Enteric Fever: Typhoid Fever

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Enteric fever (Typhoid fever) is a systemic disease mostly occurs in developing countries and continues to be a major public health problem.[1,2] It is caused by dissemination of Salmonella typhi or Salmonella paratyphi serotypes A, B and C. Enteric fever is a major cause of morbidity and mortality worldwide, causing an estimated 27 million cases with 200000-600000 deaths annually.[3] The subcontinent India bears the brunt of the disease both in terms of absolute number of cases and drug resistant strains.[3,11] The annual incidence is highest (>100 cases/100000 population) in south-central and southeast Asia; medium (10-100 cases/100000 population) in the rest of Asia, Africa, Latin America and Oceania (excluding Australia and New Zealand);…show more content…
All patients above 11 years of age of either gender attending the Medicine Department with acute febrile illness and suspected to have Enteric fever were included in this study. Febrile patients with other diagnosis were excluded. Blood culture, Widal test, Typhidot (IgM & IgG) test and other routine investigation(CBC, urine analysis and culture, liver function tests, chest x-ray PA view) were performed in all patients. 15 ml of venous blood samples were collected from every patient. Around 10 ml of blood sample was inoculated into Brain Heart Infusion biphasic medium and transported to the laboratory for culture (taken as gold standard). The remaining blood specimen was kept for serum separation in a sterile test tube that was used for Widal and Typhidot (IgM & IgG) test. Typhidot(CTK biotech) is a test consisting of a dot ELISA kit that detects IgM and IgG antibodies against the 50 KD outer membrane protein(OMP) of Salmonella typhi. The test becomes positive within 2-3 days of infection and gives result within 15…show more content…
Out of 18 Blood culture positive patients, 10 patients were positive and 8 were negative on Widal testing. Out of 27 patients who were positive for Widal test, 10 patients were positive and 17 patients were negative to Blood culture[Table 2]. However out of 36 Typhidot positive patients, 16 tests positive and 20 tests negative to Blood culture. Meanwhile out of 18 Blood culture positive patients, 16 were positive and 2 patients were negative on Typhidot tests[Table 3]. The sensitivity, specificity, positive and negative predictive value of Typhidot test were found to be 88.9%, 80.4%, 44.4% and 97.6% respectively. However sensitivity, specificity, positive and negative predictive value of Widal test were 55.6%, 83.3%, 37%, and 91.4% respectively. The diagnostic accuracy of Typhidot and Widal test were 81.7% and 79.2% respectively[Table

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