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Clinical and epidemiological features of Typhoid Fever in Pemba Zanzibar: assessment of the performance of the WHO case definitions

Thriemer, Kamala, Ley, Benedikt, Ame, Shaali M., Deen, Jacqueline L., Deok, Pak Gi, Chang, Na Yoon, Hashim, R., Schmied, Wolfgang H., Busch, Clara Jana-Lui, Nixon, Shanette, Morrisey, Anne, Puri, Mahesh K., Ochiai, Leon, Wierzba, Thomas, Clemens, John D., Ali, Mohammad, Jiddawi, Mohamed Saleh, von Seidlein, Lorenz and Ali, Said Mohammed (2012). Clinical and epidemiological features of Typhoid Fever in Pemba Zanzibar: assessment of the performance of the WHO case definitions. PLoS One,7(12):e51823.

Document type: Journal Article
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Title Clinical and epidemiological features of Typhoid Fever in Pemba Zanzibar: assessment of the performance of the WHO case definitions
Author Thriemer, Kamala
Ley, Benedikt
Ame, Shaali M.
Deen, Jacqueline L.
Deok, Pak Gi
Chang, Na Yoon
Hashim, R.
Schmied, Wolfgang H.
Busch, Clara Jana-Lui
Nixon, Shanette
Morrisey, Anne
Puri, Mahesh K.
Ochiai, Leon
Wierzba, Thomas
Clemens, John D.
Ali, Mohammad
Jiddawi, Mohamed Saleh
von Seidlein, Lorenz
Ali, Said Mohammed
Journal Name PLoS One
Publication Date 2012
Volume Number 7
Issue Number 12
ISSN 1932-6203   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84871423281
Start Page e51823
Total Pages 7
Place of Publication United States
Publisher Public Library of Science
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
The gold standard for diagnosis of typhoid fever is blood culture (BC). Because blood culture is often not available in impoverished settings it would be helpful to have alternative diagnostic approaches. We therefore investigated the usefulness of clinical signs, WHO case definition and Widal test for the diagnosis of typhoid fever.

Methodology/Principal Findings
Participants with a body temperature ≥37.5°C or a history of fever were enrolled over 17 to 22 months in three hospitals on Pemba Island, Tanzania. Clinical signs and symptoms of participants upon presentation as well as blood and serum for BC and Widal testing were collected. Clinical signs and symptoms of typhoid fever cases were compared to other cases of invasive bacterial diseases and BC negative participants. The relationship of typhoid fever cases with rainfall, temperature, and religious festivals was explored. The performance of the WHO case definitions for suspected and probable typhoid fever and a local cut off titre for the Widal test was assessed. 79 of 2209 participants had invasive bacterial disease. 46 isolates were identified as typhoid fever. Apart from a longer duration of fever prior to admission clinical signs and symptoms were not significantly different among patients with typhoid fever than from other febrile patients. We did not detect any significant seasonal patterns nor correlation with rainfall or festivals. The sensitivity and specificity of the WHO case definition for suspected and probable typhoid fever were 82.6% and 41.3% and 36.3 and 99.7% respectively. Sensitivity and specificity of the Widal test was 47.8% and 99.4 both forfor O-agglutinin and H- agglutinin at a cut-off titre of 1:80.

Typhoid fever prevalence rates on Pemba are high and its clinical signs and symptoms are non-specific. The sensitivity of the Widal test is low and the WHO case definition performed better than the Widal test.
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