Blood culture versus molecular and serological methods in the diagnosis of enteric fever: A hospital-based prospective follow-up comparative study.

Vikash Yadav; Dr. Manoj Bharatlal  Jais; Dr. Preeti  Thakur; Dr. Lekharaj Hemraj  Ghotekar

doi:10.51168/sjhrafrica.v7i3.2635

Authors

Dr. Vikash Yadav Department of Microbiology, Lady Hardinge Medical College, New Delhi.
Dr. Manoj Bharatlal Jais Department of Microbiology, Lady Hardinge Medical College, New Delhi.
Dr. Preeti Thakur Department of Microbiology, Lady Hardinge Medical College, New Delhi.
Dr. Lekharaj Hemraj Ghotekar Department of Medicine, Lady Hardinge Medical College, New Delhi.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i3.2635

Keywords:

Enteric fever, typhoid, Polymerase chain reaction, Widal test, Blood culture, Diagnosis

Abstract

Background:

Typhoid fever is a life-threatening systemic infection that is usually presented with non- specific symptoms and signs. Typhoid and paratyphoid fever are both caused by S. Typhi and S. Paratyphi, which are gram-negative, rod-shaped, flagellated, motile, and non-spore-forming bacteria in the family Enterobacteriaceae. Its diagnosis is usually confirmed by blood culture and the Widal test. The delayed results of microbiologic examination and the unreliable results of the Widal test suggest a rapid and reliable method for the diagnosis of typhoid fever. The objective of the study was to compare different diagnostic modalities used in enteric fever.

Material and Methods:

This prospective follow-up study was conducted in the Departments of Microbiology, LHMC, and Associated Hospitals, and the Department of Medicine in LHMC from April 2024 to August 2025. A total of 132 clinically suspected typhoid fever cases of adult age groups from both sexes attending were studied. The blood collected aseptically was used for blood culture, and a serum sample was used for the Widal test, and plasma for the PCR test.

Results:

Out of 132 blood samples studied, 5 cases were positive by blood culture. Widal test showed sensitivity and specificity of 20% and 82.7%, and the PCR test showed sensitivity and specificity of 80% and 90%, respectively, on blood culture-proven cases. Maximum positive cases were seen in July and November.

Conclusion:

Using blood culture as the gold standard, PCR showed a higher sensitivity compared to the Widal test. The Widal test is easy to get and cheap, but because it’s not very accurate in places where the disease is endemic, integrating molecular diagnostics with the usual culture-based methods could help in early detection of enteric fever.

Recommendation:

PCR-based molecular diagnostics should be incorporated as an adjunct to conventional methods for the early and accurate diagnosis of Enteric fever.

Author Biographies

Dr. Vikash Yadav, Department of Microbiology, Lady Hardinge Medical College, New Delhi.

Postgraduate resident, Department of Microbiology Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi
Dr. Manoj Bharatlal Jais, Department of Microbiology, Lady Hardinge Medical College, New Delhi.

Director Professor & Head of Department Department of Microbiology Lady Hardinge Medical College and

Smt. Sucheta Kriplani Hospital, New Delhi
Dr. Preeti Thakur, Department of Microbiology, Lady Hardinge Medical College, New Delhi.

Associate Professor Department of Microbiology Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi.
Dr. Lekharaj Hemraj Ghotekar, Department of Medicine, Lady Hardinge Medical College, New Delhi.

Director Professor, Department OF Medicine Medical superintendent, SSKH Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi

References

Crump JA, Mintz ED. Global trends in typhoid and paratyphoid fever. Clin Infect Dis. 2010 Jan 15;50(2):241-6. doi:10.1086/649541. PMID:20014951. https://doi.org/10.1086/649541

Saad NJ, Lynch VD, Antillón M, Yang C, Crump JA, Pitzer VE. Seasonal dynamics of typhoid and paratyphoid fever. Sci Rep. 2018 May 2;8(1):6870. doi:10.1038/s41598-018-25234-w. PMID:29720736. https://doi.org/10.1038/s41598-018-25234-w

T.P B, Sumathi S, Anuradha K, Venkatesh D, Krishna S. A comparative study of Typhidot and Widal test in the diagnosis of typhoid fever. J Evol Med Dent Sci. 2013;2(20):3720-3725. doi:10.14260/jemds/754. https://doi.org/10.14260/jemds/754

Saravanan N, Rajendiran P, Nandagopal B, Ramamurthy MB, Vadivel K. A review of acute febrile illness. Indian J Microbiol Res. 2022;9(4):232-240. https://doi.org/10.18231/j.ijmr.2022.041

Yadav K, Yadav SK, Parihar G. A comparative study of Typhidot and Widal test for rapid diagnosis of typhoid fever. Int J Curr Microbiol Appl Sci. 2015;4(1):34-38.

