HUBUNGAN TITER WIDAL DENGAN JUMLAH LIMFOSIT PADA KASUS DEMAM TIFOID DI WILAYAH KERJA PUSKESMAS SAWOO

Typhoid fever is a systemic infection that is still a global problem, especially in Indonesia. This disease is caused by Salmonella bacteria. The Widal test is used to detect antibodies to Salmonella bacteria based on agglutination reactions between bacterial antigens and antibodies called agglutinins. Routine blood tests be used to see the body's defense mechanism against infection. Lymphocytes are produced by bone marrow, the presence of bacterial endotoxin causes inhibition of the formation of lymphocytes, so that in some cases of typhoid fever, low lymphocyte counts are often found. The purpose of this study was to determine the relationship between Widal titer and lymphocyte count in patients with suspected typhoid fever. The Widal test was examined using a microscope to see the agglutination formed, while the number of lymphocytes was calculated using a hematology analyzer. The results of the Widal test with a titer of 1/160 were 63.3% with normal lymphocyte counts and 10% with low lymphocytes. While the titer 1/320 obtained 10% of respondents with normal lymphocyte count and 16.7% with low lymphocyte count. The research design used was analytic observation with the type of cross sectional study. Statistical analysis using Kendall's Tau-b correlation test with SPSS. From the correlation test, the significance value is 0.009, and the correlation coefficient is -0.404**, which means that there is a relationship between the Widal titer and the number of lymphocytes with sufficient closeness.

CLINICAL PROFILE OF TYPHOID FEVER IN CHILDREN

Background: The present study describes the clinical presentation of typhoid fever. Methods: The study was a hospital based prospective study. Children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhidot tests were included in the study. Results: Commonest sign noticed was toxic look (88.00%) followed by coated tongue (79.00%) and splenomegaly (63.00%). Hepatomegaly was also noted in 35.00% of cases. Conclusion: Typhoid fever remains to be as an endemic disease in this locality. All the signs and symptoms of the disease are nonspecific common with other acute febrile illnesses; a definitive diagnosis of the disease is required for treatment and to prevent transmission. Keywords: Enteric fever, Splenomegaly, Toxic look

Prevalence, probability, and outcomes of typhoidal/non-typhoidal Salmonella and malaria co-infection among febrile patients: a systematic review and meta-analysis

The geographical overlaps of malaria parasites and Salmonella spp. can lead to co-infection of these two pathogens, especially in the tropics where malaria is endemic. Moreover, few literatures suggested that malaria infection was associated with Salmonella bacteremia. Therefore, this study quantified pooled prevalence of typhoidal/non-typhoidal Salmonella (NTS) and probability of typhoidal/NTS and malaria co-infection among febrile patients. The systematic review protocol was registered at PROSPERO (CRD42021252322). Studies on co-infection of typhoidal/NTS and malaria were searched in PubMed, Scopus, and Web of Science. The risk of bias of the included studies was assessed using the checklist for analytical cross-sectional studies developed by the Joanna Briggs Institute. Meta-analyses on the following criteria were performed: (1) pooled prevalence of typhoidal/NTS and malaria co-infection among febrile patients, (2) pooled prevalence of typhoidal/NTS among malaria patients, (3) pooled prevalence of malaria infections among patients with Salmonella spp. infection, and (4) probability of typhoidal/NTS and malaria co-infection among febrile patients. Additionally, the case fatality rate and mean difference of malarial parasitemia between typhoidal/NTS and malaria co-infection and Plasmodium monoinfection were also determined. The subgroup analyses of typhoidal/NTS, regions (Africa and Asia), countries, time (publication year), characteristics of participants, and diagnostic tests for identifying Salmonella spp. were also conducted. A sensitivity test was performed to determine the robustness of the study outcomes. Publication bias among the included studies was evaluated using the funnel plot and Egger’s test. All analyses were performed using Stata version 15 (StataCorp LLC, Texas, USA) with a p-value < 0.05 indicating statistical significance. Eighty-one studies that met the eligibility criteria were included in the analyses. Of the 73,775 study participants, 4523 had typhoidal/NTS and malaria co-infections. The pooled prevalence rates of typhoidal/NTS and malaria co-infection among febrile patients were 14% (95% confidence interval [CI], 9–19%; I2, 99.4%; 2971/17,720 cases) and 1% (95% CI 1–1%; I2, 89.9%; 252/29,081 cases) using the Widal test and culture methods for identifying Salmonella spp., respectively. The pooled prevalence rates of typhoidal/NTS infection among patients with malaria were 31% (95% CI 23–39%; I2, 99.5%; 3202/19,208 cases) and 3% (95% CI 2–3%; I2, 86.8%; 407/40,426 cases) using the Widal test and culture methods for identifying Salmonella spp., respectively. The pooled prevalence rates of malaria infection among patients with typhoidal/NTS were 17% (95% CI 6–29%; I2, 33.3%; 13/75 cases) and 43% (95% CI 32–53%; I2, 89.1%; 287/736 cases), respectively. Malaria infection was associated with typhoidal/NTS in children aged < 15 years (p < 0.0001; odds ratio, 0.36; 95% CI 0.23–0.58; I2, 73.9%; 3188/43,212 cases). The case fatality rate in patients with malaria and NTS co-infections was 16% (95% CI 9–24%; I2, 89.1%; 18/103 cases). From the view of the present study, the inappropriate use of the Widal test for Salmonella spp. diagnosis can overestimate the prevalence of typhoidal/NTS and malaria co-infections. Malaria infection associated with typhoidal/NTS in children and the high case fatality rates among few patients with co-infections were highlighted. Future prospective longitudinal studies using the appropriate and confirmatory dsiagnosis for Salmonella spp. infections are highly recommended to ensure the real prevalence of co-infection and highlight the outcome of co-infection for providing adequate treatment in febrile patients who live in areas where malaria is endemic, such as tropical Africa and India.

