ORIGINAL ARTICLE

JIACM 2004; 5(3): 244-6

A Comparative Study of Typhidot and Widal Test

in Patients of Typhoid Fever
BL Sherwal**, RK Dhamija*, VS Randhawa**, M Jais**, A Kaintura***, M Kumar***
Abstract
Typhoid continues to be one of the leading causes of morbidity and mortality in our country. Conventional methods of diagnosis are gold
standard blood culture and supportive widal test. We studied typhidot, a rapid serological test for diagnosis of typhoid fever and its usefulness
for an early diagnosis, its sensitivity and specificity as compared to widal test.
Methods : Typhidot test is an immunodot ELISA having an outer membrane protein specific for Salmonella typhi and separately
identifies IgG and IgM antibodies. The study included 80 patients who presented with fever. Blood culture, widal test, and typhidot
test were performed in all patients. Typhidot and widal tests were compared for sensitivity and specificity.
Results : 56 patients out of 80 were clinically suspected to be cases of enteric fever (Gp-I), while 24 patients were non-typhoidal
febrile illness (Gp-II). 38 patients (68%) of the Gp-I were positive for blood culture, 32 (57%) were widal positive, and 44(79%) were
positive for typhidot test. Gp-II had all patients sterile on blood culture, 4 (17%) were widal positive, while 3 (12.5%) tested positive
for typhidot. Amongst 38 culture positive cases in Gp-I, typhidot was positive in 35 patients, while widal was positive in 28 patients,
giving sensitivity of 92% and specificity of 87.5% as compared to widal which had sensitivity of 74% and specificity of 83%.
Conclusions : Typhidot test is an equally reliable, simple test that gives rapid diagnosis and can be helpful in early institution of
therapy.
Key Words : Typhidot, Widal test, Typhoid fever.

Introduction

reducing morbidity and its complications.

Typhoid fever is a life threatening systemic infection

occurring in lesser-developed areas of the world and
continues to be a major public health problem. There are
at least 16 million new cases of typhoid globally1. The
annual incidence of typhoid fever has been reported as
more than 13 million cases in Asia and causing more than
six lakhs deaths worldwide annually2.

Typhidot is a rapid serological test for the diagnosis of

typhoid fever. However, its usefulness in terms of
specificity and sensitivity as compared to widal test has
not been studied so far in our region. Few studies
conducted in south India and other parts of Asia have
reported encouraging results. In view of this, the present
study was conducted to know its utility and effectiveness
in terms of diagnostic yields as compared to widal test
and to ascertain any difference of its specificity and
sensitivity due to different strains of Salmonella typhi in
this region.

India is the second most populous country of the world

with majority inhabiting the rural areas with little access
to modern diagnostic tools. Blood culture and widal test
are routinely employed investigations for diagnosis of
typhoid fever in all clinical settings. Widal test has been
used in the diagnosis of typhoid illness for long time in
this country but it remains a serological test with a
moderate sensitivity and specificity. Therefore, a fast,
reliable, and easy to perform serodiagnostic test with a
higher sensitivity and specificity than widal test is required
for rapid diagnosis and management of typhoid cases,
thereby enabling clinicians to initiate an early therapy,

Materials and Methods

Typhidot test is a dot ELISA kit that detects IgM and IgG
antibodies against the outer membrane protein (OMP) of
the Salmonella typhi. The typhidot test becomes positive
within 2-3 days of infection and separately identifies IgM
and IgG antibodies. The test is based on the presence of
specific IgM and IgG antibodies to a specific 50KD OMP

*Professor of Medicine, **Professor of Microbiology, ***Resident in Medicine,

Department of Medicine and Microbiology, Lady Hardinge Medical College andAssociated Hospitals, New Delhi.

antigen, which is impregnated on nitrocellulose strips. The

reaction tray was divided into 2 columns marked as G and
M. 250 ul of sample diluent was dispensed in each well
and 2.5 ul of test /control was added and then incubated
for 20 minutes. The strips were washed with washing
buffer thrice, 250 ul of anti human IgG and IgM was
dispensed then in each well and incubated for another
15 minutes. These were washed again, dispensed with 250
ul of colour development solution, and incubated for
another 15 minutes and results were then interpreted. A
positive IgM was interpreted clinically as acute typhoidal
illness, while IgM and IgG positive were taken as acute
typhoidal illness in middle stage of infection and IgG
positive was interpreted as chronic carrier or previous
infection or reinfection.

