Early Diagnosis Of Typhoid Fever Research Articles

Profiling of Humoral Immune Response in Typhoid Patients against Differentially Extracted Whole Cell Bacterial Protein Derived from S. typhi and S. spp.

Typhoid fever is a multiorgan infectious disease caused by Salmonella typhi. It is transmitted through fecal oral route and can be fatal without proper treatment. Therefore, early diagnosis of typhoid fever is crucial. In the previous study, we have developed TYPHOIDYNE EIA, which showed excellent synergy between the genus conserved and species-specific antigens in the serodiagnosis of typhoid fever. TYPHOIDYNE EIA can effectively detect and differentiate typhoid patients, typhoid vaccinated subjects, healthy subjects, and subjects with other febrile illnesses. Following the successful development of TYPHOIDYNE EIA, in this report, we further characterize the antigenic components of differentially extracted S. typhi and S. spp recognized by IgM, IgG, and IgA antibody isotypes in typhoid patients and possible typhoid carrier by the western blot (WB) assay. The WB characterization revealed a dynamic pattern of recognition, with significant variations in the number of antigenic bands observed between the differentially extracted arrays of antigens. The reactivity of patient's sera was divided into 3 regions, with region 1 (≥55 kDa) showing the strongest reactivity followed by region 2 (54 kDa-34 kDa) and region 3 (<34 kDa). Overall, the good synergy expressed in these bands suggests the potential role of these proteins in differentiating typhoid patients with possible typhoid carrier. The antigenic bands highlighted in this study are also identified as prospective biomarkers for diagnostic use and vaccine development.

Early Diagnosis of Typhoid Fever: Uses of Clinical Profile, Blood Culture and IGM Antibody: A Prospective Study from a Tertiary Care Centre in Western Uttar Pradesh

Objective:• To study clinical profile of typhoid in children.• To study Comparison of clinical profile and its correlation with blood culture and IgM antibody detection testfor early diagnosis of fever.• To study blood culture and widal at tertiary care centre in western UP.Methods: The study was carried out in Department of Pediatrics, Saraswathi Institute of Medical Sciences, Hapur,UP. All the children presenting with fever, aged from 6 months to 18 years, visited in the pediatric OPD(outpatientdepartment) and IPD(in patient department) of Saraswathi Institute of Medical Sciences from November 2020 toOctober 2022 were included in the study.Results: IgM antibody test was found positive in total 167 cases and negative in 63 cases. Also, blood culture wasreported positive in 157 cases and negative in 73 cases. Out of total positive IgM antibody, 138 showed positivefor blood culture and 29 were reported negative in blood culture. Out of total negative IgM antibody, 19 showedpositive for blood culture and 44 were reported negative in blood culture.Conclusion: Present study shows that typhoid IgM procedure is more sensitive than the established Widalagglutination assay and results can be obtained within 15 minutes while widal agglutination test can be doneafter 1 week. Typhi IgM test can be done after 72 hours of illness as IgM antibody becomes positive after 3 days ofinfection with Salmonella typhi. It is cost effective and can be done bed side.

Reliability of Typhidot-M in diagnosis of typhoid fever in children

Background: Typhoid fever continues to be endemic and a major cause of mortality and morbidity in the developing countries. Many times, it presents a diagnostic challenge to treating physicians due to overlapping clinical features with other common causes of acute fever. A rapid and reliable laboratory test would be of great help to clinicians for early diagnosis and appropriate treatment of typhoid fever. Aims and Objectives: The present study was conducted to assess the reliability of Typhidot-M in diagnosis of typhoid fever. Materials and Methods: A total of 203 children with clinical features consistent with typhoid fever were enrolled in the study. Blood culture, Typhidot-M, and Widal test were performed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for Typhidot-M and Widal test in comparison with blood culture as reference standard. Results: Out of 203 patients, 30 (14.8%) were blood culture positive. One hundred and six patients were Typhidot-M positive and 97 were negative. Typhidot-M had a sensitivity of 93.3%, specificity of 54.9%, and PPV and NPV of 26.4% and 97.9%, respectively. Conclusion: Typhidot-M is a sensitive test for early diagnosis of typhoid fever. However due to low specificity, positive results should be correlated with clinical picture and other possible diagnoses.

