A comparative study of widal test

with blood culture in the diagnosis

of typhoid fever in febrile patients
Pembimbing :
dr. Rahmi Dewi Sp.PD

ASTRID AVIDITA
H2A010007

A comparative study of widal test with blood

culture in the diagnosis of typhoid fever in
febrile patients
Gizachew Andualem, Tamrat Abebe,
Nigatu Kebede, Solomon Gebre-Selassie,
Adane Mihret and Haile Alemayehu
BMC Research Notes 2014, 7:653
http
://www.biomedcentral.com/1756-0500/7/6
53

Background
Typhoid fever
is a systemic prolonged febrile illness
caused by certain Salmonella serotypes
including Salmonella typhi, S. paratyphi
A , S. paratyphi B and S. paratyphi
C.
Human being is the only reservoir host
Transmitted fecal-oral

 more likely to be seen in

India, South and Central
America, and Africa
areas with rapid
population growth,
increased urbanization,
and limited safe water,
infrastructure, and health
systems

 Diagnosis of typhoid fever

clinical signs and symptoms
serological markers
bacterial culture
antigen detection and DNA amplification
Blood, bone marrow, stool culture most reliable
diagnostic expensive, often unavailable
Widal test
most widely used.
relatively cheaper, easy to perform and requires
minimal training and equipment

 Widal test
the value of the test to diagnose typhoid
fever has
been debated for as many years as it has
been available
It relies classically on the demonstration
of a rising
titer of antibodies in paired samples 10 to
14 days apart
such a rise is not always demonstrable,
even in blood culture-confirmed cases

Interpreting the test has been such a

problem that different cut offs have
been reported fromn different places
patient management cannot wait for
results obtained with a convalescentphase sample a treatment decision
must be made on the basis of the
results obtained with a single
acute-phase sample
evaluating the result of a single Widal
test is necessary for correct
interpretation

This study was carried out to

evaluate the value of a single
acute-phase Widal test result
by blood culture for the
diagnosis of typhoid fever in
febrile patients in St. Pauls
General Specialized Hospital,
Addis Ababa , Ethiopia.

Methods
Area & period
St. Pauls general Specialized Hospitals,
Addis Ababa, Ethiopia from December
2010 to March 2011
Study design
prospective study
Population
277 suspected febrile patients

Blood culture
Blood sampling

Inoculation in culture
medium

Biochemical
screening

Incubated again for 7

days, subculture before
reported (-)

Widal test
Qualitative slide agglutination
1 drop of S. O & H
antigen + 1 drop
serum

Serially dilute serum

sample with 0,95%
saline from 1/20-1/640

Rotated 100 rpm 1 min

reactive

Weakly
reactive

Titration test

Non
reactive

+ 1 drop of S. Otube
&H
Semiquantitative
antigen
agglutination
(titration)
O 1/80 & > H 1/160
&>
Recent infection of
typhoid

Result
Quantitative slide agglutination test

 Semi quantitative (titration)

 Blood culture

High antibody titer in non typhoidal infection

Conclusions
Sensitivity 71,4 %
widal test detects 71,4% of patients with
typhoid fever (true positives) but 28,6%
with the typhoid fever go undetected (false
negatives).
Specificity 68,44%
correctly reports 68,44% of patients without
TF as test negative (true negatives) but
31,6% patients without TF are incorrectly
identified as test positive (false positives).

 Positive predictive value (PPV) 5,7%

possibility for having typhoid fever
when widal test result (+) 5,7%
Negative predictive value (NPV) 98,9%
possibility for not having typhoid fever
when widal test result (-) 98,9%
A high antibody titer development is
also seen in nontyphoidal febrile
infections

Using Widal test as the

only laboratory test for
the diagnosis of typhoid
fever will result in
misleading diagnosis

THANK YOU