On comparative evaluation of widal test, typhidot, and

blood culture, widal test had sensitivity of 57% and
specificity of 83%, where as blood culture showed a
sensitivity of 68% and specificity of 100% and typhidot
test showed a sensitivity of 79 % and specificity of 87.5%.

The study included 80 patients of acute febrile illness who

presented to our hospital. The patients were divided into
2 groups. Group I included 56 patients with clinical
diagnosis of typhoid fever and group II comprised of 24
patients of suspected typhoid fever with alternative
diagnosis. Routine investigations, complete blood counts,
urine analysis and culture, X-ray chest, liver function tests,
blood culture, widal test, and tyhidot test were done in all
patients. Results of blood culture, widal, and typhidot test
were compared in all patients for their sensitivity and
specificity.

Typhoid fever is a systemic illness with a significant

morbidity and mortality in developing countries. Poor
sanitation, overcrowding, low standard of living, lack of
medical facilities, and indiscriminate use of antibiotics lead
to endemicity of typhoid fever and multi-resistant strains
of Salmonella typhi in developing countries3,4. Blood
culture has remained the gold standard test in diagnosis
of typhoid fever, but its utility in early diagnosis is limited
in early phase of illness thereby making the isolation of
the organism difficult.

Observations
Blood culture was positive in 38 out of 56 patients (group
I), whereas all the 24 patients in group II were sterile on
blood culture. 32 patients of group I were positive for widal
test, whereas 44 out of 56 were positive for typhidot test
(table I). A total of 4 patients (17 %) in group II were widal
positive, while only 3 (12 .5 %) tested positive for typhidot
(table I).
Table I : Comparison of Blood culture, Widal Test, and
Typhidot Test.
Test

Number Positive in
Clinical and Culture
ProvenTyphoidCases
n = 56 (sensitivity) Gp 1

Non-Typhoid
Cases
n = 24
(sensitivity) GpII

Blood culture

38 (68%)

Widal test

32 (57%)

4 (17%)

Typhidot

44 (79%)

3 (12.5%)

Journal, Indian Academy of Clinical Medicine

Amongst all the 38 patients in Group I, who were having

positive blood culture, typhi dot test was positive in 35
patients, giving a sensitivity of 92%, a specificity of 87.5%,
and a positive predictive value of 92% as compared to
widal test which was positive in 28 patients with a
sensitivity, specificity, positive predictive value of 74%,
83%, and 87.5% respectively.

Discussion

Widal test has been used for over a century in developing

countries for diagnosing typhoid fever but it has a low
sensitivity, specificity and positive predictive value, which
changes with the geographical areas. Sharing of O and H
antigens by other Salmonella serotypes and other
members of Enterobacteriaceae makes the role of widal
test even more controversial in diagnosing typhoid fever5.
However, modified widal test particularly when used
alongwith conventional widal test has a greater
sensitivity6.
Typhidot is a new, inexpensive, and reliable serodiagnostic
test recently available commercially and studied in many
endemic areas with reports of higher sensitivity and
specificity. We studied typhidot test for its usefulness in
patients of typhoid fever presenting to our hospital and
observed that it has a sensitivity of 92% and specificity of
87.5%, which was higher than that of widal test and
comparable to the studies done elsewhere in India and
outside.

