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Diagnosing enteric fever: a reappraisal
Abstract:
The diagnostic value of 19 clinical and laboratory events was assessed in 150 enteric fever cases. A logistic regression analysis revealed only 8 predicitive variables for the presence or absence of enteric fever. These were, in order of importance, the white blood cell count, the S. typhi H agglutinin titre, body temperature, the S. typhi O agglutinin titre, the S. paratyphi A H agglutinin titre, the S. paratyphi B H agglutinin titre, age and the fever pattern. This study showed that objective variables like the Widal titres were useful in predicting enteric fever, whilst symptoms such as abdominal pain were unhelpful. Use of all 8 variables to calculate the probability of enteric fever might provide an accurate method of diagnosing or confirming enteric fever when culture results are unavailable or negative.
Insights
This study identifies key clinical and laboratory factors for diagnosing enteric fever. Objective Widal titres and fever patterns are more reliable predictors than symptoms like abdominal pain.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Clinical Microbiology
Background:
- Enteric fever diagnosis can be challenging, often relying on culture results which may be negative or delayed.
- Clinical symptoms alone are frequently insufficient for accurate diagnosis.
- Identifying reliable diagnostic predictors is crucial for timely patient management.
Purpose of the Study:
- To evaluate the diagnostic value of 19 clinical and laboratory variables in enteric fever cases.
- To identify the most predictive variables for the presence or absence of enteric fever.
- To propose a diagnostic model using key predictors when culture results are unavailable.
Main Methods:
- Logistic regression analysis was performed on data from 150 enteric fever cases.
- Nineteen clinical and laboratory events were assessed for their diagnostic utility.
- Variable importance was determined based on their predictive power.
Main Results:
- Eight variables significantly predicted enteric fever: white blood cell count, Salmonella typhi H and O agglutinin titres, body temperature, Salmonella paratyphi A and B H agglutinin titres, age, and fever pattern.
- Objective laboratory markers, particularly Widal titres, demonstrated higher diagnostic value.
- Subjective symptoms like abdominal pain were found to be unhelpful predictors.
Conclusions:
- Objective clinical and laboratory variables, especially Widal titres, are valuable for diagnosing enteric fever.
- A model incorporating the 8 identified predictive variables can accurately estimate the probability of enteric fever.
- This approach offers a viable diagnostic strategy when traditional culture methods are inconclusive or inaccessible.