Comparison of rapid serological diagnostic test in diagnosing typhoid fever in a tertiary care centre in western Uttar Pradesh

: In the study we compare the sensitivity and specificity of two commonly used rapid serological test, Widal test and Typhidot, in the diagnosing of Typhoid fever. Serum samples coming to the microbiology laboratory for routine testing over the period from September 2019 to November 2020 were analysed for the comparison for the presence of the Salmonella antibodies by carrying out the Typhidot and Widal tube agglutination test in tertiary care centre.: Out of 580 blood specimen, 49.3% cases were positive by Typhidot and 38.6% cases were positive by Widal method.Typhidot is a rapid and more sensitive test for early diagnosis of typhoid fever. It is now commercially available for the diagnosis of typhoid fever in areas with limited resources. Widal test showed the sensitivity and specificity of 37% &amp; 62.4% respectively. Typhi dot test showed sensitivity of 41.4% and specificity of 56.5%.

Comparative study between WIDAL and DOT ELISA in the diagnosis of Typhoid fever

Background: Typhoid fever, also known as enteric fever, is a communicable disease, found only in man and occurs due to systemic infection mainly by Salmonella typhi organisms. Blood culture is regarded as the gold standard for diagnosis and carry 70-75% diagnostic yield in the first week of illness.&#x0D; Aims and Objective: To compare the sensitivity and specificity of Widal test and dot ELISA with blood culture in the early diagnosis of Typhoid fever.&#x0D; Materials and Methods: A Cross-Sectional study was carried out in the Department of Microbiology, Era’s Lucknow Medical College and Hospital for a period of 18 months. Patients presenting with acute febrile illness suspicious of typhoid fever accompanied by clinical signs and symptoms of typhoid fever in the absence of any other known febrile illnesses, were included in the study. Widal and Dot ELISA was performed using serum samples and for blood culture aseptically collected blood was used.&#x0D; Results: Sensitivity, Specificity, PPV, NPV of DOT ELISA as compared to Blood culture for typhoid positivity was found to be 92.6%, 83.7%, 55.6% and 98.1% respectively. Diagnostic accuracy of DOT ELISA as compared to Blood culture was found to be 85.3%. Conclusion: For both early and late diagnosis of typhoid fever with high sensitivity as well as accuracy for identification of typhoid fever, the rapid diagnostic test (Dot Elisa) is better than the Widal test. However, it may be an increased burden to healthcare owing to a low positive predictive value in a low prevalence scenario.

Performance of TUBEX® TF IgM Antibody Test Against Culture to Detect Typhoid Fever Among Hospitalized Patients in Nairobi County

Typhoid fever has remained endemic and a major health problem in developing countries like Kenya due to poor sanitation, overcrowding and limited access to diagnostic services. The main aim of this study was to determine the diagnostic value of TUBEX ® TF IGM antibody tests for early diagnosis of typhoid fever among hospitalized patients in Nairobi County. TUBEX ® TF is a competitive immunoassay which detects presence of anti-09 IgM Salmonella Typhi antibodies in a patient’s serum. We studied TUBEX ® TF a rapid sera diagnostic test for its usefulness in early diagnosis of typhoid fever and we compared its sensitivity and specificity to that of Widal test. The study was conducted on 92 (Gp-I) febrile patients who had clinically suggestive signs and symptoms of typhoid fever. Two groups of controls were created; 45 (Gp-II) and 15 (Gp-III) age and sex matched febrile and healthy controls, respectively. Blood culture was performed in all cases while TUBEX ® TF and Widal tests were performed in both cases and controls. The sample size was based on convenience at the two health facilities of our study. Gp-I had 9 (9.78%) blood culture positives for S. Typhi, 11(11.99%) were positive for TUBEX ® TF while 17 (18.48%) were positive for Widal test. 3 (6.67%) Gp-II were positive on both TUBEX ® TF and Widal test while none of the two tests tested positive on Gp-III. Among 9 culture positive cases, TUBEX ® TF was positive in 8 cases same as Widal test with sensitivity, specificity, PPV and NPV values of 88.9% (95% CI: 51.18-99.7), 97.6% (95% CI: 91.6-99.7), 80.0 %(95% CI: 44.4-97.5), 98.8 %(95% CI: 93.4-100), respectively. Widal test had 88.89% (95% CI: 51.8-99.7), 90.4% (95% CI: 81.9-95.7), 50.00% (95% CI: 24.7-75.3), 98.7% (95% CI: 92.9-100) respectively. This study demonstrated better results with TUBEX ® TF test compared to Widal test when blood culture was used as a gold standard. However, these results should be further confirmed by using multiple gold standard tests such as molecular and enzyme-linked immunosorbent assays and carried out on large scale cross-sectional studies with varied prevalence of typhoid fever in the population. Keywords : Typhoid fever, TUBEX ® TF, Widal, Cases and Controls. DOI : 10.7176/JBAH/9-4-08

