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What is being tested?
The Widal test is one method that may be used to help make a presumptive diagnosis of enteric fever, also known as typhoid fever. Although the test is no longer commonly performed in the United States or other developed countries, it is still in use in many emerging nations where enteric fever is endemic and limited resources require the use of rapid, affordable testing alternatives. While the method is easy to perform, concerns remain about the reliability of the Widal test. It is not specific for typhoid fever and can be positive when a person does not have the infection.
Enteric fever is a life-threatening illness caused by infection with the bacterium Salmonella enterica serotype Typhi (S. typhi), usually transmitted through food and drinks contaminated with fecal matter. It is associated with symptoms that include high fever, fatigue, headache, abdominal pain, diarrhea or constipation, weight loss, and a rash known as “rose spots.” Early diagnosis and treatment are important because serious complications, including severe intestinal bleeding or perforation, can develop within a few weeks.
The infection is rare in the U.S. and other industrialized nations but is more common in developing countries, including India, parts of South, East and Southeast Asia, and countries in Africa, the Caribbean, Central and South America, and Eastern Europe. Cases of enteric fever in the U.S. are usually attributed to travelers to these endemic areas.
In the U.S. and other developed nations, testing for enteric fever usually involves a blood culture to detect the bacteria during the first week of fever. A stool, urine or bone marrow culture may also be performed. A blood culture, however, can be labor- and time-intensive in areas of the world that lack the resources for automated equipment. In developing countries, such as those in Africa, the Widal test continues to be used instead of cultures because it is quicker, simpler, and less costly to perform.
The World Health Organization (WHO) has said that due to the various factors that can influence the results of a Widal test, it is best not to rely too much on this test. WHO instead recommends the use of cultures, whenever possible. Until another simple, inexpensive, and reliable option becomes available, however, use of the Widal test will probably persist in those countries with limited resources. There are newer rapid antibody tests for typhoid fever commercially available, several of which have been included in comparative studies of their reliability, for example in India and Africa. Findings seem to vary as to whether any are as reliable as blood culture for diagnosing this infection.
Sources Used in Current Review
(March 25, 2013) Centers for Disease Control and Prevention. Typhoid Fever. Available online at https://www.cdc.gov/typhoid-fever/index.html. Accessed March 2018.
(July 11, 2015) Mayo Clinic. Typhoid fever. Available online at http://www.mayoclinic.org/diseases-conditions/typhoid-fever/basics/symptoms/con-20028553. Accessed March 2018.
Adhikari A, et al. Evaluation of sensitivity and specificity of ELISA against Widal test for typhoid diagnosis in endemic population of Kathmandu. BMC Infect Dis. 2015; 15: 523. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4647669/. Accessed March 2018.
Andualem G, et al. BMC Res Notes. 2014; 7: 653. A comparative study of Widal test with blood culture in the diagnosis of typhoid fever in febrile patients. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177418/. Accessed March 2018.
(13 April 2015) World Health Organization. Typhoid. Available online at http://www.who.int/immunization/diseases/typhoid/en/. Accessed March 2018.
Sources Used in Previous Reviews
Willke A, Ergonul O and Bayar B. Widal Test in Diagnosis of Typhoid Fever in Turkey. Clin Diagn Lab Immunol. 2002 July; 9(4): 938–941. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC120044/. Accessed August 2010.
Saudi Society of Medical Microbiology and Infectious Diseases. Widal Test. Available online at http://ssmmid.org/widal-test/. Accessed August 2010.
Omuse G, Kohli R and Revathi G. Diagnostic utility of a single Widal test in the diagnosis of typhoid fever at Aga Khan University Hospital (AKUH), Nairobi, Kenya. Version published on 1 January 2010. Trop Doct 2010;40:43-44. © 2010 Royal Society of Medicine Press. Available online at http://td.rsmjournals.com/cgi/content/abstract/40/1/43. Accessed August 2010.
Ley B et al. Evaluation of the Widal tube agglutination test for the diagnosis of typhoid fever among children admitted to a rural hospital in Tanzania and a comparison with previous studies. BMC Infectious Diseases 2010, 10:180. Available online at http://www.biomedcentral.com/1471-2334/10/180. Accessed August 2010.
MedlinePlus Medical Encyclopedia. Typhoid Fever. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001332.htm. Accessed August 2010.
Begum Z et al. Comparison between DOT EIA IgM and Widal Test as early diagnosis of typhoid fever. Mymensingh Med J. 2009 Jan;18(1):13-7. Available online at http://www.ncbi.nlm.nih.gov/pubmed/19182742. Accessed August 2010.
Narayanappa D et al. Comparative study of dot enzyme immunoassay (Typhidot-M) and Widal test in the diagnosis of typhoid fever. Indian Pediatr. 2010 Apr 7;47(4):331-3. Epub 2009 Apr 15. Available online at http://www.ncbi.nlm.nih.gov/pubmed/19430063. Accessed August 2010.
World Health Organization. Guidelines on Standard Operating Procedures for MICROBIOLOGY: Enteric Fever. Available online at http://www.searo.who.int/EN/Section10/Section17/Section53/Section482_1794.htm. Accessed August 2010.
Centers for Disease Control and Prevention. Travelers’ Health, 2010 Yellow Book: Typhoid and Paratyphoid Fever. Available online at http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/typhoid-paratyphoid-fever.aspx. Accessed August 2010.
MayoClinic.com. Typhoid Fever. Available online at http://www.mayoclinic.com/health/typhoid-fever/DS00538. Accessed August 2010.
Centers for Disease Control and Prevention. Travelers’ Health. Typhoid & Paratyphoid Fever. Chapter 3. 2014 Yellow Book. Available online at http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/typhoid-and-paratyphoid-fever. Accessed September 2013.
MayoClinic.com. Typhoid fever: Symptoms Available online at http://www.mayoclinic.com/health/typhoid-fever/DS00538/DSECTION=symptoms. Accessed September 2013.
Keddy, KH et al. Sensitivity and specificity of typhoid fever rapid antibody tests for laboratory diagnosis at two sub-Saharan African sites. Bulletin of the World Health Organization 2011;89:640-647. Available online at http://www.who.int/bulletin/volumes/89/9/11-087627/en/. Accessed September 2013.
Krishna S, Desai S, Anjana V K, Paranthaaman R G. Typhidot (IgM) as a reliable and rapid diagnostic test for typhoid fever. Ann Trop Med Public Health 2011;4:42-4. Available online at http://www.atmph.org/article.asp?issn=1755-6783;year=2011;volume=4;issue=1;spage=42;epage=44;aulast=Krishna. Accessed September 2013.
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