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Journal of Clinical Microbiology, March 2001, p. 1002-1007, Vol. 39, No. 3
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.3.1002-1007.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Serology of Typhoid Fever in an Area of Endemicity and Its Relevance to Diagnosis

Deborah House,1,2,* John Wain,2,3 Vo A. Ho,4 To S. Diep,5 Nguyen T. Chinh,6 Phan V. Bay,4 Ha Vinh,5 Minh Duc,4 Christopher M. Parry,2,7 Gordon Dougan,1 Nicholas J. White,2,7 Tran Tinh Hien,5 and Jeremy J. Farrar2,7

Department of Biochemistry1 and Department of Microbiology and Infection,3 Imperial College of Science, Technology and Medicine, London, and Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford,7 United Kingdom, and Wellcome Trust Clinical Research Unit2 and Centre for Tropical Diseases,5 Cho Quan Hospital, and Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy,6 Ho Chi Minh City, and Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province,4 Vietnam

Received 28 August 2000/Returned for modification 27 October 2000/Accepted 11 December 2000

Currently, the laboratory diagnosis of typhoid fever is dependent upon either the isolation of Salmonella enterica subsp. enterica serotype Typhi from a clinical sample or the detection of raised titers of agglutinating serum antibodies against the lipopolysaccharide (LPS) (O) or flagellum (H) antigens of serotype Typhi (the Widal test). In this study, the serum antibody responses to the LPS and flagellum antigens of serotype Typhi were investigated with individuals from a region of Vietnam in which typhoid is endemic, and their usefulness for the diagnosis of typhoid fever was evaluated. The antibody responses to both antigens were highly variable among individuals infected with serotype Typhi, and elevated antibody titers were also detected in a high proportion of serum samples from healthy subjects from the community. In-house enzyme-linked immunosorbent assays (ELISAs) for the detection of specific classes of anti-LPS and antiflagellum antibodies were compared with other serologically based tests for the diagnosis of typhoid fever (Widal TO and TH, anti-serotype Typhi immunoglobulin M [IgM] dipstick, and IDeaL TUBEX). At a specificity of >= 0.93, the sensitivities of the different tests were 0.75, 0.55, and 0.52 for the anti-LPS IgM, IgG, and IgA ELISAs, respectively; 0.28 for the antiflagellum IgG ELISA; 0.47 and 0.32 for the Widal TO and TH tests, respectively; and 0.77 for the anti-serotype Typhi IgM dipstick assay. The specificity of the IDeaL TUBEX was below 0.90 (sensitivity, 0.87; specificity, 0.76). The serological assays based on the detection of IgM antibodies against either serotype Typhi LPS (ELISA) or whole bacteria (dipstick) had a significantly higher sensitivity than the Widal TO test when used with a single acute-phase serum sample (P <=  0.007). These tests could be of use for the diagnosis of typhoid fever in patients who have clinical typhoid fever but are culture negative or in regions where bacterial culturing facilities are not available.

* Corresponding author. Mailing address: Department of Biochemistry, Imperial College of Science, Technology and Medicine, Exhibition Rd., South Kensington, London SW7 2AZ, United Kingdom. Phone: 020 7594 5254. Fax: 020 7594 5255. E-mail: d.house{at}ic.ac.uk.

Journal of Clinical Microbiology, March 2001, p. 1002-1007, Vol. 39, No. 3
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.3.1002-1007.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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