Cross sectional study to evaluate rapid diagnostic test (Typhidot-M) as a tool for early diagnosis of Typhoid fever keeping blood culture as gold standard.

Cross sectional study to evaluate rapid diagnostic test (Typhidot-M) as a tool for early diagnosis of Typhoid fever keeping blood culture as gold standard.

Role of Abdominal Ultrasound in the Diagnosis of Typhoid Fever in Pediatric Patients

An early diagnosis of typhoid fever caused by Salmonella typhi is difficult because of several spectra of clinical findings, identical to those of several other types of infections. A definitive diagnosis of typhoid fever is made by hemoculture as well as the Widal test. With pediatric patients, this life-threatening infection remains inherently long enough, demanding urgent attention. In typhoid fever, splenomegaly, enlarged mesenteric lymph nodes (MLNs), bowel wall thickening, acalculus cholecystitis, and hepatomegaly occur, which are diagnosed by the ultrasonography (USG) test. USG is a noninvasive, easily available, economical, fairly acceptable, and fairly sensitive test. The high-resolution real-time gray-scale USG method has simplified the evaluation of pathologic conditions, with remarkable clarity; consequently, an accurate assessment of the associated lesions can be done. In typhoid-endemic areas, USG findings as cited above could be used for diagnosis of typhoid fever, particularly when serology is equivocal and hemocultures are negative or not available. It was evident from USG studies that 12 of 52 patients had calculus cholecystitis; these individuals as well as eight patients without cholecystitis having hemocultures negative for S. typhi were excluded from the study. The rest of the cases (n=32) were included in this USG-based study for evaluation of features specific for typhoid fever. The following observations were recorded: splenomegaly in 32 patients, enlarged MLNs in 30 patients, bowel wall thickening in 25 patients, acalculus cholecystitis in 20 patients, and hepatomegaly in 10 patients. It can be concluded that these USG features—hepatosplenomegaly, enlarged MLNs, bowel wall thickening, and acalculus cholecystitis—should strongly favor the diagnosis of typhoid.

A Comparative Evaluation of Different Diagnostic Modalities in the Diagnosis of Typhoid Fever Using a Composite Reference Standard: A Tertiary Hospital Based Study in Central India.