Vol. 5, No. 3

July-September, 2004

245

A similar study carried out in the southern part of India

reported typhidot of having a sensitivity of 100% and a
specificity of 80% and was recommended for its utility in
conjunction with widal test for an early diagnosis of
typhoid fever7. In another study group of typhoid patients
in Pakistan, typhidot test had a comparable sensitivity of
94% and specificity of 77%, while widal test had a
sensitivity and specificity of 63% and 83% only8. The
effectiveness of typhidot test in early diagnosis of typhoid
fever patients was also studied in two different studies in
Malaysia. Its sensitivity and specificity was reported as
90.3% and 91.9% respectively in the first study, and was
significantly higher, while the second study, also showed
a sensitivity and specificity of 98% and 76.6% respectively9,
10
. Both the Malaysian studies showed it to be a better test
in contrast to widal test for rapid diagnosis as well as for
its simplicity of ease in use. Results of all the studies done
to evaluate typhidot test in developing countries have
consistently shown similar and comparable results (table
III).

test and can be useful in early institution of therapy.

However, a larger prospective study would be required
to fully evaluate the usefulness of this test in countries
endemic to typhoid fever.

References
1.

Ivanoff B. Typhoid fever, global situation and WHO

recommendations. Southeast Asian J Trop Med Public
Health.1995; 26: supp 2; 1-6.

2.

Ivanoff B, Levine MM, Lambert PH. Vaccination against

typhoid fever, present status. Bull WHO, 1994; 72 (6). 957-71.

3.

Brown JC, Shanahan PM, Jesudason MV et al. Mutations

responsible for reduced susceptibility to 4-quinilones in
clinical isolates of multi-resistant Salmonella typhi in India.
J Antimicrobol Chemother 1996; 37: 891-900.

4.

Therlfall, Ward LR, Skinner JA, Smith HR, Lacy S. Ciprofloxacin

resistant Salmonella typhi and treatment failure. Lancet
1999; 353: 1590-1.

5.

Parry CM, Hien TT, Dougan G et al. Typhoid fever. N Eng J

Med 2002; 347: 1770-82.

6.

Pai AP, Koppikar GV, Deshpande S. Role of modified widal

test in the diagnosis of enteric fever. JAPI 2003; 51: 9-11.

7.

Jesudasson M, Esther E, Mathai E. Typhidot test to detect

IgG and IgM antibodies in typhoid fever 2002. Indian J Med
Res 2002; 116: 70-2.

Table II : Comparison of Widal test and Typhidot tests

In Culture Proven Cases and Non-Typhoid Cases.
Number Positive in
Culture Proven
TyphoidCases
n = 38 (sensitivity)

Non-Typhoid
Cases
n = 24
(sensitivity)

8.

Widal Test

28 (74%)

4 (17%)

Butta ZA, Mansurali N. Rapid serological diagnosis of

pediatric typhoid fever in an endemic area: a prospective
comparative evaluation of two dot enzyme
immunoassays and the widal test. Am J Trop Med Hyg 1999;
61: 645-7.

9.

Typhidot Test

33 (92%)

3 (12.5%)

Choo KE, Davis T M, Ismail A et al. Rapid and reliable

serological diagnosis of enteric fever, comparative
sensitivity and specificity of typhi dot and typhi dot M in
febrile Malaysian children. Acta Trop 1999; 72: 175-83.

Test

Table III : Comparative Evaluation of Typhidot test in

Different Studies
Author
Name/Year

Total
Patients

Sensitivity
(%)

Specificity
(%)

K. E Choo 1991

109

95

75

K. E Choo 1994

149

90

91

Butta et al 1999

97

94

89

Jesudasson et al 2002

150

100

80

Gopalakrishan
et al 2002

144

98

76.6

Present Study

80

92

87.5

10. Gopalakrishan V, Sekhar WY , Soo EH et al. Typhoid fever in

Kuala Lumpur and a comparative evaluation of two
commercially available diagnostic kits for detection of
antibodies to S. typhi 2002. Singapore Med J. 2002; 43 (10):
495.

Conclusion
Typhidot test is a highly sensitive and specific test in
diagnosing typhoid fever. It is a rapid, easy to perform,
more reliable test for typhoid fever as compared to widal

246

Journal, Indian Academy of Clinical Medicine

Vol. 5, No. 3

July-September, 2004