Saudi Journal of Gastroenterology
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Year : 2007  |  Volume : 13  |  Issue : 4  |  Page : 213
Single and unpaired sera tube widal agglutination test in enteric fever


Department of Microbiology, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda - 508254, India

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How to cite this article:
Mohanty S K, Ramana K V. Single and unpaired sera tube widal agglutination test in enteric fever. Saudi J Gastroenterol 2007;13:213

How to cite this URL:
Mohanty S K, Ramana K V. Single and unpaired sera tube widal agglutination test in enteric fever. Saudi J Gastroenterol [serial online] 2007 [cited 2019 May 20];13:213. Available from: http://www.saudijgastro.com/text.asp?2007/13/4/213/36759


Sir,

 Salmonella More Details typhi is the etiological agent of typhoid fever and is an important cause of morbidity in many regions of world with an estimated 12-13 million cases occurring annually. The number of cases in India and Africa are on the rise due to increased urbanization and other reasons. [1]

The clinical diagnosis of typhoid fever is difficult, and its definitive diagnosis, requires the isolation of  Salmonella typhi Scientific Name Search he patient. At present, patients receive antibiotics prior to the clinical diagnosis, thereby reducing the chances of isolation in blood culture. The isolation of typhoid bacilli needs a well-equipped laboratory which is frequently unavailable. Serological diagnosis relies classically on the demonstration of a rising titer of antibodies in paired serum samples 1-2 weeks apart. This is because a rise in the antibody titer is not always demonstrable, even in blood culture positive cases, owing to the natural history of the infection, prior antibiotic administration, or the patient presenting late to the hospital.

Patient management decisions cannot be put off for the results of convalescent phase sera and for all practical purposes, a treatment decision must be made on the basis of single tube Widal agglutination test. Even though the sensitivity of single tube Widal agglutination test is not very high, this test is still a valuable one when a high cut-off titer is taken in the diagnosis of typhoid fever in developing countries such as India.

We evaluated the diagnostic utility of single Widal test [2] in an endemic area in a retrospective study performed during June 2003 and September 2006 in Kamineni Institute of Medical Sciences, Narketpally and Nalgonda. The study included two groups: gpI and gpII; gpI (those who complained of fever, headache, abdominal pain and other related symptoms) comprised of 1114 cases and gpII (healthy donors) comprised of 212 subjects. The serum samples from all the cases were first subjected to Widal agglutination test for the presence of antibodies against Salmonella typhi "O" and Salmonella typhi "H" antigens. All the samples from gp II and gp I that were positive for Widal test were subjected to blood culture.

Of the tested 1114 samples, a significant number of 634 (74.8%) were found to be Widal agglutination positive. From the 553 samples available for blood culture, only 264 (47.7%) samples were culture positive having a corresponding Widal titer greater than 1/160 for Salmonella typhi "O" antigen and 1/320 for "H" antigen. Of the 212 healthy controls, 28 (13.2%) had an anti-O titer of 1/80, and 71 (33.9%) had an anti "O" titer of 1/20, 11 (5.1%) had an anti-H titer of 1/60 and 114 (43.7%) had an anti-H titer of 1/20. All the blood cultures of healthy controls were negative. The sensitivity of Widal test increased to 77.6% when the cut-off was taken as 1/160 for "O" antigen and 1/320 for "H" antigen of Salmonella typhi.

The main purpose of this study was to provide local recommendations for the interpretation of Widal test results. This study also signifies the importance of single-tube Widal agglutination test in the diagnosis of typhoid fever. The "Gold standard" for the diagnosis of typhoid fever is the isolation of bacteria from blood or bone marrow; however, the widespread and uncontrolled use of antibiotics lead to negative results. Moreover, considering the poor facilities for the isolation of bacteria by the culture methods in the peripheral health centers and rural clinics, no other diagnostic tool is introduced thus far, other than the Widal test for the appropriate diagnosis of typhoid fever. [3] The Widal test interpretation in endemic areas is difficult since majority of the normal healthy individuals also carry detectable antibodies. [4] In our study, we found that in such cases, the high titers (>1/160 for Salmonella typhi "O" and >1/320 for Salmonella typhi "H" antigens) in the Widal test performed on single acute-phase sera must be considered as significant and diagnostic. [5]


   Acknowledgment Top


We would like to acknowledge all our colleagues, which includes both the teaching and nonteaching staff.

 
   References Top

1.Pang T, Puthucheary SD. Significance and value of the Widal test in the diagnosis of typhoid fever in an endemic area. J Clin Pathol 1983;36:471-5.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Saha SK, Ruhulamin M, Hanif M, Islam M, Khan WA. Interpretation of the Widal test in the diagnosis of typhoid fever in Bangladeshi children. Ann Trop Paediatr 1996;16:75-8.  Back to cited text no. 2  [PUBMED]  
3.Clegg A, Passey M, Omena M, Karigifa K, Suve N. Re-evaluation of the Widal agglutination test in response to the changing pattern of typhoid fever in the highlands of Papua New Guinea. Acta Trop 1994;57:255-63.  Back to cited text no. 3  [PUBMED]  
4.Chongsa-nguan M, Chaicumpa W, Kalambaheti T, Thin-inta W, Echeverria P, Overtoom R. Current status of Widal test in diagnosis of typhoid fever in an edemic area. Southeast Asian J Trop Med Public Health 1989;20:493-5.  Back to cited text no. 4  [PUBMED]  
5.Levine MM, Grados O, Gilman RH, Woodward WE, Solis-Plaza R, Waldman W. Diagnostic value of the Widal test in areas endemic for typhoid fever. Am J Trop Med Hyg 1978;27:795-800.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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Correspondence Address:
K V Ramana
Department of Microbiology, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda - 508254
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.36759

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