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J Infect Dev Ctries. 2011 Mar 21;5(3):169-75.

Evaluation of a newly developed ELISA against Widal, TUBEX-TF and Typhidot for typhoid fever surveillance Fadeel MA, House BL, Wasfy MM, Klena JD, Habashy EE, Said MM, Maksoud MA,
Rahman BA, Pimentel G.
Patients with acute febrile illness as per WHO definition were eligible 234 culture-confirmed typhoid patients, done in Egypt TUBEX-TF sensitivity 75-78 Specificity 85- 88 Typhidot IgM sensitivity 63-62 Specificity 95- 97 Typhidot IgG sensitivity 28-28 Specificity 99- 99 ELISA total Ig sensitivity 93- 78 Specificity 95- 94 Using ELISA, up to 200 samples can be tested per run with cost per test at US$0.20.Typhidot $ 2.20 TUBEX-TF $ 6.00 ELISA shows superior sensitivity and specificity, when compared to Widal, TUBEX-TF and Typhidot assays

The dilemma of widal test - which brand to use? a study of four different widal brands: a cross sectional comparative study Wafaa MK Bakr, El Attar LA, Ashour MS, El Toukhy AM. Ann Clin Microbiol
Antimicrob. 2011 Feb 8;10:7. Egypt The results of Widal tests differed markedly using the four Widal brands in terms of sensitivity and specificity at three cut-off values of 1/80, 1/160 and 1/320. Remel brand gave the highest sensitivities and the lowest specificities and Dialab brand gave the highest specificities and the lowest sensitivities for both anti-O and anti-H antibodies at the three cut-off values.

Four fold rise in the antibodies titer was not demonstrable among clinically diagnosed typhoid fever patients. H agglutinins were less sensitive and less specific than O agglutinins

Gaz Egypt Paediatr Assoc. 1975 Apr;23(2):173-80.

Study of the pattern of Widal test in infants and children; II. Pattern of Widal test in children with enteric fevers. An attempt to define the diagnostic titer for upper Egypt.
Hassanein F, Mostafa FM, Elbehairy F, Hammam HM, Allam FA, El-Rehaiwy M, AbdelAziz A.

Abstract
The study embodied 45 children with enteric fevers proved by bacteriological culture of blood, stools and urine and 20 children with rheumatic fever. Widal test was done for the rheumatic fever cases and was done repeatedly at weekly intervals for the enteric fever cases. The clinical features of children with enteric fevers was discussed. By contrasting the results of Widal test in children with enteric fever with the results in apparently normal infants and children from the same locality, a minimal diagnostic dual Widal titer was suggested. This combines "O" agglutinin in a titer of 1/160 provided that the other "H" agglutinins are at a lower titer. This suggested diagnostic titer improved the specificity of Widal test. This titer is encountered only in 0.58% of normal individuals and in none of 20 children with rheumatic fever. This titer also yielded an excellent sensitivity to diagnose actual enteric fever cases reaching up to 93.3%. Bacterial isolates from enteric fever cases were S. typhi in 55.5%, S. paratyphi A in 33.3% and S. paratyphi B in 11.1%. Chloramphenicol therapy resulted in a higher cure rate and a more rapid defervescence than ampicillin therapy. Regarding the effect of these antibiotic therapies on the rise of Widal agglutinin titers in children with enteric fevers there are two observations : 1--A four fold rise, is uncommon. A two fold rise is the common finding. 2--There is no consistent difference between chloramphenicol and ampicillin as regards their effect on the rise of agglutinin titers. 2. J Clin Microbiol. 2002 Sep;40(9):3509-11.

Evaluation of dipstick serologic tests for diagnosis of brucellosis and typhoid Fever in egypt.
Ismail TF, Smits H, Wasfy MO, Malone JL, Fadeel MA, Mahoney F.

Source
U.S. Medical Research Unit No. 3, Cairo, Egypt. IsmailT@namru3.med.navy.mil

Abstract
Two dipstick assays for the detection of Brucella- and typhoid-specific immunoglobulin M, recently developed by the Royal Tropical Institute of The Netherlands, were evaluated by use of 85 plasma samples from Egyptian patients. Both dipsticks were simple and accurate rapid diagnostic assays, and they can be useful adjuncts for the diagnosis of typhoid fever and brucellosis. 3. Ethiop Med J. 2007 Jan;45(1):69-77.

Pattern of widal agglutination reaction in apparently healthy population of Jimma town, southwest Ethiopia.
Mamo Y, Belachew T, Abebe W, Gebre-Selassie S, Jira C.

Source
Department of Internal Medicine, Faculty of Medical Sciences, Jimma University.

Abstract
BACKGROUND: Typhoid fever is leading cause of morbidity in developing countries including Ethiopia. Isolation of Salmonella Typhi by culturing, from blood or other source, is the surest way of making laboratory diagnosis. However, in resource-limited countries, the Widal agglutination test provides cheaper and easy alternatives, though inappropriate technique and interpretation continue to cast a shadow on its usefulness. METHODS AND MATERIALS: A cross-sectional study was carried out during the period of February to May 2004 to determine the baseline antibody tube titration and slide agglutination pattern to Widal antigen and the usefulness of rapid slide agglutination test for diagnostic purposes among apparently healthy population of Jimma town, southwest Ethiopia. Blood samples were collected from subjects who gave their consents after thorough explanation of the procedure and the purpose of the study. The study participants were selected by a systematic random sampling technique. The sera of subjects were tested for Widal agglutination by an experienced laboratory technologist according to the standard procedural protocol-using antigen from Chronolab AG, Switzerland Data were cleaned edited and entered in to a computer and

analyzed using SPSS for window version 11.0. Major results were expressed as 95% probability limit, and validity scoring; agreement test (Kappa) was determined. RESULTS: The result indicated that among the apparently health population, almost all the blood tested showed some titer of the antibody and reactivity of agglutination slide tests. The 95% probability limit (mean + 2SD) for anti H and anti O antigen titration was 1:276.89 and 1:207.89, respectively. These figures are closer to a cut-off titer of 1.320. There was a fair agreement between slide agglutination test and tube titer for 0 antigen (Kappa=0.225) and a poor agreement for H antigen (Kappa=0.066). When agglutination test result of highly reactive (+4) and titration of 1:320 were used, few cases became reactive indicating the need to raise the cut-off value to these points respectively. CONCLUSION: It is recommended that if Widal test is to be used for the clinical work up of typhoid fever in adult population, a cut-off value highly reactive (+4),for rapid slide agglutination and a titer of 1.320 and above for tube titration test be used. At the cut-off values indicated above, Widal test has low sensitivity and positive predictive value and high specificity and negative predictive values. This makes the test useful support to clinical suspicion but unlikely means ofJscreening.