Abstract
Typhoid fever causes significant morbidity and mortality in developing countries, with inaccurate estimates in some countries affected, especially those situated in Sub-Saharan Africa. Disease burden assessment is limited by lack of a high degree of sensitivity and specificity by many current rapid diagnostic tests. Some of the new technologies, such as PCR and proteomics, may also be useful but are difficult for low-resource settings to apply as point-of-care diagnostics. Weak laboratory surveillance systems may also contribute to the spread of multidrug resistant Salmonella serovar Typhi across endemic areas. In addition, most typhoid-endemic countries employ serological tests that have low sensitivity and specificity making diagnosis unreliable. Here we review currently available typhoid fever diagnostics, and advances in serodiagnosis of S. Typhi.
Highlights
TF is a systemic infection comprising of diseases caused by Salmonella enterica serovar Typhi; while S
rapid diagnostic tests (RDTs) have demonstrated some improvement over the Widal test, they still lack the required sensitivity, specificity, cost-effectiveness and consistency to allow their use as point-of-care diagnostics in endemic settings [59]
In order to mitigate the problem of sensitivity, an IgG depletion step was applied which led to the development of Typhidot-M which removed competitive binding and allowed accessibility of the antigen to the specific IgM [61]
Summary
“Typhoid fever” (TF) was coined by the French physician, Pierre Charles Alexander Louis, who gave a description of the clinical signs and symptoms of the disease to be typhoidal, with signs of mental fogginess and persistent fever which mimicked the symptoms caused by typhus [1,2]. TF is a systemic infection comprising of diseases caused by Salmonella enterica serovar Typhi; while S. enterica serovar Paratyphi (A, B and C) cause paratyphoid fever, other serovars of Salmonella are grouped as non-typhoidal. S. Typhi are restricted exclusively to human hosts and are associated with systemic infection, prolonged fever and may result in an asymptomatic carrier state. Lack of inclusion of typhoid vaccines into routine immunization programs in addition to poor TF surveillance and weak laboratory infrastructure in most countries affected further aggravates morbidity. Typhi to fluoroquinolones has made management of TF in endemic countries even more challenging. In most TF affected countries, physicians rely on laboratory results from serologic tests that are not reliable (usually Widal) to arrive at a clinical decision. Typhi and propose solutions to challenges encountered in TF-endemic countries
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