Enteric fever, caused by Salmonella spp. is a major cause of morbidity and mortality worldwide and endemic in many developing countries including India and other South-East Asian countries. Blood culture is regarded as the gold standard for diagnosis. Currently, the standard serological method is tube agglutination with moderate sensitivity and specificity. Dot blot assay detecting IgM and IgG antibodies to a specific 50kD Outer Membrane Protein (OMP) antigen of Salmonella spp. is a simple, reliable, affordable and rapid test which can help in the early diagnosis of typhoid fever. To systematically evaluate the different diagnostic modalities against a composite reference standard for the better diagnosis of typhoid fever in clinically suspected cases of typhoid fever. This cross-sectional, prospective analytical study was carried out at a tertiary care hospital attached to Medical College in central India from November 2011 to June 2013. A total of 163 blood samples, collected aseptically from patients clinically diagnosed of enteric fever, were tested using various component tests like blood culture, Tube Widal and Dot Enzyme Immuno Assay (Dot EIA) for IgG and/or IgM. Composite Reference Standard (CRS) was created for defining the confirmed cases of typhoid fever using the component tests, wherein culture positive and in absence of culture positivity any two component test positive patients were taken as confirmed cases. All the component tests were evaluated against the CRS for sensitivity, specificity, PPV and NPV and their significance in relation to the duration of illness using statistical tests of significance. Blood culture was positive in 16 (9.81%) whereas, Tube Widal, IgM, IgG and IgM+IgG in combination were positive in 88(54%), 58(35.58%), 30 (18.40%) and 75 (46.01%) respectively. Using a two test criteria of CRS framed, a total of 104 patients were considered as confirmed cases. Though specificity of blood culture was 100%, the sensitivity was low with significant detection rate in 1st week of illness. Tube Widal showed a sensitivity of 65.38% and specificity of 89.83% with significant detection rate in 2nd week. Dot blot assay for IgM, IgG and Combined IgM and IgG showed a sensitivity of 71.15%, 65.28% and 51.72% respectively whereas, the specificity was 10.16%, 47.45% and 74.57% respectively with significant detection rate in 2nd and 3rd week of illness. It can be concluded that though blood culture is still the gold standard, Dot blot assay found to have high sensitivity and good specificity might be a practical alternative test for the rapid diagnosis of typhoid fever if interpreted with care particularly using a composite reference standard. Further, it is reliable, simple to perform and rapid; results being available in 1 hour when compared to 48 hours for blood culture and 18 hours for Tube Widal test.

Seasonal Variation and Recent Status of Typhoid Fever in a Tertiary Care Hospital

In many developing countries, typhoid fever is endemic. Early diagnosis is important for appropriate treatment on time. Typhi dot is important diagnostic tool for early diagnosis of typhoid fever. In the current study from February, 2012 to May 2014, samples from 19433 febrile cases referred to Dow Diagnostic Research and Reference lab were screened for serum IgM and IgG for Salmonella typhi by Typhi dot test. Results showed that about 12501 patients had both IgM and IgG antibodies against Salmonella typhi. Male patients were more commonly affected than female patients. Highest frequency of positive cases was seen during the month of October. Age group >15-44 was most likely affected among different age groups. This study suggested that still we are far behind in improving sanitation and elimination of such controllable disease. Therefore prompt measures should be taken to control the disease especially during hot season by vaccination, improved sanitation and education as well.

English

The public health burden of typhoid fever can be substantially reduced by early diagnosis and appropriate antibiotic therapy. This study was conducted in an attempt to assess the reliability of immunochromatographic test (ICT) for the early diagnosis of typhoid fever. Immunochromatographic test to detect IgM, IgG or combined IgM/IgG in serum in 1st week of fever was done for the diagnosis of typhoid fever. Blood samples were taken for culture and Widal test of 100 clinically suspected cases of typhoid fever in 1st week of illness of patients at Outpatient Department of Rajshahi Medical College Hospital (RMCH), Bangladesh. Forty (40) controls of comparable age and sex were also taken including 20 febrile (non-typhoidal) and 20 healthy persons. Blood culture positive cases (16) and Widal test positive cases (15) were considered as typhoid fever patients and the total number was 31. ICT was performed for 31 typhoid fever patients and 40 controls. In this study, out of 31 cases, ICT was found positive in 28 (90.32%) typhoid fever patient, while 03 (15.00%) of the controls also showed ICT positivity indicating its specificity of 92.50%. It is evident from this study that ICT as a reliable diagnostic tool for early diagnosis of typhoid fever was found highly sensitive, rapid and easy to perform. It can be a versatile test for the screening of clinically suspected case of typhoid fever. therefore, ICT have been found to be encouraging in this study. Key words: Anti-salmonella antibodies, immunochromatographic assay, diagnostic tool, early diagnosis of typhoid fever.

