Clinically Suspected Cases of Typhoid Fever in a Tertiary Care Hospital using the Widal Test for Serological Analysis: a Cross-sectional Study
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Background: Despite continuous discussions regarding the accuracy of the Widal test, typhoid fever is still a major public health concern in developing nations wherein it is frequently diagnosed. Objective: This study aimed to investigate the distribution of antibody titers and assess the pattern of Widal test results in the clinically suspected cases of typhoid fever. Methods: This cross-sectional study included 400 cases of clinically suspected cases of typhoid fever. The O, H, AH, and BH antigens at different dilutions were assessed based on the results of the Widal test, which was performed using the conventional tube agglutination method. Results: Of the 400 cases (213 females, 187 males), 86 (21.5%) showed positive Widal test results, while 314 (78.5%) showed negative Widal test results. Of the positive cases, 58 cases (67.4%) had isolated O antigen elevation (titer ≥ 1:320), 11 cases (12.8%) had combined O and H elevation (both ≥ 1:320), 1 case (1.2%) had O:320 with H:160, and 1 case (1.2%) had complete reactivity (O, H, AH, and BH; all ≥ 1:320). No discernible gender bias in the male-to-female ratio of 1:1.14 was observed. Conclusion: The majority of the cases of isolated O antigen elevation are often attributed to either cross-reactivity with other Salmonella species or early infection. In endemic areas, the low overall positivity rate (21.5%) emphasizes the necessity of additional diagnostic techniques in addition to Widal testing.
Abstract
Background: Despite continuous discussions regarding the accuracy of the Widal test, typhoid fever is still a major public health concern in developing nations wherein it is frequently diagnosed. Objective: This study aimed to investigate the distribution of antibody titers and assess the pattern of Widal test results in the clinically suspected cases of typhoid fever. Methods: This cross-sectional study included 400 cases of clinically suspected cases of typhoid fever. The O, H, AH, and BH antigens at different dilutions were assessed based on the results of the Widal test, which was performed using the conventional tube agglutination method. Results: Of the 400 cases (213 females, 187 males), 86 (21.5%) showed positive Widal test results, while 314 (78.5%) showed negative Widal test results. Of the positive cases, 58 cases (67.4%) had isolated O antigen elevation (titer ≥ 1:320), 11 cases (12.8%) had combined O and H elevation (both ≥ 1:320), 1 case (1.2%) had O:320 with H:160, and 1 case (1.2%) had complete reactivity (O, H, AH, and BH; all ≥ 1:320). No discernible gender bias in the male-to-female ratio of 1:1.14 was observed. Conclusion: The majority of the cases of isolated O antigen elevation are often attributed to either cross-reactivity with other Salmonella species or early infection. In endemic areas, the low overall positivity rate (21.5%) emphasizes the necessity of additional diagnostic techniques in addition to Widal testing.