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ABSTRACT
Typhoid fever is endemic in the tropics and sub-tropical regions of the world. It is a
major public health problem in most developing countries including Nigeria. Efforts are
ongoing to develop new test techniques and improve existing ones in order to mitigate
the morbidities and mortalities of typhoid and paratyphoid infections. As such 180
serum samples from apparently healthy blood donors of the Department of
Hematology, Ahmadu Bello University Teaching Hospital Zaria were evaluated for the
levels of Salmonella typhi and Salmonella paratyphi A somatic O and flagella H
antibodies using the quick tile technique and the Widal microtitire plate method to
determine the baseline antibody titres. The standard Salmonella O and H
(Oxoid/Remmel diagnostic) antigens were used. The presence of specific IgM/IgG
antibodies was also tested among the subjects using the Typhidot IgM/IgG test
cassettes. The occurrence of specific IgM in the study population was found in 3.9% of
the samples studied while IgG occurred in only 1.1% of the population. The
distributions of the antibody titres of S. typhi and S. paratyphi A among the subjects
were determined. Since titres of ≤ 1:20, 1:20, 1:40, were found in a significant
proportion (>80%) of the population tested for S. typhi O and H, the cut off titre for
Salmonella typhi was found to be 1:80 for both O and H antibodies. Titres above 1:80
are therefore significant for the diagnosis of typhoid in our locality. For Salmonella
paratyphi A, the cut off titre was found to be 1:40 for both anti O and anti H antibodies.
Titres ≥ 1:80 are therefore significant titres for S. paratyphi A infections when using
the Widal technique. A comparison of results from the tile method with the microtitre
plate method showed a significant difference (p value 0.0001), indicating negative
correlation between the quick tile method and the Widal microtitre plate method. The
study has established the baseline titers, the cut off titre and the significant titres of
vi
Widal test for S. typhi and S. paratyphi A in Zaria. This study clearly demonstrates that
there are deficiencies with the use of the quick tile technique in Widal testing and that
the microtitre plate (MTP) method would be more appropriate and beneficial for Widal
testing in this setting.
CHAPTER ONE
1.0 INTRODUCTION
Every year, thousands of cases of typhoid and paratyphoid infections are reported
worldwide (Hurley et al., 2014). Salmonella enterica serovar typhi (S. typhi) and
Salmonella paratyphi A,B,C are the causative agents of enteric fevers. Typhoid fever is
an acute, life threatening febrile illness caused by S. typhi which results in about
200,000 deaths worldwide each year largely in developing countries (Crump and
Mintz, 2010). Salmonella typhi infections exact a heavy toll on human populations
particularly among children. Despite the explosion of knowledge on the pathogenesis of
enteric diseases experienced during the past decade, the number of diarrheal episodes
and human deaths reported worldwide remain remarkably high (Fiorentino et al.,
2013).
Due to the importance of Salmonella in the clinical and public health setting, there has
been a significant effort to improve on the laboratory diagnosis of typhoid and
paratyphoid fever. The definitive diagnosis of typhoid fever requires the isolation of
Salmonella typhi from blood, feces, urine, or other body fluids (Kataria et al., 2013). In
developing countries facilities for isolation and culture are often not available
especially in primary and secondary health institutions. However, where facilities are
available, easy access to across the counter drugs by patients especially antibiotics
make isolation of the organism difficult. Diagnosis relies greatly upon the clinical
features and the detection of agglutinating antibodies to S. typhi by the Widal test.
Various investigators have given varying views on the diagnostic value of a single
pretreatment Widal test (Frimpong et al., 1999; Ibekwe et al., 2008). While some found
1
the test valuable, others found it of limited use. However, all the authors arrived at the
consensus that for a reliable interpretation of the Widal test, the circulating Salmonella
antibody titre profiles (baseline values) of healthy individuals in all the geographical
areas concerned must be determined.
Therefore, this study was undertaken to determine the baseline Salmonella antibody
levels in healthy population in Zaria and eventually establish the significant Widal anti-
O and anti- H titres for a more accurate and reliable diagnosis of typhoid fever using
a single pretreatment Widal test in Zaria, Kaduna State.
1.2 Statement of the Research Problem
Culture of the causative organism, Salmonella enterica serotype typhi is the most
definitive for the diagnosis
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