Typhidot M and Diazo test vis-à-vis blood culture and Widal test in the early diagnosis of typhoid fever in children in a resource poor setting

OBJECTIVE: Typhoid fever is a major public health problem. A test which is simple, reliable and can be carried out in small laboratories is the need of the hour. We prospectively evaluated typhidot M and Diazo tests vis-à-vis blood culture and Widal test in children. METHODS: Patients aged 6 months to 12 years, having fever of more than four days duration with clinical suspicion of typhoid fever were enrolled. Patients in whom other diagnosis was made served as control. The tests under scrutiny were validated against blood culture and then all the four tests were evaluated among patients who presented in the first week of illness. RESULTS: Blood culture was positive in only 27.3% of the cases. Among these culture positive cases, typhidot M test had the highest sensitivity, specificity, PPV and NPV of 90% (95% CI = 74.4-96.5), 100% (95% CI = 90.1-100), 100% (95% CI = 87.5-100), and 92.1% (95% CI = 79.2-97.3) respectively. Diazo test ranked next with sensitivity, specificity, PPV and NPV of 86.7% (95% CI = 70.3-94.7), 85.7% (95% CI = 70.6-93.7), 83.9% (95% CI = 67.4-92.9), 88.2% (95% CI = 73.4-95.3) respectively. Among clinically suspected typhoid cases, the overall sensitivity, of blood culture, Widal, typhidot M, Diazo was 27.3% (95% CI = 19.8- 36.3), 64.6% (95% CI = 55.3-72.9), 89.1% (95% CI = 81.9-93.7), 80.9% (95% CI = 72.6-87.2) respectively. In the first week of illness, typhidot M showed the best sensitivity [86.2% (95% CI = 69.4-94.5)] followed by Diazo [79% (95% CI = 61.6-90.2)], Widal [41.4% (95% CI = 25.5-59.3)] and blood culture [31% (95% CI = 17.3-49.2)]. CONCLUSION: Both Typhidot M and Diazo are good screening tests for the diagnosis of typhoid fever. Typhidot M is superior to Diazo but the latter is more suitable to resource poor settings being economic and easy to perform.

Typhidot M and Diazo test vis-à-vis blood culture and Widal test in the early diagnosis of typhoid fever in children in a resource poor setting

ObjectiveTyphoid fever is a major public health problem. A test which is simple, reliable and can be carried out in small laboratories is the need of the hour. We prospectively evaluated typhidot M and Diazo tests vis-à-vis blood culture and Widal test in children. MethodsPatients aged 6 months to 12 years, having fever of more than four days duration with clinical suspicion of typhoid fever were enrolled. Patients in whom other diagnosis was made served as control. The tests under scrutiny were validated against blood culture and then all the four tests were evaluated among patients who presented in the first week of illness. ResultsBlood culture was positive in only 27.3% of the cases. Among these culture positive cases, typhidot M test had the highest sensitivity, specificity, PPV and NPV of 90% (95% CI = 74.4–96.5), 100% (95% CI = 90.1–100), 100% (95% CI = 87.5–100), and 92.1% (95% CI = 79.2–97.3) respectively. Diazo test ranked next with sensitivity, specificity, PPV and NPV of 86.7% (95% CI = 70.3–94.7), 85.7% (95% CI = 70.6–93.7), 83.9% (95% CI = 67.4–92.9), 88.2% (95% CI = 73.4–95.3) respectively. Among clinically suspected typhoid cases, the overall sensitivity, of blood culture, Widal, typhidot M, Diazo was 27.3% (95% CI = 19.8–36.3), 64.6% (95% CI = 55.3–72.9), 89.1% (95% CI = 81.9–93.7), 80.9% (95% CI = 72.6–87.2) respectively. In the first week of illness, typhidot M showed the best sensitivity [86.2% (95% CI = 69.4–94.5)] followed by Diazo [79% (95% CI = 61.6–90.2)], Widal [41.4% (95% CI = 25.5–59.3)] and blood culture [31% (95% CI = 17.3–49.2)]. ConclusionBoth Typhidot M and Diazo are good screening tests for the diagnosis of typhoid fever. Typhidot M is superior to Diazo but the latter is more suitable to resource poor settings being economic and easy to perform.

