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Category: Volume 05 Issue 09 September 2017
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Title: Comparative Evaluation of diagnostic performance of Blood culture, Lateral flow immunoassay, Tube Widal and Slide Widal Test in diagnosis of Enteric fever using a Composite Reference Standard

Authors: Abhishek Mehta, Devesh Sharma, Vijay Prakash Singh

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i9.101

Abstract

Background: Enteric fever a potentially fatal multi systemic infectious disease is well recognised as a serious public health problem throughout the world. Undiagnosed and untreated cases may result in serious complications. Prompt and accurate diagnosis of the cases is the most important step for the efficient timely management of the disease.

Aim: to compare and evaluate the diagnostic performance of  various diagnostic modalities for Enteric fever like Blood culture,Tube widal, Slide widal and Typhoid IgG/IgM Rapid Card test using a Composite Reference standard.

Material and Methods: This cross sectional analytical study was conducted in the Dept.of Microbiology of a rural tertiary care teaching hospital of western Uttarpradesh, India from July 2016 to June 2017 over a period of one year after obtaining permission from the institutional ethics committee.

Blood culture was done using standard microbiological techniques. Slide widal, Tube widal & Typhoid IgG/IgM Rapid Card tests were done as  per instructions in the kit insert. Various diagnostic parameters like Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, Accuracy, Positive Likelihood ratio and Negative Likelihood ratio for all the tests were calculated and compared using a Composite Reference standard.

Results: In this study the overall positivity rate for Blood culture was 12%, Tube Widal 32%, Slide Widal 46% and IgG/IgM RCT 48%. Amongst all four diagnostic tests under study highest sensitivity was exhibited by IgG/IgM RCT (77.42%) and highest specificity was observed for Blood culture(100%)

Conclusion: Amongst all the tests evaluated in this study IgG/IgM Rapid card Test which is a fast, reliable, simple and easy to perform test had emerged as the best diagnostic modality for appropriate and timely management of enteric fever.

Keywords: Enteric Fever, Blood culture, Widal test, Typhoid IgG/IgM Rapid Card test, Lateral flow immunoassay, Composite Reference Standard.

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Corresponding Author

Dr Abhishek Mehta

Flat-102, Staff quarters, GL Bajaj Instt. campus, 24Km.milestone, NH#2, Akbarpur (Uttarpradesh),

Distt. Mathura, India-281406

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