Article Research Differentiation Between Typhoid and Typhus Fever Infection and Coinfection with Limited Resources in Iraq

Enteric fever is caused by the Gram-negative bacilli Salmonella typhi and paratyphi, which have similar signs and symptoms to typhus and rickettsial illness. Both typhoid fever and rickettsia typhus, whether endemic or epidemic, have similar presentations, making it difficult to distinguish between the two diseases. As a result, co-infection of typhoid and typhus fever can be ignored if not recognized clinically. Serum was collected from 182 patients from the Suweib and fourth shurta areas who had a temperature of more than 38°C and two or more signs and symptoms of typhoid and typhus, such as headache lasting more than a week, rash, myalgia, arthralgia, and bleeding. Started with widal test slide method All result results confirmed by tube method Same samples investigated for typhus infection by weil-felix tests. Data entered to analyzed by SPSS program. the results were appeared of the 182 patients tested, 58 (18%) yielded results suggested that rickettsial infections or typhoid were the most likely because of their illnesses. patients’ age ranged from 8 to 75 years with mean age 29.10 years. The majority were female and mainly student (41.4%) and housewife (25.9%) by age and sex for the 58 patients for whom data were recorded. Age groups did not differ significantly (p > 0.5). The frequency of disease was 69% in female patients and 31% in male patients (p < 0.005). Finally, can Concluded Both widal and weil-felix test should done specially if no responses to typhoid treatment and depend on trial therapy by adding doxycycline in case that more sensitive and accurate tests are not available.

Blood Culture and Widal Test as Diagnostic Tools for Enteric Fever with Antibiogram in a Tertiary Care Centre at Dhaka in Bangladesh