Jaundice in typhoid patients: Differentiation from other common causes of fever and jaundice in the tropics

While typhoid fever is common in our environment, presentation with jaundice is unusual. The aim of this study has been to determine the clinical and laboratory features that allow early diagnosis of typhoid fever in patients that present with jaundice and differentiate it from other common causes of fever and jaundice in the tropics. This prospective study was conducted between May 1997 and October 1998 at Center Hopitalier Regional de Hombo Anjuoan, Comoros Islands. Patients with clinical and laboratory evidence of typhoid fever were included. Viral or toxic hepatitis, chronic liver disease, sickle cell disease and other causes of jaundice were excluded by clinical examination and appropriate investigations. Serial evaluation of liver function test and abdominal ultrasound were done. Patients were resuscitated with fluids and electrolytes and treated with appropriate antibiotics. Liver involvement was determined using clinical and laboratory parameters. Of the 254 patients with confirmed diagnosis of typhoid fever, 31 (12.2%) presented with jaundice. Their mean age was 24.6+/-9.2SD years. Fever preceded the appearance of jaundice by 8-27 days. In 27 (87.1%) patients, there was hepatosplenomegaly. Serum bilirubin ranged 38-165 micromol/l with mean of 117+/-14SD. Conjugated bilirubin ranged 31-150 micromol/l with mean of 95+/-8SD. Serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were raised with mean values of 180, 105 and 136 IU, respectively. Six (19.4%) patients died compared to 12.1% of non-icteric patients. Typhoid patients may present with varying degrees of jaundice and fever that may be confused with viral, malarial or amebic hepatitis, diseases that are common in the tropics. Physical examination and simple biochemical tests would identify the typhoid patients who should be treated with appropriate antibiotics even before the results of blood culture are available.

Evaluation of Typhidot (IgM) for Early Diagnosis of Typhoid Fever

Typhoid fever still continues to be a major public health problem, particularly in many developing countries. A simple, reliable, affordable and rapid diagnostic test has been a long-felt need of the clinicians. We, therefore, prospectively evaluated the sensitivity and specificity of Typhidot (IgM), a serological test to identify IgM antibodies against Salmonella typhi. The study was carried out in the department of Microbiology, Mymensingh Medical College, Mymensingh between June, 2006 and July, 2007, on a total of 100 samples from clinically suspected patients to have typhoid fever. Blood culture as well as Typhidot test were performed for each of the cases. Out of 100 clinically diagnosed typhoid fever, 14 were blood culture positive for S. typhi and 73 were Typhidot (IgM) positive. Among 14 culture positive cases, 13 (92.85%) were Typhidot (IgM) positive. The test was also positive in 04 (20%) out of 20 febrile controls. None of the healthy controls was positive by Typhidot (IgM). The sensitivity, specificity, positive predictive value and negative predictive value of the test using blood culture as gold standard were 92.85%, 90.00%, 76.47% and 97.29% respectively for typhoid fever. Typhidot (IgM) test is rapid, easy to perform and reliable test for diagnosing typhoid fever, and useful for small, less equipped laboratories as well as for the laboratories with better facilities. Key words: Typhoid fever, Salmonella typhi, Typhidot (IgM) test doi: 10.3329/bjmm.v3i1.2964 Bangladesh J Med Microbiol 2009; 03 (01): 10-13

Comparative study of dot enzyme immunoassay (Typhidot-M) and Widal test in the diagnosis of typhoid fever

We compared the sensitivity and specificity of Typhidot-M and Widal test with blood culture (gold standard) for diagnosing typhoid fever in 105 children aged 1-15 years admitted with clinical suspicion of typhoid fever. Of the 105 cases, blood culture was positive for S.typhi in 41 (39%) children, Widal test was positive in 48 (45.7%) and Typhidot-M was positive in 78 (74.3%) cases. Sensitivity and specificity of Typhidot-M was 92.6% and 37.5% while sensitivity and specificity of Widal test was 34.1% and 42.8%, respectively. In children with fever of less than 7 days duration, Typhidot-M was positive in 97%, compared to 24.2% by Widal test. Typhidot-M is a simple and sensitive test for early diagnosis of typhoid fever in children.

