were analyzed by Receiver Operating Characteristic (ROC) curve and diagnostic test. Results: Forty one children diagnosed with typhoid fever, 37 were positive for IgM anti S. typhi, but only 18 were positive for S. typhi in blood culture. IgM anti S. typhi (cut-off ≥4) test had an Area Under the Curve (AUC) of 59%, sensitivity of 100% and specificity of 17.39%. IgM anti S. typhi with cut-off >8 showed the highest AUC with sensitivity of 55.56% and specificity of 73.68%. Conclusions: IgM anti S. typhi test of cut-off >8 performs better than cut-off ≥4 in terms of AUC..

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“…Additional serologic tests include Typhidot (Reszon Diagnostics, Malaysia) that detects IgM and IgG antibodies in peripheral blood to a 50-kDa outer membrane protein of S. Typhi and the Tubex assay (IDL Biotech AB, Sweden) that detects IgM responses in blood to S. Typhi O9 lipopolysaccharide (LPS). These assays have been associated with sensitivities and specificities of 56 to 95% and with specificities of 31 to 97% in field tests (1,8,(14)(15)(16). Molecularly based methods, including nucleic acid amplification tests, have been hampered in field tests by the low organism load and presence of inhibitors in peripheral blood, reagent and equipment expense, and lack of technical expertise although such assays may have higher sensitivity than blood culture (17,18).…”

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confidence: 99%

Development of a Simple, Peripheral-Blood-Based Lateral-Flow Dipstick Assay for Accurate Detection of Patients with Enteric Fever

Khan¹,

Sayeed

Sultana³

et al. 2016

Clin Vaccine Immunol

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e Enteric fever is a systemic infection caused by typhoidal strains of Salmonella enterica and is a significant cause of mortality and morbidity in many parts of the world, especially in resource-limited areas. Unfortunately, currently available diagnostic tests for enteric fever lack sensitivity and/or specificity. No true clinically practical gold standard for diagnosing patients with enteric fever exists. Unfortunately, microbiologic culturing of blood is only 30 to 70% sensitive although 100% specific. Here, we report the development of a lateral-flow immunochromatographic dipstick assay based on the detection of Salmonella enterica serovar Typhi (S. Typhi) lipopolysaccharide (LPS)-specific IgG in lymphocyte culture secretion. We tested the assay using samples from 142 clinically suspected enteric fever patients, 28 healthy individuals residing in a zone where enteric fever is endemic, and 35 patients with other febrile illnesses. In our analysis, the dipstick detected all blood culture-confirmed S. Typhi cases (48/48) and 5 of 6 Salmonella enterica serovar Paratyphi A blood cultured-confirmed cases. The test was negative in all 35 individuals febrile with other illnesses and all 28 healthy controls from the zone of endemicity. The test was positive in 19 of 88 individuals with suspected enteric fever but with negative blood cultures. Thus, the dipstick had a sensitivity of 98% compared to blood culture results and a specificity that ranged from 78 to 100% (95% confidence interval [CI], 70 to 100%), depending on the definition of a true negative. These results suggest that this dipstick assay can be very useful for the detection of enteric fever patients especially in regions of endemicity.

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Evaluation of Serological Diagnostic Tests for Typhoid Fever in Papua New Guinea Using a Composite Reference Standard

Cited by 52 publications

References 25 publications

Antibiotic resistant Shigella is a major cause of diarrhoea in the Highlands of Papua New Guinea

Antibiotic resistant Shigella is a major cause of diarrhoea in the Highlands of Papua New Guinea

Validity of Immunoglobulin M Anti Salmonella typhi Serologic Test in Childhood Typhoid Fever

Development of a Simple, Peripheral-Blood-Based Lateral-Flow Dipstick Assay for Accurate Detection of Patients with Enteric Fever

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