Background: Enteric fever still exists as one of the major public health issue occurring in our country. Antimicrobials are the mainstays of treatment of typhoid fever. Due to rapidly growing antibiotic resistance, Salmonella spp. is required to be periodically tested for susceptibility patterns. This will also enable planning of rational use of antibiotics. Objective: To observe the diagnostic accuracy of enteric fever by blood culture and Widal test in a tertiary care center, at Savar, Dhaka; Bangladesh. Antimicrobial sensitivity pattern of this study will guide to modify recent changes in the trends of antimicrobial use at the local level. Methodology: Blood samples were collected from 2194 febrile patients with clinically suspected enteric fever cases at a Tertiary Care Outdoor Centre from January 2017 to March 2020. Blood culture was performed to isolate S. typhi and S. paratyphi. Widal tests were done for the determination of antibody titer. An antibody titer of ≥1:80 for anti TO and anti TH were taken as a cut off value to indicate recent infection of typhoid fever. Antibiotic susceptibility testing was carried out using modified disk diffusion (Kirby–Bauer) technique. Results: Out of 111 Salmonella isolates, 74 (5%) were S. typhi and 37 (25%) were S. paratyphi A. Total 697 samples were positive for Widal test. A large number of isolates showed resistance to commonly used antibiotics such as nalidixic acid (94.6%), chloramphenicol (87.3%), amoxicillin (76.6%), cephradine (53.1%), azithromycin (46.8) etc. Resistance to cefixime and cefipime, ceftriaxone tended to increase than past. Imipenem, moxifloxacin and cefuroxime are escalating resistance which is alarming. Conclusion: Blood culture is the most reliable among the diagnostic methods but it needs 5 to 7 days for delivery of final report. This delay leads to late diagnosis as well as provision of irrational usage of antibiotics. It is concluded that widal test would remain relevant as a diagnostic tool for enteric fever, which is more convenient, cheaper and faster than the other molecular tests. Our study revealed the antibiotic susceptibility of Salmonella isolates will be recommended for addressing the drug resistance.

Detection of Campylobacter jejuni and Salmonella typhimurium in chicken using PCR for virulence factor hipO and invA genes (Saudi Arabia)

Campylobacter jejuni and Salmonella typhimurium are the leading causes of bacterial food contamination in chicken carcasses. Contamination is particularly associated with the slaughtering process. The present study isolated C. jejuni and S. typhimurim from fifty chicken carcass samples, all of which were acquired from different companies in Riyadh, Saudi Arabia. The identification of C. jejuni was performed phenotypically by using a hippurate test and genetically using a polymerase chain reaction with primers for 16S rRNA and hippurate hydrolase (hipO gene). For the dentification of S. typhimurim, a serological Widal test was carried out using serum anti-S. typhimurium antibodies. Strains were genetically detected using invA gene primers. The positive isolates for C. jejuni showed a specific molecular size of 1448 bp for 16S rRNA and 1148 bp for hipO genes. However, the positive isolates of the invA gene exhibited a specific molecular size at 244 bp using polymerase chain reaction (PCR). Comparing sequencing was performed with respect to the invA gene and the BLAST nucleotide isolates that were identified as Salmonella enterica subsp. enterica serovar typhimurium strain ST45, thereby producing a similarity of 100%. The testing identified C.jejuni for hippuricase, GenBank: Z36940.1. While many isolates of Salmonella spp. that contained the invA gene were not necessarily identified as S. typhimurim, the limiting factor for the Widal test used antiS. typhimurum antibodies. The multidrug resistance (MDR) of C. jejuni isolates in chickens was compared with the standard C. jejuni strain ATCC 22931. Similarly, S. typhimurium isolates were compared with the standard S. typhimurium strain ATCC 14028.

A Cross-Sectional Comparative Study of the Performance of the Widal Test and the Typhidot Immunoassay for Typhoid Fever Diagnosis in the West Region of Cameroon

