Clinical Profile and Redefining Gold Standard for Diagnosis of Enteric Fever With Nested PCR

Abstract

Background: Typhoid is mainly a disease of developing country, and inappropriately treated most of time due to lack of highly skilled diagnostic tools specially at primary level. So to validate most easy and rapid investigation Typhidot EIA with nested PCR may prove quite necessary due to low yield of culture reports. Aims: The objective was to evaluate the clinical profile and immediate diagnostic tool typhidot considering nested PCR as gold standard due to it’s high sensitivity and specificity rates. Material and Methods: Clinical profile of 100 case of provisional enteric fever recorded along with amplification of The DNA fragment of flagellin (H1-d) and stkG gene for salmonella typhi and salmonella paratyphi A respectively by nested PCR done in blood clot,unine and stool sample, along with blood clot culture,urine and stool culture done. Further validation of ELISA card test i.e. typhidot EIA done considering nested PCR as gold standard, for validation of test control group consisted of 40 health subjects. Results: Nested PCR which showed overall 84% positivity. Total Culture positivity was 60 among all samples and among that Clot culture 35(35%),urine culture 3(3%)and stool culture yield was 22(22%) respectively .Validation of Typhipoint EIA IgM showed 92.8% sensitivity and 68.7% specificity. Conclusion: It may be advised that 2-3 specific antigens of S. Typhi are spotted on the membrane and ELISA based detection should be carried out to reach the satisfactory level of diagnosis of enteric fever in field condition for more accuracy in rapid test to avoid inappropriate antimicrobial therapy and costly investigations. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: The study was conducted as a part of dissertation in collaboration with department of general medicine and department of microbiology at I.M.S , B.H.U Varanasi. The well informed consent was taken from each of the participants and the study plan was approved by the Institute Ethics Committee.