The comparison of cultures, widal agglutination test and polymerase chain reaction as a diagnostic tool in typhoid fever

Abstract Typhoid fever caused by Salmonella typhi, paratyphi A and B, is an important cause of morbidity and mortality in many developing countries. A rapid and sensitive method for the detection of S. typhi is essential for early diagnosis of typhoid fever and effective therapy. In this study 45 febrile patients who were suspected to have enteric fever were enrolled, and the results of blood cultures, widal agglutination tests and Polymerase Chain Reaction in these cases were evaluated. Group I consisted of 11 patients with diseases other than salmonella infections, group II represented 6 patients with positive cultures, and group III represented 28 patients with negative blood cultures negative but who were clinically suspected cases that had a medical history of using variable antimicrobial agents. Two positive PCR results were present; one of them was in culture positive group (16,6%) and the other was in culture negative group (3,5%). In our study widal agglutination tests and cultures were found not to be helpful in differential dignosis. Although PCR based detection of S. typhi is reported to be a sensitive and specific test for the diagnosis of enteric fever, in our study the benefit of this method in the diagnosis of especially patients who were treated with antimicrobial therapy was not clearly determined. Other methods to increase sensitiviy and specificity to levels such as those of real time PCR should be developed and large-scaled studies should be done in endemic and non-epidemic regions.

Typhoid Fever in Southern Taiwan: A Medical Center Experience

Typhoid fever is caused by Salmonella enterica serotype Typhi (5. typhi). Growing communication between Taiwan and neighboring regions in recent years could be an important source of typhoid fever. The aim of this study was to analyze the clinical characteristics of typhoid fever treated at a medical center in southern Taiwan. The study group consisted of 33 patients (aged 1-68 years) who had clinical symptoms and culture-confirmed typhoid fever. They were studied over a 20-year period from January 1987 to December 2006 at a tertiary referral hospital in southern Taiwan. Their medical records were reviewed and clinical data were collected. The study group included 17 males and 16 females. They were divided into two groups: group I (< or = 17 years; n=14) and group II (>17 years; n=19). Only one patient (7.1%) in group I had a history of travel, compared with 47.4% (n=9) in group II (p = 0.045). Patients in group I also had less chills (group I vs. group 11=7.1% vs. 57.9%, p = 0.004). A higher proportion of group I patients had respiratory problems (cough, group I vs. group II = 57.1% vs. 26.3%) and a higher proportion of group II patients developed complications (group I vs. group II = 14.3% vs. 36.8%), but the differences were not significant. Pediatric patients with typhoid fever in southern Taiwan had less history of travel and developed fewer chills than adult patients. Careful examination and familiarity with the clinical manifestations are important factors in the early diagnosis of typhoid fever.

The need for high index of suspicion in early diagnosis of typhoid fever in young children

The diagnosis of typhoid fever in young children is more difficult than in the adult due to the unusual pattern of presentation. This letter aims to sensitize general physicians and paediatricians on the need for a high index of suspicion in the diagnosis of typhoid fever in children. The case records of a child diagnosed with typhoid fever and a review of literature on the subject were used. A five year old female misdiagnosed as a case of severe malaria and sepsis was found to have typhoid fever on post mortem examination. It is important to make an early diagnosis of typhoid fever in young children in order to prevent mortality from this treatable disease.

Early diagnosis of typhoid fever by the detection of salivary IgA

Background/Aims: Current diagnostic methods for typhoid fever have low sensitivity and specificity. This study aimed to develop an enzyme linked immunosorbent assay (ELISA) with greater sensitivity and specificity. Methods: The...