Use of C-reactive protein in the evaluation of Widal test and Typhoid stripe test in the diagnosis of typhoid fever

Year 2017, Volume: 2 Issue: 1, 16 - 20, 30.03.2017

Ahmed Hasan Mohammed

https://doi.org/10.5455/jicm.17.20160921

Abstract

Background: Typhoid
fever is one of the systemic infection and responsible for high rate of
mortality especially in poor hygiene provinces. The aim of this study was to
evaluate the methods including C-reactive protein test, Widal test and        Typhoid stripe test that used in the
diagnosis of typhoid fever.

Material and Methods: Rapid direct Widal agglutination test and rapid typhoid
stripe (immunochromatography) test were used to detect typhoid infection
evaluate more accurate method in the diagnosis of typhoid fever. C-reactive
protein detected by rapid slide agglutination test to measure its level in
typhoid fever patients.

Results: The
results of Widal test showed 29 (63%) of 46 sample while the results of typhoid
stripe test showed 25 (54.3%) IgM positive and 2 (4.3%) IgG positive from 46
sample. The test of CRP accomplished in positive widal test and positive
typhoid strip test samples, the results showed that 6 (20.6%) of 29 were
positive and 6 (24%) of 25 were positive in widal and typhoid positive samples
respectively.

Conclusion: Typhoid
stripe test is more accurate and has low cross reactivity when compared with
Widal test in the diagnosis of typhoid fever. Although, C-reactive protein test
is non-specific but it is helpful in the characterization of acute inflammation
and infection, so it is recommended to use in the detection of typhoid fever.

Keywords

Typhoid fever, Widal test, typhoid stripe test, CRP

References

• The global burden of typhoid fever. The global burden of typhoid fever. Bull World Health Organ 2004; 82: 346-353.
• Paul UK, Barik KL, Sinharay K, Banik S, Bandyopadhyay A. Knowledge, Attitude and Practice of General Practitioners Regarding Typhoid Fever. Int J Sci Study 2016; 3: 83-86.
• Buckle GC, Walker CLF, Black RE. Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010. J Glob Health 2012; 2: 415-420
• Ackers ML, Puhr ND, Tauxe R V, Mintz ED. Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise. JAMA 2000; 283: 2668-2673.
• Black RE, Cisneros L, Levine MM, Banfi A, Lobos H, Rodriguez H. Case-control study to identify risk factors for paediatric endemic typhoid fever in Santiago, Chile. Bull World Health Organ 1985; 63: 899-904.
• Luby SP, Faizan MK, Fisher-Hoch SP, Syed A, Mintz ED, Bhutta ZA, et al. Risk factors for typhoid fever in an endemic setting, Karachi, Pakistan. Epidemiol Infect 1998; 120: 129-138.
• Luxemburger C, Chau MC, Mai NL, Wain J, Tran TH, Simpson JA, et al. Risk factors for typhoid fever in the Mekong delta, southern Viet Nam: a case-control study. Trans R Soc Trop Med Hyg 2001; 95: 19-23.
• Gasem MH, Dolmans WM, Keuter MM, Djokomoeljanto RR. Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia. Trop Med Int Health 2001; 6: 484-90.
• Grossman DA, Witham ND, Burr DH, Lesmana M, Rubin FA, Schoolnik GK, et al. Flagellar serotypes of Salmonella typhi in Indonesia: relationships among motility, invasiveness, and clinical illness. J Infect Dis 1995; 171: 212–216.
• Thong KL, Bhutta ZA, Pang T. Multidrug-resistant strains of Salmonella enterica serotype typhi are genetically homogenous and coexist with antibiotic-sensitive strains as distinct, independent clones. Int J Infect Dis 2000; 4: 194-197.
• Connerton P, Wain J, Hien TT, Ali T, Parry C, Chinh NT, et al. Epidemic typhoid in vietnam: molecular typing of multiple-antibiotic-resistant Salmonella enterica serotype typhi from four outbreaks. J Clin Microbiol 2000; 38: 895-897.
• Mirza S, Kariuki S, Mamun KZ, Beeching NJ, Hart CA. Analysis of plasmid and chromosomal DNA of multidrug-resistant Salmonella enterica serovar typhi from Asia. J Clin Microbiol 2000; 38: 1449-1452.
• House D, Bishop A, Parry C, Dougan G, Wain J. Typhoid fever: pathogenesis and disease. Curr Opin Infect Dis 2001; 14: 573-578.
• Wain J, Diep TS, Ho VA, Walsh AM, Nguyen TT, Parry CM, et al. Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance. J Clin Microbiol 1998; 36: 1683-1687.
• Wain J, Pham VB, Ha V, Nguyen NM, To SD, Walsh AL, et al. Quantitation of bacteria in bone marrow from patients with typhoid fever: relationship between counts and clinical features. J Clin Microbiol 2001; 39: 1571-1576.
• Bhutta ZA, Mansoorali N, Hussain R. Plasma cytokines in paediatric typhoidal salmonellosis: correlation with clinical course and outcome. J Infect 1997 ;35: 253–256.
• Póvoa P. C-reactive protein: A valuable marker of sepsis. Intensive Care Med 2002; 28: 235-243.
• Szalai AJ, VanCott JL, McGhee JR, Volanakis JE, Benjamin WH. Human C-reactive protein is protective against fatal Salmonella enterica serovar typhimurium infection in transgenic mice. Infect Immun 2000 ;68: 5652–5656.
• Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. J Clin Invest 1993; 91: 1351-1357.
• Westall FC. Molecular Mimicry Revisited: Gut Bacteria and Multiple Sclerosis. J Clin Microbiol American Society for Microbiology 2006; 44: 2099-20104.
• Danu MS, Urhekar A, Goel N, Mane V, KG AY and A. Comparison of Widal test with Immunochromatography and Enzyme Immuno Assay for Salmonella typhi IgM and IgG Antibodies. Res Rev J of Microbiology Biotechnol. Research and Reviews; 1970; 2013.
• Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340: 448-454.
• Wahid R, Simon R, Zafar SJ, Levine MM, Sztein MB. Live oral typhoid vaccine Ty21a induces cross-reactive humoral immune responses against Salmonella enterica serovar Paratyphi A and S. Paratyphi B in humans. Clin Vaccine Immunol 2012; 19: 825-834.
• Siddiqui MF, Asif A, Qazi MH, Alam R, Sarwar S, Sial GR, et al. Corellation of cholesterol and CRP with IgG & IgM positive typhoid patients from Ittifaq Hospital, Lahore, Pakistan. Can J App Sci 2015; 05: 50-55.
• Choo KE, Davis TM, Henry RL, Chan LP. Serum C-reactive protein concentrations in Malaysian children with enteric fever. J Trop Pediatr 2001; 47: 211–214.