Begum, Z, Hossain, Md.A, Shamsuzzaman, A.K.M, Ahsan, Md.M., Musa, A.K.M. Mahmud, Md.C., et al.Evaluation of typhidot (IgM) for early diagnosis of typhoid fever. Bangladesh J Med Microbiol2009; 3: 10- 13. https://doi.org/10.3329/bjmm.v3i1.2964

Narayanappa D, Sripathi R, Kumar JK, Rajani HS. Comparative study of Dot Enzyme Immunoassay (Typhidot-M) and Widal test in the diagnosis of Typhoid fever. Indian Pediatr 2009;47:331-33. https://doi.org/10.1007/s13312-010-0062-x

Jesudason MV, Sivakumar S. Prospective evaluation of a rapid diagnostic test, Typhidot, for typhoid fever. Indian J Med Res 2006;123:513-16.

Saha MR, Duta P, Palit A, Dutt D, Bhattacharya MK, Mitra U, et al. A note on incidence of typhoid fever in diverse age groups in Kolkata, India. Jpn J Inf Dis2003;56:121-22. https://doi.org/10.7883/yoken.JJID.2003.121

Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med. 2002;347:1770-82. https://doi.org/10.1056/NEJMra020201

Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology and laboratory diagnosis of invasive Salmonella infections. Clin Microbiol Rev. 2015;28:901-37. https://doi.org/10.1128/CMR.00002-15

Indian Council of Medical Research (ICMR). Antimicrobial Resistance Surveillance Network Annual Report 2022. New Delhi, 2022.

Olopoenia LA, King AL. Widal agglutination test - 100 years later: still plagued by controversy. Postgrad Med J. 2000;76:80-84. https://doi.org/10.1136/pmj.76.892.80

Maha S. Hamd, Safaa Abdel-Rahman1, Adbel- Mgeed Mostafa, Sahar Abd-El Hameed. Evaluation of the Enterocheck WB® test in the diagnosis of Typhoid Fever among Egyptian Adults.Egyptian J Med Microbiol 2014;23(4):47-52. https://doi.org/10.12816/0025919

Rahman M, Siddique AK, Tam FCH, Sharmin S, Rashid H, Iqbal A.Rapid detection of early typhoid fever in endemic community children by the TubexO9-antibody test. DaigMicrobiol Infect Dis 2007;58:275-81. https://doi.org/10.1016/j.diagmicrobio.2007.01.010

Kumar R, Singh S, et al. Comparative evaluation of the Widal test and PCR in the diagnosis of typhoid fever. J Family Med Prim Care. 2021.

Wain J, Hosoglu S. The laboratory diagnosis of enteric fever. J Infect Developing Countries 2008; 2(6):421-425. https://doi.org/10.3855/jidc.155

Sherwal BL, Dhamija RK, Randhawa VS, Jais M, Kaintura A, Kumar M. A comparative study of Typhidot and Widal test in patients of Typhoid fever. JIndian AcadClinMed2004;5:244-46.

Nga TVT, Karkey A, Dongol S, et al. The sensitivity of real-time PCR targeting invasive Salmonella serovars. BMC Infect Dis. 2010;10:125. https://doi.org/10.1186/1471-2334-10-125

Sharma P, Dahiya S, et al. Evaluation of molecular methods for diagnosis of enteric fever in a tertiary care centre in India. Indian J Med Microbiol. 2022;40:410-415.

Verma R, Gupta N, et al. Diagnostic utility of PCR in suspected enteric fever cases in North India. Indian J Pathol Microbiol. 2023.

Reddy BM, Kumar N, et al. Real-time PCR evaluation for enteric fever in a tertiary care setting in South India. J Clin Med Diagn Res. 2021;15(4):OC01-OC07.

National Centre for Disease Control (NCDC). Integrated Disease Surveillance Programme Report 2023. New Delhi, 2023.