Abstract
Objective: This study is aimed to compare the performance of two Widal test techniques with stool culture in the diagnosis of typhoid fever.
 Methods: A cross-sectional study was performed at the Dschang District Hospital in patients clinically suspected to have typhoid fever, whose stool was collected for stool culture. Furthermore, venous blood was collected and the serum was tested by both Widal slide agglutination test and Widal tube titration test.
 Results: The results showed that out of 750 participants include in the study, 325 (43.33%) were positive for Widal slide agglutination test, 174 (23.20%) for Widal tube titration test, and 159 (21.20%) for stool culture. The sensitivity, specificity, positive predictive value, and negative predictive value of Widal slide agglutination test with respect to stool culture were 97.48%, 71.23%, 47.69%, and 99.22%, respectively, but 100%, 97.46%, 91.37%, and 100% for the Widal tube titration test. With the stool culture, Widal slide agglutination test had a moderate agreement (kappa = 0.47), but Widal tube titration test had an absolute agreement (kappa = 0.94).
 Conclusion: Widal tube titration test should be used in place of Widal slide agglutination test in the diagnosis of typhoid fever in the case of limited access to stool culture test.
Highlights
Typhoid fever is an acute systemic infection caused by Salmonella enterica serotype Typhi
Moderate agreement was obtained between the Widal slide agglutination test and the stool culture
43.33%, 23.2%, and 21.2% of cases of typhoid fever were diagnosed by Widal slide agglutination test, Widal tube titration test, and stool culture, respectively
Summary
Typhoid fever is an acute systemic infection caused by Salmonella enterica serotype Typhi It is a worldwide public health problem and an important cause of morbidity and mortality with approximately 11–20 million people affected and 128,000–161,000 deaths each year [1]. In the case of suspected typhoid fever, effective diagnosis requires the isolation and the identification of S. enterica serotype Typhi in many areas where the disease is endemic [5]. There are two types of agglutination technique, namely, slide agglutination test and the tube titration test These serological tests are based on the detection of secreted circulating antibodies against Salmonella typhi O and H antigens. This study aimed to compare the performance of Widal agglutinations tests commonly used at the Dschang District Hospital with stool culture in typhoid fever diagnosis
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