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The laboratory diagnosis of enteric fever
1Wellcome Trust Sanger Institute, Hinxton, United Kingdom.
Abstract:
The diagnosis of enteric fever currently depends upon the isolation of Salmonella from a patient, most commonly by blood culture. This facility is not available in many areas where the disease is endemic. Serodiagnosis depends upon the 100-year-old Widal test, and other serological diagnostic tools have limitations because of their low sensitivity and/or specificity. The most promising recently published results are from PCR-based amplification of DNA from the blood of enteric fever patients but again this technique is not available where it is most needed. Antigen detection has not been investigated for well over three decades and detecting an immune response specific for typhoid fever has been done only with antibody detection. There is an urgent need for the rational design and evaluation of effective and appropriate diagnostics for enteric fever which must include the emerging threat of S. Paratyphi A.
Insights
Current enteric fever diagnostics like blood cultures and the Widal test are limited, especially in endemic regions. New methods like PCR show promise but lack accessibility, highlighting the need for better diagnostic tools for typhoid and paratyphoid fever.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Diagnostic Development
Background:
- Enteric fever diagnosis relies on Salmonella isolation (e.g., blood culture), often unavailable in endemic areas.
- Existing serodiagnostic tests, like the Widal test, suffer from low sensitivity and/or specificity.
- Emerging diagnostic techniques such as PCR show potential but are not widely accessible where most needed.
Purpose of the Study:
- To address the urgent need for effective and appropriate diagnostic tools for enteric fever.
- To evaluate novel diagnostic strategies beyond current limitations.
- To include the diagnostic challenges posed by Salmonella Paratyphi A.
Main Methods:
- Review of current diagnostic methods for enteric fever.
- Analysis of limitations of existing serological and culture-based diagnostics.
- Assessment of recently published promising techniques like PCR and antigen detection.
Main Results:
- Current diagnostic methods for enteric fever are inadequate, particularly in resource-limited settings.
- Established serodiagnostic tools have significant performance limitations.
- Promising molecular methods like PCR are not yet widely implemented.
Conclusions:
- There is a critical need for the development and evaluation of improved diagnostics for enteric fever.
- Future diagnostics must be accessible for use in endemic regions.
- Effective diagnostics must also address the growing threat of Salmonella Paratyphi A infections.
