article · International Journal of Infectious Diseases
A study of 502 febrile outpatients in Mekelle, Ethiopia, evaluated the accuracy of the Widal test alongside local antibiotic prescribing patterns and blood isolate drug resistance. While culture testing confirmed typhoid fever in only 1.6 percent of patients, the slide Widal test indicated infection in 68.5 percent, demonstrating low specificity of 33 percent despite 100 percent sensitivity. This inaccuracy resulted in widespread over-prescription of antibiotics, particularly ciprofloxacin. The tube titration method performed better with 95.8 percent specificity, yet its sensitivity remained modest at 75 percent, and agreement between slide and tube tests was poor. Furthermore, testing of recovered blood isolates revealed an overall multidrug resistance rate of 61.7 percent. The findings indicate that the slide Widal test is unhelpful for reliable typhoid diagnosis and highlight an urgent requirement for rapid, feasible, and more accurate diagnostic tools.
Inaccurate diagnostic tools lead to misdiagnosis and unnecessary antibiotic treatments, which drive the spread of multidrug-resistant bacteria. Demonstrating the poor reliability of standard slide Widal tests shows healthcare providers and policymakers why clinical reliance on these assays must change, underscoring the urgent need to introduce dependable, rapid diagnostic alternatives in primary care settings.
The findings define an immediate clinical requirement for diagnostic manufacturers and health authorities to supply rapid, affordable, and high-specificity typhoid diagnostic kits. Targeted users include clinical laboratories and health centres in resource-constrained environments. While this study does not develop a new device, it provides clear diagnostic performance benchmarks and operational validation needs for near-market point-of-care diagnostic tools seeking adoption in Ethiopia and similar regions.
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OBJECTIVE: To determine diagnostic value of the Widal test, treatment pattern of febrile patients and antimicrobial drug susceptibility pattern of blood isolates. METHODS: Using cross sectional methods, blood samples were collected for culture and Widal test from 502 febrile outpatients attending Mekelle hospital and Mekelle health center with similar symptoms to typhoid. Sensitivity, specificity for anti-TH and anti-TO titers using culture confirmed typhoid fever cases, and Kappa agreement between Titer and slide Widal tests were calculated. Treatment pattern of patients and antimicrobial susceptibility pattern of the blood isolates was assessed. RESULTS: From the 502 febrile patients, 8(1.6%) of them had culture-proven typhoid fever. However, patients who have results indicative of recent infection by O and H antigens of the Widal slide agglutination test were 343 (68.5%), with specificity and sensitivity of 33% and 100%, respectively. Over prescription of antibiotics was seen by Widal slide test for Ciprofloxacin 268 (76.1%), Amoxicillin- Clavulanic acid 9(2.6%), Amoxicillin 8(2.4%) and Chloranphenicol 8(2.4%). Tube titer positivity was seen in 23(5.3%) patients with 75% sensitivity and 95.8% specificity. Widal slide and Tube titer tests showed poor agreement for both antigens (kappa=0.02 for O) and (Kappa=0.09 for H). A single anti-TH titer of ≥ 1:160 and anti-TO titer ≥ 1:80 higher in our study showed an indication for typhoid fever infection. Drug resistance pattern of blood isolates ranges from 0-89.7% for gram positive and 0-100% for Gram negative, with an overall multi-drug resistance rate of 61.7%. CONCLUSION: Patients were wrongly diagnosed and treated for typhoid fever by Widal test. The tube titration method was relatively good but still had poor sensitivity. Blood isolates showed multi drug resistance, which may be due to the indiscriminate prescription as seen in this study. Based on our results, the slide Widal test is not helpful in the diagnosis of typhoid, hence other tests with rapid, feasible, better sensitivity and specificity are urgently needed in Ethiopia.
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DOI: 10.1016/j.ijid.2015.04.014
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