Background. The diagnosis of typhoid fever based on the Widal slide agglutination test remains a major hurdle in developing countries due to varied perceptions of the value of the Widal test in determining clinical decision-making. We undertook a study to evaluate the diagnostic performance of the Widal test and the Typhidot immunoassay in patients suspected of having typhoid fever in the Menoua division, West Region of Cameroon. Methods. Blood and stool samples were collected from 558 consenting febrile patients on the basis of suspicion of typhoid fever. These patients attended three district health services of the Menoua division between April 2018 and September 2019. These patients had clinical symptoms suggestive of typhoid fever as determined by their consultant. Serum was used for the Widal slide agglutination test and for the Typhidot rapid immunoassay test based on manufacturer’s guidelines. A composite reference of fever plus positive coproculture for Salmonella typhi and Salmonella paratyphi was used as the reference. The sensitivity, specificity, and predictive values of the positive and negative tests were calculated as well as Cohen’s kappa for agreement between the two tests. Results. Of 558 patients, 12.90% tested positive for the reference method, 57.17% tested positive for the Widal slide agglutination test, while 15.59% were positive for Typhidot-IgM. The overall sensitivity, specificity, and predictive values of the positive and negative tests were 80.56%, 94.03%, 66.6%, and 97.03% for Typhidot-IgM and 94.44%, 48.35%, 21.32%, and 98.33% for the Widal slide agglutination test, respectively. Cohen’s kappa estimates were 0.1660 (0.121–0.211) and 0.386 (0.312–0.460) for the Widal test and Typhidot immunoassay for 53.6% and 76.16% agreements of all observations, respectively. Conclusion. The Widal test was found to have a lower predictive value for the diagnosis of typhoid fever in our setting. However, the Typhidot test, although better, was not ideal. Diagnosis of typhoid fever should therefore rely on adequate clinical suspicion and a positive Typhidot test to improve the clinical management of typhoid fever in our setting.

Diversity in Typhoid Diagnostic Protocols And Recommendation for Composite Reference Standard

Typhoid fever is a major public health burden which causes substantial global morbidity and mortality due to lack of decisive diagnostic protocols. The capacity of commonly use diagnostic test to validate the absence of typhoid fever is controversial. This study explores to evaluate new techniques for typhoid diagnosis and proposed a harmonised suitable standardized composite reference to be adopted. Published peer-reviewed articles indexed in PubMed, MEDLINE and Google scholar were reviewed for hospital-based studies. This study reveals new typhoid diagnostic techniques such as proteomics, serology, Rapid Diagnostic tests (RDTs), transcriptomics, genomics, and metabolomics. 34.4% of the studies use prospective study design. The study result establishes that, Widal test has a moderate diagnostic accuracy with average percentage sensitivity (52.9%), specificity (54%), positive predictive value (PPV) (56.8%) as well as negative predictive value (NPV) (55.6%) when compared with 29.4%, 28%, 29.5%, and 27.8% of Typhidot respectively. The findings showed a statistically significant difference on the sensitivity between Widal and Typhidot t (40) = 2.639, p = 0.012 at p&lt;0.05 using independent sample t-test. When there is no perfect reference standard that has an optimal diagnostic accuracy, the need for a harmonised suitable standardized composite reference is essential. Hence, this study recommends that, peripheral blood culture with established sensitivity of 60% and Widal test with average sensitivity of 52.9% be adopted as a consensus composite reference standard for typhoid fever diagnosis in other to improve confidence in prevalence estimates.

Diversity in Typhoid Diagnostic Protocols And Recommendation for Composite Reference Standard

Typhoid fever is a major public health burden which causes substantial global morbidity and mortality due to lack of decisive diagnostic protocols. The capacity of commonly use diagnostic test to validate the absence of typhoid fever is controversial. This study explores to evaluate new techniques for typhoid diagnosis and proposed a harmonised suitable standardized composite reference to be adopted. Published peer-reviewed articles indexed in PubMed, MEDLINE and Google scholar were reviewed for hospital-based studies. This study reveals new typhoid diagnostic techniques such as proteomics, serology, Rapid Diagnostic tests (RDTs), transcriptomics, genomics, and metabolomics. 34.4% of the studies use prospective study design. The study result establishes that, Widal test has a moderate diagnostic accuracy with average percentage sensitivity (52.9%), specificity (54%), positive predictive value (PPV) (56.8%) as well as negative predictive value (NPV) (55.6%) when compared with 29.4%, 28%, 29.5%, and 27.8% of Typhidot respectively. The findings showed a statistically significant difference on the sensitivity between Widal and Typhidot t (40) = 2.639, p = 0.012 at p&lt;0.05 using independent sample t-test. When there is no perfect reference standard that has an optimal diagnostic accuracy, the need for a harmonised suitable standardized composite reference is essential. Hence, this study recommends that, peripheral blood culture with established sensitivity of 60% and Widal test with average sensitivity of 52.9% be adopted as a consensus composite reference standard for typhoid fever diagnosis in other to improve confidence in prevalence estimates.