Abstract
BackgroundTyphoid fever is a major health problem in developing countries and its diagnosis on clinical ground is difficult. Diagnosis in developing countries including Ethiopia is mostly done by Widal test. However, the value of the test has been debated. Hence, evaluating the result of this test is necessary for correct interpretation of the result. The main aim of this study was to compare the result of Widal test and blood culture in the diagnosis of typhoid fever in febrile patients.MethodsBlood samples were collected from 270 febrile patients with symptoms clinically similar to typhoid fever and visiting St. Paul’s General Specialized Hospitals from mid December 2010 to March 2011. Blood culture was used to isolate S.typhi and S.paratyphi. Slide agglutination test and tube agglutination tests were used for the determination of antibody titer. An antibody titer of ≥1:80 for anti TO and ≥1:160 for anti TH were taken as a cut of value to indicate recent infection of typhoid fever.ResultsOne hundred and eighty six (68.9%) participants were females and eighty four (31.1%) were males. 7 (2.6%) cases of S. typhi and 4 (1.5%) cases of S. paratyphi were identified with the total prevalence of typhoid fever 4.1%. The total number of patients who have indicative of recent infection by either of O and H antigens Widal test is 88 (32.6%). The sensitivity, specificity, Positive predictive Value and Negative predictive Value of Widal test were 71.4%, 68.44%, 5.7% and 98.9% respectively.ConclusionsWidal test has a low sensitivity, specificity and PPV, but it has good NPV which indicates that negative Widal test result have a good indication for the absence of the disease.
Highlights
Typhoid fever is a major health problem in developing countries and its diagnosis on clinical ground is difficult
Accurate diagnosis of typhoid fever at an early stage is important for diagnosis of etiological agent, and to identify individuals that may serve as a potential carrier, who may be responsible for acute typhoid fever outbreaks [3]
277 febrile patients from the Hospital involved in the study data from 270 patients (68.9% female) were analysed, because three missed due to insufficient serum samples to perform Widal test, other three missed due to incomplete sociodemographic data, and one missed due to both insufficient serum sample and incomplete sociodemographic data
Summary
Typhoid fever is a major health problem in developing countries and its diagnosis on clinical ground is difficult. Diagnosis in developing countries including Ethiopia is mostly done by Widal test. The main aim of this study was to compare the result of Widal test and blood culture in the diagnosis of typhoid fever in febrile patients. The World Health Organization (WHO) estimates about 21 million cases of typhoid fever with >600,000 deaths annually. Options for the diagnosis of typhoid fever are clinical signs and symptoms, serological markers, bacterial culture, antigen detection and DNA amplification [4,5]. In many countries including Ethiopia, the Widal test is the most widely used test in typhoid fever diagnosis because it is relatively cheaper, easy to perform and requires minimal training and equipment [9,10]
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