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Evaluation of the Widal tube agglutination test for the diagnosis of typhoid fever among children admitted to a rural hdospital in Tanzania and a comparison with previous studies

Ley, Benedikt, Mtove, George, Thriemer, Kamala, Amos, Ben, von Seidlein, Lorenz, Hendriksen, Ilse, Mwambuli, Abraham, Shoo, Aikande, Malahiyo, Rajabu, Ame, Shaali M., Kim, Deok R., Ochiai, Leon R., Clemens, John D., Reyburn, Hugh, Wilfing, Harald, Magesa, Stephen and Deen, Jacqueline L. (2010). Evaluation of the Widal tube agglutination test for the diagnosis of typhoid fever among children admitted to a rural hdospital in Tanzania and a comparison with previous studies. BMC Infectious Diseases,10:180-188.

Document type: Journal Article
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Title Evaluation of the Widal tube agglutination test for the diagnosis of typhoid fever among children admitted to a rural hdospital in Tanzania and a comparison with previous studies
Author Ley, Benedikt
Mtove, George
Thriemer, Kamala
Amos, Ben
von Seidlein, Lorenz
Hendriksen, Ilse
Mwambuli, Abraham
Shoo, Aikande
Malahiyo, Rajabu
Ame, Shaali M.
Kim, Deok R.
Ochiai, Leon R.
Clemens, John D.
Reyburn, Hugh
Wilfing, Harald
Magesa, Stephen
Deen, Jacqueline L.
Journal Name BMC Infectious Diseases
Publication Date 2010
Volume Number 10
ISSN 1471-2334   (check CDU catalogue  open catalogue search in new window)
Start Page 180
End Page 188
Total Pages 9
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
Abstract Background
The diagnosis of typhoid fever is confirmed by culture of Salmonella enterica serotype Typhi (S. typhi). However, a more rapid, simpler, and cheaper diagnostic method would be very useful especially in developing countries. The Widal test is widely used in Africa but little information exists about its reliability.

Methods

We assessed the performance of the Widal tube agglutination test among febrile hospitalized Tanzanian children. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various anti-TH and -TO titers using culture-confirmed typhoid fever cases as the "true positives" and all other febrile children with blood culture negative for S. typhi as the "true negatives."

Results

We found that 16 (1%) of 1,680 children had culture-proven typhoid fever. A single anti-TH titer of 1:80 and higher was the optimal indicator of typhoid fever. This had a sensitivity of 75%, specificity of 98%, NPV of 100%, but PPV was only 26%. We compared our main findings with those from previous studies.

Conclusion

Among febrile hospitalized Tanzanian children with a low prevalence of typhoid fever, a Widal titer of ≥ 1:80 performed well in terms of sensitivity, specificity, and NPV. However a test with improved PPV that is similarly easy to apply and cost-efficient is desirable.

Keywords Widal tube agglutination test
typhoid fever
Tanzania
rural hospital
Salmonella enterica serotype Typhi (S. typhi)
reliability
DOI http://dx.doi.org/10.1186/1471-2334-10-180   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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